Médecine néonatale et pédiatrique

Abstrait

Factors Associated with Mortality Outcomes in Neonatal Septicemia in Srinagarind Hospital, Thailand

Zarghoon Tareen, Junya Jirapradittha, Chukiat Sirivichayakul and Watcharee Chokejindachai

Background: Neonatal Septicemia is a major cause of mortality and morbidity in newborns both in developed and developing countries.

Objective: The objective of this study was to determine the risk factors for mortality in neonatal septicemia

Materials and Methods: This retrospective case-control study was conducted in Srinagarind Hospital, Khon Kaen, Thailand. The study considered the demographics, laboratory results, and clinical features for a total of 133 patients during the period May 2005- September 2010. Thirty four out of these patients died from their condition.

Results: Investigation of neonatal demographics found that low Apgar scores in 1 minute (OR 12.237, P<0.001) and 5 min (OR 13.143, P<0.001), VLBW (OR 5.312, P<0.001), EOS (3.749, P<0.001), prematurity (2.723, P<0.01), and out born delivery (6.253, P<0.001), were all significantly associated with fatality. Laboratory results showed that hyperglycemia (OR 6.213, P<0.001) and thrombocytopenia (3.853, P<0.002), were significant contributors to fatality. Among all clinical features, lethargy (14.667, P<0.001), apnea (OR 13.160, P<0.001), poor feeding (OR 7.807, P<0.001), hypothermia (OR 4.807, P<0.001) and jaundice (OR4.769<P0.007), were significantly associated with fatality. Gram-negative bacteria were frequently isolated from dead septicemic neonates. E. coli was the most common bacteria isolated from dead septicemic neonates (18.2%), followed by Klebsiella spp. (15.9%), Enterobacter spp. (15.9%), Acinetobacter spp. (13.6%) and Pseudomonas spp. (11.3%).

Conclusion: Early detection and management of these associated factors are necessary to prevent severe and life threatening complications and death in neonatal septicemia. Strict infection control measures remain the mainstay in the management of the multidrug resistant bacterial infections in neonates.