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The National Neonatology Forum (NNF) set up a multi-center network of institutions in 1994 to collect and pool data on newborn morbidity and mortality. This database, the National Neonatal-Perinatal Database (NNPD), encompasses intramural births at the participating centers and employs a uniform protocol incorporating standard definitions( 1). Important excerpts of the 1995 report of the NNPD were published earlier in the Journal(2). This communication focuses on antimicrobial sensitivity of the organisms causing neonatal sepsis, and the primary causes of neonatal deaths and stil1 births. The methodology of the database has been described earlier(2). The cohort of 38,592 births (37082 live births, 1510 still births) was enrolled from 16 centers during the year 1995. The investigators cum authors and the participating centers are listed in Annexure l.
Organisms Causing Neonatal Sepsis and Their Antimicrobial Sensitivity
A total of 996 organism were cultured from blood or CSF. These included: Klebsiella pneumoniae (299, 30.0%), Staphylococcus aureus (130, 13.0%), Escherichia coli (121, 12.2%), Pseudomonas sp. (87, 8.7%), Enterobacter sp. (66, 6.6%), Staphylococcus albus (67, 6.7%), Acinetobacter sp. (84, 8.4%), Streptococcus viridans (12, 1.2%), Candida sp. (45,4.5%), Group B streptococcus
(3, 0.3%) and others (82, 8.2%). The antibiotic sensitivity of the major organisms is depicted in Table I. Most of the S. aureus and S. albus strains were resistant to penicillin, while aminoglycosides appeared to be a better choice for them. Over two thirds of E. coli strains were sensitive to gentamicin and amikacin. Among K. pneumoniae strains, over 60% were resistant to gentamicin, while almost 40% were resistant to amikacin. Enterobacter sensitivity data exhibited even more frequent resistence to gentamicin and other antibiotics. For Pseudomonas sp., amikacin, ceftriaxone and ceftazidime emerged as useful antibiotics. Other salient findings were: (i) ampicillin
had a very poor coverage of organisms causing neonatal sepsis; (ii) cefotaxime covered E. coli and K. pneumoniae to a moderate extent only (40.9% and 37.8%, respectively), (iii) ciprotloxacin had a good coverage of S. aureus and E. coli, and was effective in over half of the Kelbsiella strains tested, and (iv) Netilmicin was, in general, inferior to amikacin.
TABLE 1
Antibiotic Sensitivity of Major Organisms (in Each Case, the Numerator is
the Number of Sensitive Organisms. The Denominator is the Total
Number of Organisms Which Were Actually Tested for a Given Antibiotic)
|
|
Sensitivity (%)
|
|
S.aureus |
S. albus |
E.coli |
Klebsiella |
Enterobacter |
Pseudomonas |
|
Penicillin |
8/61(13.1) |
9/31(29.0) |
2/27(7.4) |
7/41(17.0) |
1/9(19.0) |
0/14(0) |
|
Ampicillin |
16/53 (30.2) |
8/37(21.6) |
18/58(31.0) |
221167(13.2) |
1/25(4.0) |
0/30(0) |
|
Cloxacillin |
23/48 (47.9) |
4/33(12.1) |
0/8(0) |
4/46(8.7)
|
2/9(22.2) |
0/6(0) |
|
Gentamicin |
55/83 (66.3) |
14/24(58.3) |
42/69(67.7) |
61/160(38.1) |
5/26(19.2) |
14/36(38.9) |
|
Amikacin |
25/34 (73.5) |
12120(60.0) |
46/62(74.1) |
91/152(59.8) |
19/26(57.6) |
23/31(74.2) |
|
Netilmicin |
40/51 (78.4) |
6/10(60.0) |
26/42(61.9) |
50/105(47.6) |
7/20 (35.0) |
14/22(63.6) |
|
Cefazolin |
7/13 (53.8) |
1/6(16.7) |
1/10(10.0) |
10/41(24.3) |
1116(6.2) |
0/4(0) |
|
Cephexin |
17/33 (51.5) |
14/20(70.0) |
6/20(30.0) |
12164(18.7) |
3/18 (16.7) |
2/5(40.0) |
|
Cefotaxime |
34/59 (57.6) |
23/28(82.1) |
9/22(40.9) |
36/95(37.8) |
4/25 (16.0) |
9/16(56.2) |
|
Ceftriaxone |
2/8 (25.0) |
31/37(83.7) |
6/11(54.5) |
14/58(24.1) |
1/11(9.0)
|
13/16(81.2) |
|
Ceftazidime |
5/11 (45.4) |
2116(12.5) |
4/11(36.3) |
19169(27.5) |
3/26(11.5) |
13/16(81.2) |
|
Piperacillin |
717 (100.0) |
16/27(59.2) |
3/8(37.5) |
6/44(13.6) |
3/13(23.0) |
2/5(40.0) |
|
Vancomycin |
10/13 (76.9) |
5110(50.0) |
1/6(16.7) |
9/38(23.7) |
3/10(30.0) |
1/4 25.0) |
|
Ciprofloxacin |
74/99(74.7) |
22/37(59.4) |
22/32(68.7) |
57/118(48.3) |
3/20(15.0) |
12119(63.1) |
Figures in parentheses represent percentages
Overall, antimicrobial resistance in K. pneumoniae and Enterobacter sp. emerged as a major problem.
