Changes in the differential white blood cell count in screening for group B streptococcal sepsis

We compared several previously defined scoring systems using white blood cell indices as part of a retrospective evaluation of infants with early onset Group B streptococcal (GBS) sepsis. Nineteen newborns were diagnosed with GBS sepsis between January, 1988, and April, 1990. Case controls (n = 33) were selected from patients admitted to the Neonatal Intensive Care Unit for suspected sepsis. Complete blood counts obtained at admission and between 12 and 24 hours of age were reviewed. There was a significant change in the ratio of immature to total neutrophils in the GBS group over time. Scoring systems for neonatal sepsis by Manroe et al., Rodwell et al. and Spector et al. had poor sensitivity, specificity, positive predictive value and negative predictive value when initial white blood cell count criteria were used, but scoring systems by Manroe and Rodwell were 100% sensitive and had 100% negative predictive value when applied to the repeat white blood cell count. We conclude that a single early complete blood count may not be an adequate screening tool for early onset GBS sepsis and should not be used to rule out infection. Optimal screening for GBS sepsis requires a repeat complete blood count within the first 24 hours of age.     

Early diagnosis of neonatal sepsis using a hematologic scoring system

Hematologic findings and published complete blood cell count criteria were evaluated as screening tests for neonatal sepsis. From the data obtained, a hematologic scoring system was formulated that assigns a score of 1 for each of seven findings: abnormal total leukocyte count, abnormal total neutrophil (PMN) count, elevated immature PMN count, elevated immature to total PMN ratio, immature to mature PMN ratio greater than or equal to 0.3, platelet count less than or equal to 150,000/mm3, and pronounced degenerative changes in PMNs. There were 298 evaluations for sepsis (243 in the first 24 hours of life and 55 between days 2 and 30). Twenty-six of 27 (96%) infants with sepsis and all 23 infants with probable infection had scores greater than or equal to 3, compared with 35 of 248 (14%) noninfected infants. The likelihood of sepsis with score greater than or equal to 3 was 31%, and this value differed with both gestational and postnatal ages (34% vs 8% in preterm and term infants less than 24 hours of age, and 65% thereafter). The higher the score the greater was the likelihood of sepsis. With score less than or equal to 2 the likelihood that sepsis was absent was 99%. The hematologic scoring system should improve the diagnostic accuracy of the complete blood cell count as a screening test for sepsis and could simplify and standardize the interpretation of this global test.     

新生儿败血症合并早期弥散性血管内凝血相关因素的临床研究

目的 探讨新生儿败血症合并早期弥散性血管内凝血(DIC)的相关临床因素,为临床早期诊断新生儿败血症合并DIC 提供参考。方法 采用临床回顾研究方法对我院NICU 2012~2013 年确诊为新生儿败血症的100 例患儿进行研究。根据ISTH 显性DIC 评分系统将患儿分为凝血功能正常组、非显性DIC 组(早期DIC 组)及显性DIC 组(晚期DIC 组),对各组临床表现及相关临床因素进行统计分析。结果 100 例败血症患儿中合并早期DIC 者44 例(44%);3 组患儿硬肿的发生率差异有统计学意义(χ2=12.776,P<0.05);窒息、出血及G- 菌感染是败血症合并早期DIC 的独立危险因素。结论 对于临床有窒息、出血及G- 菌感染的新生儿应积极监测凝血功能并采取早期干预措施,预防患儿由早期DIC 进展为晚期DIC,降低新生儿败血症的病死率。     

