Late onset neonatal sepsis in very low birth weight premature infants in the neonatal high care unit, Pelonomi Hospital, Bloemfontein: a cohort study

[摘要] Background: Late onset neonatal sepsis (LOS) is a common problem in very low birthweight (VLBW) infants and is associated with increased mortality, morbidity and cost of care.Several known risk factors are reported in the literature, which may be maternal, host orhealthcare related. Hygiene practices, overcrowding, staffing and healthcare interventions allplay a role in the risk of LOS. Pelonomi Neonatal High Care is a 32-bed regional neonatalunit. The study period was from September 2015 to March 2016.Methods: This was a prospective cohort study.Study Population: All VLBW infants with birth weight between 1000g and 1499g excludingthose referred to tertiary centers and those born with major congenital abnormalities wereenrolled and followed up to 28 days of life.Results: 117 infants were included. 43,6% of infants had at least one episode of LOS(incidence 435 per 1000 births per annum). There was a higher incidence of gram-negative(31%) and fungal infections (17%) than reported elsewhere. The use of invasive ventilation,nasal CPAP, nasal prong oxygen and surfactant were significantly associated with LOS as wasincreased duration of umbilical venous catheterisation. Longer periods to the initiation offeeding and the use of cefotaxime increased the risk of LOS. Breastfeeding appears to conferprotection against LOS. Exposure to human immunonvirus and high maternal viral load maybe a risk factor for LOS. LOS was present in 40% of deaths beyond 72hours of life and 10% ofinfants with LOS died. LOS was associated with increased morbidity in the form of increasedlength of stay, longer duration to full enteral feeding, longer duration of parenteral nutritionand increased necrotising enterocolitis. Only 50% of the infants received antenatal steroidtherapy and 96.5% of infants experienced some degree of hypothermia. The unit waspersistently overcrowded and key consumables for hand hygiene were frequently unavailable.Due to the persistence of overcrowding and the short duration of the study period astatistical relationship with LOS could not be proven.Conclusion: LOS was significantly more frequent in this study population than reported inthe literature with serious consequences for patients. Many identified risk factors areassociated with routine practices in the care of VLBW infants in this unit. The unit waspersistently overcrowded and there were several barriers to appropriate hand hygiene.Several factors such as role of genetic factors and HIV require investigation.

[发布机构] University of the Free State