Community Acquired Neonatal SepsisA Cohort Study in Rural Southern India

Abstract

Introduction: Neonatal sepsis is responsible for 30% to 50% of all neonatal deaths in developing countries in a year. Incidence of neonatal sepsis was reported to range between 30.7-35.9 per 1000 live births in low middle income African and Southeast Asian countries and 23% neonatal deaths occur due to neonatal sepsis. Aim: To identify the organisms isolated from various surfaces around the neonate, including body surfaces of neonate and mother, in a hospital and home environment and to estimate the incidence of Community Acquired Neonatal Sepsis (CANS) among hospital-born neonates. Materials and Methods: A cohort study was conducted in a rural area of Southern India, enrolling 100 healthy neonates, born in a rural tertiary care hospital. These neonates were then followed-up in community. Knowledge regarding antenatal and postnatal practices related to neonatal sepsis prevention was assessed. Swabs were collected from various surfaces, on the day of birth (day 1) in hospital, on day 3 and day 7 of life of the neonate, at household. The outcome measure was CANS. The data was collected by trained investigators and swabs were transported to the lab under aseptic conditions as per the standard protocol. Descriptive analysis by calculating frequencies and means were done and the data were presented as rates, proportions and mean±standard deviation. Results: Total 100 newborns were included for the analysis; 49% were males and 51% had low birth weight. Forty two neonates contracted infection in their household, of which 32 were hospitalised; none were culture confirmed sepsis. The CANS (culture negative) rate was 3.23 per 1000 live births (95% CI:0.00- 4.28; p=0.01). The common organisms isolated from different surfaces in hospital were coagulase negative Staphylococci and Klebsiella, while E.coli, Citrobacter, Acinetobacter, Pseudomonas and non-ferementers were additionally isolated from household surfaces. Caretaker’s hands showed the highest number of organisms, both in hospital (26%) and in community (12%). Conclusion: Institution born neonates followed in households showed a high prevalence (60.4%) of pathogenic organisms from various surface swabs both in institution (83%) and household (54.5%). Most common organisms isolated from different surfaces in hospital as well as home were coagulase negative Staphylococci, Klebsiella and E. coli. Staphylococcus aureus was highly prevalent in hospital compared to home.

Keywords

• antenatal
• knowledge
• neonate
• newborn care practices
• surface organisms