Bacterial flora in mothers and babies with reference to causative agent in neonatal septicemia

One hundred newborns and their mothers were subjected to aerobic bacterial cultures and sensitivity study from different sites. Out of 36 clinically suspected neonatal septicemia cases, the blood culture was positive for bacterial growth in 24 neonates. The incidence of septicemia in PT-AGA, FT-AGA, FT-SFD and postterm-AGA babies was found to be 50.0, 13.5, 28.1 and 50.0%, respectively. The incidence of septicemia in LBW and FT-AGA babies was found to be 45.3 and 13.5%, respectively. The single major isolate in the positive blood culture was Staphylococcus aureus. In Gram positive septicemia the commonest site for colonization of the same organism in newborn was found to be umbilicus followed by nose, throat and external auditory canal, while in Gram negative septicemia rectum and umbilicus were the commonest sites.     

Lessons from improved neonatal survival at Chandigarh

We observed a significant fall in neonatal mortality in babies weighing less than 2 kg during 1986 as compared to 1973 (7.94% vs 12.88%; p less than 0.005), and in preterm babies the mortality fell from 26.88 to 11.5% (p less than 0.001) during 1986. This was achieved despite 2-3 fold increase in the high risk babies and without any increase in the number of neonatal special care beds or nurses. Effective utilisation of the facilities was made possible through: (a) reduction in admissions to neonatal special care unit of babies with birth weight more than 1500 g; (b) early discharge of babies to home from NSCU; (c) involvement of the mothers in the care of their high risk babies: and (d) care of babies with sucking difficulties and asymptomatic birth asphyxia outside NSCU. All babies discharged home at less than 2 kg weight, and living in Chandigarh were followed for 3 months and 98.2% were doing well. This observation highlights the judicious use of neonatal special care facilities and mothers for the care of high risk neonates.     

Neonatal septicaemia among inborn and outborn babies in a referral hospital

Neonatal sepsis was studied among one hundred neonates (50 hospital born and 50 outborn babies) over one year period. The incidence of neontal septicaemia was 15.5 per 1000 live births in the hospital. Among outborn babies it accounted for 6.1% of total pediatric admissions and 43.7% of sick neonates referred from outside. Low birth weight and prematurity were important predisposing factors in both the groups. Blood culture was positive among 32% of outborn and 34% of inborn babies. Coagulase-negative Staphylococcus, Klebsiella and Acinetobacter were the common causative organisms. All isolated organisms were sensitive to Gentamicin whereas 75% of them were resistant to Ampicillin. Mortality among outborn neonates (32%) was much higher in comparison to (10%) hospital born babies. Early identification of high risk antenatal cases and neonates and appropriate referral can bring down mortality and morbidity from neonatal sepsis.     

INCREASING INCIDENCE OF NEONATAL SEPTICEMIA: CAUSATIVE ORGANISM AND PREDISPOSING RISK FACTORS

ABSTRACT. Bennet, R., Eriksson, M. and Zetterstrom, R. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Increasing incidence of neonatal septicemia: Causative organism and predisposing risk factors. Acta Paediatr Scand, 70:207, 1981. –The incidence of neonatal septicemia in the referral area of St. Göran's Children's Hospital in Stockholm has been studied during a ten-year period (1969–1978). An increase was noticed during the period 1974–1978 in comparison with the preceding five-year period. The incidence per 1000 live births was 1.4 and 3.1, respectively. The incidence of osteoarthritis increased from 0.21 to 0.41 per 1000. Mortality rate from neonatal septicemia remained unchanged. Gram-negative organisms as an etiologic factor seemed to be decreasing while staphylococcal infections have increased. Group B streptococcal infection occurred with the same frequency during the whole period. The low incidence of enteric organisms might be related to the common practice of feeding the babies with milk from their own mothers. Perinatal risk factors were equally common in both five-year periods. The observed increase of the prevalence of neonatal septicemia caused by Staphylococcus aureus may be explained by a higher rate of survival of highly susceptible low-birthweight infants and other sick neonates treated in the neonatal intensive care unit.     

Bacteriological profile of neonatal septicemia

Fortyfive cases of blood culture positive neonatal septicemia treated during 1985 and 1986 were studied. Klebsiella was the most common causative organism (68.8%). This remained the predominant organism in early as well as late onset septicemia, in preterm as well as full term babies and in low birth weight as well as normal weight babies. Even in neonates referred to our hospital from outside and blood cultured on hospital admission, commonest causative bacteria was Klebsiella. The organism had a high order of in-vitro sensitivity to a gentamicin, streptomycin and cephaloridine. A combination of cephaloridine and gentamicin covered all the Klebsiella isolates. Overall mortality was 53.3%.     

