Detection of Extended Spectrum β-Lactamases (ESBL) Producing Bacteria in Sepsis Suspected Neonates

Introduction: Neonatal sepsis is a clinical syndrome that is caused when the bloodstream of an infant is invaded by bacteria in the first month after birth. Objective: The objective of the study was to identify bacteria involved in the infection and to determine “extended-spectrum beta-lactamase” (ESBL) producing bacteria from blood samples of sepsis suspected neonates in the Neonatal Intensive Care Unit and Special Care Baby Unit. Methods: This cross-sectional study was conducted from January to July 2019 at Microbiology laboratory of Paropakar Maternity and Women’s Hospital. A total of 380 venous blood specimens were included in the study. The blood culture was performed and organisms were identified with standard microbiological methods. The Antibiotic susceptibility test was performed using the modified Kirby Bauer disk diffusion method. Screening of the organisms was done using cefotaxime and ceftazidime antibiotic disc and confirmation of ESBL was done by combined disk test. The data were considered statistically significant if the p-value was < 0.05. Results: Out of a total of 380 blood specimens, the prevalence of neonatal sepsis was found to be 21.05% among which 57.5% were EOS type and 42.5% were LOS type. In EOS, E. coli (72.73%) was the predominant isolate while CoNS (100%) was the predominant isolate in LOS. Of the total 80 isolates, 65% isolates were found multidrug-resistant (MDR) whereas 58.75% of isolates were found to be ESBL producers. Conclusions: This study concludes that routine bacterial surveillance and study of their resistance patterns is an essential component of the neonatal care unit. Keywords: Extended-spectrum β-Lactamases; neonates; neonate intensive care unit; special care baby unit; sepsis.

Rhesus Negative Pregnancy: Prevalence and Foetomaternal Outcomes in a Tertiary Hospital, South-South Nigeria

Rhesus incompatibility can pose a problem in pregnancy and cause obstetric failure in a handful of women. The Rhesus factor is a red blood cell surface antigen; and there are many antigen subtypes that make up the Rhesus blood group systems, of which the most commonly involved and most immunogenically associated with Rhesus isoimmunisation is the D antigen. The objective of this study is to determine the prevalence of Rhesus negativity and the foetomaternal outcomes at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. This was a 5-year retrospective study conducted between 1st January, 2016 and 31st December, 2020 at our Obstetric Unit. Data were retrieved, entered into a pre-designed preformed and analyzed using SPSS version 25.0. Results were presented as mean and standard deviation for continuous variables and frequencies or percentages for categorical variables. Of the 4,571 pregnant women, 104 were Rhesus negative, giving a rate of 2.27%. The most common blood group among the women (53.8%) and their partners (84.6%) was the O blood group. Only 2 (1.9%) women were sensitised. Out of the 104 Rhesus negative women, 81 were unsensitised (77.9%) and received anti-D immunoglobulin. Majority of the babies had a good outcome, though 19 (18.2%) of them were admitted into the special care baby unit for various conditions. The incidence of Rhesus negative pregnancy in our study was 2.27%, and 1.9% of the women were sensitised. Prompt administration of anti-D immunoglobulin after sensitising events and post-delivery is key in the prevention of Rhesus isoimmunisation.

To Determine the Frequency of Congenital Heart Disease in Infants of Diabetic Mothers

Aim: To determine the frequency of Congenital Heart Disease in infants of diabetic mother. Methodology: Cross sectional (Descriptive) study conducted in the Department of Pediatrics Special Care Baby Unit (SCBU) Khyber Teaching Hospital Peshawar from 15-04-2015 to 15-10-2015. The sample size was150 patients, using 52.5% incidence of CHD in IDM and 95% confidence interval with 8% margin of error under WHO software Results: This study was carried out on 150 patients at the Department of Pediatrics, Khyber Teaching Hospital Peshawar. CHD was detected in 79 (52.7%) patients while in 71 (47.33%) patients, CHD was not detected. Conclusion: Our study concluded moderate prevalence of Congenital Heart Disease in infants born to diabetic mothers. Keywords: Diabetes mellitus, Pregnancy, Newborn, Heart defects

Neonatal morbidity and mortality: A 5-year analysis at federal medical centre, Gusau, Zamfara State, Northwest Nigeria

Objectives: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. Material and Methods: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). Results: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. Conclusion: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.

COVID-19 Infection in a 8 Day Old Neonate: Report of the 1st Case in a Term Neonate in Special Care Baby Unit (SCABU) at Dhaka Shishu (Children) Hospital

not available DS (Child) H J 2020; 36(2): 163-165

Pattern of Blood Transfusion in the Special Care Baby Unit of Benue State University Teaching Hospital in Makurdi North-Central Nigeria

Blood transfusion is a life-saving procedure in which whole blood or parts of blood are introduced into a patient's bloodstream intravenously. The need maybe due to physiological or pathological causes. The objective of this study was to document the pattern and indications for blood transfusion at the Special Care Baby Unit of the Benue State University Teaching Hospital (BSUTH), Makurdi. This study was a retrospective review of 126 neonates who received blood transfusion at the Special care baby unit of BSUTH from 1st January 2015 to 31st December 2019. Data was retrieved from patient's medical records and analyzed using IBM SPSS version 23. A total of 1142 neonates were admitted over the study period and 126 had blood transfusion giving a prevalence of 11.0%. Male/Female ratio of 1.57:1.Mean (±SD) Birth weight and gestational age (GA) were 2.23±0.82Kg and 35.48 ±3.95 weeks respectively. Exchange blood transfusion was the most frequent 53(42.1%) type of blood transfusion. The most common indications for blood transfusion were anaemia of prematurity, sepsis and severe neonatal jaundice. A hundred and twelve (88.9%) who received transfusion were discharged while 4(3.2%) died. The rate of blood transfusion was low, while severe neonatal jaundice and anaemia were the main indications for blood transfusion in this study. Exchange blood transfusion was the main type of transfusion.

