Fatores perinatais associados à sepse neonatal precoce em uma maternidade-escola do sul do Brasil / Perinatal factors associated with early neonatal sepsis in the maternity ward of a teaching hospital in southern brazil

Introdução: Sepse neonatal é uma condição potencialmente fatal, que constitui um problema de saúde pública de impacto global e é responsável por taxas expressivas de morbidade e mortalidade. O objetivo deste artigo é estimar os fatores associados à sepse neonatal precoce em uma maternidade-escola do sul do Brasil. Métodos: Realizou-se estudo de caso-controle para observar eventual associação entre fatores relacionados à sepse neonatal precoce e características clínicas e sociodemográficas maternas e fatores perinatais dos recém-nascidos, utilizando-se dados de prontuários de pacientes no período entre 2014 e 2017. A amostra foi composta por 293 binômios mãe/recém-nascido, sendo 1 caso para 2 controles. Todas as variáveis com valores de p< 0,05 na análise bivariada foram incluídas em uma análise multivariada por meio de Regressão Logística. Resultados: Idade gestacional menor que 37 semanas (OR 19,6 IC 95% 5,3; 73,0) (p<00,1) e presença de fator de risco para Streptococcus agalactiae beta hemolítico (SGB) (OR 5,1 IC 95% 1,2; 21,8) (p=0,027) foram as exposições independentemente associadas à sepse neonatal precoce. Conclusão: Identificou-se maior chance de desenvolver sepse neonatal precoce quando prematuridade e fatores de risco maternos para SGB estão presentes. Assim, medidas mais eficazes de prevenção e controle desses fatores são de extrema importância.

Introduction: Neonatal sepsis is a potentially fatal condition that constitutes a public health problem worldwide, being responsible for significant rates of morbidity and mortality. The objective of this study was to identify factors associated with early neonatal sepsis in the maternity ward of a teaching hospital in Southern Brazil. Methods: We conducted a case-control study to identify if factors related to early neonatal sepsis are associated with maternal clinical and sociodemographic characteristics and perinatal factors of infants, using data from patient records between 2014 and 2017. The sample consisted of 293 mother/newborn binomials, 1 case for 2 controls. All variables with p-values < 0.05 in the bivariate analysis were included in a multivariate analysis using logistic regression. Results: A gestational age < 37 weeks (odds ratio [OR] 19.6; 95%CI 5.3; 73.0) (p < 00.1) and the presence of a risk factor for beta-hemolytic Streptococcus agalactiae (GBS) (OR 5.1; 95%CI 1.2; 21.8) (p = 0.027) were independently associated with early neonatal sepsis. Conclusions: Prematurity and the presence of maternal risk factors for GBS increase the likelihood of developing early neonatal sepsis. Thus, more effective measures to prevent and control these factors are extremely important.

Sepsis de inicio precoz en el recién nacido pretérmino / Sepsis of early beginning in the preterm newborn

La sepsis es una enfermedad potencialmente mortal que puede afectar al neonato. En tal sentido, se expone la información necesaria para brindar una atención adecuada al recién nacido pretérmino con sepsis de inicio precoz: concepto, epidemiologia, patogenia, manifestaciones clínicas, diagnóstico, tratamiento y prevención. Asimismo, se abordan los factores que aumentan la posibilidad de infección en este recién nacido, las condiciones predisponentes en la madre y la corioamnionitis (clínica e histológica). Dicha infección puede prevenirse mediante un adecuado control prenatal y una correcta atención durante el parto, lo cual disminuirá la morbilidad y la mortalidad, así como tendrá gran impacto en la salud pública del país.

The sepsis is a potentially mortal disease that can affect the newborn. In such a sense, the necessary information is exposed to offer an appropriate care to the preterm newborn with sepsis of early beginning: concept, epidemiology, pathogenesis, clinical signs, diagnosis, treatment and prevention. Also, some factors that increase the infection possibility in this newborn, the predisposing conditions in the mother and the chorioamnionitis (clinical and histological) are approached. This infection can be prevented by means of an appropriate prenatal control and a correct care during the childbirth, which will diminish the morbidity and mortality, as well as will have great impact in the public health of the country.

