Prevalence, aetiology, associated factors and immediate outcome of neonatal septicaemia in Mulago hospital
Abstract
Description
A dissertation submitted in partial fulfillment of the requirements for the award of the degree of Master of Medicine (Paediatrics and Child Health) of Makerere University
Background: Neonatal septicaemia is a common problem, which is associated with a mortality rate of more than 50% in some countries. However, its prevalence, causative organisms, and their sensitivity patterns have been shown to vary from place to place. In Mulago Hospital, there is no documentation on the prevalence, associated factors and immediate outcome of neonatal septicaemia. Objective: To determine the prevalence, aetiology, associated factors and immediate outcome of neonatal septicaemia in Mulago Hospital. Methodology: This was a cross sectional study carried out from July 2002 to November 2002 in Acute Care Unit (ACU) and Special Care Baby Unit (SCBU) of Mulago Hospital. Two hundred and ninety three neonates with a provisional diagnosis of septicaemia were enrolled into the study using the WHO case definition. A detailed history was taken and physical examination done on these neonates. In addition, the following investigations were carried out: Blood cultures, Grain stain for organisms in CSF and CSF cultures, WBC count, ESR and Random blood sugar. Antimicrobial sensitivity of isolated organisms was determined. Main outcome measurements: The main outcome measurements were the mortality rate, average duration of clearance of symptoms and weight gain/loss for neonates with septicaemia. Results: Of the 293 neonates with a provisional diagnosis of septicaemia, 110 (37.5%) had positive blood cultures. The most predominant organisms isolated were S. aureus (69.2%) followed by E. coli (17%) and Group B haemolytic Streptococcus (7%). The sensitivity of S. aureus to gentamicin and cloxacillin was 95% and 65.3% respectively. Gram-negative organisms had 100% sensitivity to cephalosporins. Although most organisms were resistant to ampicillin, sensitivity of GBS to ampicillin was 86%. Factors significantly associated with occurrence of neonatal septicaemia were male sex (p=0.034), age group of 8-28 days (p=0.001), history of convulsions (p=0.003), umbilical pus discharge (p=0.009), hypoglycaemia (p=0.004) and failure to attend antenatal care by the mother (p=0.026). Outcome: The overall fatality rate among neonates in the study was 55 (18.8%), 20 (6.8%) of whom had positive and 35 (12%) had negative blood cultures. The majority (84%) of deaths among neonates with positive cultures occurred in the first 2 days of admission. There was no significant association between resistance of causative organisms of neonatal septicaemia and outcome. Hypoglycaemia was however significantly associated with death (p<0.01). More deaths occurred among neonates with negative cultures 35 (12%) than among those with positive cultures 20 (6.8%) however, the difference was not significant (p=0.841). Conclusions and recommendations: Conclusions: The prevalence of neonatal septicaemia was 37.5%. S. aureus (62.9%), E. coli (17%) and Group B haemolytic Streptococcus (7%) were the main blood culture isolates with gentamicin and ampicillin forming the best antibiotic combination. Late onset septicaemia, male sex, history of convulsions, history of umbilical pus discharge, failure to attend antenatal care and hypoglycaemia were predictive of neonatal septicaemia. The total mortality rate was 18.2% with hypoglycaemia as the only factor significantly associated with death. Neonates with confirmed septicaemia had a significantly poor weight gain compared to those with negative cultures. Recommendations: A high index of suspicion of septicaemia should be considered in neonates8 to 28 days old presenting with history of convulsions, umbilical pus discharge, hypoglycaemia and especially if they are males. Gentamicin and ampicillin should remain empirical antibiotic in the treatment of neonatal septicaemia. Prompt screening/treatment for hypoglycaemia together with close monitoring should be provided to all admitted neonates.
Background: Neonatal septicaemia is a common problem, which is associated with a mortality rate of more than 50% in some countries. However, its prevalence, causative organisms, and their sensitivity patterns have been shown to vary from place to place. In Mulago Hospital, there is no documentation on the prevalence, associated factors and immediate outcome of neonatal septicaemia. Objective: To determine the prevalence, aetiology, associated factors and immediate outcome of neonatal septicaemia in Mulago Hospital. Methodology: This was a cross sectional study carried out from July 2002 to November 2002 in Acute Care Unit (ACU) and Special Care Baby Unit (SCBU) of Mulago Hospital. Two hundred and ninety three neonates with a provisional diagnosis of septicaemia were enrolled into the study using the WHO case definition. A detailed history was taken and physical examination done on these neonates. In addition, the following investigations were carried out: Blood cultures, Grain stain for organisms in CSF and CSF cultures, WBC count, ESR and Random blood sugar. Antimicrobial sensitivity of isolated organisms was determined. Main outcome measurements: The main outcome measurements were the mortality rate, average duration of clearance of symptoms and weight gain/loss for neonates with septicaemia. Results: Of the 293 neonates with a provisional diagnosis of septicaemia, 110 (37.5%) had positive blood cultures. The most predominant organisms isolated were S. aureus (69.2%) followed by E. coli (17%) and Group B haemolytic Streptococcus (7%). The sensitivity of S. aureus to gentamicin and cloxacillin was 95% and 65.3% respectively. Gram-negative organisms had 100% sensitivity to cephalosporins. Although most organisms were resistant to ampicillin, sensitivity of GBS to ampicillin was 86%. Factors significantly associated with occurrence of neonatal septicaemia were male sex (p=0.034), age group of 8-28 days (p=0.001), history of convulsions (p=0.003), umbilical pus discharge (p=0.009), hypoglycaemia (p=0.004) and failure to attend antenatal care by the mother (p=0.026). Outcome: The overall fatality rate among neonates in the study was 55 (18.8%), 20 (6.8%) of whom had positive and 35 (12%) had negative blood cultures. The majority (84%) of deaths among neonates with positive cultures occurred in the first 2 days of admission. There was no significant association between resistance of causative organisms of neonatal septicaemia and outcome. Hypoglycaemia was however significantly associated with death (p<0.01). More deaths occurred among neonates with negative cultures 35 (12%) than among those with positive cultures 20 (6.8%) however, the difference was not significant (p=0.841). Conclusions and recommendations: Conclusions: The prevalence of neonatal septicaemia was 37.5%. S. aureus (62.9%), E. coli (17%) and Group B haemolytic Streptococcus (7%) were the main blood culture isolates with gentamicin and ampicillin forming the best antibiotic combination. Late onset septicaemia, male sex, history of convulsions, history of umbilical pus discharge, failure to attend antenatal care and hypoglycaemia were predictive of neonatal septicaemia. The total mortality rate was 18.2% with hypoglycaemia as the only factor significantly associated with death. Neonates with confirmed septicaemia had a significantly poor weight gain compared to those with negative cultures. Recommendations: A high index of suspicion of septicaemia should be considered in neonates8 to 28 days old presenting with history of convulsions, umbilical pus discharge, hypoglycaemia and especially if they are males. Gentamicin and ampicillin should remain empirical antibiotic in the treatment of neonatal septicaemia. Prompt screening/treatment for hypoglycaemia together with close monitoring should be provided to all admitted neonates.
Keywords
Neonatal septicaemia – Prevalence, Neonates, Neonatal septicemia, Mortality, Mulago Hospital