Early onset neonatal sepsis, rule out viral infection

ABSTRACT

This cross-sectional prospective study was an attempt to define the frequency of viral infections in early onset neonatal sepsis. It was conducted on 260 septic neonates with different diagnoses who had been admitted to Neonatal Intensive Care Unit, affiliated to Obstetric and Gynecology Department, Ain Shams University Hospitals throughout one year from November 2001 to October 2002. Their mean gestational age was 35.9 +/- 3.7 weeks, their mean birth weight was 2.4 +/- 1.08 kg and their mean postnatal age was 12.35 +/- 10.34 days. They included 148 males and 112 females. The results of this study revealed that 49 out of 260 septic neonates [19%] were diagnosed as virus infected using different cell cultures. Seven viruses were identified by indirect fluorescent antibody tests [IFA] which were in order of frequency; cytomegalovirus [5%], respiratory syncytial virus [3.4%], Echo-11 [3.1%], Echo-14 [2.7%], Coxsackie B5 [2.7%], mumps [1.2%] and parainfluenza type 3 [0.8%]. Most of virus infected cases presented with low Apgar score, low or very low birth weight, prematurity, jaundice, peticheal rash, in addition to signs of sepsis. Meanwhile, respiratory viruses [respiratory syncytial virus, parainfluenza virus] were the major pathogens among respiratory distressed infants, enteroviruses, cytomegalovirus and mumps were implicated in neonates with multiple congenital malformations. Cytomegalovirus was the most prevalent single virus isolated. Thirteen cases out of 260 septic neonates proved to be CMV positive. 77% were congenitally acquired, while 23% were postnatally acquired. These neonates presented with various clinical presentations, the most common were prematurity [85%], very low birth weight [62%], jaundice [54%] and hepatosplenomegaly [46%], meanwhile congenital malformations were recorded in 23% of cases [microcephaly, congenital hernia and congenital cataract]. Mortality rate was 46%. It is concluded from this study that viral infection is significantly implicated in the etiopathogenesis of neonatal sepsis. So, this study should raise the awareness of the neonatologists for the diagnosis and anticipation of the potential implications of virus infection on the subsequent growth and development of the newborn infants.