Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up.

BACKGROUND: Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. Thus, we used a historic cohort design to assess the association between a series of neonates and their mothers, in addition to hospital evolution features and the risk and prognosis of neonatal sepsis (defined by Pediatric Sepsis Consensus [PSC] criteria) in 11,790 newborns consecutively admitted to a Neonatology Service in Mérida, Mexico, between 2004 and 2007. RESULTS: Sepsis was found in 514 of 11,790 (4.3 %) newborns; 387 of these cases were categorized as early-onset (<72 h) (75.3 %) and 127, as late-onset (>72 h) (24.7 %). After logistic regression, risk factors for sepsis included the following: low birth weight; prematurity; abnormal amniotic fluid; premature membrane rupture (PMR) at >24 h; respiratory complications, and the requirement of assisted ventilation, O(2) Inspiration fraction (IF) >60 %, or a surgical procedure. Some of these factors were differentially associated with early- or late-onset neonatal sepsis. The overall mortality rate of sepsis was 9.5 %. A marked difference in the mortality rate was found between early- and late-onset sepsis (p >0.0001). After Cox analysis, factors associated with mortality in newborns with sepsis comprised the following: prematurity; low birth weight; low Apgar score; perinatal asphyxia, and the requirement of any invasive medical or surgical procedure. CONCLUSIONS: The incidence of neonatal sepsis in southeastern Mexico was 4.3 %. A different risk and prognostic profile between early- and late-onset neonatal sepsis was found.

[Relapsing risk and obstetric-neonatal outcome in pregnancy and systemic lupus erythematosus]. / Reactivación y pronóstico obstétrico-neonatal en lupus y embarazo.

OBJECTIVE: to assess the effect of pregnancy on systemic lupus erythematosus (SLE) activity, and the obstetric/neonatal outcome. METHODS: historic cohort including 24 female SLE patients who became pregnant. For every pregnant/puerperal period, the presence of lupus relapse, mean relapse, Mex-SLEDAI score and prednisone dose were compared. RESULTS: higher relapse risk (RR = 11.8), more relapse episodes (1.0 ± 1.3 vs. 0.02 ± 0.17), higher Mex-SLEDAI scores (2.0 ± 2.5 vs. 01 ± 0.7) and higher prednisone requirements (13.5 ± 12.6 vs. 7.2 ± 7.5 mg/day), were observed in pregnancy puerperal periods. The abortion incidence: 10.8 %, fetal death: 5.4 %, preeclampsia: 18.8 %, preterm deliveries: 18.9 %, neonatal mortality rate: 6.0 %, perinatal mortality rate: 10.5 %, LES activity associated to obstetric morbidity (83.3 % vs. 38.8 %, p = 0.005), preterm deliveries (43.6 % vs. 11.1 %), neonatal morbidity (46.7 % vs. 11.1 %, and low birth weight (25 % vs. 0). CONCLUSIONS: lupus pregnancy resulted in higher relapse risk, and more severe LES activity. Lupus activity also worsens obstetric and neonatal outcome.

[Neonatal mortality in a regional perinatal hospital in Merida, Yucatan, 1995-2004. II. Analysis of causes and risk factors]. / Mortalidad neonatal en un hospital perinatal regional de Mérida, Yucatán, de 1995 al 2004. II. Anlisis de causas y factores de riesgo.

OBJECTIVE: To analyze the causes of neonatal mortality, its distribution, the moment of appearance and risk factors. PATIENTS AND METHOD: We studied a cohort of 46,297 live newborns born at the mentioned hospital, weighing 500 g or more. In a database we registered: birth weight, gestational age, days of hospital stay, discharged condition, one and five Apgar minute score, morbidity, death causes, moment of death, reducible death/reducible difficult death rate presented in less than 24 hours, 1 to 6 days, and 7 to 27 postnatal days. We compared morbidity, mortality, and risk factors in a three-year period to facilitate the analysis. RESULTS: Mortality increased with the lesser one minute Apgar score: 0.2, 9.7 and 42.9% when score was 7-10, 4-6, or 0-3, respectively, and 0.6, 41.9 and 62.9% at five minute Apgar score. Malformations were the first cause of death, which increased from 28.6 to 40.3%. Respiratory distress syndrome mortality decreased 34% and that of meconium aspiration syndrome 53%. Reducible death/hardly reducible death rate occurred from 1 to 6 days decreased 67%, from 5.2 to 1.7 (reference value 1). CONCLUSIONS: Preventable causes of death decreased significantly, particularly those related to perinatal causes, although they are still high compared with developed countries.