A study of the prevalence of group B streptococci in the third trimester of pregnancy

Background: Group B Streptococci (GBS) is an important cause of early onset neonatal sepsis and the maternal colonization of this organism is a key factor in the occurrence of GBS associated morbidity and mortality in the newborns. Timely recognition of its presence in the genital tract of a pregnant women and intrapartum antibiotic prophylaxis can significantly bring down the burden of the disease in neonates. A cross sectional study was conducted on  antenatal women during 35-37weeks of gestation to evaluate the prevalence of Group B Streptococci in third trimester of pregnancy and explore the feasibility of including GBS screening in the routine antenatal investigation protocol.Methods: 200 antenatal women satisfying the exclusion/inclusion criteria were recruited for the study. Vaginal and perianal swabs were collected using sterile swab sticks and inoculated using the specified media. Beta hemolysis and typical colonies were looked for under microscope. Positive cases were subjected to intrapartum antibiotic prophylaxis and the neonates were observed for 72 hours to look for any signs of sepsis.Results: It was found that 2% of the women screened were positive for GBS .While none of the newborns of the 4 positive cases showed any signs of sepsis.Conclusions: Prophylactic intrapartum prophylaxis against GBS has shown to decrease the chances of neonatal sepsis but more detailed and robust studies are required before incorporating routine screening in our antenatal care system.

Sepsis neonatal temprana y ruptura prematura de membranas como factor de riesgo en las UCI neonatales / Early neonatal sepsis and premature rupture of membranes as a risk factor in neonatal ICUs

Propósito: conocer el perfil sociodemográfico de madres con factores de riesgo que acuden al Hospital Carlos Andrade Marín, con hijos ingresados al área de neonatología por sepsis neonatal temprana, durante el periodo de enero 2013 a diciembre 2014, a fin de establecer la asociación de factores de riesgo maternos con sepsis neonatal temprana. Diseño: estudio observacional, documental. Resultados: la edad promedio fue 29 años, solteras y empleadas privadas; respecto a los factores de riesgo asociados a sepsis neonatal temprana, la ruptura prematura de membranas fue el único factor asociado con una probabilidad 3,3 veces superior de desarrollar sepsis comparado con madres sin ruptura prematura de membrana. No se estableció asociación estadística de sepsis neonatal temprana con corioamnionitis no se estableció asociación con sepsis neonatal temprana, sin embargo que todos los recién nacidos presentaron sepsis neonatal temprana si se presentó concomitantemente corioamnionitis. Con infección de vías urinarias o vaginosis no hubo asociación. Conclusión: existe asociación estadística entre sepsis neonatal temprana y ruptura prematura de membranas, observándose un 33,5% de incremento riesgo (p<0.01). La infección de vías urinarias y la vaginosis bacteriana, asociadas a ruptura prematura de membranas son considerados como factores de riesgo, pero al ser analizadas independientemente, son factores de riesgo de prematurez y no de sepsis neonatal temprana. Hijos de madres con corioamnionitis fueron catalogados potencialmente sépticos y recibieron tratamiento profiláctico, sin demostrarse asociación estadística. (AU)

Purpose: to know the social-demographic profile of mothers with risk factors attending Hospital Carlos Andrade Marín who have children admitted at neonatology with early neonatal sepsis in the period from January 2013 to December 2014; and establish the relation of such risk factors to early neonatal sepsis. Design: observational and retrospective study. Results: the social-demographic profile of the mothers under study shows an average age of 29 years old, private employees, single. From the risk factors associated to early neonatal sepsis, the premature membrane rupture is the only related factor with an OR 3.3 times higher of having children from mothers with this factor. Although chorioamnionitis established no relation to early neonatal, it did appear as a neonatal sepsis risk factor, since all the newborn presented early neonatal sepsis. There was no relation to urinary tract infection and bacterial vaginosis. Conclusions: statistically significant relation to early neonatal sepsis was found with premature membrane rupture, which shows an absolute increase of the risk of 33.5% (p<0.01). When urinary tract infection and bacterial vaginosis vas are associated to premature membrane rupture these are considered risk factors. Although they are not the cause of early neonatal sepsis in themselves, the premature element is considered a risk factor. Newborn from mothers with chorioamnionitis were catalogued as potentially septic and received early treatment, although the association was not established. Keywords: early neonatal sepsis, maternal risk factor, early membrane rupture, chorioamnionitis, urinary tract infection, bacterial vaginosis.

