Early neonatal morbidities in late preterm infants

Objectives  

To compare early neonatal morbidity (within first 7 days of life) in late preterm infants with term infants.     

Changing bacteriological patterns in neonatal septicaemia

The various organisms responsible for septicaemia and their changing sensitivity patterns were studied. The incidence of neonatal septicaemia was 26·3%. Group I comprised of 242 cases in 1981–1982 and group II 150 cases in 1984. Gram negative organisms were isolated in the majority of blood cultures, 52·5% and 43·4% in group I and II respectively. Klebsiella though showing a fall in incidence, still remained the commonest Gram negative organism isolated. The incidence of E. coli, pseudomonas and staphylococcal infections also doubled in group II as compared to group I. An alarming trend was the increasing resistance of the isolates to commonly used penicillins and aminoglycosides. The incidence of organisms resistant to all commonly used antibiotics has also increased from 13% to about 40%. This problem could be combated by rotating the commonly used antibiotic combinations, as well as discouraging the unnecessary use of antibiotics.     

Polymorphonuclear leucocyte transfusion in neonatal septicaemia

In one neonatal intensive care unit during a 15 month period 6 infants developed septicaemia which was resistant to antibiotic treatment. The infants' mean gestational age and birthweight were 32.7 weeks and 1519 g respectively. Intravenous infusions of polymorphonuclear leucocytes were given. Three infants died and the remainder survived without complications. No side effects of the treatment were identified.     

The bacteriology of neonatal septicaemia in Ile-Ife, Nigeria.

The incidence of septicaemia among neonates categorized as being at high risk was 55 per cent in Ile-Ife, Nigeria. Gram-positive organisms, specifically Staphylococcus aureus, were predominant (33.8 per cent) among bacteria cultured from proven cases of septicaemia. Other coagulase-negative staphylococci also contributed 21 per cent, with Staphylococcus epidermidis occurring in 5 per cent of the isolates. Listeria monocytogenes was cultured from 8.4 per cent of septic neonates. Pseudomonas aeruginosa was cultured from 3 per cent, Klebsiella pneumoniae from 14 per cent, and Escherichia coli from 7 per cent. Other Gram-negative bacilli cultured were Enterobacter aerogenes (5 per cent), Citrobacter freundii, Salmonella sp., and Proteus sp. (2 per cent each). The bacterial isolates were relatively resistant to antibiotics traditionally employed to treat cases of septicaemia. The study shows a high prevalence of neonatal bacterial sepsis at the centre and the emerging role of Listeria monocytogenes in the aetiology of neonatal sepsis. It highlights the preponderance of multiple antibiotic resistant organisms among these neonates early in life which is of epidemiological importance in the control of the infectious agents.     

Early neonatal hypocalcaemia.

In our hospital early neonatal hypocalcaemia is now the major cause of low serum calcium in the neonatal period. Over a 2-year period, only 2 cases of hypocalcaemic convulsions were seen in a total of 8700 deliveries, though 51 infants had early neonatal hypocalcaemia. All sick low birth-weight infants should have daily serum calcium estimations carried out. Calcium supplements should be considered if symptoms of hypocalcaemia are present.     

Predictive value of C-reactive protein in neonatal septicaemia

The following non-specific indices of infection were studied in septicaemic and non-septicaemic babies: haemoglobin, total white blood cell count, differential white count, ESR, platelet count, C-reactive protein (CRP), serum immunoglobulins, plasma C3 and haptoglobin. Forty-three low-birthweight (LBW) infants with clinical features suggesting septicaemia were investigated; blood cultures were positive in 19 and negative in 24. The mortality was 53% in the culture-positive and 13% in the culture negative group. Comparisons between the two groups of babies showed that the CRP titre (measured by Latex agglutination) was the only reliable non-specific indicator of infection. The titre was elevated more often in culture positive (16/19) than culture negative (7/17) babies (P less than 0.001). The CRP titre (Mean +/- 2 S.D.) was 15.75 +/- 12 in blood culture positive and 6.13 +/- 11.72 in culture negative neonates respectively (P less than 0.0004). Positive CRP titres were found in 5 of 20 healthy controls (4 +/- 8.4). Sequential CRP titres showed a gradual decline with clinical improvement in both groups of patients. The IgM was unhelpful as it was raised (greater than or equal to 40 mg%) in 37 of the patients.     