Polymerase chain reaction in rapid diagnosis of neonatal sepsis

In a prospective study a total of hundred neonates who fulfilled the American College of Obstetrics and Gynecology's (ACOG) criteria for probable sepsis admitted to NICU of tertiary care armed forces hospital were investigated for evidence of sepsis. The investigation protocol included sepsis screen, blood culture and 1 mL of venous blood for molecular analysis by polymerase chain reaction (PCR) for bacterial DNA component encoding 16 s RNA in all cases. 100 newborns with probable sepsis were studied to evaluate the molecular diagnosis of sepsis using PCR amplification of 16 S RNA in newborns with risk factors for sepsis or those who have clinical evidence of sepsis. We compared the results of PCR with blood culture and other markers of sepsis screen (total leucocyte count (TLC), absolute neutrophil count (ANC), immature/total neutrophil count ratio (I/T ratio), peripheral blood smear, micro ESR and C reactive protein (CRP). Controls consisted of 30 normal healthy newborns with no overt evidence of sepsis. Sepsis screen was positive in 24 (24%) of cases in study group with sensitivity and specificity of 100% and 83.5% respectively. Blood culture was positive in 09(9%t) with sensitivity of 69.2% and specificity of 100%. PCR was positive in 13(13%) of cases (9% are both blood culture and sepsis screen positive and 4% are positive by sepsis screen); the sensitivity of PCR was 100% and specificity was 95.6%. Blood culture is the most reliable method for diagnosis of neonatal sepsis. Polymerase chain reaction is useful and superior to blood culture for early diagnosis of sepsis in neonates.     

简化小儿危重病例评分法的临床应用

目的简化小儿危重病例评分法.分析用简化评分系统评估患儿病情的效果,以期更好地适用于基层医院.方法对14家三级医院的1 036例患儿,于入院第1、3、7天及出院或死亡时进行小儿危重病例评分.原评分10项指标中,依次减去动脉氧分压(PaO2)和pH、BUN或肌酐、血钠和血钾,余8、7、5项指标,原评分分别乘以0.8、0.7、0.5形成新的评分系统.分析简化评分系统评估病情与原评估方法的符合率(应>80%)及二者的相关性,观察简化后评分体系的病死率变化与原评分法是否一致.结果首次评分减去2、3、5项指标后,与原病情评估一致的病例分别为82.6%(856/1 036)、80.7%(836/1 036)、69.9% (724/1 036),显示用5项指标评估病情符合率较低.简化后第3、7天和末次评分,与原病情评估符合率为81.5%～97.1%.简化前、后有良好相关性(r=0.629～0.948, P均<0.001).简化后4次评分,非危重、危重、极危重组病死率差异有非常显著性(χ2 =86.13～740.33,P均<0.001),即评分越低,病死率越高.在同一病情状态下,简化前后的病死率变化不大.如极危重组首、末次评分原病死率为29.8 %、67.4%,简化后病死率分别为30.0%～27.9%、66.3%～64.4%.结论首次评分减去2项指标、其余各次评分减去5项指标后的病情评估与原评分法基本一致.用简化后的评分体系评估极危重、危重、非危重组间的病死率,差异仍有非常显著性,其病死率变化趋势与原评分体系一致.     

Neonatal endocarditis due to staphylococcus aureus as a complication of neonatal sepsis

We present the case of a newborn with bacterial endocarditis with mitral valve involvement as a complication of late-onset sepsis due to Staphylococcus aureus with associated pyelonephritis and meningitis. The diagnosis was confirmed by echocardiogram and blood culture with growth of S. aureus. Treatment was medical and surgical. Neonatal bacterial endocarditis is extremely difficult to diagnose. The signs and symptoms are usually nonspecific and cannot be distinguished from those of sepsis or congenital heart disease. Consequently, a high degree of suspicion is needed for the early diagnosis of this condition. Echocardiography should be performed in children who present sepsis and heart murmur and even in those with staphylococcemia (sepsis due to S. aureus) without associated heart murmur. This investigation enables an early diagnosis of endocarditis to be made and appropriate treatment to be given without having to wait for the development of signs and symptoms that frequently go undetected.     

