Risk factors in early neonatal sepsis.

OBJECTIVE: To study the maternal and neonatal risk factors for neonatal sepsis. MATERIALS AND METHODS: This is prospective case control study, conducted on the neonates up to 7 days of life with a diagnosis of neonatal sepsis. There were 100 cases of neonatal sepsis and 100 control cases. The neonates in the case and control groups were evaluated for various maternal and neonatal risk factors. RESULTS: The factors which carried a significant risk for development of neonatal sepsis were premature rupture of membrane (PROM), meconium stained amniotic fluid (MSAF), foul smelling liquor, low birth weight, prematurity and low Apgar score at birth. The blood culture was positive in 22% of cases. The commonest organisms isolated were S. aureus and Klebsiella. The overall mortality was 11%. The incidence of risk factors was almost equal in culture positive and culture negative cases. CONCLUSION: The study identifies PROM, MSAF, foul smelling amniotic fluid, prematurity, low birth weight and low Apgar score at birth as strong risk factors for development of neonatal sepsis. In the presence of above factors, the neonate should be screened and observed for sepsis and considered for early institution of antibiotics.

Sirenomelia.

Sirenomelia is a rare congenital anomaly with incidence of 1.5-4.2 per 100,000 births. Vascular steal phenomenon, posterior axial mesodermal defect or teratogenic defects have been implied in its pathogenesis. The authors present two cases with associated upper limb involvement and vertebral defects and complete absence of one lower limb bones in one case. Autopsy revealed abnormalities in internal organs. Both cases were associated with single umbilical artery and severe oligohyramnios. Sirenomelia should be suspected in antenatal period in cases presenting with severe oligohydramnios and intrauterine growth retardation for a early diagnosis and appropriate management of pregnancy.

Serum TNF-alpha and free radical scavengers in neonatal septicemia.

Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.

Perception about AIDS among residents of a Calcutta slum.

A study was carried out in a slum area of South Calcutta to assess the impact of the current mass education programme against AIDS. Two hundred and six residents, mainly of lower middle class, aged 18-60 years of both sexes were selected at random. They were interviewed to know their perception and sources of information about AIDS. Two-third of them had their own TV and radio, which they watched/heard for about three and half hours each day. Another 28% watched TV outside for about one and half hours a day. About 46% were daily readers and 20% occasional readers of newspapers. Fifty nine percent knew about persons vulnerable to get AIDS, but most of them associated it to promiscuity only. Avoiding it was the main means known to them for preventing AIDS. The role of condom in it was known to only 2.5% residents. The source of their knowledge was mainly TV, either alone or with other mass media (67%). Such knowledge was related to higher education. To make perception about AIDS more effective, it is suggested that local health and voluntary agencies should involve the community in the AIDS education programme along with the back-up of mass media. An apex agency solely responsible for AIDS education should be set up for each big city to co-ordinate the activities of local agencies.

Fatal pulmonary infection caused by Mycobacterium smegmetis in an infant.

Mycobacterium smegmetis is a rapidly growing mycobacteria which is usually regarded as an environmental saorophyte. Recently it has been isolated from human beings mainly from skin and soft tissue lesions. Pulmonary lesions are extremely rare. A case of pulmonary consolidation caused by M. smegmetis in an infant is reported. The outcome was fatal. The organism was resistant to various antitubercular drugs. A brief review is presented.