Changing pattern of neonatal septicaemia in an African city

The pattern of neonatal septicaemia in a large cosmopolitan African city is presented. Comparison of microorganisms isolated in the present study when compared with the results of previous reports from the same institution, show an increase in the incidence of klebsiella and pseudomonas septicaemia. In contrast, Escherichia coli infection has decreased appreciably from an incidence of 56.8% to 14.3%. Staphylococcus aureus has remained the dominant Gram-positive pathogen over the last decade while group B streptococcal (GBS) disease was rarely encountered. A significant finding was the emergence of gentamicin-resistant strains of E. coli and proteus species during the past 5 years. The overall incidence of neonatal septicaemia was 5.6/1000 livebirths and the mortality rate was 30.6%.     

Neonatal septicaemia.

A total of 410 proved cases of neonatal septicaemia from seven Finnish hospitals seen between 1976 and 1980 were reviewed. The annual incidence of neonatal septicaemia was 3 per 1000 births, and overall mortality was 23%. Onset was early in most patients. Symptoms of septicaemia occurred within the first 24 hours of life in 44% and within the first week of life in 90%. In the very early onset disease (within 24 hours) mortality was 30%, compared with 17% in all other cases. Group B streptococcus was the leading cause in very early onset disease (52%) but mortality from infection with this organism was similar to that in other very early onset cases. It is concluded that very early onset neonatal septicaemia, probably of intrauterine origin and caused by group B streptococcus in one half of the cases, constitutes the major form of neonatal septicaemia in Finland and should receive the highest priority in preventive measures.     

Increase of staphylococci in neonatal septicaemia: a fourteen-year study

All cases of neonatal septicaemia during 1981-94 were studied at Örebro Medical Centre Hospital, Sweden. One hundred and thirty-two children fulfilled laboratory and clinical criteria for neonatal septicaemia and were included. Staphylococcus aureus ( n = 41), Group B streptococcus (GBS) ( n = 32) and coagulase-negative staphylococci (CoNS) ( n = 27) were the dominating aetiologies. The annual incidence of septicaemia increased significantly, from 2.3 cases during the first 7-year period to 3.3 per 1000 live births during 1988-94. This increase was caused by S. aureus and CoNS, which mainly affected premature children and had an onset more than 48 h after delivery. GBS, on the other hand, slightly decreased and affected full-term children within 48 h. The overall mortality was 11%. CoNS isolated during the latter 7-year period were more resistant to antibiotics than those isolated during 1981-87; resistance to methicillin increased from 14 to 45% and to gentamicin from 0 to 20%. These changes in aetiology and antibiotic susceptibility should be considered when selecting antibiotic treatment in neonatal septicaemia.     

Severe progressive late onset myelopathy and arachnoiditis following neonatal meningitis.

This case series describes four children who had meningitis in the neonatal period. After a stable period of years, they developed a myelopathy caused by chronic arachnoiditis. The myelopathy was precipitated by a fall in two cases, and in two cases there was an acute deterioration after surgery. A history of neonatal meningitis should be taken into consideration before planning surgery or anaesthesia. Careful intra-operative positioning, immobilisation of the neck, and maintenance of blood pressure is important but may not prevent this complication.     

Sequential determination of CRP, alpha 1-antitrypsin and haptoglobin in neonatal septicaemia

In 312 preterm and term newborn infants serum concentrations of C-reactive protein (CRP), haptoglobin and alpha 1-antitrypsin were measured during several days by radial immunodiffusion. In addition white blood cell count and the ratio of band to total neutrophils (B/N-ratio) were determined. In 12 infants with proven sepsis CRP was found elevated above the upper limit of the normal range (20 mg/l). Successful therapy was followed by a decrease of CRP concentration. In infants with suspected infection high CRP values were found in most cases. In contrast, haptoglobin and alpha 1-antitrypsin concentrations differed not significantly between the group of infants without infection, with proven and with suspected infection. White blood cell count and B/N-ratio also were not appropriate for the early identification of bacterial infection in the newborn period.     

Incidence and etiology of neonatal septicaemia and meningitis in western Sweden 1975-1986

In a retrospective study of neonatal septicaemia and meningitis in a defined region of western Sweden 1975-1986, 231 cases were identified. The incidence was 2.8/1000 live births. The case-fatality rate was 15%. thirty-three patients had meningitis. Only 55 patients (24%) had no known risk factors. Preterm delivery was a most important risk factor for both morbidity and mortality. The most common causative organisms were group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods, together isolated from 82% of the patients. The cases were approximately equally divided between very early, early and late onset infections. Group B streptococci were over-represented in very early onset infections in all birthweight groups and aerobic Gram-negative rods were the most common isolates from low birthweight infants with late onset infections. However, group B streptococci, Staphylococcus aureus and Gram-negative rods were found in all birthweight and gestational age groups. Thus, initial antimicrobial therapy must be equally broad in all neonates with suspected septicaemia.     

Six year trend of neonatal septicaemia in a large Malaysian maternity hospital

Abstract A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaeia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.