Optimizing Resource Utilization in Low-and Middle-Income Country NICUs: A Clinical Audit of Surgical Infection Screening Practices at a High-Volume NICU in Pakistan

Objective: Post operative sepsis in neonates is a serious problem that may be challenging to diagnose. It is standard practice at our Neonatal Intensive Care Unit (NICU) in Pakistan to perform routine Blood Cultures (BLCS) and C-Reactive Protein (CRP) to screen for post-operative sepsis. We aimed to review this practice to investigate its effectiveness at screening for post-operative sepsis. Methodology: All neonates admitted to the NICU post-operatively at our center from 2017-2022 were included. Relevant clinical and demographic data were collected. The sensitivity of BLCS was calculated for each postoperative day (POD) and an ROC curve was constructed for overall CRP values to quantify their screening value. Results: A total of 109 post-operative neonates were included (median gestational age 37 weeks, birth weight 2.4kg). Thirteen (12.6%) developed sepsis. Only two patients had pathological microbe growth on POD 0 or 1, both having growth preoperatively. BLCS sensitivity increased significantly after POD 2. CRP performed poorly at discriminating post-operative sepsis (AUROC=0.55). Conclusion: Routine BLCS performed immediately after surgery did not predict the onset of post-operative sepsis. CRP performed poorly at discriminating post-operative sepsis, likely due to physiologic inflammation in postoperative neonates. Unnecessary screening tests represent a significant financial burden in LMICs, with little clear clinical benefit.