NEONATAL INFECTION RISK
Martin
Fernández-Mayoralas D: and Martin Caballero JM.-
Pediatric Departament, Neonatology
Service.Virgen de la Arrixaca Hospital. Murcia, Spain.
AIM.-I try to quantify, in
our medium, the neonatal infection, risk and its prevention, according to
certain obstetric-perinatal precedents.
MATERIAL AND METHODS.- A prospective study,
during two years, in 1000 newborns (NB), coming to our Service in the first day
of life, is been carried out. The patients precedents are valuated
("risk"): a) amniorrexis: >24 hours (A>24), b) abnormal colour
amniotic fluid (AAF). c) maternal infection either amniotitis (MIA). d)
delivery instrumentation or cesarean (Dl). e) fetal suffering (FS). f) Apgar
test: <7 (A<7) at one minute time. The clinical-analitical infection
suspicion (IS) in the newborns is determined in the first day of life, and an
antibioticotherapy (betalactamic + aminoglucoside agents) is set up. In the
remainder NB with the mentioned precedents (with no IS), the same
antibioticotherapy is set up in one over two-four NB (randomized for the
different risk types). The different diagnosed infections (DI), developed in
the first week of life are shown and the differentes percentages of infection
for previous risk and antibioticotherapy groups (AA: yes; no AA:
no) are stablished. Statistic method:
square-Chi test (NS: non-significative differences) RESULTS are shown in
the following table:
|
|
N |
Dl |
% |
P |
AA |
01 |
% |
NOAA |
01 |
% |
P |
|
NB IS NolS |
1000 64 936 |
111 40 71 |
11 62 8 |
<.01 |
|
|
|
|
|
|
|
|
A>24 A<24 |
253 747 |
46 66 |
18 9 |
<.01 |
65 |
8 |
12 |
165 |
18 |
11 |
NS |
|
AAF No |
370 630 |
51 60 |
14 10 |
<.05 |
109 |
15 |
14 |
234 |
23 |
10 |
NS |
|
MIA No |
140 860 |
26 85 |
19 9 |
<.01 |
42 |
4 |
9 |
77 |
8 |
10 |
NS |
|
Dl No |
261 739 |
24 87 |
9 12 |
NS |
56 |
6 |
11 |
187 |
10 |
5 |
NS |
|
FS No |
150 850 |
16 95 |
11 11 |
NS |
60 |
5 |
8 |
78 |
5 |
6 |
NS |
|
A<7 A>7 |
298 702 |
33 78 |
11 11 |
NS |
111 |
11 |
10 |
164 |
9 |
5 |
NS |
CONCLUSIONS I found out in our patients: 1) the
qualification of "Infection suspicion" in the first day of life has a
good predictive value of infection in the first week of life.
2) delivery instrumentation, fetal
suffering and Apgar-test <7 at one minute-time, do not seem to result in a
higher incidence of neonatal infection in the first week of life; to the
contrary, it does so the amniorrexis >24 hours, the abnormal amniotic fluid
colour and the maternal infection-amnionitis.
3) the newborns without infection
suspicion in the first 24 hours of life. have a slightly superior percentage of
infection in the first week of life, when prophylactic antibioticotherapy is
set up (with no statistical significance).