Neonatal septicemia

A study of 92 consecutive cases of neonatal septicenia showed incidence of clinical and bacteriological positive septicemia of 10·97 and 6·55 per 1,000 live-births respectively. Blood culture was positive in 59·8% cases of which 76·3% showed Gram negative organisms like klebsiella, E. coli, citrobacter, pseudomonas and 23·7% Gram positive organisms predominantly staphylococci and streptococci. Only one anaerobic peptococcus was isolated. 68·5% cases had membrane rupture more than 24 hours before delivery. 70% cases developed septicemia within 5 days. Refusal of feeds, lethargy, diarrhea, hypothermia, abdominal distention and jaundice were the major presenting features. Respiratory distress, apnoeic spells, convulsion, sclerema were bad prognostic features. Gentamycin and cloxacillin were the drugs of choice for combating Gram negative and positive organisms respectively. All cases were resistant to ampicillin. Chloramphenicol showed better result than kanamycin. The overall mortality was 57·6%. Male sex, prematurity, LBW and Gram negative infection were associated with higher incidence and mortality.     

Bacterial profile of sepsis in a neonatal unit in south India

OBJECTIVE: To study the pattern of sepsis in a neonatal unit in south India and assess the influence of maternal factors on early onset sepsis (EOS). DESIGN: Prospective survey from 1995-1996. SETTING: Medical College Hospital. SUBJECTS: All inborn babies who had clinical signs of sepsis or were born to mothers with potential risk factors for infection were screened for sepsis. Neonatal septicemia was defined as a disease of infants who were younger than 1 month of age, were clinically ill, and had positive blood cultures. RESULTS: Among 13,367 live births in the study period, there were 131 episodes of neonatal septicemia among 125 newborn infants, 18 (14.4%) of whom died. Thirty (24%) had EOS (< or = 48 hours) and 95 (76%) had late onset sepsis (LOS) (> or = 48 hours). Sepsis occurred in 9.8 per 1000 livebirths and 4.4% of all nursery admissions. E. coli and E. fecalis were the predominant organisms causing EOS, while Klebsiella and E. fecalis were the predominant organisms in LOS. The mean gestational age (GA) and birth weight (BW) of babies with EOS was significantly higher than those with LOS. Maternal factors significantly associated with EOS were meconium staining of liquor and multiple vaginal examinations. CONCLUSIONS: The incidence of neonatal bacterial sepsis is 9.8 per 1000 livebirths. E. coli and Klebsiella were the most common organisms causing EOS and LOS, respectively. E. fecalis was also a major pathogen, both in EOS and LOS.     

Neurodevelopmental outcome of babies weighing less than 2001 g at birth: influence of perinatal transfer and mechanical ventilation.

From 1976 to 1980, 1034 children who had weighed less than 2001 g at birth were cared for at the North Western regional neonatal intensive care unit. Of these, 315 babies were neonatal referrals and 91 were born in the unit after antenatal transfer from their district hospital. Significantly fewer of the babies referred as neonates survived (n = 167, 53%) compared with 67 of the antenatal referrals (74%), and 490 of those born in the unit (78%). They also had a higher incidence of major handicaps (24 of 167, 14%) compared with six of 67 (9%) of the antenatal referrals and 35 of 490 (7%) of those born in the unit. To control for selection bias among neonatal referrals, the outcome of ventilated neonatal referrals was compared with that of ventilated babies born in the unit. The two groups were comparable for the incidence of a wide range of neonatal complications. No differences in rates of survival or handicap were found. We conclude that sick babies transferred after birth to regional neonatal intensive care units have similar short and long term outcomes to sick babies born in regional units.     

Benefits of maternal participation in newborn nurseries

Objective : To evaluate the outcome of active involvement of mothers/mother substitutes in day-to-day care of high risk neonates admitted in a level II newborn care unit.Methods : An observational study was carried out over a period of eleven years incorporating active participation of mothers/substitute in the day to day care of their sick neonates. The outcome is assessed in terms of mortality due to the three major illnesses (asphyxia, sepsis and prematurity) during this phase. The data is compared with that of a similar level II care centre where conventional neonatal care is practised.Results : There is a significant and sustainable reduction in neonatal mortality due to the three major illnesses when the mothers are also involved in the neonatal care, in spite of a considerable increase in the number of admissions during this period.Conclusion : The concept of active participation of mother/substitute in neonatal nursery ensures 1:1 care at all times. It is a cheap and effective alternative to inadequacy of bed:nurse ratio (BNR).     

