Risk factors in neonatal anaerobic infections

Anaerobic bacteria are well known causes of sepsis in adults but there are few studies regarding their role in neonatal sepsis. In an attempt to define the incidence of neonatal anaerobic infections a prospective study was performed during one year period. A total number of 400 neonates under sepsis study were entered this investigation. Anaerobic as well as aerobic cultures were sent. The patients were subjected to comparison in two groups: anaerobic culture positive and anaerobic culture negative and this comparison were analyzed statistically. There were 7 neonates with positive anaerobic culture and 35 neonates with positive aerobic culture. A significant statistical relationship was found between anaerobic infections and abdominal distention and pneumonia. It is recommended for those neonates with abdominal distention and pneumonia refractory to antibiotic treatment to be started on antibiotics with anaerobic coverage

Prevalence of anaerobic and aerobic bacteria in early onset neonatal sepsis

To determine prospectively the prevalence of anaerobic and aerobic infection in early onset [during 72 hours of age] neonatal sepsis, in Tehran Vali-e-Asr Hospital. Among all the live birth, neonates suspecting of having septicemia were investigated for isolation of microorganisms. Culture bottle containing enriched tryptic soy broth was used for standard blood culture system to detect aerobes and an ANAEROBIC/F bottle was inoculated using BACTEC 9120 continuous monitoring blood culture system to determine the growth of anaerobic bacteria. Among 1724 live births, 402 consecutive neonates suspecting of having septicemia were investigated for isolation of micro organism. A total of 27 episodes of early onset neonatal sepsis occurred with an incidence of 15.66 [11.6 aerobe + 4.0 anaerobe] per 1000 live births. Aerobic bacteria were the major etiological agents, accounting for 20 cases. 7 [26%] cases had positive blood cultures with anaerobic bacteria. Propionibacterium and Peptostreptococccus [amongst anaerobic] and coagulase-negative staphylococci and staphylococcus aureus [amongst aerobic] were the most commonly isolated organisms. Comparison of clinical findings and demographic characteristics between aerobic and anaerobic infection did not have a significant statistical difference. Our impression is that while anaerobic bacteremia in the newborn infants can occasionally cause severe morbidity and mortality, majority of cases experience a self limited illness with transient bacteremia

Hypothermia at birth and its associated complications in newborns: a follow-up study

Hypothermia is one of the main causes of neonatal mortality in developing countries. The aim of this prospective study was to determine the relationship between hypothermia at birth and the risk of mortality or morbidity among neonates born in Imam Hospital in Tehran, Iran. During a one-year period, body temperature was taken from all newborns using a low-reading rectal thermometer, immediately after their admission into the Neonatal ward of the above hospital. A temperature less than 36.5 C was considered as hypothermia. A questionnaire was filled for each subject. Using logistic regression the risk of development of respiratory distress in the first six hours of birth, hypoglycemia, metabolic acidosis, hyperbilirubinemia, scleroderma, pulmonary hemorrhage, Disseminated Intravascular Coagulopathy [DIC] in the first three days of birth were assessed and compared with the hypothermic and normothermic newborn infants. Nine hundred and forty neonates were enrolled into the study. A significant relationship was found between hypothermia and respiratory distress in the first six hours of birth and death, as well as with jaundice, hypoglycemia and metabolic acidosis in the first three days of birth [P=0.0001]. Logistic regression showed that, regardless of weight and gestational age, hypothermia at birth alone could increase the risk of neonatal death [OR=3.64, CI=1.85-7.18], Respiratory distress [OR=2.12, CI=1.53-2.93], metabolic acidosis [OR=2.83, CI=1.74-4.59] and jaundice [OR=2.01, CI=1.45-2.79]. Neonatal hypothermia at birth increases mortality as well as significant morbidity and hospitalization period

Neonatal hypothermia in Tehran, Iran: incidence, severity and death rate

In 1958, Silverman demonstrated that maintenance of body temperature reduces mortality in low birth weight infants. From the early 1990s it was already recognized that adequate environmental warmth was essential in the case of newborns. However, neonatal hypothermia continues to be a significant issue in developing countries.In order to describe the incidence and severity of hypothermia after delivery and to determine the possibility of related mortality risk among neonates in a tertiary nursery, we measured the body temperature on admission of 898 consecutive inborn infants after birth by a low-reading thermometer. Body temperature less than 36.5°C was designated as 'hypothermia'. In such cases the infants were re-warmed according to WHO recommendations. Their body temperature was checked and recorded every hour and their final outcome was noted.The overall incidence of hypothermia was 53.2%. 456 [i.e., 50.2% of] infants had mild hypothermia [35>T>36.5] while 22 [2.5%] of them had moderate to severe hypothermia [T<35°C]. The incidence and severity of hypothermia was found to be significantly associated with birth weight [p= 0.000] and gestational age [p= 0.000]. The duration of re-warming was also correlated with birth weight [p= 0.000]. Logistic regression analysis showed that the mortality rate of hypothermic neonates is 3.64 times that of the normotherms. The risk of death was higher in the moderate to severe hypothermic groups than in the mild hypothermic infants.In our study, the incidence of hypothermia was found to be high with both the incidence and severity to be significantly associated with birth weight and gestational age. The risk of death was recognized to be higher in the hypothermic new borns than non-hypothermic ones

Detecting hip joint dysplasia in high risk group infants

Early diagnosis of Developmental Dysplasia of the Hip [DDH] in newborns is essential if treatment is to be successful. Despite the introduction of clinical screening and early treatment of DDH the prevalence of subluxated / luxated hips in later infancy is still reported. For babies at risk, some authors suggest ultrasonography [US] combined with clinical examination. In this prospective study we compared clinical and ultrasonographic findings of 180 high risk neonates during two weeks of their birth a maternity hospital which is referral for high risk pregnancies. We could perform US in 180 cases with one or more risk factors of DDH, or with positive physical examination. Among them 28[15%] had immature and 13 [7.2%] had dysplastic hips. All the babies with immature hip had normal hip in follow up studies at 4 to 6 weeks of age. Ten [77%] out of 13 infants with dysplastic hip, had positive clinical findings. Twenty [33%] infants out of 59 infants with positive physical examination had normal sonography. The accuracy, specificity and sensitivity of physical examination were 71.1%, 70.6%, positive and negative predictive values were also 16.9% and 97.5% respectively that were similar to the other studies. Although most of dysplastic hips were recognized by primary clinical examination, but 3 cases were missed. In the presence of risk factors, further caution and follow up clinical examination might be exercised and another level of screening could be considered

Transient hyperinsulinism an asphyxiated small for gestation infant

Transient hyperinsulinism has been implicated in the prolonged hypoglycemia observed in small for gestational age or asphyxiated newborns. These infants are at high risk for severe and permanent brain damage, thus necessitating appropriate diagnosis and correct treatment. A term male asphyxiated small for gestation 30 day infant with long-standing hypoglycemia and intractable seizures was managed successfully. The case is described with a review of the literature

Pseudohypoaldosteronism: a case report

A four day old female infant was admitted because of poor feeding, vomiting and jaundice. Laboratory examination showed hyperkalemia, mild hyponatremia and renal tubular acidosis type 4. Serum aldosterone and plasma renin activity were elevated but serum cortisol, 17 -hydroxy progesterone, ACTH, 24 hour urinary 17-ketosteroid, pregnanetriol, renal function and sonogram were normal and hence pseudohypoaldosteronism type 1 [pHA 1] was differentiated from congenital adrenal hyperplasia [CAH] and other metabolic disorders. These abnormalities were corrected with sodium chloride supplementation