Early onset sepsis in Suriname: Epidemiology, Pathophysiology and Novel Diagnostic Concepts

Early Onset Sepsis (EOS) is defined as a bacterial infection in a newborns bloodstream within 72 hours after birth. In Western countries, incidence of EOS is 1 in 1,000 (0.1%). Timely detection or exclusion of EOS is difficult and many newborns are either diagnosed too late or treated unnecessarily with antibiotics. The research in this thesis focuses on EOS in Suriname and on methods for detection or exclusion of EOS based on aspects of the inflammatory response in the blood vessel. The results are as follows. The number of cases of EOS in Suriname is 50-100 in 1,000 newborns and 30% of newborns receive antibiotics for suspected EOS. The online EOS Calculator helps to estimate the risk of EOS. Low blood levels of the immature granulocyte, a specific type of immune cell, predict absence of EOS in newborns, which helps to prevent unnecessary antibiotics. The blood levels of two groups of proteins in the blood, the endothelial cell adhesion molecules and sheddases are high but not associated with EOS. Measurement of the Angiopoietins reveals a dysbalance during EOS between the two major forms Ang-1 and Ang-2. This indicates that the inner lining of the blood vessel - the endothelium - is involved in the inflammatory response during EOS. The results of thesis show that EOS is a major problem in Suriname. Further research is necessary to determine whether the methods mentioned above are useful in the clinic to detect or exclude EOS.