No abstract

Over a period of 15 years the incidence of neonatal septicemia seen at St Göran's Children's Hospital has increased both per 1000 births and per 100 admitted neonates. The spectrum of causative organisms has changed towards more Gram-positive organisms and fewer Gram-negative organisms. In the initial antibiotic treatment an aminoglycoside and ampicillin derivate will still be needed to give full coverage.

Chlamydia trachomatis (Ct) was isolated from eyes of 33 out of 160 infants with neonatal conjunctivitis. In nineteen (58%) of the infants with chlamydial conjunctivitis Ct could also be isolated from the nasopharynx. All infants were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 hours for 14 days combined with lid hygiene. All were clinically cured, and none had a relapse of clinical Ct conjunctivitis during an observation period of one year. However, one infant had persistent asymptomatic chlamydial eye infection, two displayed a persistent infection of the nasopharynx, and one infant's vagina was infected despite therapy. Serum IgG antibodies to Ct were significantly more often detected in clinical cases (90%) than in controls (33%) (p less than 0.01). Infants with conjunctivitis developed detectable IgM antibodies to Ct in 43% as compared to 7% in controls (p less than 0.01).

The bacterial colonization of the nose, umbilicus, perineum and faeces in 85 newborns was studied during one period of high and one of low occupancy in a neonatal intensive care unit. Cultures were taken on admission, at three days, at one week of age, and then weekly during the stay in the unit. Colonization took place early and potential pathogens were responsible for a significant part of the spectrum. At one week of age, more than 50% of the infants had Staphylococcus aureus in the nose and umbilicus, 25% had E. coli and/or Klebsiella enterobacter in the umbilicus, and 60% had Klebsiella enterobacter in the perineum. Neither the occupancy rate in the unit nor the clinical state of the infant seemed to influence the colonization pattern significantly. Changes in flora were frequent in the individual infant. However, the bacterial spectrum remained essentially the same with increasing age during the stay in the unit and during the two periods. Only on two occasions was the same phage type of Staphylococcus aureus found in two infants at the same time. Two cases of septicemia occurred in the 85 infants during the three months of the study. Both infants were colonized beforehand with the causative organism. The results may indicate that the clinical state of the infant is of greater importance for risk of septicemia than the pattern of the bacterial colonization.