Etiología y patrones de resistencia antimicrobiana en sepsis neonatal temprana y tardía, en una Unidad de Terapia Intensiva Neonatal / Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit

Introducción. La sepsis neonatal es una de las principales causas de muerte en recién nacidos. El tratamiento antimicrobiano empírico se sustenta en información epidemiológica y pruebas de susceptibilidad antimicrobiana. El objetivo del estudio fue describir los agentes etiológicos y su sensibilidad antimicrobiana enreciénnacidos con sepsis temprana (SNTe) o tardía (SNTa) de una Unidad de Terapia Intensiva Neonatal. Métodos. Estudio transversal realizado en un hospital de concentración del occidente de México. Se determinó la resistencia antimicrobiana de los gérmenes aislados en sangre o líquido cefalorraquídeo de pacientes con SNTe o SNTa nosocomial. Resultados. Se aislaron bacterias o levaduras en 235 cultivos de 67 eventos de SNTe y 166 eventos de SNTa. Del total de aislamientos, las bacterias más frecuentes fueron enterobacterias (51,5%), seguidas de Streptococcus spp. en SNTe y Staphylococcus spp. en SNTa. En cuanto a las enterobacterias de adquisición nosocomial, el 40% fueron productoras de betalactamasas de espectro extendido. En especies de Staphylococcus, la resistencia a oxacilina se registró en el 65,5%. En las enterobacterias (n: 121), la frecuencia de resistencia a amikacina, piperacilina-tazobactam y meropenem fue menor del 3%. En bacterias no fermentadoras, no se observó resistencia a amikacina, ciprofloxacino y cefepime; sin embargo, el número de aislamientos fue escaso. Conclusiones. Las bacterias identificadas con mayor frecuencia en SNTe fueron enterobacterias (67,6%) y Streptococcus spp. (17,6%), mientras que, en SNTa, fueron enterobacterias (44,9%) y Staphylococcus spp. (34,7%). El 40% de las enterobacterias de adquisición nosocomial fueron productoras de betalactamasas de espectro extendido y el 65,5% de Staphylococcus spp. mostraron resistencia a oxacilina.

Introduction. Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. Methods. Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. Results. Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. Conclusions.The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.

Colonización vaginal/rectal por Streptococcus agalactiae en gestantes de Melena del Sur, Cuba / Vaginal and rectal Streptococcus agalactiae colonization in pregnant women from Melena del Sur municipality in Cuba

Introducción: en Cuba se desconoce el peso de la colonización vaginal o rectal por Streptococcus agalactiae o estreptococo ß-hemolítico grupo B (SGB) como factor de riesgo para el desarrollo de sepsis neonatal precoz. Objetivo: determinar la prevalencia de colonización vaginal/rectal por SGB entre la población de gestantes del municipio Melena del Sur, Mayabeque. Métodos: se realizó un estudio observacional de corte transversal entre febrero-agosto 2011, en el que se incluyeron 120 gestantes (35-37 semanas). Se obtuvieron muestras vaginales y rectales que se cultivaron en caldo Todd Hewitt y medio Granada y se calculó la sensibilidad y especificidad de ambos medios de cultivo para la recuperación de SGB. Se hizo seguimiento de las embarazadas hasta el momento del parto para conocer acerca de la aparición de factores de riesgo para el desarrollo de sepsis neonatal, sobre la imposición de profilaxis antibiótica intraparto y si se produjeron casos de sepsis neonatal (tipo y evolución). Resultados: la especificidad lograda con el medio Granada para el aislamiento de SGB fue superior (94,57 %) pero la sensibilidad fue de solo 60,71 %; la combinación de su empleo y el caldo Todd Hewitt permitió la demostración de colonización por SGB en el 27,5 % de las gestantes. Se constató la administración de tratamiento profiláctico a las embarazas colonizadas en las que se presentaron factores de riesgo en el momento del parto y se produjeron solo cuatro casos de sepsis neonatales, lo que realza el valor de esta estrategia en la intercepción de la transmisión vertical.

Introduction: the impact of vaginal or rectal colonization by Streptococcus agalactiae or group B hemolytic streptococcus as risk factor for the development of early neonatal sepsis is still unknown in Cuba. Objective: to determine the prevalence of group B hemolytic streptococcus colonization of the vagina and the rectum among the pregnant women of the Melena del Sur municipality in Mayabeque province, Cuba. Methods: observational and cross-sectional study conducted from February to August 2011, which covered 120 pregnant women (35 to 37 weeks of gestation). Vaginal and rectal samples were taken to be cultured in ToodHewitt broth and grenade medium and the sensitivity and specificity of both culturing media were then calculated for recovery of Group B hemolytic streptococcus. The pregnant women were followed-up up to the delivery time so as to learn about the occurrence of risk factors for developing neonatal sepsis, the application of antibiotic prophylaxis intrapartum and the occurrence of cases of neonatal sepsis (type and progress). Results: the specificity of the grenade medium for Group B streptococcus was higher (94.57 %), but sensitivity was just 60.71 %. The combination of grenade medium plus Todd Hewitt broth allowed showing the Group B hemolytic streptococcus colonization in 27.5 % of pregnant women. It was then confirmed that prophylactic treatment was given to colonized pregnant women who presented with risk factors at the time of delivery and that there were just four neonatal sepsis cases, which stressed the value of this strategy in halting the vertical transmission.

