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Identification of bacterial agentsand antimicrobial susceptibility of neonatal sepsis with patient,s outcome

Authors: Abdul-Kareem Mohammed Ali عبد الكريم محمد --- Lamia Abdul-Kareem لمى عبد الكريم --- Emad Japur Rashed عماد جبر رشيد
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 17 Pages: 148-161
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background : Sepsis neonataroum is an important factor for morbidity and mortality in neonates. The incidence of neonatal bacterial sepsis depends on geographic area and may vary from country to country as well as within the same country. Objective: To identify the percentage of neonatal septicemia confirmed by positive blood cultures among 664 neonates admitted in neonatal care unit, and to identify the bacterial agents causing early and late neonatal sepsis and their antimicrobial susceptibility, and the outcome from neonatal septicemia. Patients and methods: The total number of patients(with clinical signs and symptoms suggesting sepsis) collected from neonatal care unit of AL-Kadimiya Teaching hospital from the 1st of January to the end of october 2011 were 664 neonates, and only 105 neonates who show signs and symptoms suggestive of septicemia that were confirmed by a positive blood culture were enrolled in this study. Data were collected include :Gestational age, Birth weight , Gender, Onset of sepsis, Place of delivery and also we followed up the subjects and recorded the outcome till discharge. Results: In this prospective study and from 664 neonate were admitted (total number of admission), positive blood cultures were obtained for 105 neonates (15.8%). Gram negative bacteria were the commonest causative agent in both early (66.7%) and late (56.9%) onset sepsis. Among neonates with sepsis, 33 patients (31.4%) had early onset and 72 patient (68.6%) had late-onset neonatal sepsis. The susceptibility of the isolated causative agent to selected antibiotics were the same in early and late onset sepsis. Over 70% of gram negative bacilli were resistant to both ampicillin and cloxacillin but show variable sensitivity to gentamicine and cefotaxime. Most of the isolated gram positive bacteria were sensitive to ampicillin, cloxacillin and cefotaxime but highly resistant to gentamicin. The death rate was 20.9%. Early onset sepsis, male gender, gestational age less than 37 weeks and birth weight less than 2500 gm were found to be significantly associated with death. Conclusions: Gram negative bacteria were the main cause of early and late-onset neonatal sepsis in our center and many of these isolated bacteria were resistant to the used antibiotics. Low birth weight neonates <2500 gm, gestational age < 37weeks, male gender and early onset sepsis were significantly associated with death. The death rate due to neonatal sepsis was higher compared with the other studies. Recommendations: Proper antenatal care and optimal obstetric management in early detection and treatment of mothers at risks together with minimizing invasive procedures of infants as much as possible and ideal nursery setup which includes adequate space for care of infants and aseptic equipments for monitoring.

