Epidemiologic characteristics of suppurative-septic diseases in newborn infants at obstetrical hospitals keeping mother and child together and separated

The advantages of keeping mothers together with their infants at the postnatal period have been revealed; these advantages are manifested by the quick colonization of newborns by maternal microflora, thus preventing their further colonization by opportunistic hospital microbial strains. As compared with common maternity hospitals, those maternity hospitals where mothers are kept together with their infants have less intensive circulation of hospital microflora, and the morbidity rate in purulent and septic diseases among newborns is twice as low in such hospitals. All these findings may be regarded as the epidemiological substantiation of propositions in favor of further development of maternity hospitals where mothers and their infants are kept together.     

The characteristics of the epidemic process of hospital infections in maternity hospitals influenced by an operational management system]

As shown in this investigation, the introduction of the algorithmic system of the control of the epidemiological process of hospital infections (HI) in maternity hospitals makes it possible to reduce HI-induced morbidity and mortality rates more than by half, as well as to alter their nosological and age structures, without additional economic expenditures and under the existing material conditions of maternity hospitals. Such success is achieved by the observation of infection precursors indicating the activation of the mechanisms of the transmission of Staphylococcus, Escherichia and Klebsiella infections and the risk factors (preconditions) facilitating this activation with the immediate involvement of all relevant specialists into action at the stage when an increase in the contamination of newborns and puerperal women is noted and not as late as at the stage of morbidity and mortality.     

Ecologic and epidemiologic features of the circulation of streptococcus group B at a maternity clinic

In a maternity clinic the circulation of group B streptococci among the newborns, their mothers and the personnel was established during the period of 1982-1985. Group B streptococci were detected at different biotypes of newborns (the pharynx, the imbilical stump, external suditory meatus, nasal and oral mucosa, eyes and feces), their mothers (the vagina, the perianal area, breast milk, the pharynx, urine, the umbilical cord, amniotic fluid) and in the pharynx of the personnel. In this maternity clinic 15 combinations of type antigens were detected, two combinations (1a/c and 1 b/c) prevailing among them. These results confirmed earlier data concerning two possible ways of transferring infection to newborn infants: vertical, i.e. from the mother to the child during parturition, and nosocomial, i.e. from contaminated newborns or members of the personnel.     

Microbial colonization and succession on the faucial mucosa in newborn infants rooming in with their mothers in a maternity hospital]

The formation of microflora on the laryngeal mucosa in newborn infants during the first 5 days of their life was studied in one of the maternity hospitals of Moscow. In this work modern methods of the isolation and identification of aerobic and anaerobic microorganisms were used, and the results thus obtained were computer-processed. In the maternity hospital of the "mother-child" type the microbial colonization of the laryngeal mucosa by normal and opportunistic microorganisms was noted in newborn infants. A wave-like course of the formation of laryngeal microflora, indicative of microbial succession occurring in the child, was revealed. The attempt to establish the cases of microbial interference between the species colonizing the laryngeal mucosa revealed that it was very rarely observed in 5-day-old newborns. This feature was seemingly the cause of low resistance of the larynx to colonization in newborn infants, which determined frequent colonization of their laryngeal mucosa with Staphylococcus aureus and Klebsiella.     

The role of antibiotics in the prevention of cross infections in newborn infants and mothers during the puerperium]

Epidemiological efficiency of antibiotic prophylaxis of hospital infections (HIs) in maternity homes was analyzed by the materials on the clinical observation of 43995 newborns and their mothers within a period of 1986 to 1989 as well as by the data on the bacteriological examination of 6616 smears from the mucosa of the nose, pharynx, rectum and umbilical wounds of 1890 newborns carried out within the same period. It was shown that the prophylactic use of the antibiotics in the maternity homes led to changes in the microflora colonizing the newborns. The more massive was the use of the antibiotics in the departments of newborns and the postnatal departments, the more intensive was replacement of gram-positive microflora in the newborns by gram-negative organisms among which Klebsiella strains with high antibiotic resistance predominated. This involved an increase in the incidence of pneumonia and sepsis in the newborns and a higher death rate among the newborns due to HIs. In parallel there was observed an increase in the incidence of metro-endometritis in the puerperae++ and a simultaneous decrease in the number of the cases with lactational mastitis as a result of lower numbers of Staphylococcus aureus cultures isolated from various loci of the newborns. It was concluded that antibiotics were not the drugs to be used as prophylactic agents in control of HIs in maternity homes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Circulation of methicillin-resistant staphylococci in hospitals with different profiles

