l

CLIMCAL PATIERN OF NE1ONATAL M'rECTIO]ISS

.Julv t99l"June 19931

M, N, Istamr , Abdul HM2, s. zemd Ho$dns. Md. Habibu Ranl'h4, s, A.

N€onatal i.fecdon is d t4ortdt cause ol mo.btdtty and monality mone
hlaits. Clhical pattm of n€mtal infection ln the neonarar rnit of Institute of
Post craduate Merlcine & Res€rch UPGM&R). Dhal<a n6 been .eport€d: out or
tot l 2160 Nconatal admrsston from July 1991 to June 1993. 320 (1a€%l ca$s
of nonatal inf*uons wre tound. Sepscamta wa9 lh€ connon€st tyrE fou'rd h
rra (5.5%) cases. Other rnfecuons hcluded unb:lrcal s.ps,s 14.7%) Skb
rnfecdons u.6%), MdrnEujs (1.2%1, T€tanus neomtrun ftre not includ€d, out
of 32O .ases, 20 pati€nt dtcd (6.2%). Preletu, b{ bln]: {eiEht dd birth
asPbt da sg€ the connm nsk factoF.

IatndrciloD
I.Jecdons ae a nequmt dd lnportant GuE of monitdlty dd no.tallB, ln the
nmnabl p€nod. ,c. m y as 2% of betu*s aE tfected tn utei! dd upto l0%
rrfmb m bf{red dutne delvery or th. fi$i bonth of Mel. Inlection €n b€ of
s! E?es. Eary on6et jnlecdon *lrh pdlet€r paihogen€sb ,hose usual on$t is
v,ltlrh 72 hour, wher6 late neonatal hfeddon is applred to rrf€cuons thosc
occu aite. one sek. Neomtal rnl€ctlons vary ftoh the tnrral (Minor) whi.h
does not 6dan8€r lrf€ to pnfoudry damagr8 (Majorl2,3. They -"y b. s'b-
.tnical br may k l the n bom. Among lhe najor tnf€cuons, sep0.aenta,
pneufonia, dtanhoea, !tuary b?ct hf.ctton luflj, n€.t€tils *e connon.
wh@s oinor hfecdons, cg omphalrtrs. conjdctMt s are comoon prcblems.
Nemtal septicaenla ls a clftar *ndrome chdacterlz.d by sigc of bfectton
md deloelt€d by a pGttiv€ blood cuLtur€ ]n the ltrst four veeks of lif€. The
if'dm,e oI neotubl .epd.c.da lu" bftn "stimried b ange lrom I ro lo pFr
Iooo lve births.4 5 E ly onset sepsF rs mDrc indindt, combonly dragnGed
dtl n the nGt 4a hous dd almost always drine th€ lirst week oI nfe. Late
oNet spsrs rs mo.e hsidio6. D€spite the drelopm€nt of broad spectnm and
mlcrcblal agents and lmproved obstetic ud paedjatic ce. s€pflcaeota sdrl
@ntlbulcs gEUy to neomtzl norbiditr md nortaliv paiticlndy lrl dsetoPrng



!ourde<.6 lr Bancladesh. rh.'- 5 -o dennre s'udy on re u udence, euotos,,risk rddob and pmgnoes or neo!"rct seprcreaa bur .r js Lrety to b" tueh-jn
Banstad€sh xke oth d€v€toptng comtries.T Rjsk raciors lor a*bpn;! of
nconar6r sepsts e lov btrlh werghi, Apg score tcss tno 7 at
sq. cohpxcauon of labour e.e. p.otonEed labour. .arly ruptu.e of mdb.alq
nalp'*entcrlon !ompkarod or deljvFR rkc scpn. deln-ry rnshmenFl
d.llwru end pnmsry @e.Mr sruon dd poor sorto-Fonon
ctuup B slr€pto4oc@s & Escneichia con aE rh. tcadbe €u*s of $p6ts. oth6
pathog€ns like siaphylococcus aureus, Kjebsielta, Ente.obacrd. crouD D
s(cproi o.fl and Prcuoomonas dF'oenocc
nerl4,LdE ard Ha.mopbius mnuel%- ar rrety .n.ounte
dso common.rr Mcuulbs F one or dr rpol@tbmr or url..uons. I Bdy be
$nl dd b3ct Hr. tr F on6 6a$dared q4'h.eps,s rd ts d cau{ ors€ dMr
morbdr.y 4 d don-Iry L6.r/. 3 u'rl f nrybom 5 drm.,nt ro 4Bbt,b beca6e,
as mny as 40% of the hfections € asyrptobauc.rg Dimhoa t, one of rhe
inpondl componenr of nalo. hr€ctjons dd js a leadinF cause of mness dd
death aaong chjrdr€n of the ds€rophg countnes.2o Anone thc nntr. ht€cuoB

