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Lancet study suggests means to reduce sepsis

Caring for preterm babies in single family rooms reduces the incidence of sepsis and increases exclusive breastfeeding rates, according to a recent review published in The Lancet Child & Adolescent Health.

The study compared the rate of sepsis within neonatal and single family rooms. It found finding that in the isolated rooms there was a 37 percent reduction in sepsis rate, compared to traditional open-ward neonatal units.

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Sepsis is a difficult condition to address due to the variety of pathogens that can cause it.

Preterm babies are at the greatest risk of infection due to the underdeveloped immune system. In babies born at full term the immune system is still underdeveloped, with a heightened risk within the first month after birth. In preterm babies this risk period can be far longer.

India bears a high burden of neonatal sepsis. Moreover, the mortality rate in the first month for babies that contract sepsis has been estimated at anywhere between twenty to fifty percent, highlighting the dangers of the condition.

With sepsis reaping such a high toll on India’s newborns, it is vital to implement any possible measures that could reduce its incidence.


Isolation reduces the risks of sepsis


The study focuses on preterm babies, as well as the potential for the reduction of sepsis by improving access to single family rooms as opposed to wards in which multiple families may be present.

This concept is a simple one in the case of sepsis. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated immune response to infection. A critical factor to the condition is that there is not one single bacteria or virus that causes sepsis – it can be brought about by any type of pathogenic infection can result in sepsis.

Due to the myriad of pathogens that may be responsible for sepsis, it is all but impossible to ensure that conditions within a ward containing multiple families and potentially large groups remains sterile. However, by reducing the capacity of the room to single family units, the risk of spreading infection is, at the very least, both reduced and isolated to single families.

Developmental implications


The study goes on to assess the neurodevelopmental implications of the single family rooms. A key issue in studying this aspect was the significant lack of long-term follow up studies.

“Our findings support future development of single family rooms in neonatal units to reduce sepsis and improve breastfeeding rates during hospital stay. But to establish whether single rooms have an impact on long-term neurodevelopment we also need well-designed studies…in whom no follow-up studies have been done,” says Dr Sophie van der Schoor, who led the study.


Conflict regarding the isolated rooms


Offering comments on the isolated wards, Dr Jayanta Banerjee from Queen Charlotte’s and Chelsea Hospital, London suggests there may be negative consequences. The parents may feel isolated both from other families — which may offer support and comfort through the ordeal — as well as from hospital staff.

Staffing may also become an issue. Not only would hospitals need to be rearranged and priorities reassessed, the number of staff required for these new wards could increase significantly.

In the context of India, a country already afflicted by often crippling medical staff shortages, the additional staff strain put in place by increased ward count could leave neonatal wards far less efficient. While the concept may reduce deaths associated with sepsis, this lack of staffing could lead to unforeseen consequences such as an increase in other conditions.

In the worst case, sepsis cases could even show a rise as nursing staff may be overworked and rushed between wards, causing lapses in sanitation protocol. In order for the concept to work, staff would need to be allocated to deal with the rearranged work load.


Sepsis in India, a critical condition?


The overall prevalence of sepsis in India is high. As with the mortality rate with newborns, the mortality rate due to sepsis in India far surpasses the expected rates of other nations.

A recent study detailed the five-year experience of the sepsis mortality rates for intensive care units (ICU) and in-hospital patients to be 56 percent and 63 percent, respectively. These figures are above the high estimate range of mortality rate for sepsis-related deaths elsewhere.

This higher rate of the condition within India may be partly attributed to disparities in healthcare infrastructure creating a situation where sepsis is often misdiagnosed — due to similarities in symptoms to the flu or various other infections. When the condition is diagnosed, it often is not diagnosed in time. Treatment within a short window of opportunity is often vital to survival of sepsis, as the condition may develop to cause severe organ damage.

Despite the potential drawbacks of the isolated family room concept, it is an idea worth looking into. A 37 percent reduction to sepsis cases is a notable improvement. While this concept may not be appropriate or feasible for all cases of newborns in India, the rooms could provide an invaluable resource in the case of babies already established to have deficiencies in their immune system.


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