Primary Causes of Neonatal Deaths
There were 1,400 neonatal deaths. The primary cause of neonatal
deaths were presented in the previous communication(2). The regrouped data according to the four basic categories of causes namely, immaturity, hypoxia, infection and malformation accounted for 31 %,26%, 22% and 10% neonatal deaths, respectively.
Primary Causes of Still Births
A total of 1,460 still births were reported
during 1995 in the participating centers. Of them, 562 (38.5%) were macerated and 898 (61.5%) were fresh. There were 1042 (71.4%) low birth weight and 815 (55.8%) preterm fetuses. The primary causes of still births were as follows: asphyxia (484, 33.1 %), trauma (33, 2.3%) malformation (144, 9.9%), infection (49, 3.6%) and others (170, 11.6%). No definite cause could be established in 580 (39.7%) still births.
Therapy in Neonates
Antibiotics and oxygen were the commonest modalities of the treatment instituted in the neonates (Table Il).
TABLE II
Therapy in Neonates (n=37082).
|
Modality |
Number |
Percent |
|
Antibiotics |
3511 |
9.5 |
|
Oxygen |
3014 |
8.1 |
|
Assisted ventilation |
810 |
2.2 |
|
Blood/plasma transfusion |
633 |
1.7 |
|
Phototherapy |
2063 |
5.6 |
|
Exchange transfusion |
513 |
1.4 |
|
Parenteral nutrition |
354 |
0.9 |
|
Surgery |
151 |
0.4 |
Annexure 1
Investigators-cum-Authors and the Participating Centers
Sheth PN, Verma RS, (Bombay Hospital, Bombay); Sen A, Dasgupta S, Lahiri A (lPGMER, SSKM Hospital Calcutta); Vani S, Shah B (Civil Hospital BJMC, Ahmedabad); Gandhi D, Aiyer S, Nayak U (SSG Hospital, Baroda); Jain S, Kher A (Choithram Hospital, Indore); Verma M, Chacko B (Christian Medi- cal College, Ludhiana); Behal L, Grover N (I.G. Medical College, Shimla); Narang A, Bhakoo ON (POIMER, Chandigarh); Maiya PP (M.S. Ramaiah Medical College, Bangalore); Bhat SR (St. John's Medical College, Bangalore),
Shenoy A, Karthik NN (Manipal Hospital, Ban- galore); Bhat BV, Shuba S (llPMER, Pondicherry); Jayam S (Government Kasturba Gandhi Hospital, Madras); Irani SF (KEM Hospital, Bombay); Thirupuram S, Ramji S (LN Hospital, New Delhi); Deorari AK, Paul VK (All India Institute of Medical Sciences, New Delhi). Nodal Center: Singh M, Paul VK (Faculty); Sekharan NG, Kailash S, Narang R (Data System); Sehrawat S, Tandon R, Bhutani A (Secretariat).
Note: The above list of faculty investigators and authors also applies to the earlier publication on the Report in the Indian Pediatrics(2).
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