n.2r.22 h€ pFstr, judy Ms
he dr-L.l Pa,rer, e,.otosrrt sg.-F.

Mat.dars ud M.tto&
nr.s drrdv bci don" unr o lhe DepsnDen, oi paedFhc..

cEduar" v.dl.lne d Re*arh rrPcv&R'. Dhsr.a ovc' a
pertod of 2 y€ars fton July t99r ro June lsS3, l.hfte hurdrcd t{Eb? n€onares
ulth dlre.€nr glp* of infedon were duded. ToRcH inJecuo
B ud nrcnatal ret"nu. wec ex, tuded rom fijs s,Ld) br.au* tbese m*: ".Fa&nrtted r4 a sep ate hrecrous disease hosptrat. A detdled pftmbr, naral md
post natar hrsbry frtn spe.ral emphasis o. any pr€disposhg faclors fo. Inf€ction
Ms ralen bd tnorough cthrcal eaJfuaum rrc done h sI $e cses and w€re
'flord-d. 

Panen' 3 prLrutrs Uke, 
'Fdnpss 

6rund rhe unb.l,,us, unb.lical
drschdge, fev€r, hy?oih€da, drarhoea, EspLatory dlsrres dd feedt g brstorv
ve.e noted, Ha€noelobh. iotal hd diffcrenual count of wB
vtre done in aI padents. sMbs nm dre Umbilcus & *pdc spors @re sent for
grm stardng 3id c/s. cdrlres of urhe. sr.ot & btood wrc crded out ,n all
c6es, RadiogEphs of rh€ chest and csF *mimtion m.€ canted out vh€lffi

of th€ total 2160 neonatal adnrsstons, 320 O4.a) had diflerenr tyTes of
i.f€cuons, There were 2I2 (66.2%l male and roa (33.a%) femat€ babies. ase
drstrlbuuon is snom in Tabk r. Mem age @s 9.5 days. Tabl€ll shows tne

of rnf€crtons. septtcaemra r13 (36.37%), pn€umonis 70
(21.37%) dd Mtfuetds 20 (6.25%) wre rh€ major inl€cuons whle omphaxds
ror (3r-56%) md penpr gus 2a 1a.75%) '€re 

the mtnor tntec$otu in the



I

sludied Populatron. Table-In shNs ihe age ol onset of hfecrjons. Most pauerrs
frth major or ninor tnfecrons presented after 4a hI, Table-Iv shovs tlc risk
lacrors ol rnrcctto!. Pretem low bftn weght 223 (7t%) prolonged rupture of
ncnbde roa (33.7%l blrL! asphyda !t6 (r4.3%) nom€ delivFt by unb,rned
p4ons 52 (16.2%) dd u6e ol undte.n€ blade ro cut rhe cod 36 (a%) cses
rerc the rrsk facrois in tre 51udy eroxp. Fev€r 160 (5o%),
rr5 t35.92%t, Reluciant ro feeds r12 (35%). atldomrnat distensron 1o2 {31.a%).
vom'thg 9a {30.6%1. apno,c spens 23 (3,796). jaundtE 36 01.2%1, ror sn lxrg
umbrlrcal drschalge 30 {25%), hypothemia rr €.4%), Penphigus 2a {4.7%) dd
convulslons were the cltntcal presentation. of course rhey had ovedaptng or
clhlcal presentatlons Oable \4
Tabl€-\4 shms the orgdisms tsolat€d lron sanples ofblood, urtn€, siool and
+nbili.ar swab. Blood cullure done inla4 pa!€nb shoMd po
@ses of vhtch 35 shoMd E. coli and 6 pad€nts showed staph aureus, Urrne
cuhure done i. 1a4 cas€s Felded rhe gmv,rh of E. col, tn r5 patlelts. st ot

ses. Umbmcar sub clltlE showed rhe Browtn ol
sbph au. s rn 75 c6es rd E. @li in a GSes.

