958 MANAGEMENT OF INFANTS BORN UNDER CONDITIONS THAT ARE NOT ASEPTIC (INFANTS CONTAMINATED AT BIRTH)

Abstract

This study was designed to determine and evaluate the current management procedures for newborns delivered under non-aseptic conditions. Firstly, a nationwide survey of neonatology centers was conducted to determine their practices in relation to the prevention and/or detection of post-contamination sepsis. Secondly, 100 consecutive contaminated infants who were cultured and followed at Howard University Hospital were studied.

Seventy-three percent of the centers surveyed (96) responded. Results of this phase of the study are as follows: 1) Infants contaminated at birth were routinely cultured by 75%; the commonest sites were umbilicus and nasopharynx; 2) Special cleansing bath (hexachlorophene) was employed by 15%; 3) Isolette care was routinely utilized by 42%; and, 4) 66% reported that the culture results did not influence management.

The phase two study cases included 15 low birth weight newborns. All infants were closely observed in isolettes for 72 hours for signs of possible sepsis, except when preliminary culture reports indicated a need for earlier intervention. No cases of clinical sepsis, septicemia or meningitis were encountered. The minor problems of mild jaundice, tremors and poor feeding noted in four infants spontaneously resolved shortly afterwards.

These preliminary findings suggest that the widely employed practices of routinely culturing and housing contaminated infants in isolettes may have no sound scientific basis, and, therefore, might be discontinued without adversely affecting their outcome.

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