Neonatal sepsis and mortality in a regional hospital in Trinidad: aetiology and risk factors

A total of 132 neonatal deaths among 627 infants admitted to the neonatal ward of the San Fernando General Hospital, Trinidad over a 2-year period were reviewed. The most common cause of death was prematurity (43.9%). Infection was the second most common cause (21.2%). Pseudomonas aeruginosa and Staphylococcus aureus were the most frequently isolated organisms (43%). The major drugs used empirically in suspected cases of sepsis were ampicillin or ceftazidime plus gentamicin. About 85% of S. aureus were resistant to ampicillin, and P. aeruginosa resistance to ceftazidime and gentamicin was 76.7% and 72.1%, respectively. Significant risk factors in maternal history were infrequent antenatal care and prolonged rupture of membranes. The incidence of infection among low birthweight infants was 85.6%. Early-onset sepsis (86.4%) seemed to have a nosocomial origin because of the type of pathogens seen. There is an urgent need to improve the staff-to-patient ratio in the neonatal unit and for staff to be constantly reminded to employ simple infection control practices such as proper hand-washing to reduce cross-infections.

Perinatal and neonatal care at the Port-of-Spain General Hospital, Trinidad: an analysis of mortality - abstract

In this retrospective study the following information was recorded for all 1,296 infants born in 1990 and admitted to the neonatal ward, General Hospital, Port-of-Spain: date of birth, gestational age, birthweight, Apgar scores after one and five minutes, type of delivery, foetal presentation, mother's address and data concerning death. The annual perinatal mortality rate was 25.2 per 1,000 live births. The neonatal mortality rate (NMR) equaled 12.8 per 1,000 live births and the still birth rate was 15.0 per 1,000 births. The NMR for the month of August was remarkably high. During the past ten years, the NMR showed a sharp decline since 1982. From a regression analysis, birthweight (R2 = .27), Apgar score after five minutes (R2 = .26) and gestational age (R2 = .22) emerged as predictors of neonatal mortality. Birthweight-specific NMRs in infants born in a regional hospital were equal to or higher than our monthly, yearly and interhospital variations in mortality rates, although the effects of differences in the study populations cannot be completely excluded (AU)

Current problems of neonatal septicaemia in Barbados - abstract

Neonatal septicaemia is a common cause of mortality and morbidity in the neonatal period, contributing factors being rapidly changing causative organisms and increasing resistance of gram-negative organisms. In this study, current problems of neonatal sepsis at the Queen Elizabeth Hospital were analysed in 227 infants suspected of having sepsis and who were admitted to a neonatal special care unit, during a two year period. There were 134 (59 percent) males and 93 (41 percent) females, a ratio of 1.4:1. Most patients (131 or 61 percent) presented at less than 24 hours of age, the most related obstetric factor being spontaneous vaginal delivery in 162 patients (71 percent). One hundred and twenty-one (50 percent) were low birth weight and 53 percent mothers had ruptured membranes for less than 12 hours. There were 24 deaths, 12 (50 percent) occurring during a Klebsiella epidemic. The mean hospital stay per patient was 12 days. One hundred and sixty-one bacterial isolates were recovered - 47 (29 percent) gram-positive and 114 (71 percent) gram-negative. Staph. albus, Staph. aureus, Klebsiella and E. coli were the most frequent isolates. Bacteriological sensitivity analysis revealed gram-negatives as highly sensitive to gentamycin and tobramycin and gram-positives as highly sensitive to cloxacillin. Proven sepsis was predominantly gram-negative. We recommend practising routine surveillance, aggressive investigation and no change in antibiotic policy at this time.

Neonatal intensive care at the Leila Wynter intensive care unit over the past 5 3/4 years - abstract

Since February, 1974, 207 neonates have been admitted to the Bustamante Hospital for Children accounting for a third of the total admissions. 40 percent of these neonates were referred from country hospitals throughout the island. Two-thirds of the admissions had medical conditions, respiratory distress being the prime reason for referral. Idiopathic respiratory distress syndrome, neonatal tetanus, and whooping cough accounted for most of the medical admissions, whilst congenital anomalies of the gastro-intestinal tract accounted for most of surgical admissions. Eleven cases of necrotising enterocolitis have been seen. Neonatal deaths accounted for 45 percent of the total deaths. 63 percent of the neonates who died had medical conditions and 37 percent had surgical conditions. 58.9 percent of the neonatal deaths occurred within the first 24 hours. Aspiration pneumonia as the primary cause of death has been shown in neonates dying within 24 hours, and the average birth weight of these infants was 2 kgms. Trachio-oesophageal fistulae accounted for most of the surgical deaths, and the majority of these cases were seen between October and January. A success rate of 54 percent reflects some improvement in neonatal care in this hospital since 1974, factors hindering this improvement are mainly centred around lack of nursing staff, equipment maintenance and supplies. Of the 112 surviving neonates, only one has been referred for assessment of his mental status (AU)