Antibiotic treatment in preterm babies born before arrival (bba) at Kenyatta National Hospital.
Neonatal Septicaemia has been a subject of periodic reviews in many parts of the world. An incidence of 1/1000 to 3/1000 live births has been reported in developed countries, compared to 4/1000 to 9/1000 reported in Africa (1,2,3,4). Preponderance of higher sepsis rate in BBAs has been found in some studies (10,11,12), but other studies have not shown BBAs to be at a higher risk of infection (18,19). Since in the absence of predisposing factors to sepsis it is unusual for an infant to develop early onset sepsis after an uneventful pregnancy and delivery, it was the aim of this study to determine if there was benefit in treating all Preterm BBAs as potentially infected at admission in the absence of such factors. The diagnosis of septicaemia was based on clinical grounds together with a positive blood culture and suggestive haematologic parameters. Infants who developed jaundice, fever respiratory difficulties, irritability, lethargy and diarrhoea were investigated. Blood cultures were obtained from a peripheral vein after aseptic preparation to the skin to minimize contamination by skin flora. The infants were evaluated radiologically when this was indicated. The initial treatment for the Cases and any baby in the Control group who showed signs of sepsis included a combination of crystalline penicillin and gentamicin in two divided doses. The antibiotics were altered accordingly depending on the organisms and their pattern of antibiotic sensitivity when this became available. The present study showed an overall prevalence of infection of 37% in all preterms entered into the study, 33% in BBAs who were treated with routine antibiotics, 40% in BBAs who were not started on antibiotics at admission and 37 % in babies who were born in the KNHLabour Ward. In all the three groups, gram-negative organisms were the highest isolates with Klebsiella being the leading isolate. The only gram-positive isolate was coagulase negative staphylococcus, which showed high resistance to penicillin (100%), with moderate sensitivity to erythromycin (70%). The gram-negative organisms showed good sensitivity (80-100%) to gentamicin and other aminoglycosides and cephalosporins. In conclusion, there was no significant difference in sepsis rate, bacterial isolates and sensitivity to antibiotics in the three groups and therefore routine antibiotics should be discouraged in all preterm BBAs and treatment instituted for only those with suspected sepsis considering perinatal, natal and other risk factors for sepsis. An aminoglycoside and a cephalosporin should be the drugs of choice in a neonate with suspected sepsis while awaiting culture and sensitivity results.