Lipid peroxidation and antioxidants in neonatal septicemia

Free radicals have been implicated in the pathogenesis of neonatal septicemia. The present study was planned to estimate the lipid peroxidation and antioxidant status in neonatal septicemia. The study was done to evaluate the lipid peroxidation and antioxidant status, both enzymatic and non-enzymatic in neonates with septicemia. This prospective study included 44 septicemic babies as cases and a group of 84 matched healthy babies formed the control. Malondialdehyde (MDA), Superoxide dismutase (SOD), Glutathione peroxidase (GTPx), Catalase, Uric acid (UA) and Albumin (Alb) were estimated in the serum and compared between the groups. The statistical analysis was done by using SPSS-10 software. Neonates with septicemia had significantly higher levels of MDA, SOD, GTPx, and Catalase, while the levels of UA and Alb were significantly lower as compared to controls (p<0.001). Significantly elevated levels of MDA (p<0.05) and depressed levels of UA (p<0.001) were found in babies with late onset sepsis. Neonates who ultimately succumbed had significantly elevated levels of MDA, SOD, GTPx and Catalase, whereas levels of UA and Alb were significantly depressed (p<0.001). Neonates with sepsis are handicapped in terms of their defense mechanism against free radicals. The utility of supplementation of antioxidant enzymes in neonates with septicemia needs further evaluation.     

Enterobacter aerogenes outbreak in a neonatal intensive care unit

BACKGROUND: Enterobacter aerogenes, a Gram-negative bacterium, is an important, although infrequent, cause of nosocomial bacteremia in the hospitalized pediatric and neonatal population. Enterobacter aerogenes was isolated for the first time in our neonatal intensive care unit (NICU) from blood culture of a 5-day-old neonate; 12 more cases were discovered in the next 70 days. The present report summarizes the clinico-bacteriological spectrum and outcome of the affected neonates. Efforts made to find the source of infection and curb the outbreak are also presented. METHODS AND RESULTS: Thirteen newborns, including seven preterms, acquired E. aerogenes septicemia. Perinatal risk factors were present in all the neonates. The mean birthweight of affected infants was 1880 +/- 540 g. Symptoms appeared at a mean age of 3.5 +/- 1.5 days (range 3-8 days). The clinical presentation was indistinguishable from septicemia caused by other Gram-negative organisms. Complications encountered included sclerema, bleeding diathesis, meningitis and shock. The organism, isolated from blood in all and from the cerebrospinal fluid in two cases, was found to be resistant to all antibiotics in the first five cases, but turned sensitive to gentamicin, cefotaxime and amikacin during the latter half of the epidemic. The bacterium in the last case (no. 13) was again found to be resistant to all the antibiotics. Overall mortality was 46.2%; the mean interval between onset of symptoms and death being 2.3 +/- 1.8 days. The organism was traced to the rubber pipe attached to a foot-operated suction machine in the NICU. The neonatal unit was temporarily closed, fumigated and reopened with strict instructions to follow proper hand washing protocol and ensure cohort nursing of infected infants. CONCLUSIONS: Enterobacter aerogenes is capable of causing nosocomial outbreaks of septicemia in NICU. Low birthweight infants with associated perinatal risk factors appear to be predisposed. The sensitivity patterns of the isolates highlight the capability of E. aerogenes to acquire or lose resistance to antibiotics rapidly during treatment. A high mortality rate coupled with a short interval between onset of symptoms and death, suggested high virulence of the strain.     

Metabolism: Comparison of Outcome: Inborn and Outborn Infants Weighing Less Than 1,500 Grams

The fetal mortality, neonatal mortality and developmental outcome of 690 less than 1,500 gram infants born during 1974–78 in Denver, Colorado, USA, was studied. Comparisons were made of 393 babies born at University Hospital (UH) where an intensive intrapartum care program was established and 297 babies born in five metropolitan Denver hospitals (MDH) who did not have intensive care capability. They were usually transported to The Children's Hospital (CH), Denver, for neonatal intensive care. Fetal mortality was lower in the UH population than the MDH population; neonatal mortality in the UH and. MDH babies was not different above 700 grams; neonatal delay was least(8%) in the babies born to mothers transported to UH for delivery (UH-MT) and highest (21%) in the MDH babies who were transported to CH for neonatalintensive care. The authors conclude that fetal survival improved at UH andthat mental delay is least in babies born to mothers who are transported to UH for perinatal intensive care.     

