The prevalence and some clinical characteristics of bacterial infections in preterm neonates having respiratory distress at Kenyatta National Hospital

Abstract

Fifty eight preterm neonates having respiratory distress within the first forty eight hours of life were studied. Seven had positive blood cultures for bacteria giving a prevalence rate for infection of 12.1%. Nineteen infants (32.8%) were suspected to have sepsis based on clinical and laboratory criteria .. The remaining thirty two (56%) had no evidence of sepsis. These infants were studied with respect to their maternal antenatal clinic attendances, maternal fever, duration of rupture of membranes, Iiquor characteristics and mode of del ivery. Al so studied were their clinical examination findings, degree of respiratory distress, hematological, radiological and bacteriological characteristics. Seventy six percent (76%) of the mothers were below 25 years (age range 15-45 years). A majori ty of the mothers (65.5%) attended antenatal clinics. Twenty eight (42.2%) of the mothers had ruptured membranes for less than eleven hours before delivery while 13 (22.4%) and 17 (29.4%) had ruptured membranes between eleven and twenty four hours, and for greater than 24 hours respectively. Forty six infants (79.3%) were delivered in clear liquor; of these 6 (13.1%) had positive bacterial cultures. Seven infants (12.1%) delivered in offensive liquor had suspected infection. Of the five (8.6%) delivered in meconium stained liquor, two had some evidence of infection. Spontaneous vertex delivery was the commonest mode of delivery in all the three groups of infants; occurring in 5 (71%) of the infants with proven sepsis, 14 (73.7%) of the infants with

suspected sepsis and 24 (75%) of those with no sepsis. None of the infants delivered by caesarian section had confirmed sepsis. Infants del ivered by breech extraction had either suspected or confirmed sepsis.Maternal fever and infant Apgar scores did not appear to affect the outcome of the infants in this study. On hematology the ratio of immature to total polymorphs correlated best with sepsis as higher values of more than 0.2 were seen mainl y in infants with confirmed sepsis. Total whi te cell counts were also useful since normal range of counts were only seen in infants with no evidence of sepsis. Infant chest radiology helped eliminate other causes of respiratory distress like pneumothorax, congenital heart disease and lung collapse. None of the infants with confirmed sepsis had normal radiological findings. The orqanisms isolated were of high virulence and multipleantibiotic resistance. Amikacin and cefotaxin enjoyed higher sensitivity rates of 71.4% and 88.8% respectively.