unt rron 20,ooo,30.ooo/cn3 h r20 (37.5%l dd
f.om ro,ooo ro 2o.ooo/.n3 h l4o (43.7%) cases.
padents had hazy csF drh plenry of n€urophils. cram statnhg shNed the
presenc€ ol 6 ad a cases ol cram posttiv€ dd c.aD neeative backna
Especuvely. H@de. cultm dld.oi show eros-ft of my bactdia, MeD €rue of
proid & sug{ h csF w€re 15? & 22ngldl Gspectivety.
Table-Da sbows the x-Ey lindirgs of the studterl populatton. 30 142.a%J cases

ih€ lung fi.lds. out of 32o c6es of n€onstal infe.rion 20 (6.2%) parients died in

hfectom of the neonates d
special care baby urits. Tlns study shMd ihe !}atr€m ad prcdspodng fftbrs
of rdnatal jnfectjoE h a tediary cmft frtn onc or the brg
Bdgladesh. out of 32o 

'eonates. 
r34 had major hrectrons and the renahtne

had mhor hfecrioE. nosdy onphalrds. s.pflcacmla alonc or ln assrarion Mth
pneunonre, men,ngds dranhca and nrl wre tnc major lnfc
sepd.aemta vere pncumonra rn (21.3?%1, nenrngu's rr
{6.25%1, drarhoea h l2.rs%l w\ 11.27%\ cases (Tabb D Malodry or these
padots weE .erered rmm ditr€renr chtcs, home and oth.r hosptl:rs. vdous

rnappropdat. or !o tEatnent eic. .ould be the contdbltory factoE for the
hlahd lfttdence of lnfccdon. The.€ @s a prepdderenc of hoys over eFls tn an
tTes of lrtfecuoN. The male to renale raiio Ms 2:t. The prepondcrence or n3le
s* is posturabd to be rink€d to ttE x'lrnked factor23. It nuht be d!€ to g.eaie.
cd€ gva to the nBre chrd h our seler set ud4. h thts strdy. msi padenb
were low btrth vetght (43.75%). Nunerous studres havc found LBw io be



predspodiig factor for neomtar infecdon. rd btrth rcigtt qd pretem babr€s
ha\e ld I3.c as Mrl .s rmpafed leuu5r lmdututo nrr "k tor noe.omra.rtuedon ls &edGr rn holprtat. t ,s e\rabltsb.d rlEt rmbrlldl b.unp,s eoodmedra fd_llrnnant gro*rh or det' or orsErnsns2s. Bur rn tbrs $;y ft vs
ob$rcd that most of ihe patienb nad rhetr unb1ncal cord cur 6epucany.
Rr"usclEDon w needrd m l4.J?l6 caces Lr rhe mslor Crup ot.d{Uons most
otthe ndndres prsen'ed u,trh pvr{a oL\e, fertuE. btrC r.spraEry. sr>s,
r.luctant to f€ed, abdontnat dist€nslon. mnr!.g, Apnoic spens, raDndi.e etc.
Pytua b on€ o, r,\r npolbr Gs rur.s of s"pui d.nla26. pneumoda Un2? rd
menrnSrrs.6 FFvs ltempe'arure 5bo!e 3a.ct hcd b"en re, orded h 50% o
Deonates dih tnfectron h tlds se.res. Resplrarory distress was pr€sent rn
35,32% ca*s vbich ts sitund b the nndjngs of ofte.
Abdonhal dlstmsron ftr neonat€s !n 11$ srudy qs 3r,a7% vhlch b hrghd tltu
Among ti€ bino. rnfe.flons. omphatitis vas the,cobdon€sr. Mosi of thed
{e-4%r had fo'i selllnc purulent dlschfse md penuDo cdl rednes DLgiosb
or neonatal .nleiLon ts one or lhe mod
Di,{dent authoE hav€ sugg*red swerat tabo.atory d€rmiquts33. p.e*nce of
neutrophrl precursors rs bore sugg€s|ve of rrrecuon th t}le totar drfierenrbl
.ount, other aurhors demonstrated ihar a. Low (<rsooo/cn3) or htArr
(>20,000/chs) wBc count 