Analysis of blood-culture isolates from neonates of a rural hospital

All blood culture reports obtained from newborns admitted in a neonatal care unit during 1983-87 were reviewed to determine the current bacteriological profile of neonatal septicemia. A total of 1160 neonates of high risk category or having clinical features suggestive of septicemia were subjected to blood culture study during this period. The culture positivity rate was 73%. Of these, 24.9% cultures were polymicrobial. Among the 1059, growths obtained, 60.1% were Gram negative, with Klebsiella, E. coli and Pseudomonas as the commonest pathogens. In Gram positive group, coagulase negative Staphylococci were most frequent, constituting 24% of the total isolates. An increasing incidence of coagulase positive Staphylococci and Pseudomonas infections was observed in recent years. Another significant finding was a comparatively high prevalence of Group D beta hemolytic isolates among streptococcal growths, with S. fecalis as the single commonest streptococci isolate.     

Clinical profile of Klebsiella septicemia in neonates

A detailed clinical study of 51 consecutive cases of neonatal klebsiella septicemia was carried out prospectively over a 20 months period. The incidence was 6.27 per 1000 live births. Majority (85.5%) were either preterms or small for date. Almost fifty percent babies had associated perinatal risk factors. Mean age of onset was 5.7±2.2 days. General symptoms were the earliest to occur at mean age of 5.7 days followed by respiratory, alimetary, hematological and neurological symptoms at 6.2, 6.3, 6.6 and 7.9 days respectively. About half of the neonates had associated complications; commoner being meningitis (20%), bleeding manifestations and sclerema (17.6% each) and pneumonia (15.7%). Cefatoxime was found to be the drug of choice (86% sensitivity). Nine babies (17.6%) died during the study period at a mean age of 9.1±3.2 days. Mean duration of hospital stay in rest of neonates was 27.9±12.1 days. Neurological symptoms were commoner in late onset disease. Bleeding manifestations, sclerema and granulocytopenia were seen exclusively in preterms. Presence of respiratory symptoms, bleeding, sclerema, shock and granulocytopenia were identified as poor prognostic factors in neonatal klebsiella septicemia.     

Changing etiology and outcome of neonatal septicemia in Riyadh, Saudi Arabia

To study the etiology of neonatal septicemia and factors associated with outcome, all charts of neonates with bacteremia and clinical sepsis admitted to a neonatal unit in Saudi Arabia, from 1 November 1980 to 31 October 1984 were reviewed. The results were compared to a previous study period in the unit (1 November 1976-31 October 1980). Septicemia was diagnosed on 50 occasions in 49 neonates. The incidence of neonatal sepsis among patients born in the hospital was 2.5/1,000 live births. Mortality from sepsis was 33% and was associated with neutropenia in 63%. The most commonly isolated bacteria were E. coli, Klebsiella and Staphylococcus aureus. Salmonella enteritidis serotypes were isolated in 4% of the cases. Group B streptococci (GBS) were isolated, for the first time, from blood of 3 neonates. Salmonella species were less frequently and GBS more often isolated than previously. GBS have now appeared as etiologic organisms in neonatal sepsis also in Saudi Arabia. Salmonella septicemia remains more common in Saudi Arabia than in the West.     

Changing Etiology and Outcome of Neonatal Septicemia in Riyadh, Saudi Arabia

ABSTRACT. To study the etiology of neonatal septicemia and factors associated with outcome, all charts of neonates with bacteremia and clinical sepsis admitted to a neonatal unit in Saudi Arabia, from 1 November 1980 to 31 October 1984 were reviewed. The results were compared to a previous study period in the unit (1 November 1976-31 October 1980). Septicemia was diagnosed on 50 occasions in 49 neonates. The incidence of neonatal sepsis among patients bom in the hospital was 2.5/1000 live births. Mortality from sepsis was 33% and was associated with neutropenia in 63%. The most commonly isolated bacteria were E. coli , Klebsiella and Staphylococcus aureus. Salmonella enteritidis serotypes were isolated in 4% of the cases. Group B streptococci (GBS) were isolated, for the first time, from blood of 3 neonates. Salmonella species were less frequently and GBS more often isolated than previously. GBS have now appeared as etiologic organisms in neonatal sepsis also in Saudi Arabia. Salmonella septicemia remains more common in Saudi Arabia than in the West.     

Chest radiographs in neonatal septicemia.

Chest radiographs of 63 culture proven cases of neonatal septicemia were evaluated in this prospective study. Gram negative septicemia was responsible for 76.2% cases. Radiological abnormalities were observed in 27 cases (42.8%). Seven of these had no respiratory distress. The findings were right sided infiltrates (27%); hyperinflation (7.9%), bronchopneumonia (6.3%) and pneumothorax (1.6%). Increasing gestational age, late onset of illness (greater than 3 days) and presence of respiratory signs of distress had a positive correlation with presence of X-ray findings. Term newborns with respiratory distress of late onset sepsis (greater than 3 days) had significantly higher number (p less than 0.05) of abnormal radiographs. Presence of radiological abnormality neither influenced the clinical outcome nor was affected by the causative organisms. The practice of doing a chest radiograph routinely in cases of neonatal septicemia is justified irrespective of presence of respiratory signs of distress.     

