تظاهرات بالینی و مرگ و میر در نوزادان مبتلا به سپتی سمی در مرکز طبی کودکان

Background: To identify the clinical manifestations and mortality rate among neonates with early- and late-onset sepsis.Methods: We retrospectively reviewed the hospital records in Children’s Hospital Medical Center, Tehran University of Medical Sciences of 104 neonates (50 females and 54 males) diagnosed with septicemia and treated from September 1994 to August 1995. Diagnosis of septicemia was based on standard criteria. According to the time of onset of disease, there were 50 neonate with early-onset and 54 with late-onset septicemia. Results: Of the clinical signs in the 104 patients, respiratory signs were found in 31 patients, poor feeding in 57, jaundice in 42, apnea in 25 and hyporeflexia in 25. Blood cultures were positive in 31 (34.8%) of the neonates: the most common species isolated was Staphylococcus aureus with eight cases, while five had Staphylococcus epidermidis, all of whom had a single species of bacterium isolated. Seventy-three (70%) had normal birth weights (equal to or heavier than 2500 g) and 31 (30%) were classified as low birth weight (birth weight less than 2500 g). Cerebrospinal fluid culture was positive in four (6%) of the patients, including one case of Escherichia coli, one Salmonella typhi, one Klebsiella, and one Staphylococcus aureus. The frequency of infection in male and female infants was 53% and 47%, respectively. Among the infants with early-onset sepsis, 16 (32%) were low birth weight. Overall, the mortality rate among these patients was 30%, including 18 out of the 50 with early onset and 14 out of the 54 with late onset sepsis. Of these infants, 23 had meningitis, including 13 (26%) with early-onset sepsis and 10 (9.6%) with late-onset sepsis. Among the low birth weight infants, the mortality rate was higher (42%) than that of the infants with normal birth weight (26%). Conclusion: Because of the high mortality rate among low birth weight neonates with sepsis, we suggest that this group of patients should receive more care and there should be greater effort to ensure that they are treated with the appropriate antibiotics. Furthermore, all healthcare givers responsible for the management of neonates with sepsis should receive additional continuing education courses to ensure that they are aware of the risks, complications and mortality rate among these patients.