Severe Perinatal Asphyxia and Risk of Neonatal Jaundice at a Tertiary Hospital in Northern Nigeria

Background: The risk factors of neonatal jaundice are largely known, yet there is little agreement on the association between it and perinatal asphyxia. Aim: To investigate the association between severe perinatal asphyxia (SPA) and the risk of clinical jaundice (NNJ) among neonates managed at the Federal Medical Centre, Azare, Nigeria. Methodology: Case control design was employed. Medical records of 315 babies managed at the special care baby unit from 1st January, 2011 to 31st December, 2018 were analysed. The exposure of interest was SPA and the outcome was jaundice. Logistic regression was applied to demonstrate the relationship between neonatal jaundice and SPA. Relative risk was provided as odds ratio and 95% confidence interval. Results: Sixty-three cases and 252 controls were enrolled in the study. The mean age of the cases (4.39) and that of the controls (4.95 ) did not differ significantly (t= -0.52, P= 0.30). One hundred and fifty-six (61.9%) of the controls were males while 34 (54.0%) of the cases were females. For 59 (93.7%) of the cases treatment for jaundice was done with phototherapy and 1.6% required exchange blood transfusion. SPA significantly reduced the risk of developing NNJ (adjusted OR = 0.27, P-value ˂ 0.01). Conclusion: We demonstrated a significantly reduced risk of developing neonatal jaundice with prior exposure to severe perinatal asphyxia. Prospective multicenter and community based studies correlated with serum bilirubin levels are recommended.

Indoor Air and Surface Fungal Contamination in the Special Care Baby Unit of a Tertiary Hospital in Jos, Nigeria

Fungi frequently contaminate the indoor air as well as surfaces of hospital equipment and furniture. This pose a significant risk for neonates in the Special Care Baby Unit. This study aimed to determine the rate of fungal contamination of indoor air and surfaces of the special care baby unit of a tertiary health facility in Jos, Nigeria. The study was carried out at the special care baby unit of the Jos University Teaching Hospital. Indoor air samples were obtained using sedimentation method whereas samples from surfaces were collected using sterile pre-moistened cotton tipped swab sticks. The swab sticks were inoculated onto sabouraud dextrose agar plates which were incubated along with indoor air culture plates for seven days. Univariate analysis was carried out using STATA (version 14IC). Fungal contamination rate of the special care baby unit was 20.2%. Aspergillus species (29.6%) was the most predominant fungus isolated. Most of the fungi were isolated from the outborn term and outborn preterm rooms of the special care baby unit. The fungi isolated include Aspergillus spp, Candida spp, Penicillium spp, Cladosporium spp, Curvularia spp, Fusarium spp, Paecillomyces spp, Alternatia spp, and Rhodotorulla spp. Fungi are a major cause of indoor air as well as surface contamination in special care baby unit of the hospital. Routine cleaning and disinfection will lead to a reduction in the fungal load.

Bacteriology and Antibiotic Susceptibility Patterns among Neonates Diagnosed of Omphalitis at a Tertiary Special Care Baby Unit in Western Uganda

Background. Newborn infections remain a major cause of morbidity and mortality among neonates in low-income countries. Clinical diagnosis for omphalitis in such settings is possible but this does not depict the microbiological characteristics of the involved organisms, and clinicians have often prescribed empirical antibiotics in neonates with omphalitis, despite an increasing burden of antibiotic resistance. Methods. A hospital-based cross-sectional study was conducted to evaluate the bacteriology and antibiotic susceptibility patterns among neonates diagnosed with omphalitis at the special care baby unit (SCBU) of Kampala International University-Teaching Hospital (KIU-TH), western Uganda from March to June 2019. Sixty-five (65) neonates with a clinical diagnosis of omphalitis were consecutively recruited in the study. Cord swabs were taken under sterile (aseptic) precautions from all neonates, and antibiotic susceptibility tests performed using the Kirby Bauer disk diffusion technique with commercially available antibiotics disks of ampicillin, cloxacillin, gentamicin, amikacin, cefotaxime, ceftriaxone, vancomycin, and imipenem on Mueller Hinton agar plates. The data was analyzed using STATA version 13.0, frequencies and proportions used to describe the variables. Results. Fifty-five, 55 (84.6%), neonates with suspected omphalitis had positive cord swab culture. Staphylococcal aureus (58.2%) was the commonest cause of omphalitis followed by Neisseria spp (16.4%), E. coli 6 (10.9%), Proteus spp (5.5%), Klebsiella spp (3.6%), Citrobacter spp (3.6%), and Haemophilus spp (1.8%) in decreasing frequency. Isolates were resistant to ampicillin (87.7%), gentamicin (54.4%), and cloxacillin (34.4%), the drugs recommended for use in neonates with suspected omphalitis. Conclusions. Staphylococcal aureus is still the predominant cause of omphalitis among neonates. There was high resistance to the commonly used antibiotics in the treatment of omphalitis among newborns. This study reemphasizes that clinicians should do cord swabbing for both culture and susceptibility tests among newborns with suspected omphalitis before initiation of antibiotics.