Epidemiological, Clinical, and Microbiological Aspects in Newborns with Neonatal Infection (Sepsis and Unspecified Neonatal Infection) Treated at the Department of Neonatology of the Lithuanian University of Health Sciences During 2007-2013

Abstract

NTRODUCTION Neonatal infection (NI) is a worldwide problem – according to the World Health Organization (WHO), infections are the major cause of neonatal deaths worldwide (36%). About 8 out of 1,000 live-born neonates are diagnosed with NI, 1 to 3 newborns are diagnosed with early-onset neonatal sepsis (EONS), and even more neonates (1 to 5) are diagnosed with late-onset neonatal sepsis (LONS). About 5% to 60% of newborns who have received antibiotics to treat NI suddenly die. AIM The aim of this study was to analyze the incidence, epidemiology, causative agents, and clinical manifestations of neonatal sepsis (NS) and unspeci9ed neonatal infection (UNI) among newborns treated at the Department of Neonatology of the Lithuanian University of Health Sciences during 2007-2013. METHODS In total, 631 medical histories of newborns diagnosed with NS or UNI and treated at the Clinical Department of Neonatology of the Lithuanian University of Health Sciences during 2007-2013 were analyzed in retrospect. The data were analyzed using the statistical software IBM® SPSS® statistics 20.0; 95% con9dence intervals were calculated (p < 0.05). RESULTS The incidence of NS and UNI in Lithuania is 25 out of 1,000 live-born neonates (2.6%). The incidence of NS is 0.8%, and the incidence of UNI – 1.8%. In the study, the percentage of newborns diagnosed with NS in the group of newborns with ≤ 32 weeks of gestation was 39.8%, in those with 33 to 36 weeks of gestation – 38.8%, and in those with ≥ 37 weeks – 24.9%. Concerning birth weight, 46.3% of newborns weighing ≤ 1,500 had NS, and 26.9% of newborns weighing ≥ 2,500 grams had NS. The most common pathogens for EONS were group B Streptococcus (12%) and E. coli (10%), while for LONS – group B Streptococcus (32%) and S. aureus (22%). The incidence of NS and UNI were higher in neonates born via vaginal delivery than in those born via Cesarean section. The majority of the newborns with NS had normal body temperature. Newborns diagnosed with NS had higher temperature than those who were diagnosed with UNI. The mortality rates in newborns with NI were 1.4 out of 1,000 live-born neonates. More newborns with NS and UNI were registered during 2007-2009 than during 2010-2013, and the mortality rates were higher as well. CONCLUSIONS More cases of NS and UNI were registered during the period of 2007-2009 than during 2010-2013, the mortality rates were higher as well, (p < 0.05). Early neonatal infection (NS and UNI) was more common in newborns with birth weight ≥ 2,500 g, (p < 0.05). The most common pathogens for EONS were group B Streptococcus, E. coli, and S. aureus, while the most common pathogens for LONS – group B Streptococcus, S. aureus, and coagulasenegative staphylococci (p < 0.05).