Common causes of neonatal sepsis in AL-kadhimiyia

Sepsis is common in the neonatal period which may be acquired in utero through the placental or trans-cervical routes and during or after birth and because the immunological system of neonates is not well developed make this infection series and fatal if did not treated in optimal manner . To identify the most common causes of sepsis in AL-Kadhthimyia Teaching Hospital and its mortality rate. Cross-sectional study was conducted during the period between 14 th of February 2009 to 25 th of February 2010 on 127 neonates with sepsis diagnosed clinically and they were admitted in AL-Kadhthimyia Teaching Hospital ,they ere divided into two groups according to the time of appearance of the disease which were early onset sepsis and late onset sepsis. blood was taken from them and send for culture. The most common clinical presentation in early lethargy ,and respectively late


Introduction
Neonatal sepsis is a significant cause of neonatal morbidity and mortality in the newborns particularly in preterm and low birth weight infants.(1)The frequency of neonatal bacterial infection range from 1-5 per 1000 live birth .(2)The epidemiological data from developing countries shows important difference in the incidence ,risk factors, causative microorganisms and antimicrobial sensitivities of pathogens and mortality rate from that of developing countries. (3,4)group Bstreptococcal disease is the most important cause of neonatal sepsis in Europe and north America,(5)but there is preponderance of gram negative organisms in tropical and developing countries. (6) The clinical presentations are non specific in both early and late neonatal sepsis including poor feeding, lethargy ,temperature instability, respiratory distress, seizures and abdominal distention. (7)This study was conducted to determine the clinical presentations, bacteriological profile and mortality rate in neonates admitted in Al-Kadhimiyia teaching hospital in Baghdad with clinical diagnosis of sepsis.

Materials and Methods
This study includes 127 case of neonatal sepsis, admitted to Pediatric department of Al-Kadhimiyia Teaching hospital during the period between 14th of February 2009 to 25thof February 2010,diagnosis of neonatal sepsis was clinical depending on the signs and symptoms including poor feeding, lethargy, temperature instability, respiratory distress , abdominal distention and seizures. Early onset sepsis(EOS) was considered when the onset of symptoms was before one week of life and late neonatal sepsis (LOS) was considered in cases present after one week of life. Blood samples were collected from all the cases for culture and sensitivity studies. CRP was not available at laboratory all the time so it was not included in our study.

Results
A total of 127 newborn with clinical sepsis were evaluated, blood culture reports were +ve in 87 (89.76%) of the cases, males were affected more than females (59.84% and 40.16% respectively) ,as shown in table 1.

Discussion
For the effective management of neonatal sepsis , knowledge about bacteriological profile play a vital role ,in this study we found that EOS was more common than LOS which is similar to other reports. (8,9) Males are affected more than females as documented by other studies. (9,10,11) The international criteria for the diagnosis of sepsis include lethargy, no sucking, respiratory rate>60, grunting, fever, convulsion and abdominal distention, (5) in this study there is no statistically significant difference in the clinical presentation between , EOS and LOS ,as the P values > 0.05 except in fever where there is statistical difference as the P value is < 0.05. In this study blood culture is +ve in( 89.76%) , -ve blood culture (10.34%) could be due to administration of antibiotic before blood collection or may be due to infection by anaerobes, negative blood culture dose not exclude sepsis and this finding is comparable to other reports (10,11,12), where about 26-30%of all neonatal sepsis caused by anaerobes.
In this study there is no significant statistical difference regarding the etiological organism between EOS and LOS as the P value is > 0.05,except in Enterobacteria the statistical difference is significant as the P value is < 0.05 . In our study the predominant organism isolated from blood culture is staph . aureus, which is in agreement with other reports. (13,14)In Europe and north America group B streptococci is the most common organism. (5) In this study Enterobacteria is the predominant gram -ve organism in both EOS and LOS, the report of the National Neonatal -Perinatal showed Klebsiella as the predominant gram -ve pathogen. (15)A study in Nepal showed that Enterobacteria as well as Klebsiella as the predominant gram -ve agents. (16) Mortality rate is 29.92%,and in males the mortality rate is much higher than in females (63.16% , 36.84% respectively), these results are similar to that found by other studies in Karatchi and in Taiwan, (17,18) while a study in Italy shows a mortality rate of 6% only.

Conclusion
Thus it is concluded that Staph. aureus and Enterobacteria are the leading cause of sepsis in both early and late onset groups, while staph.epidermidis was more common in EOS and E.coli was more common in LOS and the mortality rate were more in male and premature neonate .