Late onset neonatal sepsis in very low birth weight premature infants in the neonatal high care unit, Pelonomi Hospital, Bloemfontein: a cohort study
Pienaar, Michael A.
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Background: Late onset neonatal sepsis (LOS) is a common problem in very low birth weight (VLBW) infants and is associated with increased mortality, morbidity and cost of care. Several known risk factors are reported in the literature, which may be maternal, host or healthcare related. Hygiene practices, overcrowding, staffing and healthcare interventions all play a role in the risk of LOS. Pelonomi Neonatal High Care is a 32-bed regional neonatal unit. The study period was from September 2015 to March 2016. Methods: This was a prospective cohort study. Study Population: All VLBW infants with birth weight between 1000g and 1499g excluding those referred to tertiary centers and those born with major congenital abnormalities were enrolled and followed up to 28 days of life. Results: 117 infants were included. 43,6% of infants had at least one episode of LOS (incidence 435 per 1000 births per annum). There was a higher incidence of gram-negative (31%) and fungal infections (17%) than reported elsewhere. The use of invasive ventilation, nasal CPAP, nasal prong oxygen and surfactant were significantly associated with LOS as was increased duration of umbilical venous catheterisation. Longer periods to the initiation of feeding and the use of cefotaxime increased the risk of LOS. Breastfeeding appears to confer protection against LOS. Exposure to human immunonvirus and high maternal viral load may be a risk factor for LOS. LOS was present in 40% of deaths beyond 72hours of life and 10% of infants with LOS died. LOS was associated with increased morbidity in the form of increased length of stay, longer duration to full enteral feeding, longer duration of parenteral nutrition and increased necrotising enterocolitis. Only 50% of the infants received antenatal steroid therapy and 96.5% of infants experienced some degree of hypothermia. The unit was persistently overcrowded and key consumables for hand hygiene were frequently unavailable. Due to the persistence of overcrowding and the short duration of the study period a statistical relationship with LOS could not be proven. Conclusion: LOS was significantly more frequent in this study population than reported in the literature with serious consequences for patients. Many identified risk factors are associated with routine practices in the care of VLBW infants in this unit. The unit was persistently overcrowded and there were several barriers to appropriate hand hygiene. Several factors such as role of genetic factors and HIV require investigation.
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