Factores determinantes de sepsis neonatal temprana en el Hospital Nacional Dos de Mayo, enero-diciembre 2012 / Determinants factors of early neonatal sepsis at the National Hospital Dos de Mayo, January-December 2012

Determinar los factores determinantes de sepsis neonatal temprana en el Hospital Nacional Dos de Mayo, Enero-Diciembre 2012. Material y Métodos: Estudio analítico, retrospectivo de corte transversal tipo caso control. Revisando las historias clínicas de madres y recién nacidos que presentaron sepsis neonatal temprana en el Hospital Nacional Dos de Mayo de Enero a Diciembre 2012. Resultados: El 50 por ciento de casos y 47.8 por ciento de controles fueron de sexo femenino. El 20 por ciento de casos tuvieron edad gestacional menor a 37 semanas y el 5 por ciento más de 41 semanas. Se evaluó los siguientes factores de riesgo de sepsis neonatal temprana: sexo, edad gestacional, sufrimiento fetal agudo, ruptura prematura de membrana, presencia de corioamnionitis, infección del tracto urinario materna, vulvovaginitis, preeclampsia severa, oligohidramnios, líquido amniótico meconial, tipo de parto, tacto vaginal, bajo peso al nacer, depresión neonatal, fiebre materna y control prenatal insuficiente. Conclusiones: Los hallazgos del presente estudio demuestra que la sepsis neonatal temprana está determinada por factores de riesgo, en este trabajo el factor de mayor frecuencia fue los controles prenatales insuficientes (OR=4.42), seguida por la presencia de líquido amniótico meconial (OR=3.67), infección del tracto urinario de la madre (OR=3.61) y tacto vaginal (OR=3.39); el control prenatal adecuado permite la prevención precoz y tratamiento de la sepsis neonatal temprana, con el consiguiente beneficio para el paciente...

To determine the determinants factors of early neonatal sepsis in the National Hospital Dos de Mayo, January-December 2012. Materials and Methods: An analytical, retrospective, transverse study of type case-control. Reviewing the medical record of mothers and newborns who presented early neonatal sepsis in the Hospital Nacional Dos de Mayo from January to December 2012. Results: 50 per cent and 47.8 per cent were of feminine sex in the cases and controls respectively. In the group of cases 20 per cent they had a gestational age smaller to 37 weeks and 5 per cent had more than 41 weeks of gestational age. One evaluated the following factors of risk of early neonatal sepsis: sex, gestational age, acute fetal suffering, premature rupture of membrane, presence of chorioamnionitis, maternal infection of the urinary tract vulvovaginitis, severe preeclampsia, oligohydramnios, meconium amniotic liquid, type of delivery, vaginal tacts, weight when being born, neonatal depression, maternal fever and insufficient prenatal control. Conclusions: the findings of this study shows that early neonatal sepsis is determined by risk factors, in this work the factor most frequently was insufficient prenatal controls (OR=4.42), the continuous meconium amniotic liquid (OR=3.67), maternal infection of the urinary tract (OR=3.61) and vaginal tacts (OR=3.39); adequate prenatal control allows for early prevention and early treatment of neonatal sepsis, with consequent benefit to the patient...

Profilaxis de sepsis neonatal por Streptococcus Agalactiae (grupo B) basada en vacunas: revisión de la literatura / Prophylaxis of early neonatal sepsis Streptococcus Agalactiae (group B) based on vaccines: literature review

El Streptococcus agalactiae o grupo B (SGB), es el principal agente de sepsis neonatal precoz. A pesar de los intentos de prevención de esta infección, aún no se logra la efectividad esperada. Es por esto que se ha intentado desarrollar una vacuna que pueda prevenir la mayoría de las patologías que esta bacteria produce, incluyendo la sepsis neonatal precoz y tardía. De esta manera se evitarían las limitaciones actuales de la profilaxis antibiótica. Los intentos de crear una vacuna han incluido la utilización de polisacáridos del SGB tanto puros como asociados a proteínas como el toxoide tetánico. También, se han usado proteínas específicas de la cápsula que tienen potencial efectividad como factores inmunogénicos. Las vacunas conjugadas son las más estudiadas en la actualidad, habiendo completado estudios clínicos en fase II, tanto en adultos sanos como en embarazadas. Al ser la sepsis neonatal una complicación grave aún no controlada óptimamente, la creación de una vacuna contra este patógeno sería de gran impacto en salud pública. Se presentan los diferentes tipos de vacunas desarrolladas y el estado de avance en el que se encuentran.

