Neonatal septicaemia : the incidence, symptomatology and microbiology

Abstract

INTRODUCTION: The awareness of incidence and aetiology of septicaemia plays an important role when implementing preventive measures. The identification of offending organism helps to guide the initial antibiotic therapy which should be started immediately as the progression of early symptoms to death could occur in less than 24 hour. OBJECTIVES : To assess incidence and to identify' clinical presentations and offending organisms of neonatal septicaemia. METHODS : This study was carried out in the University Paediatric Unit, Colombo North Teaching Hospital Ragama from January to December 1996. Neonates with positive blood cultures and those having septicaemia clinically with negative blood cultures were included in the study. Data was analysed by Epilnfo version 6. RESULTS : 98 babies were diagnosed to have septicaemia during the study period. The incidence of septicaemia in the University Obstetric Unit was 24.4 per 1000 livebirths (98 out of 3851 live bom babies) and the case fatality rate was 11.2%. The incidence was significantly higher in babies with low birth weight (LBW) and in those born following instrumental delivery (p<0.01). 21.4% of babies developed septicaemia on first day of life, 74.5% between 2-7 days and 4.1 % after first week. The common presenting features were fever 61.2%, jaundice 52%, lethargy 37.8%, refused feeding 25.5%, coffee grounds vomiting 22.4% and fits 12.2%. The common bacteria identified were Klebsiella 29.2%, Staphylococcus aureus 16.9%, E.coli 5.6%, Coliform bacilli which could not be identified further 13.5% and non haemolytic streptococci 8.2%. The common sensitive antibiotics were Amikacin 88.9%, Amoxycillin + ClavuL'oic acid 183%, Ceftriaxone 78.1%, Netilmicin 63.9%, Gentamicin56.4% and Ceftazidime55.2%. CONCLUSIONS : This study shows that septicaemia is an important cause of morbidity in babies w ith LBW and those with instrumentation at birth. Our study confirms the nonspecific presentation of septicaemia. The finding of high incidence of late septicaemia and septicaemia due to Klebsiella and Staph. aureus indicates that most babies acquired it from the hospital.