Clinical Observation of Neonatal Sepsis according to Onset of Disease

Jang, Young Chul; Baik, Soon Kyung; Lim, Chang Sung; Lee, Dong Jin

Abstract

We have experienced 113 cases of neonatal sepsis comfirmed by clinical manifestations and blood cultures from Jan. 1988 to Dec. 1992 at the Neonatal Intensive Care Unit of Ulsan Dong-Kang Hospital and observed the incidence, predisposing perinatal factors, clinical manifestations, associated illnesses, laboratory findings, isolated microorganisms, antibiotics sensitivity test and mortality rate of neonatal sepsis according to onset of disease. The result were as follows: 1) The incidence of neonatal sepsis was 1.39% and male to female ration was 1.38:1. The incidence and sex difference between early onset and late onset disease were not significant. 2) Neonatal sepsis was more prevalent in premature infants (2.47%) than in fullterm infants (1.28%) and nore prevalent in low birth weight infants(3.01%) than in normal birth weight infants (1.25%). In premature infants, neonatal sepsis was more prevalent in early onset (63.2%) than in late onset diease (36.8%). In low birth weight infants, neonatal sepsis was more prevalent in early onset (64.8%) than in late onset dieases (35.7%P). 3) Predisposing perinatal factors, such as meconium staining, birth asphyxia, difficult delivery, premature rupture of membrane, maternal infection, toxemia and postpartum bleeding were slightly frequent in early onset disease. 4) Among the clinical manifestations, jaundice, respiratory symptoms, pallor, lethargy, poor feeding and hepatosplenonegaly were slightly frequent in early onset disease, but temperature instability and gastrointestinal symptoms were slightly frequent in late onset disease. 5) Among the associated illness, pneumonia, disseminated intravascular coagulopathy, amnionitis, hyaline membrane disease and osteomyelits were more common in early onset disease, but gastroenteritis, urinary tract infection, necrotizing enterocolitis, wound infection and meningitis were mors common in late onset disease. 6) The difference of laboratory findings between early onset and late onset disease was not significant. 7) Causative organisms were gram positive organisms in 87 cases(77.0%), gram negative organisms in 22 cases (18.6%) and mixed infections in 5 cases (4.4%). Among them, coagulase negative staphylococcus was the most common one and staphylococcus aureus was the second. The incidence of infections caused by coagulase negative staphylococcus and staphylococcus aureus, between early onset and late onset disease, was not significantly different. Streptococcal infection was more prevalent in early onset disease, especially all group B streptococcus caused early onset disease. 8) Gram positive organisms ware sensitive to Cephalothin (92.9%), Chloramphenicol (90.0%) and Ceftriaxone (88.9%). Gram negative organisms were sensitive to Amikacin (91.3%) and Colistin (82.6%). The difference of antibiotics sensitivity for organisms causing early onset and late onset diease were not significant. Gram negative organisms causing early onset disease were resistant to gentamicin and terramycin, but those organisms causing late onset disease were more sensitive to gentamicin (88.9%) and tobramycin (77.8%). 9) The mortality rate was 7.96%. It was higher in gram negative infections (23.8%) than in gram positive infections (4.6%). No significant difference of mortality rate between early onset and late onset disease was found.

Clinical Observation of Neonatal Sepsis according to Onset of Disease

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