All issues > Volume 30(2); 1987

Original Article

J Korean Pediatr Soc. 1987;30(2):130-138. Published online February 28, 1987.

Clinical Observations on Neonatal Sepsis.

Beyong Il Kim¹, Hae Lim Chung¹, Yoon Deok Kim¹, Weon Soon Park¹, Son Moon Shin¹, Hoan Jong Lee¹, Jung Hwan Choi¹, Chong Ku Yun¹

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea

Abstract

We studied the 73 cases of proven neonatal sepsis among 11,102 newborn infant under 1 month of age, admitted to the pediatric ward, the nursery and the NICU of Seoul National University Hospital from Jan. 1, 1980, to Dec. 31, 1985. The results were as follows: 1) The incidence was 6.6/1000 live births. Incidence of male babies was 8.3/1000 live births. The morbidity rate of male (0.83%) was higher than that of female (0.48%) significantly (P valve<0.05). 2) According to the gestational period, the morbidity rate of prematurity (2.67%) was higher than that of full term (0.47%) significantly (P value<0.05). 3) According to the age at onset of neonatal sepsis, the ratio between early onset neonatal sepsis (≦72 hr of age) and late onset neonatal sepsis (>72 hr of age) was 1.05:1.00 and it only accounted to 9.5% of all cases after 2 weeks of age and mean age at onset was 6.7 days. 4) The perinatal complications associated with neonatal sepsis were premature rupture of membrane (≧24 hrs) (24.7%), asphyxia (Apgar score≧6 at 5 mins), history of difficult labor, meconium staining, preeclampsia and eclampsia, bleeding (including placenta previa, abruptio placentae) and maternal infection in the order of frequency. 5) In the clinical manifestations of neonatal sepsis, major symptoms were poor feeding (54.8%), jaundice (50.7%), fever and hypothermia (46.6%), lethargy (45.2%), hepatomegaly (43.8%) and dyspnea (32.9%). 6) The associated focal infections in neonatal sepsis were pneumonia (26.0%), UTI (17.8%), meningitis (16.4%), omphalitis (13.7%), abscess (5.5%), osteomyelitis (4.1%), and otitis media (1.4%), in the order of frequency. 7) The concurrent conditions in neonatal sepsis were SIADH (9.6%), congenital heart disease (6.8 %), hyaline membrane disease (5.5%), D.I.C. (5.5.%), congenital anomaly (4.1%), intracranial hemorrhage (4.1%), congenital syphilis (2.7%), and hypocalcemia (2.7%). 8) The commonest organism isolated from blood culture showed Staphylococcus aureus (28.2%), E. coli (17.9%), K. Pneumoniae (15.4%) and Staphylococcus epidermidis (12.8%) in the order of frequency. But not a case of group B streptococcus was isolated. 9) The laboratory data that supported an early diagnosis of neonatal sepsis were CRP ≧1 +，ESR 15 mm/hr, total WBC≧ 24,000/mm3 and immature: total Neutrophil ratio ^0.2. 10) According to the comparison between early onset (≦72 hrs) and late onset (>72 hrs) neonatal sepsis, the morbidity rate of early onset neonatal sepsis was higher than that of late onset neonatal sepsis in view of prematurity and perinatal complications significantly. 11) The overall mortality rate of neonatal sepsis was 21.9% and the mortality rate of prematurity was 36.0%. According to the comparison between expired and survived newborns with sepsis, the mortality rate was highly significant in prematurity, low platelet count (<100,000/mm3), and isolated K. pneumoniae organism.

Keywords :Neonatal sepsis.