Bacterial sepsis in neonates: Single centre study in a Neonatal intensive care unit in Bosnia and Herzegovina.

OBJECTIVE: The aim of the study was to evaluate the incidence, mortality, risk factors, aetiology and the susceptibility to antibiotics of the bacteria responsible for sepsis. MATERIAL AND METHODS: A single centre, prospective, observational study, involving 200 neonates admitted over 12 months to the NICU of the University Children's Hospital, Tuzla, Bosnia and Herzegovina. RESULTS: The crude incidence of all neonatal sepsis was 68.0% (136/200) and that of late-onset sepsis (LOS) was 48.5% (97/200), yelding an incidence density of LOS of 41.6/1000 patient days. LOS represented the most frequent infection and was significantly more frequent than early-onset sepsis (EOS) (71.3% versus 28.7% p<0.001). The overall mortality was 14.0%, and 18.4% among infected neonates. Risk factors associated with LOS were: mechanical ventilation, intravascular catheter, surgical procedures, birth weight ≤1500 g, gestational age ≤ 28 weeks and Apgar score ≤ 3 at 5 minutes. Culture proven sepsis developed in 43.4% of neonates. Klebsiella pneumoniae and Enterococcus faecalis were the predominant bacteria. Gram-negative bacteria were susceptible to amikacin, imipenem and meropenem; gram-positive bacteria to vancomycin and amikacin. CONCLUSION: Neonatal sepsis in our NICU showed a high incidence rate, and gram-negative bacteria were predominant. Low gestational age, mechanical ventilation and an intra-vascular catheter were significantly associated with sepsis. It is necessary to develop a multidisciplinary approach for routine surveillance of nosocomial infections, to improve the asepsis of therapeutic procedures, and to implement the more appropriate use of antibiotics.

Neonatal bacterial meningitis: Results from a cross-sectional hospital based study.

OBJECTIVE: The aim of the study was to determine the epidemiological characteristics of bacterial meningitis observed in neonates born in the Department of Gynaecology and Obstetrics, University Clinical Centre Tuzla, Bosnia and Herzegovina, admitted to Intensive care unit (NICU) or readmitted, because of suspected infection, after discharge from the nursery. SUBJECTS AND METHODS: This study was carried out from July 1, 2012 to June 30, 2013. During this period 4136 neonates were born. All neonates admitted to the Intensive care unit with signs and symptoms of systemic infections, and neonates readmitted to the Intensive care unit, after discharge from the nursery for sepsis work up were included in the study. RESULTS: Eighteen of 200 neonates (9%) admitted or readmitted to the NICU developed meningitis. 61% cases were late onset meningitis. The overall incidence was 4.4/1000 live births. The mortality rate was 11.1%. The mean age of symptom presentation was 8.7 days. The most common clinical features were: fever, respiratory distress and jaundice. Significant risk factors for acquiring meningitis were: male gender, Caesarean delivery, stained amniotic fluid. Positive CSF finding were detected in 6/18 (33.3%) of cases. Gram-positive bacteria were more frequently responsible for confirmed meningitis. In all neonates with meningitis blood culture was examined and 5 (50%) yielded Gram-negative bacteria. CONCLUSION: The high rates of neonatal meningitis with predominant late onset may suggest nosocomial origin. Measures to improve antenatal, intrapartum and delivery care and measures during NICU hospitalisation are necessary to lower the risk of nosocomial infections.

[Infant feeding in respiratory and gastrointestinal infections during the first six months of life]. / Ishrana i obolijevanje dojenceta od respiratornih i gastrointestinalnih infekcija u prvih sest mjeseci zivota.

OBJECTIVE: To investigate the effect of the method of feeding on respiratory and gastrointestinal illnesses during the first six months of life. METHODS: Observational study of infants feeding practice and respiratory and gastrointestinal illnesses in first six months who were born in Gynecology-Obstetric department in period from May-September 2004, who weighed 2500 gm or more and at least 37 gestation weeks. In that period was born 1838 babies. Dates were collected by means of answered questionnaires. RESULTS: We sent 612 questionnaires and 518 (85%) were answered. From 493 eligible questionnaires 395 (80.1%) infants were breastfed, and 98 (20%) formula fed. A total of 279 episodes of illnesses were observed in 493 infants. These infants had on average 1.76 episodes of illnesses. The crude incidence density ratio (IDR) revealed a protective effect of breastfeeding on respiratory illnesses (IDR = 059; 95% confidence interval (CI), 0.44-0.79), for gastrointestinal illnesses (IDR = 0.50; CI, 0.24-0.86) and on all illnesses (IDR = 0.58; CI 0.45-0.86). The IDR adjusted in turn for infant's age, mother's age, socioeconomic status and cigarette consumption in family were similar to the crude IDR. CONCLUSION: the results of this study suggest a protective effect of breastfeeding against respiratory and gastrointestinal illnesses.

[Infants feeding practice in first six month in Tuzla canton]. / Ishrana dojencadi u prvih sest mjeseci zivota u Tuzlanskom kantonu.

OBJECTIVE: To investigate the infants feeding practice in first six months in Tuzla canton. METHODS: Observations of feeding practices in first six months of infants life, born in Obstetrics and Gynecology Department in Tuzla in period May-September 2004 who weighted more than 2500 gm and over 37 weeks gestation age. Dates were collected by standardized questionnaire mailed to 493 mothers from 13 regions in Tuzla canton. With questionnaire we mailed the explanatory letter with investigations detail. RESULTS: Exclusive breast feeding at first 3 month was very high reaching from 74.4% in 1 month, 62.3% in 2 month and 50.9% in 3 month of life. After third month exclusive breast feeding was decreasing and reached 12% at sixth month. Predominant breast feeding was reaching from 13.2% at first month, 27.6% at fourth month and 20.7% at sixth month. Breast feeding and complementary feeding before six month was very low, 1% in first month reaching 47.7% in sixth month. Bottle feeding rate was 11.4% in first month and 20% in sixth month of infant life. CONCLUSION: Infants feeding practice in first 6 months was inadequate according to WHO recommendation, exclusive breast feeding for first six months. Breast feeding initiation rate was high but lack of mothers support after discharge and many barriers discourage exclusive breast feeding of infants in first six months in Tuzla canton.