Pneumococcal sepsis and pneumonia in the neonate.

Two neonates had early onset Diplococcus pneumoniae septicemia and pneumonia. Both recovered after intensive respiratory and antibiotic therapy, although a review of the literature indicates that early pneumococcal septicemia has been associated with an extremely high mortality. Pneumococcal septicemia in a one-year period accounted for 12% of all documented neonatal bacteremias. This may indicate an increasing incidence of this organism in newborns.     

Neonatal mortality: effects of selective pediatric interventions

A previous prospective study of neonatal mortality in babies receiving special care at the University College Hospital, Ibadan, revealed that respiratory failure associated with prematurity, perinatal asphyxia, sepsis, and congenital malformations were the major causes of high neonatal mortality. To improve survival, selective measures were taken to improve care of low-birth-weight infants and prevent or treat intrapartum and postnatal hypoxia, metabolic acidosis, hypoglycemia, and hypothermia. A change in the initial antibiotic management of suspected septicemia to the use of cloxacillin and an aminoglycoside was also introduced, based on the current knowledge of etiologic agents and their antimicrobial sensitivities. In the 5-year period (1976 to 1980), the neonatal mortality in babies weighing 2,500 g and more at birth dropped significantly from 1.2% to 0.7% (P less than .02). The case fatality rates from birth asphyxia and neonatal sepsis dropped by 48% and 32%, respectively. Despite therapeutic interventions, however, the neonatal mortality in babies with birth weight of 1,000 g or less, 1,001 to 1,500 g, 1,501 to 2,000 g, and 2,001 to 2,499 g remained unchanged at about 82%, 25%, 9%, and 3%, respectively. These results suggest that early identification of infants at risk of developing birth asphyxia or neonatal septicemia and institution of prompt and appropriate management could produce a significant reduction in mortality in infants of normal birth weight. Survival of low-birth-weight infants requires additional high technical, financial, and manpower resources, which most centers in developing countries cannot afford at the present time. Therefore, efforts are probably better concentrated on decreasing the incidence of low birth weight.     

晚发型新生儿败血症院内感染和社区感染的病原菌对比与分析

目的 晚发型败血症是新生儿期常见的感染性疾病,也是新生儿死亡的常见原因之一.新生儿一旦感染,病情可以迅速恶化,故早期有效的抗菌素治疗至关重要.该研究的目的 就是通过回顾性地分析晚发型新生儿败血症(LONS)的病原菌及其药敏,以指导临床早期对可疑LONS患儿合理用药.方法 对2002年1月1日至2005年12月31日温州医学院附属育英儿童医院NICU收住的具有临床表现以及至少一次血培养阳性的LONS临床特点、药敏进行回顾性分析.结果 102例LONS多通过皮肤、消化道、呼吸道等途径感染,临床表现无特异性.其中院内感染22例,社区感染80例,院内感染组与社区感染组比较,患儿胎龄小,体重轻,发病早(t=2.255、P＜0.01,t=8.818、P＜0.01,t=7.581、P＜0.05),差异有统计学意义.两组患儿血培养共检出110株病原菌,以凝固酶阴性葡萄球菌(CNS)居首(50/103,48.5%),其次为肺炎克雷伯杆菌(16/103,15.5%)、金黄色葡萄球菌(9/103,8.7%).社区感染主要病原菌为葡萄球菌属和大肠埃希菌,院内感染则为肺炎克雷伯菌.大部分(＞80%)的葡萄球菌尤其是CNS对青霉素类、红霉素及头孢唑啉耐药,MRSA达66.7%(6/9),但对万古霉素未发现耐药,大部分对利福平亦敏感.几乎所有(15/16)的ESBLS肺炎克雷伯菌具多重耐药性,仅对碳青霉烯类、氨基糖苷类以及喹诺酮类等少数抗菌药物敏感.发现1例对万古霉素耐药的粪肠球菌,然而,未发现B组链球菌感染的病例.结论 LONS临床表现非特异性,B组链球菌不是温州地区社区感染LONS的主要致病菌.由于医院和社区抗菌素的滥用,出现越来越多的多重耐药菌.对于可疑败血症患者应常规进行血培养以确定病原菌,并根据最可能的病原菌选用相关抗生素.为减少多重耐药菌感染的发生,应尽量减少第三代头孢菌素的使用.