'€re 
assodated dth neomiar inr*don3a. h.u;s

serrs lMst wBc cou Es aooo/chs. HoM a cdut over 2o,ooo/.ns ms
lound .n 37.5q !a"cs Thus n this qe- d hqh wBc was . I qehJt ,ndt.a,o, of
mreton. c'itur€ o, r EbJrcal sEb3 k'c done rn alt !6e or
study predotuar orgdism wrc gla poiuv€ cd sraphyt
rouno i ss l5dn.*Fs ard E {h d 5.s3\ fte ttndfes conrasL! @ rhF fdf,
ondhc" wherc E.,ot wde fornd m 5560n dd ,Lph aur.ub.n 20% on Lh.
orbc-hand htu rd ste, h lhe ffndne- or Anm.o Haqu. d atrd. tr U-ts
en6 no group B str.ptocdci w tsolat€d. The edorosr of n€onatrl *d.a€da
En€s troh dunL-y to cmrr sd fon o'e hosplbr to the;th€r, Th€ djtfe.snce
ls du€ to preErlhg obstetnc sd nlEery fac[rues and paneh of usag€ ot
dur crcb'al agmrs. Blood.Dru.€ done in rs4 es6 sealed posur.T€ curiu; h
4r {22.24%) €s€s. Srrha er ar reporred tu isoladon nt€ of 2a.oa%, Khatua €t sr
found a much hlghd rare of tsolation {60%). Trls htEh rate ot tuoladon could
probably be due to the usc ot more senstdve m€dla. ches! xray shoMng
unilateral and bllateEr patchy opacides tn vdous zones of lungs vere rh;
radrologtcal cllddce of pr€senc€ 9t pneumonta. Mo6t paucDts had rmerved

ttbrouc pdor to adnlsston. More of o.ganisms coutd be
erp€.ted rf prior ddbtoflcs were not eiven. 20 {6.25%) parients sfth neonatal

Errght dd mre hosp[abed h a ddcat sta!. of lnes6.

stlll rcmahs a
pmlonA€d ruptur€ of n€hbrane,

dr€aded dt*ase;.Pr€tem low ttrth welght,
bith asphyia. hon€ deuvcry erc. were the



rmpoltarr rhk faciors lor inf€.tion. sepuca.mia, pneumonia, merl]ngltl3,
db.rho€a, UT! vere the najor infccirons prcscnlcd clth.r 3hgly or nt
combhaen. omphalids tu the comon€sr mhor mdit€sta{d. Alrhough 1b13
!s a hosptar based dudy h a rcferel hospttal, rt has neen anb b lndout tlc
cnnhal patbm ol neombl bfection. Mo.e q1ensrre studres lnElvlng la8er
smpl. ol n6mtB dih good tulftbrological support ls d4'lable to study the
c[nrcal patt€m ol n@nalar bfetbc t! rh€ cdnr4.

Ase dd sd Distnbudds (N = 320.1

r4
1\,25

Slectrum of Inf€ctlon (N=320)

!&l!Il!&c!!E:

Th.rc wer€ dslapb€ of mlor bfes@s h soD€ larl€ntg



Age at oet of bfecu@s

55

Rrsk Factos for Infe.tions

r. Prctem low ltrth wt.
2. ProlonEed ruptuE otm€nbtue

4. Hom€ dellvsy Untrah.d peMn
5, Use ofUEie.dc blad. for dttxrt cdd.

Th€rc wE morc thd tu dsk fa.for tn nmy subJdts.

Foul strElxng ffiblllcal rl&harge
11 ?5-



MAJOR IN=1A4)

\rNoR N=r361

136

I5

H&matoloBcal Data h lnfeuon

Ha@tolodicar Data I@e

csF study h Medngrs tN=2o)

wBc (Ndfophlrs) nmv
QEq\NIl![q (6rm st in)

CULTURE
gogEEU!@



Fadtlodcal findliss ln Pn{bar a lN-7o)

Btlatefar pabhy opacrty,n lung n€lds
oPactry rn th€ Rr uooer md ddzonB
opactty h the F{I uppcmn€ of the lunas

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