Neonatal Sepsis Incidence among Neonates (0-1) Month

Neonatal Sepsis Incidence among Neonates (0-1 Month) in Teaching Hospital, Enugu (June 2015-June 2016)

ABSTRACT

This research assessed the incidence of neonatal sepsis among neonates (0-1) month in Teaching Hospital Enugu. Three objectives guided the study which include to determine the number of neonates (0-1) month with sepsis, to identify the factors responsible for neonatal sepsis among the neonates and to identify the treatment modalities used in the management of neonatal sepsis in Teaching Hospital, Enugu. Related literature was reviewed and summarized. A descriptive and retrospective research designs were used for the study. The study population comprised of 400 neonates with sepsis. A self-structured proforma validated by the project supervisor was used to collect the needed data. The data collected were analyzed with the use of frequency distribution tables. The result of the study showed that 400 neonates had sepsis within period of June 2015-June 2016 with a lower incidence of 35.75%. The major factors responsible for sepsis among neonates were out-born delivery and prematurity, with antibiotic therapy as the major treatment modality used. Based on the findings, it was recommended that midwives should ensure that adequate history of every mother is taken and early adequate management of such condition during antenatal visit for early identification of problems or complications and early adequate management of such conditions which might lead to neonatal sepsis.

CHAPTER ONE

INTRODUCTION

Background of the Study

World Health Organization (2013) opined that a newborn also known as a neonate is a child under 28 days of age. Usually they are small in size, both in stature, height and weight. The neonates have low immune response against diseases, at greater risk of injury and death particularly those who were born prematurely. Sepsis is a systemic bacterial, viral or parasitic infection that invades the blood stream of the newborn. It occurs either during or after birth in approximately 1 of 1000 full term birth (Lynna & Joan, 2010). Sepsis is a potentially life threatening complication of an infection which occurs when chemicals released into the blood stream to fight the infection trigger a cascade of changes that can damage multiple organs (Mayo, 2014). It can affect anyone at anytime but it does tend to strike more often people at the extremes of life, the very old and young. As a result children, particularly premature babies and infants can be more susceptible to developing sepsis.

Neonatal sepsis is an invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, non-specific and includes diminished spontaneous activity and less vigorous sucking. It can also cause apnea, bradycardia, temperature instability, respiratory distress, vomiting, diarrhea, abdominal distension, jitteriness, seizures and jaundice (Casserta, 2015).  Paul (2010) posited that neonatal sepsis is also a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks of life. At birth, a baby moves from a sterile environment inside the uterus to the one filled with micro-organism such that pathogenic bacteria gain access into the blood stream and cause overwhelming infection without much localization (septicemia) or may get predominantly localized to the lungs causing pneumonia or the meninges causing meningitis.

The World Health Organization (2013) estimated that one million deaths per year (10% of all under five mortality) are due to neonatal sepsis and that 42% of these deaths occurs in the first week of life. They recorded that 30% of neonatal sepsis cases were early onset. Considering the recent WHO reports in 2015, the estimate of the incidence of early onset bacterial sepsis vary widely and the available data indicates a high burden of the disease among neonates (Awoniyi, Udo & Oguntibeju, 2012). There are wide disparities in neonatal care between high and low income countries. In high income countries the major concern is the increasing number of extremely premature infants with high nosocomial infection rates due to multi-resistant organisms in intensive care units. Health facility infection are also a major problem in low income  countries but the more pressing issues are high proportion of home deliveries in unclean environment predisposing neonates to sepsis and ensuring that all neonates have access to effective interventions from the health care providers in the first days of life.

According to Onyedide, Nedosa, Okolo, Ita, Udoh & Egah (2012) neonatal sepsis is very prevalent in sub-Saharan Africa and contributes up to 69% neonatal mortality in Nigeria and other parts of Africa.  Neonatal sepsis occurs in 0.5-8.0/1000 birth. The highest rate occurs in low birth weight (LBW) infants, those with depressed function at birth as manifested by a low apgar score, those with maternal perinatal risk factors e.g low socioeconomic status, premature rupture of membrane (PROM), minorities and males (Beers, Fletcher, Porter & Berkwits, 2013). Worldwide, neonatal mortality rate has been set at 30/1000 resulting in 4 million deaths each year, 95% of these deaths occurs in developing countries where the risk of neonatal death is 6 times higher than that of developed countries. Thus, neonatal sepsis is a relevant public health issue because it consistently emerges as one of the main causes of neonatal morbidity and mortality (Edmond & Zaidi, 2010).