中性粒细胞粘附分子CD11b表达对新生儿败血症早期诊断价值的研究

目的　观察新生儿败血症中性粒细胞粘附分子CD11b表达的规律 ,并评价其在新生儿败血症早期诊断中的价值。方法　将 5 1例临床疑似败血症的新生儿根据其临床表现及WBC、PLT、血浆CRP和未成熟中性粒细胞数与中性粒细胞总数比值 (I/T)四项指标 ,分为败血症和可疑败血症两组。采用全血流式细胞术检测患儿和 15例正常对照组新生儿中性粒细胞CD11b的平均荧光强度 (MFI)。结果　败血症组 2 3例 ,可疑败血症组 2 8例。两组中性粒细胞CD11b分别为 (32 0± 189)、(4 5 6± 2 13)MFI,均显著低于正常对照组的 (10 90± 338)MFI(t分别为 - 9 0 1、- 7 5 6 ,P均 <0 0 0 1) ,败血症组又低于可疑败血症组 ,差异有显著性 (t=- 2 39,P <0 0 5 )。高CRP组患儿CD11b为 (2 11± 16 4 )MFI,低于低CRP组的 (5 0 5± 2 6 5 )MFI,差异有显著性 (t=2 6 4 ,P <0 0 5 )。中性粒细胞CD11b≤ 6 0 0MFI对疑似败血症新生儿诊断的敏感性、特异性、阳性和阴性预测值分别为 86 3%、10 0 %、10 0 %、6 8 2 % ,CD11b检测阳性率为 86 3% ,高于血培养的阳性率 (17 6 % ) ,差异有显著性 (χ2 m=31 2 ,P <0 0 5 )。结论　新生儿败血症中性粒细胞粘附分子CD11b表达下调 ,其下调与感染严重程度有一定关系。中性粒细胞CD11b的动态检测对早期     

Sepsis screen in neonates with evaluation of plasma fibronectin

Two hundred twenty neonates with suspected early onset sepsis were prospectively studied to evaluate the ability of a sepsis screen to discriminate infected from noninfected newborn infants. A positive sepsis screen consisted of positive findings in two or more of the following tests: total white blood cell count; immature/total neutrophil ratio; C-reactive protein; micro-erythrocyte sedimentation rate; or plasma fibronectin. For proved sepsis a four-part screen excluding fibronectin yielded a sensitivity of 100%, specificity of 83%, positive predictive value of 27% and negative predictive value of 100%. In contrast the sensitivity of white blood cell count and immature/total neutrophil ratio was only 46%. Adding fibronectin to the four-part screen provided equal sensitivity and negative predictive value but decreased specificity and positive predictive value. While plasma fibronectin may play an important role in the pathogenesis of neonatal sepsis, it is not useful as a marker for infection. The screens did not identify preterm infants with late onset nosocomial sepsis. Although clinical judgment should be the primary factor in the decision to institute antibiotic therapy, a simple four-part sepsis screen provides valuable presumptive information for excluding the diagnosis of early onset neonatal sepsis.     

Incidence,management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network

Aim: To investigate the incidence, clinical management, mortality and its risk factors, major outcome and costs of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) in a Chinese network of 26 paediatric intensive care unit (PICU). Methods: In a consecutive 12‐month period, AHRF and ARDS were identified and followed up for 90 days or until death or discharge. Results: From a total of 11 521 critically ill patients, 461 AHRF were identified in which 306 developed ARDS (66.4%), resulting in incidences of 4% and 2.7%, respectively, with pneumonia (75.1%) and sepsis (14.7%) as main underlying diseases and 83% were 5 years and 1 month‐old. In‐hospital mortality of AHRF was 41.6% (44.8% for ARDS), accounted for 15.5% of all PICU deaths. For those of pneumonia or sepsis with AHRF and ARDS, mortality and its relative risk were significantly higher than those without. Relatively lower tidal volume and total fluid balance, adequate upper limit of PaCO₂ in the early PICU days, and family affordability, tended to result in better outcome. Conclusion: In this prospective study, AHRF had high possibilities to develop ARDS and death risk, as impacted by ventilation settings and fluid intake in the early treatment, as well as socioeconomic factors, which should be considered for implementation of standard of care in respiratory therapy.     