Analysis of prevalence of methicillin-resistant staphylococci in hospitals with different specializations was performed. 2584 strains were isolated. Methicillin-resistant (MR) strains were present in different profile hospitals and their total prevalence between isolated strains was 12.3% while significantly varied in different hospitals (from 8% to 37%). Along with MRSA (methicillin-resistant Staphylococcus aureus), MRSE (methicillin-resistant Staphylococcus epidermidis) and MRSS (methicillin-resistant Staphylococcus saprophyticus) were presented in all studied hospitals. The prevalence of MR strains was highest among strains isolated from flame burn wounds (37%), while in samples from newborns in maternity hospital resistant strains represented 12% of isolates, and in general clinical hospital--not more than 9% of isolates. Relationship between rates of isolation of methicillin-resistant staphylococci and specialization of hospital unit was noted. For example, prevalence of MR staphylococci in isolates from newborns in ICU (47.5%) differed from the same one in maternity hospital (11.6%).     

Ecology of serogroup B streptococci in maternity hospitals (preliminary report)

Materials on the study of the colonization of newborns, their mothers and the medical staff of a maternity hospital by group B streptococci are presented. These streptococci were isolated from 26.3% of newborns, 19.6% of puerperae and 14.7% of the staff members. Group B streptococci were found to colonize different loci in newborns (the fauces, the nose, the umbilical cord, the ears, feces) and their mothers (the fauces, the vagina, the perianal fold, milk, the skin around the nipples, amniotic fluid, the umbilical cord). The serological typing of streptococci, isolated simultaneously from newborns and their mothers, suggested the presence of two possibilities of infecting the newborns with these microorganisms: (1) from their mothers and (2) from other newborns or members of the hospital staff during the stay in the maternity hospital.     

Measures to prevent outbreaks of hospital infections

On the basis of the analysis of 69 outbreaks of hospital infections registered in the USSR in 1986-1989, as well as additional observations made by the authors, a number of factors which determined the present state of the problems concerning this kind of morbidity in the USSR were established: an insufficient level (in cases of enteric infections) or a low level (in cases of purulent septic infections) of etiological diagnosis; poor efficiency of the epidemiological investigation of outbreaks; defects in the work on the prophylactic detection of potential sources of infection among medical staff, parturient women or mothers taking care of their infants. Some possible solutions on these aspects were proposed. Cases of outbreaks of hospital infections among newborns were used as an example demonstrating that such outbreaks were caused mainly by breaches of antiepidemic and sanitary rules in respective hospitals; thus, in one-third of the cases of outbreaks such breaches were observed in maternity clinics with insufficient material and technical equipment. The prevention of these breaches is considered to be the main road to the solution of the whole problem of the prevention of epidemic outbreaks in hospitals.     

Presence of maternal anti-HBs antibodies does not influence hepatitis B vaccine response in Brazilian neonates

Recently, it was suggested that maternal hepatitis B surface antigen antibodies (anti-HBs) acquired transplacentally could play a negative role in newborn infants' immune response to the hepatitis B vaccine. We compared the hepatitis B virus (HBV) vaccine response in infants born to mothers previously vaccinated against HBV (n = 91) to infants born to mothers who were not previously vaccinated (n = 221). All newborn infants received three intramuscular doses (10 μg) of HBV vaccine (Butang?) at 0,1 and six months. The first dose was administered at the maternity hospital within 12 h of birth. The geometric mean titres of anti-HBs were not different among newborn infants born to mothers who were anti-HBs-negative (492.7 mIU/mL) and anti-HBs-positive (578.7 mIU/mL) (p = 0.38). Eight infants did not respond to the HBV vaccine. Of them, six were born to anti-HBs-negative mothers and two were born to mothers with anti-HBs titres less than 50 mlU/mL. Despite the mother's anti-HBs-positive status, our data show a good immunogenicity of the Brazilian HBV recombinant vaccine in neonates.     

Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early?

