PREVALENCE, FACTORS ASSOCIATED WITH AND IMMEDIATE OUTCOMES OF NEONATAL SEPTICEMIA AMONG NEONATES ADMITTED WITH BIRTH ASPHYXIA TO SPECIAL CARE UNIT, MULAGO HOSPITAL

Abstract

Background: Neonatal mortality continues to be a global burden. This is despite the reduction in the under five mortality rate. The burden is highest in the low and middle income countries including Uganda. The common causes of admission of the neonates and contributing the neonatal mortality are complications of prematurity, birth asphyxia and neonatal sepsis. In the SCU of Kawempe Referral hospital, birth asphyxia contributes the highest to early neonatal mortality. This is followed by prematurity and sepsis. Presentation of neonatal septicaemia and birth asphyxia are similar. The co-occurrence of the two conditions could explain why the babies with birth asphyxia have worse outcomes. Objectives: To determine the prevalence, factors associated with and immediate outcomes of neonatal septicemia among neonates with birth asphyxia admitted to SCU. Specific objectives: To determine the prevalence of neonatal septicemia among neonates admitted with birth asphyxia to SCU. To determine the factors associated with neonatal septicemia among neonates with birth asphyxia To determine the pathogenic causes of septicemia and their antimicrobial sensitivity patterns. Methods: This was a study with cross-sectional and prospective components. Neonates with an APGAR score below 7 at 5 minutes admitted to SCU were recruited. Informed consent was obtained from the caretakers. A blood sample for culture and sensitivity, CBC and RBS were taken off. A pretested questionnaire was administered to the mother/caretaker to extract information on factors associated and outcomes of neonatal septicaemia among the study participants. These were followed up for up to 7 days. The average length of stay in the SCU is 3 days for term neonates. For neonates found to have positive cultures, results were communicated to the attending doctors with the corresponding sensitivity profiles. Those who were discharged before 7 days, were contacted by phone for follow up. Data was entered in MS Access data base and analyzed using Stata version14.1. xiv

Results: Of the 125 neonates enrolled in the study, 24 had positive blood cultures. However, only 7 had a true pathogenic cause of neonatal septicemia giving a prevalence of 5.6% (CI, 2.7-11.4). The only factor found to be strongly associated with neonatal septicaemia was presence of convulsions (AOR=11.04, 95% CI: 1.21-100.8, p=0.033). Other factors that seemed to be associated with neonatal septicaemia were respiratory distress, parity, PROM and meconium stained liquor. However, these did not show any strong association on multivariate analysis.The neonates with septicaemia were more likely to be hypoglycaemic (p=0.009). There was no difference in median duration of hospitalization between those with and without septicaemia. Two of the seven neonates with septicaemia died while the rest recovered and were discharged. The pathogens identified of neonatal septicemia were E.coli (42.9%), Viridans streptococcus (28.6%), Citrobacter spp and Enterococcus spp(14.2%). Most of the identified organisms were resistant to Ampicillin but sensitive to Gentamicin. Conclusions and recommendations: The prevalence of neonatal septicaemia among neonates admitted with a diagnosis of asphyxia in this study was 5.6%. Convulsionswere strongly associated with septicaemia and these neonates were more likely to be hypoglycaemic.It is recommended that the neonates who present with convulsions should be promptly investigated for septicaemia, including blood cultures. The blood sugar levels of these neonates should also be closely monitored, and interventions given accordingly. Further studieswith larger sample size should be done to identify factors associated with septicaemia in these asphyxiated neonates are also recommended.