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NEONATAL SEPTICAEMIA AS SEEN IN THE SPECIAL CARE BABY UNIT OF AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA
Abstract
Neonatal septicaemia is associated with high morbidity and mortality, particularly
in the tropics where risk factors for the development of the disease are prevalent. The
epidemiologic, aetiologic and antibiotic sensitivity patterns of neonatal septicaemia
vary from place to place and from time to time. Appropriate and prompt antibiotic
therapy is pivotal to reducing complications that could arise from the disease, hence
the need for a stand-by empirical treatment protocol. In order to determine the current
pattern of neonatal septicaemia in this locality, a prospective study was conducted in
ABUTH, Zaria, between 25th May 2004 and 31st May 2005.
Babies (in-born and out-born) admitted in the SCBU of the hospital with the
working diagnosis of septicaemia were studied. Each of the babies that fulfilled the
inclusion criteria was evaluated clinically and a single venous blood sample obtained
under aseptic conditions was inoculated into a thioglycolate containing bottle for
culture before commencement of antibiotics. The blood samples were subjected to
standard microbiologic culture technique. Isolated bacteria were identified using
standard biochemical and enzymatic tests. Antibiotic sensitivity testing was done on
each isolate using antibiotic discs manufactured by Oxoid and Abtek Biological Ltd.
Fourteen antibiotics (ampicillin, amoxicillin, Augmentin,® cloxacillin, cotrimoxazole,
chloramphenicol, cefuroxime, ceftriaxone, ceftazidime, ciprofloxacin, erythromycin,
gentamycin, tetracycline and ofloxacin) were employed. Relevant haematologic
indices of infection were also determined on each blood sample. The patient’s data
(biodata, pregnancy and delivery history, clinical features and laboratory findings) were
entered into a proforma and the babies were subsequently managed as per the unit
routines.
Two hundred and eleven (211) infants were studied, consisting of 69 in-born
infants and 142 out-born infants. The M:F ratio was 1.37:1. Seventy-five (35.5%) of
them had proven septicaemia. Among those that had proven septicaemia, 21(28.0%)
were in-born infants while 54(72.0%) were out-born infants. The prevalence of
septicaemia among in-born and out-born babies was 30.4% and 38.0% respectively
(p>0.05). The M:F ratio of the septicaemic neonates was 1.21:1. The total number of
live births in the hospital during the study period was 1190, thus the incidence of
neonatal septicaemia for in-born babies was 17.6 per 1000 live births.
The symptoms and signs of neonatal septicaemia were non-specific and there
were no significant differences in the frequency of symptoms and signs in septicaemic
and non-septicaemic neonates.
The perinatal risk factors for neonatal septicaemia encountered among the 211
neonates are lack of antenatal care 40 (19.0%), prolonged rupture of membranes 31
(14.7%), prolonged labour 18 (8.5%), intrapartum maternal fever 14 (6.6%),
unsupervised delivery 79 (37.4%), preterm delivery 25 (11.8%), perinatal asphyxia 25
(11.8%), traditional uvulectomy 31 (14.7%), umbilical cord care without use of
antiseptic agents 95 (45.0%) and presence of symptoms of maternal infections during
pregnancy such as copious/offensive vaginal discharge, diarrhoea and dysuria 13
(6.2%). The frequency of maternal risk factors among neonates with proven
septicaemia were generally higher than those in non-septicaemic neonates, though
only the frequency of unsupervised antenatal period (p<0.05), prolonged labour
(p<0.05), prolonged rupture of membranes (p<0.05) and presence of symptoms
suggestive of maternal infections during pregnancy (such as copious/offensive vaginal
discharge, diarrhoea and dysuria) (p<0.05), reached statistical significance, especially
in neonates with early-onset septicaemia. Among the host risk factors, only preterm
delivery (p<0.05) and perinatal asphyxia (p<0.05) had statistically significant
association with the occurrence of septicaemia.
Staphylococcus aureus was the commonest isolate, accounting for 33 (42.9%) of
the total (77) isolates in the 75 septicaemic neonates, two of which had double
isolates. The other common isolates were Escherichia coli 15 (19.5%), Streptococcus
species seven (11.0%), Klebsiella pneumoniae six (7.8%), Proteus mirabilis five
(6.5%), Citrobacter species three (3.9%) and Acinetobacter species three (3.9%).
Staphylococcus aureus was also the commonest isolate among the out-born infants
(p<0.05) while Streptococcus species predominated among the in-born neonates with
early-onset disease (p<0.05). Gram-negative bacteria were the commonest isolates
among neonates (in-born and out-born) with early-onset septicaemia, while Gram
positive bacteria predominated among those with the late-onset type.
The sensitivity of the pathogens to commonly used antibiotics was on the decline
when compared with those of previous studies. However, cefuroxime (85.0%
sensitivity to Gram-positive, 32.4% to Gram-negative) and gentamycin (70.5%
sensitivity to Gram-positive, 78.4% to Gram-negative) still retained good sensitivity
rates. Chloramphenicol, third generation cephalosporins and quinolones also showed
very high in-vitro activity.
It is concluded that the current aetiologic and epidemiologic patterns of
septicaemia are similar to patterns earlier documented in our unit except for the higher
incidence of the disease and the increasing prevalence of antibiotic resistant agents.
Therefore a combination therapy consisting of cefuroxime and gentamycin is
recommended as the preferred empirical choice for the treatment of neonatal
septicaemia in the unit. Preventive measures should be re-emphasised through
aggressive health education, while the institution of an effective infection surveillance
system is highly desired in order to combat the problems associated with the
increasing prevalence of antibiotic resistant organisms.