BACKGROUND: A growing body of evidence suggests that the trend toward earlier discharge may affect newborn morbidity. The authors assessed how hospital readmission rates were affected by a clinical guideline aimed at discharging newborns from hospital 24 hours after birth. METHOD: A retrospective before-after cohort study was conducted involving 7009 infants born by uncomplicated vaginal delivery at a large level II hospital in Toronto between Dec. 31, 1993, and Sept. 29, 1997. The primary outcome was a comparison of the rate of hospital readmission among newborns before (5936 infants) and after (1073 infants) the early-discharge policy was implemented (Apr. 1, 1997). The causes for readmission were secondary outcomes. RESULTS: Before the early-discharge guideline was implemented, the mean length of stay declined from 2.25 days (95% confidence interval [CI] 2.18-2.32) to 1.88 days (95% CI 1.84-1.92) (p < 0.001). After implementation there was a further decline, to 1.62 days (95% CI 1.56-1.67) (p < 0.001). A total of 126 infants (11.7%) in the early-discharge cohort required readmission by 1 month, as compared with 396 infants (6.7%) in the preguideline cohort (odds ratio 1.86, 95% CI 1.51-2.30). The main reason for early readmission was neonatal jaundice, with a higher rate among infants in the early-discharge cohort than among those in the preguideline cohort (8.6% v. 3.1%; odds ratio 2.96, 95% CI 2.29-3.84). INTERPRETATION: Decreases in newborn length of stay may result in substantial increases in morbidity. Careful consideration is needed to establish whether a reduction in length of stay to less than 24 to 36 hours is harmful to babies.     

Occurrence of Staphylococcus aureus enterotoxigenic strains isolated from pregnant women with pathology

137 S. aureus strains, isolated from the larynx of pregnant women in cases of pathology, were studied for the formation of staphylococcal enterotoxins of types A and B (SEA and SEB) by the indirect hemagglutination test. The study revealed that SEA was produced by 35.0% and SEB, by 56.6% of the strains under study. The proportion of SEA and SEB producers among staphylococci isolated from mothers and children was, respectively, 18.4% and 20.0%, 89.41% and 67.5%. The number of enterotoxigenic staphylococci in the upper respiratory tract of newborn infants and mothers practically coincided with that in mothers. The occurrence of SEA- and SEB-producing enterotoxigenic strains in the medical personnel was 25.5% and 62.7% respectively.     

Characteristics of the formation of the HBsAg carrier state among pregnant women and newborn infants and their role in the spread of hepatitis B

The authors analyze the incidence rate of HBsAg carriership among 8, 120 pregnant women and 261 newborn infants at different periods after birth. The levels of HBsAg carriership among pregnant women and the members of their families, as well as among the personnel of maternity clinics and blood donors, have been established. The rate and time of the detection of HBsAg in infants born to mothers found to be HBsAg carriers have been determined. Measures for the prophylaxis of hepatitis B are discussed with due regard to the specific epidemiological features of the spread of HBsAg carriership, established in this study, and to the presence of antibodies to HBsAg among the above-mentioned groups of the population.     

Streptococcus group B in meningitis and infection of newborn infants

Streptococci were isolated from the liquor or blood of 102 newborn infants and 16 infants in the first month of their life, suspected of having purulent meningitis, in 22 cases (18,5%). 5 isolated streptococcal strains were classified with group B on the basis of their cultural, biochemical and serological features. All of these strains were isolated from newborn infants during the first 3-4 days of their life. The occurrence of group B streptococci among all examined newborn infants was 4.8%; among the newborns with the positive results of bacteriological examination (73 infants) this figure was as high as 6.8%. The authors emphasize the necessity of producing, on an industrial scale, diagnostic preparations for the identification of group B streptococci playing a significant role in septic diseases and meningitides in newborns.     

Sex differences in infant integration in a semifree-ranging group of Barbary macaques (Macaca sylvanus,L. 1758) at Salem,Germany

Sixteen multiparous Barbary macaque females with newborns were studied over a 16 month period within the context of their naturally formed group. Analysis of their social behavior revealed 1) triadic interactions involving focal females, their newborns, and other group members occurred mainly with other females; and 2) mothers with female newborns interacted mainly with females of their own matriline, while mothers with male newborns interacted mainly with nonmatriline females. Observed in two successive birth seasons, this pattern indicates that partners of maternal interactions chose each other according to the sex of the newborn. Measures of distance from the mother also reflected differences between infants of different sex. At about five months of age, female infants were observed close to their mothers significantly more often than males. This finding follows the pattern of a sex-specific infant socialization process which integrates female infants into the network of their matrilines and male infants into the broader group. This sex-specific integration pattern is interpreted as supporting female philopatry and male dispersal. © 1995 Wiley-Liss, Inc.     

Risk factors of development of nosocomial pyogenic and septic infections in maternity hospitals

During prospective epidemiological surveillance cases of pyogenic and septic infections (PSI) in mothers and newborns in two maternity hospitals were studied using standard case definition and leading risk factors of their development were revealed. These factors differed in two hospitals and were connected mainly with high level of patients colonization, contamination of the environment by nosocomial strains of microorganisms, and degree of participation of mother's relatives in delivery. It was shown that permission to relatives for presence on delivery did not influence on the rate of PSI. Specificity of risk factors of PSI in mothers and newborns dictates necessity to determine them in each maternity hospital.     

