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Clinical observation in 72 Cases with Neonatal Sepsis.

Journal of the Korean Pediatric Society 1986;29(12):1309-1313.
Published online December 31, 1986.
Clinical observation in 72 Cases with Neonatal Sepsis.
Jae Seung Yang, Ran Namgung, Chul Lee, Dong Gwan Han
Department of Pediatrics, College of Medicine, Yonsei University
신생아 패혈증에 관한 임상적 관찰
양재승, 남궁란, 이 철, 한동관
연세대학교 의과대 학 소아과학교실
Abstract
Since the clinical features of neonatal sepsis were first reported by Dunham in 1933, there have been many studies. But because of the uncertain early symptoms and it’s rapid progression, the mortality rate of neonatal sepsis runs still high. We are reporting 72 cases of neonatal sepsis confirmed by clinical symptoms and blood culture studies over 3 years and 5 months between Jan. 1982 and May 1985 at Severance Hospital of Yonsei University College of Medicine. The results obtained were as follows: 1) The sex ratio of patients was 1.2;1 with 39(54.2%) males and 33(45.8%) females. The early onset type was found in 45(62.5%) cases and the late onset type in 27(37.5%) cases. 2) Clinical symptoms at the time of admissions consisted of jaundice in 58.3% and the most, G-I symptoms in 56.9%, fever in 54.2%, respiratory distress symptoms in 25%, lethargy in 25%, hepatomegaly in 20.8%、cyanosis in 19.4% and seizure in 9.7%, 3) Leukopenia with WBC count of less than 5,000/mm3 was seen in 9(12.5%) cases, and leukocytosis with WBC count of more than 25,000/mm3 was seen in 16(22.2%) cases. Thro-mbocytopenia with platelet count of less than 150,000/mm was found in 41.9%. 4) Among the associated diseases the hyperbilirubinemia was seen in 30 cases (41.3%) and the highest in incidence, acute gastroenteritis in 17 cases (3.6%), DIC in 13 cases (18.1%), pneumonia in 8 cases(11. 1%), and meningitis and urinary tract infections were also present in lower incidence. 5) Of the 72 cases with neonatal sepsis, the following causative organisms iere isolated.; Gram positive organisms were isolated in 34 cases (47.2%), gram negative organisms in 27 cases (37.5%) and in 11 cases(15.3%} more than two strains of bacteria were isolated. Among the gram positive organisms, Staphylococcus coagulase negative organisms were isolated in 21 cases (29.2%), Staphylococcus positive in 10 cases (13.9%), and Streptococcus in 8 cases(ll. 1%). Among the gram negative organisms, Serratia was isolated in 7 cases (9.7%), Klebsiella in 5 cases (6.9%), Enterobacter in 4 cases (5.6%), and Acinetobacter and E. Coli were also isolated in lower incidence. 6) Sensitivity test for bacteria were observed for Staphylococcus among the gram positives and for Serratia-Enterobacter-Klebsiella among the gram negatives, and the results are as follows; a) The Coagulase negative Staphylococcus strains were sensitive to cephalothin but resistent to other drugs. The coagulase positive Staphylococcus strains showed relative sensitivity to cephalothin, oxacillin and clindamycin. b) Enterobacter showed sensitivity to gentamycin, and co-trimoxazole but was resitent to ampicillin and cephalothin. Serratia was relatively sensitive only to co-trimoxazole but resistent to other drugs. Klebsiella was most sensitive to amikacin. 7) Among 72 patients with neonatal sepsis, 52(72.2%) patients improved and 20(27.8%) patients died. The mortality rate was higher in early onset type with 35.5% than in late onset type with 8.9%
Key Words: Neonatal sepsis.


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