Neonatal bacterial sepsis in a neonatal intensive care unit: A 5 year analysis

Objective : To study the pattern of neonatal sepsis in a neonatal intensive care unit (NICU) during a 5 year period and assess the relationship between maternal risk factors and early onset sepsis (EOS).
Methodology : The study reported here was a retrospective analysis of 209 episodes of septicaemia and 5 episodes of bacterial meningitis in 198 newborn infants, 22 of whom died. Eighty-one infants had EOS (≤72h) and 117 infants had late onset sepsis (LOS >72 h). All infants had clinical evidence of sepsis, a computerized haematological score for sepsis of 4 or greater, and either treatment with antibiotics for 7 days or more or had earlier death due to sepsis. The organisms causing neonatal sepsis were analyzed according to the day of onset, gestational age, birthweight and year of infection.
Results : Sepsis occurred in 5.6 per 1000 live births and 3.8% of NICU admissions. There were 81 episodes of EOS and 128 of LOS. Coagulase negative staphylococci (CONS) 38.8%, group B Streptococcus (GBS) 20.1% and Gram-negative bacilli (GNB) 20.1% were the common causes of sepsis; and GBS (50.6%) and CONS (60.9%) were the most common organisms in EOS and LOS, respectively. The mean gestational age and birthweight were heigher in babies with EOS than compared with LOS. The higher likelihood of probable rather than definite infection in infants with EOS was related to more mothers in the EOS group receiving intrapartum antibiotics. GNB infection was more common in their babies.
Conclusions : GBS and CONS were the most common causes of EOS and LOS, respectively. The use of maternal intrapartum antibiotics interferes with neonatal blood culture results. Because blood cultures are not always positive in neonatal septicaemia, a combination of clinical, haematological and other microbiological evidence should be used when diagnosing neonatal septicaemia.     

Antibiotic therapy of fulminant E. coli K1 sepsis in infant rabbits

A model of overwhelming E. coli K1 sepsis and early meningitis was developed in infant rabbits and used to compare clinical and bacteriologic efficacy of ampicillin, moxalactam, cephalothin and chloramphenicol. Intraperitoneal injection of 10(7) E. coli K1 into 1- or 2-wk-old rabbits produced a rapidly progressive infection which, if left untreated, produced bacteremia in 100% of animals, meningitis in 78%, and mortality in 100%. Therapy was initiated 4 h after ip infection at which time mean bacterial concentration (log10 CFU/ml) ranged from 4.4-4.8 in the blood and from 1.8-2.3 in the cerebral spinal fluid (CSF). Pre-treatment frequency of bacteremia (100%) and meningitis (17-23%) was similar for all experimental groups. Antibiotic concentrations in blood and CSF 2 h after a dose exceeded the E. coli minimum inhibitory concentration with the exception of CSF cephalothin, which was undetectable. Moxalactam, ampicillin, and chloramphenicol significantly reduced the incidence of bacteremia and meningitis relative to cephalothin or saline controls (P less than 0.02). Mortality rates among the former three groups were high (64-82%) but significantly less than in saline or cephalothin-treated rabbits (100%). In this neonatal model of fulminant sepsis with early meningitis, moxalactam provided no therapeutic advantage over ampicillin or chloramphenicol.     

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目的 探讨中性粒细胞CD11b、CD64在新生儿败血症诊断中的价值.方法 2005年1月至2005年12月检测河北医科大学第一医院儿科36例败血症新生儿及26名健康新生儿中性粒细胞CD64、CD11b的表达水平和CRP质量浓度,比较各指标对诊断新生儿败血症的灵敏度、特异度、阳性预测值、阴性预测值和约登指数,评价它们对诊断该病的价值.结果 (1)败血症组CD64、CD11b水平均明显高于对照组(P＜0.01);(2)以CD64≥35MFI,CD11b≥1300MFI,CRP≥8mg/L为阳性标准,三指标对诊断败血症的灵敏度分别为95.7%、82.6%、69.6%,CD64的特异度95.8%、阳性预测值95.6%、阴性预测值95.4%、约登指数91.5%;(3)CD11b、CD64水平在治疗前后差异有显著意义,P均＜0.01.结论 中性粒细胞CD11b、CD64可作为新生儿败血症早期诊断、判断病情的可靠指标.     

