Comparison between preterm and fullterm infants in neonatal sepsis

Kim, Sung Hee; Hur, Kum Hee; Kim, Hee Sup; Chey, Myoung Jae; Kim, Kil Hyoun; Lee, Hak Soo

Abstract

We retrospectively evaluated datas on 61 cases of neonatal sepsis confirmed by clinical symptoms and blood cultures at the NICU of Gil general hospital From Mar. 1989, to Fed. 1992. The results obtained were as follows: 1) The mean gestational age was 32.7+/-2.6 Weeks in preterm infants, and 39+/-1.5 weels on term infants. The mean birth weight was 1,701.4+/-422.4 g in preterm infants, and 3,232+/-581.7 g in term infants. 2) There were 61 infants with neonatal sepsis identified among 13, 486 live births, resulting in an incidence of 0.45%. The sex ratio of male to female was 1.2:1. The incidencdence was higher in preterm infants (2.21%) than in term infants (0.27%). 3) The most commom presenting symptoms of neonatal sepsis were apnea and bradycardia (53.6%) in preterm infants, jaundice (33.3%) in term infants 4) The concurrent diseases in neonatal sepsis were urinary tract infection (UT)(25%), pneumonia (21%), hyaline membrane disease (21%) in the order of frequency. Hyaline membrane disease (33.3%) was the most frequently associated disease in preterm infants, UTI (41.4%) in term infants 5) Gram positive organisms were isolated in 33 casess (52%), gram negative organisms in 30 cases (48%). The most common ortanism isolated from blood cultures was CONS (28.6%). The more common organisms in preterm infants were CONS (26.7%), Enterococcus (23.3%) and Klebsiella (10%). CONS (30.3%), E. Coli (27.3%) and Staphylococcus aureus (12%) were more frequent in term infants. 6) The significant diagnostic laboratory findings for neonatal sepsis were leukopenia ( < or =5000), I:T 0.16, thrombocytopenia ( <150,000/mm3), CRP> or =1+.2 or more of abnormal hematologic values were significantly more frequent in preterm infants (P< 0.05). 7) The risk factors associated with neonatal sepsis were endotracheal intubation (57%), birth ashyxia (Apgar score< or =6 at 5 min.)(39%) and umbilical catheterization (35.7%) in preterm infants, while endotrachial intubation (12.1%), birth ashyxia (12.1%) and premature rupture of membrane ( > or =24hrs)(9.0%) in term infants. 8) Early onset neonatal sepsis (72< or =hr of age) was found in 40 cases (65.6%). 9) The overall mortality rate of neonatal sepsis was 26.0%(39,3% in preterm infants, 15.2% in term infants). The mortality rate was significantly high in pseudomonas infection. 10) In low birth weight infants, the susceptibility to neonatal sepsis was greatest in the infants of lowest birth weight (1,00-1,500 gm) and the mortality rate was inversely proportional to birth weight. 11) Sensitivity to antibiotics in gram postitive organisms were chlorampjenicol (37%), Erythromycin (29%), ampicillin (26%) and cephalothin (26%). It clearly showed that newer antibiotics such as vancomycin is neccessary. In cases of gram negative organisms, sensitivity to antibiotics were amikacin (85%), gentamicin (65%), tobramycin (58%) and cephalothin (54%).