study of birth-canal bacterial colonization in relation to early-onset neonatal sepsis in full-term infants

Summary and conclusionBacterial vaginosis is considered one of the most common lower genital tract infection among women in childbearing period recording an incidence about 15 % to 20 %.The complications of bacterial vaginosis are numerous. The most important of which is premature rupture of fetal membranes and preterm labour. It is responsible for about 60 % of those cases with premature rupture of membranes.Neonatal sepsis, one of neonatal complications of premature rupture of membranes, is still a major cause of morbidity and mortality in neonatal units with high incidence in developing countries about 5.6 per 1000 live births.The aim of the present study was to determine the sources and prevalence of the causative organisms causing early onset neonatal septicemia in full term neonates delivered vaginally and its relation to birth canal bacterial colonization.This study was carried on 100 pregnant women and their neonates who have the following criteria; full term (> 37 weeks gestational age), delivered vaginally, free of congenital anomalies and signs of congenital infections and their mothers. In addition to 200 pregnant women full term with intact membrane as a control group for mothers with PROM.All studied cases both neonates and their mothers were subjected to full history and clinical examinations. The predominant risk factors of the mothers were multiple vaginal examinations, premature rupture of membranes more than 18 hours and maternal intrapartum fever more than 38.5?C.High vaginal swabs were taken from all mothers. Also, surface swabs from the body of all studied neonates were taken from nose and umbilicus as well as swabs from the suction set used in their care.The neonates were prospectively followed up in the first week of life for clinical evidences of sepsis e.g. the most important of which were poor feeding, respiratory problems, lethargy and diarrhea. The septicemic neonates were investigated by blood culture.Our results showed that out of the hundred (100) studied neonates, 24 cases were suspected clinically to be septicemic. Only 7 cases of those neonates had positive blood cultures.The septic group included 7 neonates with 4 males and 3 females. Their mean gestational age 37.7 ± 1.1 weeks and their mean body weight 3.1 ± 0.25 kg.The most common organisms detected in blood cultures were Staphylococcus aureus (42.85%), Enterobacter species (28.6%), GB streptococci species (14.3 %) and klebsiella (14.3%).There was higher matching between results of high vaginal swabs and blood cultures results in 4 cases (57.1%) of those 7 septic neonates. The other 3 cases (42.9%) had the same organism isolated from the suction set. A difference which was statistically significant.So, we can conclude that vertical transmission of pathogenic organisms colonizing the birth canal and the early nosocomial infection with pathogens in the equipments dealing with neonates are the most important sources of pathogens responsible for early onset neonatal septicemia.RecommendationsAccording to the results obtained in the present stu