Streptococcus agalactiae or group B, is the mayor causing agent of early onset neonatal sepsis. Although mayor prevention strategies have been made, the expected effectiveness hasn't been achieved. That's why efforts have been made to develop a vaccine that can prevent most of the diseases these bacteria can produce, including early and late onset neonatal sepsis. These way, actual antibiotic prophylaxis limitations can be avoided. Attempts include the utilization of Streptococcus group B polysaccharides in their pure state or combined with proteins as tetanic toxoid. Specific capsule proteins have been used also because of their potential effectiveness as inmunogenic factors. Overall vaccines conjugated ones are the most studied, having completed phase II clinical trials in healthy adults and pregnant women. Neonatal sepsis is a severe complication that has not been controlled yet, so the creation of a vaccine against this pathogen would be of great impact in public health. We introduce now the different developed vaccines and their state of progress.

Factores de riesgo asociados a sepsis neonatal / Risk factors associated to neonatal sepsis

Objetivos: identificar los factores de riesgo y el grado de asociación de los mismos con la sepsis neonatal precoz y tardía. Métodos: se realizó un estudio analítico observacional de casos y controles en el Servicio de Neonatología del Hospital de la Mujer, La Paz Bolivia, de 322 recién nacidos (historias clínicas), 108 casos y 214 controles. Resultados: se analizaron 322 historias clínicas y los factores que tuvieron significancia como riesgo para sepsis neonatal precoz fueron: edad gestacional pretérmino (OR 5.47, IC 95% 2.14-14.83), el bajo peso al nacer (OR 3.09, IC 95% 1.55-6.16), la ruptura prematura de membranas (OR 3.87, IC 95% 2.06-7.32), la infección de vías urinarias (OR 3.21, IC 95% 1.49-6.89) y la corioamnionitis (OR 4.69, IC 95% 1.0521.63). La hipertensión arterial (OR 114.44, IC 95% 37.90-366), la utilización de vía central (OR 5.41, IC 95% 2.57-11.4) y ventilación mecánica (OR 3.26, IC 95% 1.6-6.66) como procedimientos invasivos fueron factores de riesgo significantes para sepsis neo natal tardía. Los factores de riesgo para el fallecimiento de los niños fueron: ser recién nacido pretermino (OR 3.3, IC 95% 1.6-6.87), tener bajo peso al nacer (OR 13.07, IC 95% 6.84-25.13), que la madre haya presentado infección de vías urinarias (OR 2.08, IC 95% 1.03-4.15) y la utilización de vía central (OR 8.46, IC 95% 4.43-16.26) y ventilación mecánica (OR 17.94 IC 95% 9.17-35.45) en los neonatos. Conclusiones: los hallazgos del presente estudio demuestran que la sepsis es una causa de mortalidad neonatal y que la presencia de esta patología ya sea de tipo precoz o tardía, esta determinada por varios factores, los cuales, al estar presentes en la madre o el niño se convierten en factores de riesgo que puedes ser tratados o prevenidos una vez que son diagnosticados.

Objectives: Identifying risk factors and to what degree are these associated to early and delayed neo natal sepsis. Method: An analytical study was carried out observing cases and their follow-up at the Neonatology Department of the Women's Hospital in La Paz, Bolivia. The study included 322 newborn clinical histories, 108 cases and 214 follow-ups. Results: 322 clinical histories were revised. Risk factors that were significant for neo natal sepsis, either early of delayed were: premature birth (OR 5.47, IC 95% 2.14-14.83), low birth weight (OR 3.09, IC 95% 1.55-6.16), premature membrane rupture (OR3.87, IC 95% 2.06-7.32), urinary tract infection (OR 3.21, IC 95% 1.49-6.89) and "chorioarnnionitis" (OR 4.69, IC 95% 1.05,-21.63). Significant risk factors for delayed neonatal sepsis were invasive procedures such as high blood pressure (OR 114.44, IC 95% 37.90-366), use of main pathway (OR 5.41, IC 95% 2.57-11.4) and mechanical ventilation (OR 3.26, IC 95% 1.6-6.66). Risk factors for newborn deaths were: premature births, (OR 3.3, IC 95% 1.6-6.87), low birth weight (OR 13.07, IC 95% 6.84-25.13), urinary tract infection in the mother (OR 2.08, IC 95% 1.03-4.15) use of main pathway (OR 8.46, IC 95% 4.43-16.26) and mechanical ventilation (OR 17.94, IC 95% 9.17-35.45) Conclusions: findings in this study show that sepsis causes neonatal death be it early or delayed and that it is caused by several factors which may originate either in the mother or the baby which turn into risk factors that may be treated or prevented once they are diagnosed.