小儿铜绿假单胞菌脓毒症的临床特点

目的 探讨小儿铜绿假单胞菌脓毒症的临床特点及其治疗措施.方法 对广州市妇女儿童医疗中心儿童医院院区2008年5月-2010年7月收治的7例铜绿假单胞菌脓毒症病例资料进行回顾性分析.结果 7例铜绿假单胞菌脓毒症患儿中男6例,女1例;5例年龄＜1岁,最大2岁.2例患儿有基础疾病,分别为阑尾炎行阑尾切除术和粒细胞减少症;4例为社区获得性感染,3例为院内感染.患儿均有发热、皮肤损害和多器官功能损害,皮肤损害表现为坏疽性深脓疱疹,全身均可分布,肛门周围皮肤多有受累(4/7例),5例存在深部组织和体内器官的化脓性病变.患儿血培养铜绿假单胞菌均阳性,血清超敏CRP均升高,其中3例患儿还有1个或1个以上病灶组织培养出铜绿假单胞菌;外周血白细胞计数和血小板计数多降低(5/7例),患儿出现高胆红素血症和低清蛋白血症.7例入院后均进行抗生素治疗,5例住院早期即使用敏感抗生素;6例住院期间进行外科手术,2例行多次血浆置换、连续静脉-静脉血液滤过单独或联合治疗.治愈或好转出院6例,死亡1例,平均住院天数33 d.结论 社区获得性铜绿假单胞菌脓毒症并不罕见,坏疽性深脓疱疹是铜绿假单胞菌脓毒症的特征性表现.早期使用有效抗生素、适时的外科干预治疗很重要,对多器官功能损害的患者血液净化治疗有助于改善病情.     

Evaluation of WHO classification of hypothermia in sick extramural neonates as predictor of fatality

The objective of this study is to correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements. This is a prospective observational study carried out at the referral neonatal unit of a teaching hospital admitting extramural neonates. The subjects comprised of 100 extramural hypothermic neonates transported to the Referral neonatal unit. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5 degrees C at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis, vitals, place of delivery, details of transportation and capillary filling time were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter. Samples for sepsis screen, blood culture and blood glucose were taken at admission. During the study it was observed that fatality was 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9% respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality. The conclusion drawn from this study is that the WHO classification of severity of hypothermia correlates with the risk of fatality. However, it considers only body temperature to classify severity of hypothermia. The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification.     

Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit

Seven hundred twenty-six patients from five pediatric intensive care units were studied to determine the association of multiple organ system failure (MOSF) with mortality and to test the hypothesis that MOSF associated with sepsis has a higher mortality rate than MOSF without sepsis. There were 177 (24%) patients with MOSF and 83 (11%) nonsurvivors of MOSF. The mortality rates for two, three, or four or more failed organ systems were 26%, 62%, and 88%, respectively (P less than 0.001). Eighty-four (47%) patients with MOSF had associated sepsis. Sepsis (both bacteremia and clinical sepsis syndrome) did not significantly increase mortality rates in the groups with organ system failure. Mortality rates for patients with sepsis before or within 24 hours of development of MOSF (early sepsis) did not differ from mortality rates for those patients with onset of sepsis more than 24 hours after developing MOSF (late sepsis, 53% vs 33%, P = NS). We conclude that underlying pathophysiologic mechanisms of MOSF other than sepsis are as important as sepsis in critically ill pediatric patients.     

Cerebral blood flow velocity in early-onset neonatal sepsis and its clinical significance

Chorioamnionitis is a known risk factor for neurological damage in newborns. The present study aimed at assessing the changes in cerebral blood flow velocity (CBFV) in early-onset neonatal sepsis (EONS) and determining its predictive value as well as prognostic significance. Inborn neonates with antenatal risk factors for chorioamnionitis were followed up for development of EONS, diagnosed by presence of clinical signs along with positive blood culture and/or elevated interleukin-6 (IL-6) concentrations (≥50?pg/mL) in umbilical cord blood. Comparison group was formed by asymptomatic neonates who had risk factors for chorioamnionitis but did not develop EONS and cord blood IL-6 concentrations were <50?pg/mL. CBFV (resistance and pulsatility indices, peak systolic flow velocity, and vascular diameter) of internal carotid, vertebral, and middle cerebral arteries was assessed by transcranial Doppler ultrasonography within 24?h of birth. The babies were kept under clinical and radiological follow-up for a minimum period of 6?months. Data were analyzed by SPSS 16.0. Final study group contained 55 neonates with sepsis and 35 asymptomatic control neonates. Blood culture was positive in 27 babies of the sepsis group with a preponderance of Gram-negative bacterial isolation. Significantly lower resistance, vasodilatation, and higher blood flow were noted in all the cerebral arteries of the sepsis group. Increase in CBFV was correlated with elevated IL-6 concentrations. CBFV parameters showed significant predictive accuracy as early diagnostic markers of EONS. Among the sepsis group, 14 patients showed signs of intracranial hemorrhage during the hospital stay of which four expired and six showed signs of ventricular dilatation during follow-up. These patients had significantly higher CBFV compared to those who survived. Assessment of CBFV at early hours of birth can be adopted as an additional bedside, non-invasive investigation with immediate diagnostic and late prognostic significance.     

