Incidence of early onset neonatal sepsis in preterm newborn and characteristic of maternal vaginal pathogen,Prapokklao Hospital

Abstract

Background : Preterm labor is a leading cause of neonatal morbidity and mortality. Intrauterine infection has been found to play a major role in preterm labor. The most common pathway of intrauterine infection is thought to be the ascending route from cervix and vagina. Vaginal infection increase not only the incidence of preterm labor, but also opportunities of early onset neonatal sepsis.

Objectives : The purpose of this research was to sort the type of maternal vaginal pathogen and incidence of early onset neonatal sepsis in preterm infants born at Prapokklao hospital.

Methods : Prospective descriptive study was carried out at Prapokklao hospital during 1 May 2005-30 April 2006. Eighty-five pregnant women who had spontaneous preterm labor at GA 20-36+6 without complications agreed to participate in this project.Vaginal discharges were collected for aerobic culture and the health status data of both infants and mothers were analyzed.

Main Outcome Measures : Types of vaginal pathogen and the incidence of early onset neonatal sepsis in preterm infants.

Results : One hundred and fifty five preterm labor women admitted at Prapokklao hospital and 85 out of 155 cases were included in this study. Seventy one participants gave birth and most of them delivered at GA> 35 weeks (57.7 percent). Most of preterm infants did not have sepsis. Nine cases had suspected sepsis and only one case met the definition of definite sepsis which was found S.aureus. The incidence of early onset neonatal sepsis in preterm infants was 14.1 percent, equivalent to 2.14 per 1,000 live births. Among 35 out of 85 pregnant women found vaginal pathogen (41.2 percent). The organisms were Escherichia coli (10.6 percent), Enterococcus faecalis (8.2 percent), Candida spp. (7.1 percent), Group B streptococcus (5.9 percent) and Gardnerella vaginalis (4.7 percent) respectively. Most clinically septic infants, maternal vaginal cultures were negative. Mother and newborn was not necessary sharing the same pathogen.

Conlusion : The results of this research could not be generalized to general population. They showed some importance such as the high incidence of early onset neonatal sepsis in preterm newborns that mostly have negative hemoculture.

Keywords : Preterm labor pain, early onset neonatal sepsis, vaginal pathogen