Neonatal sepsis-- a global problem: an overview.

Neonatal sepsis is one of the major health problems throughout the world. Every year an estimated 30 million newborns acquire infection and 1-2 million of these die. The present review provides updates regarding neonatal sepsis to help paediatricians to protect the newborn from this deadly problem. The onset of sepsis within first 48 hours of life (early onset sepsis) is frequently associated with pre and perinatal predisposing factors while onset after 48-72 hours of life (late onset sepsis) frequently reflects infection acquired nosocomially. Some literatures say that early onset disease presents in the first 5-7 days of life. Klebsiella pneumoniae is the leading pathogen causing neonatal sepsis in Bangladesh and neighbouring countries. Among many risk factors the single most important neonatal risk factor is low birth weight. Other main risk factors are invassive procedures in the postnatal period and inadequate hand washing before and after handling babies. Sepsis score is a useful method for early and rapid diagnosis of neonatal sepsis which was developed by Tollner U in 1982. Antibiotics should be given to most of the neonates suspected of infection. Ampicillin and gentamicin are the first drug of choice. In Bangladesh context sepsis score may be used as a good parameter for the early and rapid diagnosis of sepsis and that will guide the treatment plan. Clean and safe delivery, early and exclusive breastfeeding, strict postnatal cleanliness following adequate handwashing and aseptic technique during invasive procedure might reduce the incidence of neonatal sepsis. Prompt use of antibiotic according to standard policy is warranted to save the newborn lives from septicaemia.

Incidence of low birth weight in three selected communities of Bangladesh.

This prospective study was conducted in urban affluent, slum and rural communities of Bangladesh during Feb '94 to Feb '95. From each community, 250 pregnant mothers were recruited in the study and at the end total 660 live births were studied to determine the incidence and risk factors of low birth weight. Incidence of low birth weight was highest in urban slum (36.8%) followed by rural area (20.9%) and lowest in urban affluent community (18.3%). The area of residence had a significant influence on birth weight suggesting that environmental stress had detrimental effect on birth weight. Age, weight and height of mothers were also risk factor for low birth weight of their babies. Mothers of less than 20 years and more than 35 years, weighing less than 40 kg and having height less than 140 cm had the higher risk of giving birth to low birth weight babies. Incidence of low birth weight was highest (73.2%) among the primigravidae mothers and 36.8% among the mothers who had no antenatal check-up, but it was 15.9% among those who had check-up more than 7 times. The distribution of low birth weight babies was higher (48.2%) among the mothers who had never gone to school. To reduce the incidence of low birth weight, upliftment of socio-economic condition has got no alternative which is very much related to education level of the people. Emphasis should be given on mothers' education which is one of the influencing factors of birth weight of babies.