Prevalence and risk factors of Streptococcus agalactiae (group B) colonization in mothers and neonatal contamination at Srinagarind Hospital.

From July 1999 to November 1999, 901 pregnant women at Srinagarind Hospital, who fulfilled the criteria and had signed consent forms, were cultured from the lower vagina and perineum for group B streptococcus (GBS). Their neonates were also cultured from ears and anuses within 30 minutes after birth. There were 56 cases or 6.22 per cent colonization in pregnant mothers at the onset of labor and 14 cases or 1.55 per cent colonization in their neonates. Risk factors for GBS colonization in mothers were intrapartum fever and episiotomy. The risk factors for GBS colonization in the neonates were; 1. husband's occupation, 2. antepartum fever, 3. intrapartum fever, 4. postpartum morbidity and 5. gestational age. No cases during the study period had clinical infection from GBS. The prevalence rate in this study was much lower than the United States but similar to many developing countries. At this moment, it is not possible to culture for GBS in all pregnant women in Thailand. Intrapartum antibiotic prophylaxis for GBS infection was recommended if, 1. maternal fever was more than 38 degrees C, 2. ruptured membranes of more than 18 hours and 3. previous birth with neonatal GBS infection.

Prediction of idiopathic respiratory distress syndrome by the stable microbubble test on gastric aspirate.

We evaluated the usefulness and accuracy of the stable microbubble test (SMT) performed on gastric aspirates of neonates to predict idiopathic respiratory distress syndrome (IRDS) and compared the results with those of the shake test, using the clinical characteristics of IRDS as the gold standard for the diagnosis of IRDS. One hundred forty paired samples of gastric aspirates, obtained within 1 hour of delivery from neonates with gestational ages between 27 and 42 weeks (mean, 36.6+/-3.5 weeks) and birth weights between 800 and 4,090 grams (mean 2,571+/-826 grams ) were evaluated. The sensitivity and specificity of the SMT with a predefined cut-off value of less than 20 bubbles/mm2 were 94.7% and 95%, respectively, with a positive and negative predictive value of 75% and 99.1%, respectively. The positive predictive value and specificity were increased to 100% in premature neonates. These values, especially the positive predictive value and specificity, were much higher than those obtained with the shake test. We conclude that the SMT on gastric aspirates obtained within 1 hour of delivery is a rapid and simple procedure to identify those neonates who will develop IRDS and who may benefit from prophylactic exogenous surfactant replacement.

Risk factors for neonatal Klebsiella septicemia in Srinagarind Hospital.

Three years' data were analysed to assess the risk factors for neonatal Klebsiella septicemia in Srinagarind Hospital. The incidence of Klebsiella septicemia was 4.1 per 1,000 livebirths or 5.2 per 100 discharged infants. Eighty-two per cent of infected cases were low birth weight infants and 67.7% were born prematurely. From multivariate analysis, the risk factors were endotracheal intubation (OR 31.57, 95% CI 289-343.82) and central venous catheterization (OR 16.99, 95% CI1.15-250.37). The overall mortality rate was 67.7%. Periodic review and continuous reinforcement of infection control policies in the neonatal unit are of paramount importance to decrease the incidence of nosocomial infection and successful control of outbreaks as well.

Comparison of immunogenicity of hepatitis B vaccine between low and normal birth weight infants.

A comparative study was conducted to evaluate the immunogenicity of hepatitis B vaccine in low and normal birth weight infants. Hepatitis B vaccine (Hevac B Pasteur) was given to 50 low birth weight infants and 50 controls, matched by sex and date of delivery. The vaccine was given at birth, 1, 2 and 12 months of age. HBsAg and anti-HBs were assessed at birth, 4, 9 and 13 months of age by the micro-ELISA technique. Using the geometric mean titre of anti-HBs and the seroconversion rate as indicators, the immunogenicity of hepatitis B vaccine in low birth weight infants was as good as in normal birth weight infants.

Perinatal mortality at Srinagarind Hospital.

PIP: Researchers included all 8647 infants born at Srinagarind hospital in Khon Kaen, Thailand between 1983-1985 in their study to determine the perinatal mortality rate and evaluate the status of neonatal health and perinatal management. 82 of the infants died at birth, mainly due to asphyxia, anencephaly, and hydrops fetalis. After subtracting neonates who had a congenital anomaly which could not sustain life, e.g., anencephaly, the 1983--1985 perinatal mortality rates for those weighing = or 1000g decreased insignificantly from 14.02 and 14.41 to 10.64/1000 births respectively (p=.321). Using the same criteria, the 1983-1985 early neonatal mortality rates for these infants did not change significantly (7.84, 6.38, and 8.49 respectively; p=.8995). The number of infants who died in the delivery room increased from 4 in 1983 and 1984 to 14 in 1985. 77.3% of these infants weighed 2500g. The major cause of death in the delivery room was perinatal asphyxia. The 14 deaths in 1985 accounted for almost half of all early neonatal deaths. The total early neonatal death rate for all 3 years stood at .87%. The overall early neonatal death rates ranged from .23% for infants 2500g to 76.9% for those 1000g. The major cause of early neonatal death for almost all infants was congenital anomalies (30.7%) with 39.2% of them being anencephaly. Idiopathic respiratory distress syndrome led the causes of death for neonates 1500g, except for those 1000 g which was prematurity. 87 infants died within 28 days after delivery: 75 within 7 days and 46 of these died within 24 hours. The perinatal mortality rate for Srinagarind hospital stood higher than that of other medical school hospitals in Thailand. The main objective of Srinagarind is to reduce the incidence of low birth weight thereby decreasing the infant mortality rate.^ieng