Changes in the blood immunological indices of newborn infants as affected by T-activin in vitro

T-activin, introduced into the culture of mononuclear cells obtained from the blood of healthy newborn infants, does not induce any essential changes in the levels of E-, Ea- and EAC-rosette-forming cells. An overwhelming majority of healthy infants has shown a decrease in the functional activity of lymphocytes in the blast transformation test in response to the optimal dose of ConA and an increase in their functional activity in response to the suboptimal dose of this mitogen. After stimulation with phytohemagglutinin, both the increase of the stimulation index and its decrease have been observed in an equal number of cases. The introduction of the preparation into the culture of mononuclear blood cells isolated from newborn infants with sepsis leads to a considerable increase in the detection rate of Ea-rosette-forming cells with a tendency to an increase in that of E- and EAC-rosette-forming cells. The final values of the stimulation indexes, no matter what the mitogens used, are in conformity with the values characteristic of the normal parameters for healthy newborns, due to a specific pattern of changes in the T-lymphocyte functional activity in the blast-transformation test.     

The spread of Klebsiella in obstetrical hospitals and the biological properties of the isolated strains]

Examination of 278 newborn infants, parturients, and medical personnel in two maternity hospitals revealed a high level of Klebsiella colonization of all examined biotopes of infants (the nasal cavity in up to 36.5% of cases) and the skin of the mammary glands of nursing mothers (in 36.2% of cases). In the intestine and the nasal cavity of parturient women and medical personnel Klebsiella could be detected 3-10 times more often than in the same biotopes of nonhospitalized pregnant women. From 254 objects of the hospital environment Klebsiella were isolated in 9.05% of cases. The possibility of the transmission of Klebsiella in hospitals by patients with inflammatory processes in their genitals were established. The diversity of the serological picture of strains of most K-serovars and a short period of their isolation were shown. In one hospital serovar K10 with some features of a "hospital" strain was isolated. The strains under study were sensitive to aminoglycosides, cephamesine, chlorhexidine, but resistant to semisynthetic penicillins and chloramine.     

The microbial colonization of the skin of newborn infants rooming in with the mother in maternity homes]

The formation of skin biocenosis in children under the conditions of a maternity hospital with the joint care of mother and child was studied with the use of commercial bacteriological imprints manufactured in the USSR. The colonization of newborn infants in maternity hospitals with opportunistic, saprophytic and normal microflora was established. In newborn infants aged up to 5 years low skin resistance to colonization and, as a consequence, frequent colonization of the skin with opportunistic and saprophytic microflora was observed.     

胎膜早破早产的临床分析

目的:探讨胎膜早破早产的临床处理方法及其对新生儿的影响.方法:以2009年3月至2012年1月在我院产科住院的妊娠满28～36+6周的205例胎膜早破早产患者为研究对象,针对不同孕周,采用相应的治疗方法,并对其妊娠结局和早产儿的状况进行观察和分析.结果:胎龄28～34+6周的早产儿并发症的发生率和死亡率分别为52.2％和10％,胎龄35～35+6周的早产儿并发症的发生率和死亡率分别为32.3％和4.8％,分别明显高于胎龄＞36周出生的早产儿(1.6％和0),差异具有统计学意义(P＜0.05);但孕周在36周以上出生的新生儿的并发症的发生率和死亡率与足月出生的新生儿相比无明显差异(P＞0.05).结论:胎膜早破早产是新生儿患病和死亡的主要原因,胎龄越小新生儿的患病率和死亡率越高,对于胎膜早破早产的孕妇,应针对不同孕周采用不同的治疗方法,以延长孕周以降低早产儿的患病率和死亡率.     

Virologic and serologic studies on an outbreak of echovirus type 11 infection in a hospital maternity unit.

An outbreak of echovirus type 11 (E-11) infection occurred among newborn babies in a hospital maternity unit in the summer of 1971. The results of studies are as follows: 1) Forty-one of 188 infants developed febrile illness with stomatitis during one and a half months from July to September. E-11 was isolated from stool specimens of 14 infants and two throat swabs. Antibody response to the virus was shown in all the 19 cases examined. Some of their mothers were suffering from subclinical infection. 2) The isolates were identified as a variant of E-11 which is not neutralized with antiserum against prototype E-11. Antiserum against the current virus neutralized both current and prototype viruses. 3) Sucrose gradient centrifugation of sera from infants revealed that the neutralizing antibody activity resided more predominantly in 19S than in 7S fractions. These antibodies reacted more specifically with the current strain than with the prototype Gregory strain.