Mother-infant colonization and neonatal sepsis in prelabor rupture of membranes

This study aims to determine the incidence of prelabor rupture of membranes [PROM] in a tertiary care institution, the bacterial pathogens involved in maternal and neonatal colonization, and the major bacterial pathogens of neonatal sepsis in PROM. This prospective study was conducted over 2 years from March 1999 to February 2001 in Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia. Consecutive admissions of infant-and-mother pairs with PROM constitute the subjects of this survey. Every mother had endocervical swab taken before delivery, and their infants had surface swabs and sepsis screening before starting antibiotic therapy. The incidence of PROM was 12.6 per 1000 live births. Premature delivery rate was 54.6% while, the overall prematurity rate was 7.2%. The major microorganisms involved in genital colonization of the mothers were coagulase negative Staphylococcus [CONS] [24%], Klebsiella pneumoniae [13%], Pseudomonas aeruginosa [11.3%] and Enterococcus species [11.3%]. The infants were colonized largely with CONS [31%], Klebsiella pneumoniae [18%] and Escherichia coli [E.coli] [17%]. Fourteen% of the infants were infected but in only 6% was septicemia documented [Staphylococcus aureus, 3 cases and 1 case each with CONS, group B Streptococci [GBS] and E.coli]. In contrast to Western experience, the incidence of GBS was uncommon in both mothers and infants. The bacterial pattern suggests vancomycin and cefotaxime or aminoglycoside combination as empirical antibiotic therapy for both infected infants and selected contaminated mothers with PROM. Generally, it appears wasteful to routinely admit, screen and empirically treat all infants born after PROM; only ill infants, febrile mothers, or either, with associated chorioamnionitis deserve antibiotic treatment

Neonatal septicemia

To determine the prevalent bacterial agents of neonatal septicemia and their antimicrobial susceptibility in Abha Maternity Hospital, Saudi Arabia, during the years 1996-98. Any newbom with a positive blood culture during the period was prospectively studied. All isolates were tested for antimicrobial susceptibility. There was a total of 1033 nursery admissions, of which 106 episodes of septicemia occurred amongst 97 neonates. The incidence of neonatal septicemia in the hospital was 8.6/1000 live births. The main pathogens were: Klebsiella pneumoniae [61%], Escherichia coli [10%] and Staphylococcus aureus [9%]. Group B Streptococcus was isolated in only 4 infants [4%]. Thirty percent of the positive growths were obtained under 24 hours, and 37% within 48 hours of birth, indicating intrauterine and intrapartum origin; 63% of the sepsis occurred beyond 48 hours of hospitalization thus suggesting nosocomial acquisition. This study thus identifies Klebsiella pneumoniae as the leading bacterial agent of neonatal sepsis in our environment in contrast with Western countries where Group B Streptococcus is predominant. Based on in vitro susceptibility test results, a combination of gentamicin and cefotaxime is recommended: and no more conventional use of ampicillin, for empirical treatment of neonatal sepsis in our hospital. Control measures for limiting nosocomial infection are suggested

Congenital hydrocephalus due to aqueductal stenosis of probable autosomal recessive inheritance

Hereditary stenosis of the aqueduct of Sylvius is known to be transmitted as an X-linked recessive trait, thus affecting only the male offspring. We describe a family of consanguineous marriage where 2 sons and 2 daughters were afflicted with congenital hydrocephalus associated with stenosis of aqueduct of Sylvius. The pattern of the disease in this family is consistent with autosomal recessive inheritance. The authors of this communication are not aware of any literature reporting a similar mode of inheritance regarding this condition. Perhaps this discordant genetic mode of inheritance could have been caused by the consanguinity between the parents

Morbidity- mortality due to exchange blood transfusion: Comparing

A retrospective study of 164 jaundiced but otherwise healthy term newborn infants who received exchange transfusions [EBT] in Assir Central Hospital, Abha, Saudi Arabia, during the period January 1989 through December 1993, has demonstrated that morbidity and mortality rates were low with the usage of peripheral vessels [PV] but comparatively high with the umbilical artery [UA] and highest with the umbilical veinous [UV] route. Transient and benign blanching of the corresponding limbs used for the EBT was the main observation involving infants with PV catheter but bacteraemia/septicaemia, necrotising enterocolitis and portal hypertension were significantly related to the umbilical route [UV> UA]. No infant in which the PV were utilised died whereas the mortality rate associated with the UA and UV routes was about 9% each. It is concluded that while the cannulation of P V may be difficult and therefore not yet popular with paediatricians, it is the safest compared with umbilical artery and umbilical vein routes