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Neonatal septicemia and meningitis in Göttingen, West Germany
Insights
Neonatal septicemia incidence increased, with Group B Streptococcus emerging and E. coli rising, while P. aeruginosa declined. Case fatality for neonatal infections significantly decreased over time.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatrics
Background:
- Neonatal septicemia and meningitis pose significant risks to newborns.
- Understanding trends in causative agents and outcomes is crucial for effective treatment.
Purpose of the Study:
- To analyze changes in the incidence, causative agents, and outcomes of neonatal septicemia and meningitis over two distinct time periods.
- To identify predisposing factors and key diagnostic indicators for neonatal infections.
Main Methods:
- Retrospective analysis of 181 infants treated for neonatal septicemia and/or meningitis between 1962-1974 and 1975-1982.
- Comparison of infection incidence, pathogen distribution, and case fatality rates between the two periods.
- Evaluation of predisposing factors and hematological markers, including the immature/total neutrophil ratio.
Main Results:
- Septicemia incidence increased from 0.88 to 2.0 cases/1000 live births (LB), with Group B Streptococcus appearing in the later period.
- Escherichia coli infections rose, while Pseudomonas aeruginosa decreased; meningitis incidence remained stable but relative case numbers declined.
- Case fatality decreased from 53% to 29%, with prematurity and prolonged rupture of membranes as common predisposing factors.
- An elevated immature/total neutrophil ratio (60%) was a more consistent indicator than total white blood cell or neutrophil counts.
Conclusions:
- Significant shifts in neonatal septicemia epidemiology occurred between the 1960s and 1980s.
- Improved diagnostic and therapeutic strategies likely contributed to reduced case fatality rates.
- The immature/total neutrophil ratio shows promise as a sensitive marker for neonatal infection.
Abstract:
Data were analyzed from 181 infants treated for neonatal septicemia and/or meningitis between 1962 and 1974 (n = 88) and between 1975 and 1982 (n = 93). In addition to an increase in the incidence of septicemia (1962 to 1974, 0.88 case/1000 live births (LB)/year; 1975 to 1982, 2.0 cases/1000 LB/year), there was also a change in the pattern of infection. Group B streptococcal infections were first observed in 1975. Infections with Escherichia coli increased (1962 to 1974, 0.25 case/1000 LB; 1975 to 1982, 0.75 case/1000 LB), while those with Pseudomonas aeruginosa decreased (1962 to 1974, 0.15 case/1000 LB; 1975 to 1982, 0.1 case/1000 LB). Although the incidence of meningitis was similar in both time periods (0.5 case/1000 LB), the relative number of cases declined (1962 to 1974, 51 of 88 patients; 1975 to 1982, 23 of 93 patients). Case fatality also decreased during the second time period (1962 to 1974, 53%; 1975 to 1982, 29%). The most common predisposing factors for septicemia were prolonged rupture of membranes (21 of 93 cases) and prematurity (41 of 93). Blood analysis showed that the immature/total neutrophil ratio was more consistently abnormal (60% of the cases) than were total counts of white blood cells, neutrophils or immature neutrophils.