العفن الولادي هو سبب مهم من أسباب الوفيات للأطفال حديثي الولاده.أن نسبة حدوث العفن الولادي البكتيري تعتمد على المنطقه الجغرافيه وقد تختلف من بلد ألى بلد وأيظا في البلد الواحد.الهدف من الدراسه لمعرفة نسبة حدوث العفن الولادي , البكتيريا المسببه للعفن الولادي المبكر والمسببه للعفن الولادي المتأخر وأيضا معرفة مدى أستجابتها للمظادات الحيويه ومعرفة نسبة حدوث الوفيات الناتجه من العفن الولادي في وحدة حديثي الولاده. لقد تم جمع المرضى من وحده حديثي الولاده في مستشفى الكاظميه التعليمي للفتره من الاول من كانون الثاني الى نهاية تشرين الاول لسنة 2011 م. كل المرضى الدين أدخلوا الى وحدة حديثي الولاده والذين لديهم العلامات والاعراض التي تدل على العفن الولادي والتي تم تأكيدها بواسطة زرع الدم الموجب تم أدراجها في هده الدراسه. المعلومات التي جمعت تشمل:عمر الجنين عند الولاده , الوزن عند الولاده , جنس المولود , تأريخ حدوث العفن الولادي , مكان الولاده , وكدلك تم متابعة المرضى وتسجيل النتيجه النهائيه للمرض. في هذه الدراسه ومن 664 مريض تم أدخالهم, كانت نتيجة زرع الدم موجبه ل105 حاله (15,8%). البكتيريا السالبه لصبغة الكرام كانت اكثر انواع البكتيريا المسببه لكل من العفن الولادي المبكر(66,7%) والعفن الولادي المتأخر(56,9%). أن من بين هؤلاء المرضى كانت هناك 33 حاله (31,4%) من عفن الدم المبكر و 72 حاله (68,6%) من عفن الدم المتاخر. أن استجابة البكتيريا للمضادات الحيويه التي جربت كانت متشابهه في حالتي العفن المبكر والعفن المتأخر في هذه الدراسه. أن أكثر من 70% من البكتيريا السالبه لصبغة الكرام كانت مقاومه لكل من الامبسيلين والكلوكساسيلين ولكن اظهرت استجابات متفاوته لكل من الجينتامايسين والسيفوتاكسايم. أن معظم البكتيريا الموجبه لصبغة الكرام اظهرت استجابه لكل من الامبيسيلين والكلوكساسيلين والسيفوتاكسايم بينما اظهرت مقاومه عاليه للجينتامايسين. أن نسبة الوفيات كانت 20,9%. أن العفن المبكر, الذكور, الولاده المبكره الاقل من 37 اسبوع و الوزن الاقل من 2500غرام عند الولاده كانت عوامل مصاحبه للوفاة . البكتيريا السالبه لصبغة الكرام كانت السبب الرئيسي للعفن الولادي المبكر والمتاخر في مركزنا وان العديد من البكتيريا المسببه كانت مقاومه للمظادات الحيويه المستخدمه. نوصي بالعنايه الجيده خلال اللحظات الاولى للولاده والمتابعه الافضل اثناء التداخلات الولاديه والكشف المبكر والعلاج اللازم للأم المصابه بالألتهابات مع تقليل التداخلات الجراحيه المساعده للولاده قدر المستطاع مع مراعاة ترك مسافات مناسبه بين الاطفال الحديثي الولادة واستخدام الادوات المعقمه عند المراقبه


Article
Types ,Frequency,Clinical Presentation of Congenital Central Nervous System Anomalies in Al- Kadmayhia Teaching Hospital

Author: Lamyaa Abdul Kareem Hamoodi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 524-531
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The central nervous system (CNS)anomalies are the most severe, difficult to detect its etiology, and predict its clinical presentation and course. OBJECTIVE:To find out the common types of congenital malformations in central nervous system.,determine the frequency and the clinical features of these malformations.And to study the risk factors associated with congenital central nervous system malformations.PATIENTS AND METHODS:This cross-sectional study was performed at Al-Kadhimiyia Teaching Hospital (Neonatal care unit) from the 1st of January to the 1st of July, 2011.One hundred newborn infants were proved to have congenital abnormalities by physical examination alone. Fifty five neonates were diagnosed as having CNS congenital anomalies.neonatal evaluation include: gestational age, sex, body weight, type of CNS congenital anomaly.Maternal age, parity, antenatal care, any history of abortion, previous baby with CNS congenital abnormality, still births, or drug intake during pregnancy.the residency of the family and consanguinity .RESULTS:The number of neonates delivered alive was 2700 neonates, one hundred of them (3.7% of total deliveries) were delivered with congenital anomalies, and 55 cases from those (2% from total deliveries / 55% from congenitally abnormal deliveries) have had CNS congenital anomalies,the most frequent anomalies aremeningocele 25( 45.5%),the second and third in frequency were hydrocephaly 12 (21.8%), and myelomeningocele 10 (18.2%) respectively.There were 34(61.8%) male and 21 (38.2%) female. There were 30(54.5%) full term and 25(45.5%) preterm.Thirty cases out of the total 55 cases (54.5%) with body weight 3-3.5 kg.Most of the affected neonates to mothers with an age range of 20-40 years where 34 mothers (61.8%) aged between 20-30 years .Most of the mothers were multipara (45 cases / 81.8%) .The majority of the neonates were the product of a consanguineous marriage 39 (70.9%).Maternal peri-conceptional folic acid supplementation was not taken in the vast majority of cases (43 cases / 78.2%).Positive family history of CNS congenital anomalies was reported in 4 cases only (7.3%) .Familial residence was documented as urban in 30 cases (54.5%), and rural in 25 cases (45.5%).CONCLUSION:The most common type of CNS anomalies is meningocele with relatively higher male to female ratio.These anomalies occur in full term multipara mothers. Occur more frequent in infants with larger body weight and to younger multipara mothers. Consanguinity is a major risk. There was a low utilization of maternal peri-conceptional folic acid supplementation

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