The incidence of neonatal sepsis varies among the different geographical areas, the highest being registered in Africa and Asia (23-38/1000 live births) and the lowest in countries such as U.S and Australia (range 1.5-3.5/1000 live births). In south American and Caribbean the incidence of neonatal sepsis ranges between 3.5 and 8.9/1000 live birth (Vergano, Kazemba & Mwamsambo, 2010). The incidence of culture proven sepsis in the United States is approximately 2 per 1000 live births. Of the 7-13% of neonates who are evaluated for neonatal sepsis. Only 3-8% have culture proven sepsis. This disparity arises from the cautious approach to management of neonatal sepsis (Anderson-berry, 2015).  In Nigeria, there is a high prevalence of sepsis 31.7% and 34.4% reported in Calabar and Jos respectively but much higher than the 10.7% reported in Ogun state. There is death of information concerning the incidence of neonatal sepsis in Nigeria and Enugu in particular. The researcher therefore deemed it right to carry out this study to add to the few information in literature.

Statement of the Study

Neonatal sepsis has remained a thing of concern to Medical and Nursing profession and many questions have been asked concerning its incidence and factors responsible for it. Worldwide, neonatal sepsis is one of the major health problems throughout the world. Every year an estimated 30 million newborn acquire infection and 1-2 million of these die (Afroza, 2006).  The first 28 days of life-neonatal period represent the most vulnerable time for a child’s survival.

During her clinical posting in neonatal ward of  Teaching Hospital, Enugu , the researcher noticed that a good number of the newborns were diagnosed neonatal sepsis. She therefore wondered what might be the incidence within a specific period of time in the hospital.

Being touched by the fact that sepsis in neonates posed situational crisis to parents and great responsibility and concern to nurses, midwives and obstetricians, the researcher felt it is very necessary to research on this topic which will  provide information that will help to curb this ugly situation both within Enugu and other parts of Nigeria.

Purpose of the Study

The purpose of the study is to investigate on the incidence of neonatal sepsis among neonates (0-1) month in  Teaching Hospital, Enugu  within the period of June 2015-June 2016.

Research Objectives of the Study

The specific objectives of this study are as follows:

  • To determine the number of neonates (0-1) month with sepsis in Teaching Hospital, Enugu  within the period of June 2015-June 2016.
  • To identify the factors responsible for neonatal sepsis among neonates (0-1) month in  Teaching Hospital, Enugu          .
  • To identify the treatment modalities used in the management of neonatal sepsis at Teaching Hospital, Enugu .

Research Questions

The following research questions have been raised with the view to help the researcher determine the incidence of neonatal sepsis among neonates (0-1) month within the period of June 2015-June 2016.

  • What is the number of neonates (0-1) month with sepsis in Teaching Hospital, Enugu within the period of June 2015-June 2016?
  • What are the factors responsible for neonatal sepsis among neonates (0-1) month in Teaching Hospital, Enugu ?
  • What is the treatment modality used in the management of neonatal sepsis in Teaching Hospital, Enugu ?

 Significance of the Study

The study is of great benefit in the following ways:

  • This study will enable the entire public including the midwives to know more about neonatal sepsis hence they make concerted efforts to improve delivery standards in order to reduce the incidence and its mortality rate.
  • The hospital management and Government will appreciate the need to provide health care facilities including staff training for improved care and management of neonates both in rural and urban hospitals.
  • This study would urge nurses and midwives to put more efforts in health educating the public on the incidence rate of neonatal sepsis, its prevention and control.
  • This study will as well stimulate all midwives to research further into the incidence/prevalence of neonatal sepsis in the society.

Scope of the Study

This study is delimited to the incidence of neonatal sepsis among neonates (0-1) month in  Teaching Hospital, Enugu within the period of June 2015-June 2016.

 Operational Definition of Terms

  • Neonatal Sepsis: A clinical syndrome of bacteremia (such as meninigitis, pneumonia, pyelonephritis or gastroenteritis in the setting of fever) with systemic signs and symptoms of infection in the 28 days of life.
  • Factors Responsible for Neonatal Sepsis: Those things that cause sepsis (infection) in a neonate. For the purpose of this study they include maternal febrile illness, prolonged rupture of fetal membranes, instrumental deliveries, unskilled hands etc
  • Treatment Modalities: The methods of treatment given to neonates with sepsis which may include antimicrobial therapy, supportive therapy, combined therapy etc.

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