Evaluation of neonatal sepsis screening in a tropical area. Part III: neonatal sepsis in meconium stained deliveries

ABSTRACT

Of the 6,060 consecutive live births delivered at the University Maternity Unit of Guadeloupe (French West Indies) during a 30-month period, 635 newborns (10.4 percent) presented with meconium stained (MS) amniotic fluid, of which 595 (94 percent) received bacteriological screening at birth (light MS, n=543; thick MS, n=52). Thirty (5 percent) of MS newborn had a bacteraemia (n=13, group B streptococcus, GBS), and 128 (21.5 percent) a bacterial positive gastric aspirate (n=54, GBS). Sixty-six newborns among MS babies needed tracheal suctioning (11 percent) in the delivery room for meconium inhalation. Among these 595 screening MS newborn, 286 (48 percent) presented clinical signs of postmaturity of birth, having therefore an explanation for their MS condition. For the other MS newborn without the postmaturity explanation, we experienced twofold increased risk of neonatal sepsis (OR 1.88 for bacteraemia and 2.61 for external carriage p < 0.02, Chi square) as compared with their MS postmature counterparts. We conclude that when meconium stained deliveries are associated with postmaturity signs, one may not need to initiate prophylactic antibiotic treatment at birth unless they present with other traditional risk factros for neonatal sepsis such as intrapartum fever and prolonged rupture of membranes.(Au)