Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan

  • Muhammad Matloob Alam Aga Khan University, Karachi, Pakistan
  • Ali Faisal Saleem Aga Khan University, Karachi, Pakistan
  • Abdul Sattar Shaikh Aga Khan University, Karachi, Pakistan
  • Owais Munir Aga Khan University, Karachi, Pakistan
  • Maqbool Qadir Aga Khan University, Karachi, Pakistan
Keywords: neonatal sepsis, prolonged rupture of membranes, blood culture, prematurity

Abstract

Introduction: Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis (EONS), which is associated with increased neonatal morbidity and mortality. We reported the incidence and associated risk factors of PROM for culture-proven EONS.

Methodology:The medical records of all neonates born at Aga Khan University, Karachi over a period of five years (2007-2011) with PROM (> 18 hours) were reviewed. Data about maternal and neonatal risk factors for EONS was collected and adjusted logistic regression (AOR) analysis was applied.

Results:Incidence of PROM in this neonatal birth cohort was 27/1,000 live births. A total of 17 (4%) cases with blood-culture proven bacterial sepsis were identified within 72 hours of birth. Klebsiella pneumonia (n = 5; 29%) and Pseudomonas aeruginosa (n = 4; 24%) were the commonest isolates followed by group B Streptococcus (n = 3; 18%) and Escherichia coli (n = 2; 12%). Maternal fever (p = <0.001; AOR, 36.6), chorioamnionitis (p < 0.001; AOR, 4.1), PROM > 48 hr. (p < 0.001; AOR, 8.2), neonatal prematurity < 34 weeks (p < 0.001; AOR, 4.1) and low birth weight < 1,500 grams (p 0.001; AOR, 9.8) along with neonatal thrombocytopenia and raised CRP were found to be independent risk factors associated with culture-proven EONS in PROM.

Conclusions: Preventive measures should focus on recognition of these high-risk infants with prompt laboratory screening for sepsis and early institution of empirical antibiotic based on local data. Such approaches would be a safe and cost-effective strategy, especially in developing countries.

Author Biographies

Muhammad Matloob Alam, Aga Khan University, Karachi, Pakistan

Fellow Pediatric Hematology and Oncology

Department of Pediatrics and Child Health

Aga Khan University Hospital, Karachi, Pakistan

Ali Faisal Saleem, Aga Khan University, Karachi, Pakistan

Fellow Pediatric Infectious Diseases

Department of Pediatrics & Child Health,

Aga Khan University

Abdul Sattar Shaikh, Aga Khan University, Karachi, Pakistan

Fellow Pediatric Cardiology

Department of Pediatrics & Child Health,

Aga Khan University

Owais Munir, Aga Khan University, Karachi, Pakistan

Pediatric Resident

Department of Pediatrics & Child Health,

Aga Khan University

Maqbool Qadir, Aga Khan University, Karachi, Pakistan

Consultant Neonatologist

Associate professor

Department of Pediatrics & Child Health,

Aga Khan University

Published
2014-01-15
How to Cite
1.
Alam MM, Saleem AF, Shaikh AS, Munir O, Qadir M (2014) Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan. J Infect Dev Ctries 8:067-073. doi: 10.3855/jidc.3136
Section
Original Articles