血清高迁移率族蛋白B1在儿童脓毒症中的变化及意义

目的 探讨血清高迁移率族蛋白B1（high mobility group box 1,HMGB1）在儿童脓毒症中的变化及临床意义.方法 检测30例健康体检儿童和46例脓毒症患儿入院第1天血清HMGB1浓度及降钙素原（procalcitonin,PCT）水平,并对脓毒症患儿进行急性生理与慢性健康状态评分（acute physiology and chronic health evaluationⅡ,APACHEⅡ）,于入院后第3、5天同样采集上述指标,将HMGB1与PCT及APACHEⅡ评分进行相关性分析.结果 儿童脓毒症组第1天、第3天及第5天血清HMGB1水平均显著高于对照组,差异有统计学意义[（26.28±1.54） ng/ml,（20.32±1.29） ng/ml,（12.84±1.06） ng/ml vs （1.52±0.29） ng/ml,P＜0.05],脓毒症组各时间点间HMGB1水平比较差异亦具有统计学意义（P＜0.05）,且血清HMGB1水平与PCT水平呈正相关（r =0.931,P＜0.05）,与APACHEⅡ评分呈正相关（r=0.915,P＜0.05）.结论 儿童脓毒症时血清HMGB1水平明显升高,且其水平与病情严重程度相关.     

先天性马蹄内翻足动物模型胚胎后肢(芽)评分系统的建立

目的 建立一套稳定的评分系统,提供客观的观察指标来确认胚胎早期先天性马蹄内翻足(congenital clubfoot,CCF),进行序列胚胎研究.方法 60只Wistar大白鼠,体重220～250 g,随机分成实验组和对照组各6组.从怀孕第10天起,将维甲酸玉米油混悬液经胃管单次注入,以建立马蹄内翻足动物模型,分别在受孕第13、14、15、16、17、18天取出胎鼠的后肢芽并经过一系列处理.应用评分系统对胎鼠进行评分.结果 经评分系统得出的动物模型CCF发病率为80.9%,经评分系统矫正后的CCF发病率较既往报道高.在实验组和对照组之间的软骨分化存在显著差异.结论 应用评分系统可以有效地筛选出CCF,可以对筛选出的CCF胚胎在关键的研究时间窗口进行系列研究,有效地解决了长期困扰CCF研究难以深入的瓶颈问题.     

Septicaemia in an Austrian neonatal intensive care unit: a 7-year analysis

The results of blood cultures and clinical data of 101 neonates with 110 episodes of septicaemia during a 7-y study period were reviewed. The overall incidence of culture-proven sepsis within the study period was 6.0 per 100 neonatal intensive care unit admissions and the mortality rate was 14%. Three groups of pathogens accounted for 70% of all isolates: coagulase-negative staphylococci (27%), aerobic Gram-negative rods (24%) and Enterococcusfaecalis (19%). Group B streptococcus was the major pathogen of very early-onset septicaemia (within 24 h of birth), whereas late-onset infections were most commonly caused by coagulase-negative staphylococci. Birthweight <1500g, gestational age <30 weeks of gestation and early onset of symptoms within the first week of life were associated with poor prognosis. In addition, the case fatality rate of episodes caused by Gram-negative organisms was significantly higher than that of Gram-positive bacteraemia.