Effect of the pattern of colonization of the maternal genital tract at the time of delivery on early onset neonatal sepsis

Early onset neonatal sepsis increases significantly in the presence of vaginal and cervical colonization with pathogenic organisms. The aim of this study was to study the effect of the pattern of colonization of the maternal genital tract at the time of delivery on early onset neonatal sepsis. A prospective clinical study was conducted in Cairo University Hospitals on 352 pregnant women coming for delivery and their newborns. Vaginal swabs were taken from the mothers before first vaginal examination [PV] and just before delivery. Surface swabs from the body of babies were taken. The neonates were clinically evaluated and prospectively followed up in the first week of their life for clinical evidence of sepsis and blood cultures were done for clinically septic neonates. Swabs were taken from different environmental sources in the Obstetric and Neonatology wards. Microbiological typing was conducted by biotyping and antibiogram to prove the similarity between microorganisms isolated from maternal or environmental sources and the corresponding neonates. Pulsed field gel electrophoresis was used for genotyping of phenotypically similar isolates. Microbiological similarity between culture results of mothers and their newborns was proven in 86% of cases. The correlation between clinical sepsis and microbiological agreement was also highly significant [p value=0.001]. Positive vaginal swab cultures were highly predictive of positive blood culture [p-value=0.09]. We found that, multiple vaginal examinations [more than 3 times] was the most frequent maternal risk factor of neonatal bacteremia [p-value=0.049]. Contamination of environment [gel and gloves] and equipment [suction sets] used for mothers and their babies during delivery was probably an important source of microorganisms. Maternal colonization and the contaminated environment were important risk factors for neonatal sepsis. Hence, limitation of PV and strict infection control measures should be followed in delivery room

Cranial ultrasonographic screening of preterm newborn

The objective of this prospective, descriptive study was to screen all high risk preterms admitted in the neonatal intensive-care unit of Kasr El Einin hospital by transfontanellar sonography on days 1, 3 and 7 of life to identify the various cranial pathologies and to find the relationship between the abnormal sonographic data of the neonates and the maternal risk factors. The study population included 175 high risk preterms representing all high risk preterms admitted to Kasr El Eini intensive care unit having different perinatal risk factors during a 6 months period. The results showed that 65 preterms [37%] of the 175 included in the study had abnormal sonographic findings. Subependymal intraventricular hemorrhage [SE-IVH] was present in 25 cases [14% of all preterms screened], brain edema in 15 cases [9%], hypoxic ischemic changes in 7 cases [4%], posthemorrhagic hydrocephalus [PHH] in 6 cases [3.5%] as a complication of SE-IVH. Posthemorrhagic hydrocephalus [PHH] developed in 24% of preterms with SE-IVH [6 out of 25], subependymal cysts developed in 5 cases [3%], congenital hydrocephalus in 4 cases [2%], ventriculitis in 2 cases [1%] and agenesis of the corpus callosum in 1 case [0.5%]. Not a single case was diagnosed as having periventricular leukomalacia [PVL]. All cases of congenital hydrocephalus and agenesis of the corpus callosum were detected on day 1. Most cases of brain edema [80%] were also detected on day 1. In >/= 50% of cases with hypoxic ischemic changes, subependymal cyst and ventriculitis were detected on day 3. as for PHH, 80% of cases were detected on day 7. Many of the maternal risk factors were highly correlated with certain sonographic findings as eclampsia, diabetes mellitus, chorioamnionitis, antepartum hemorrhage, fever, abnormal presentation, multiple pregnancies, prelabour rupture of membrane [PROM] and traumatic delivery. Other maternal risk factors were not correlated with any of the sonographic findings as asthma, cardiac troubles, old age, hepatitis and polyhydramnios. None of the neurological manifestations was specific to a certain cranial pathology. There was a significant statistical difference between the mean I/T ratio among patients with ventriculitis compared to those without. However, no correlation was found between laboratory findings and SE-IVH. There was a significant difference among neonates with post hemorrhagic hydrocephalus and congenital hydrocephalus compared to those without as regard to survival. The richness of information obtained from screening of preterm infants by transfontanellar sonography which is obvious from the above results reveals the importance of cranial ultrasonography In the diagnosis of SE-IVH, hypoxic ischemic changes, brain edema, posthemorrhagic hydrocephalus, congenital hydrocephlus, ventriculitis, subependymal cysts and agenesis of the corpus callosum. Forth per cent of the preterms having cranial pathology were clinically well. For this besides, its safety and its accessibility, and in order to improve the outcome of the preterms, routinely screening all preterms on day 1, 3 and 7 of life is mandatory. Further weekly screening is recommended even if the initial sonographic findings were normal so as not to miss a case of PVL as the development of PVL may be delayed to weeks after birth

Cerebral atrophy in protein energy malnutrition

CT scans of 60 patients with various forms and degrees of PEM were studied. The patients were classified clinically as suffering from marasmus, KWO or marasmic KWO. Anthropometric measurements based on expected weight, length, head circumference and arm circumference for age using Egyptian percentile curves were studied. Biochemical studies of serum total proteins, albumin, protein electrophoresis and electrolytes were also carried out. The degree of cortical and/or central atrophy was noted by measuring the bifrontal index [BFX], sylvian fissure [SF], interhemispheric fissure, cortical sulci and basal cisterns. BFX and SF measurements showed statistically significant higher values in the 3 groups compared to the control group except for BFX which was statistically not significant in cases of marasmus. Comparing the 3 groups together, it was found that the BFX was statistically and significantly higher in KWO than in marasmus indicating a more severe degree of central atrophy in KWO. A positive correlation was found between duration of the disease and the degree of both cortical and central atrophy. Follow up studies of some cases showed marked improvement of CT scan findings after treatment

Some causes of anaemia in Egyptian neonates

Thirty-four new borns with a calculated gestational age ranging from 30 to 42 weeks were included in the study. Half of them were preterm. Eleven healthy new borns were taken as a control. The anemia proved to be dyshaematopoietic in 15 cases [44.1%], hemolytic in 12 cases [35.3%] and hemorrhagic in 7 cases [20.6%]. Dyshaematopoeitic anemia was due to septicemia. The hemolytic cases proved to be due to Rh incompatibility, ABO incompatibility and G6P.D. deficiency. Hemorrhagic anemia was due to intracranial hemorrhage [2 cases] bleeding from umbilicus [one case]. In the remaining cases hemorrhage was due to twin transfusion, cephalhaematoma, antepartum hemorrhage and hemorrhagic disease of the newborn

Renal function in neonates with hyperbilirubinemia

Renal function was studied in twenty full term neonates with hyperbilirubinemia of the unconjugated type. Causes of hyperbilirubinemia were exaggerated physiological jaundice, Rh, ABO incompatibilities. Ten healthy full term were included as a control group. None of the cases nor the controls showed any stress factor which may affect renal function e. g. septicemia, hypoxia, dehydration. All samples were taken the 7th day post-natally. The results showed glomerular and tubular impairment in all cases evidenced by elevated serum creatinine, low sodium level, poor urinary concentration and acidification, mild grade proteinuria. The study suggests a bilirubin toxic effect on the kidney and directs the attention to judicious use of nephrotoxic drugs, negative Na+ balance and base deficit in such risky group