Evaluation of Efficacy of Sterile Saline Gastric Lavage in Reducing Early Onset Neonatal Sepsis

Dhana Lakshmi Angappan; Ram Kumar U; Soundara Rajan P; Guna Sekaran D

doi:10.4172/2376-127X.1000142

ISSN: 2376-127X

Journal of Pregnancy and Child Health

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Evaluation of Efficacy of Sterile Saline Gastric Lavage in Reducing Early Onset Neonatal Sepsis

*Dhana Lakshmi Angappan^, Ram Kumar U, Soundara Rajan P and Guna Sekaran D**
Mahatma Gandhi Medical College and Research Institute, Puducherry, India
Corresponding Author :	Dhana Lakshmi Angappan Mahatma Gandhi Medical College and Research Institute Pediatrics Pillayarkuppam, Puducherry, India Tel: 04132615449 E-mail: pediatrics@mgmcri.ac.in
Received September 23, 2014; Accepted March 31, 2015; Published April 01, 2015
Citation: Angappan DL, Ram Kumar U, Soundara Rajan P, Guna Sekaran D (2015) Evaluation of Efficacy of Sterile Saline Gastric Lavage in Reducing Early Onset Neonatal Sepsis. J Preg Child Health 2:142. doi: 10.4172/2376-127X.1000142
Copyright: © 2015 Angappan DL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objective: To evaluate the presence of risk factors like PROM and more than 3 per-vaginal examinations during active labour, to estimate the incidence early onset sepsis with above risk factors and to determine the efficacy of gastric lavage with normal saline in reducing the occurrence of early onset neonatal sepsis.

Methods: Case control study, conducted in the Mahatma Gandhi Medical College and Research Institute on neonates admitted in the neonatology unit. The trial was approved by the institute ethics committee

Results: On comparing the two groups no difference was found in terms of sepsis screen, clinical sepsis or blood culture positivity.

Conclusion: In conclusion, Study results revealed that immediate neonatal intervention with saline gastric lavage did not reduce the occurrence of early onset neonatal sepsis.

Keywords

Gastric lavage; Neonatal sepsis

Abbreviation

CRP: C - reactive protein; DLC: Differential leucocyte count; EONS: Early onset neonatal sepsis; ESR: Estimated sedimentation rate; IUGR: Intra uterine growth retardation; SSGL: Septic saline gastric lavage; TLC: Total leucocyte count

Introduction

Neonatal sepsis is the commonest cause of neonatal mortality. It is responsible for about 30-50% of the total neonatal deaths in the developing countries. Early onset neonatal sepsis usually present within seventy two hours of life and in severe cases, the neonate may be symptomatic since birth. The organisms causing EONS are those which are usually present in the maternal genital tract. Knowledge about the potential risk factors would help in the early diagnosis of sepsis [1].

The risk factors for EONS include low birth weight baby, prematurity, chorioamnionitis, premature rupture of membranes; perinatal asphyxia.it is a known fact that in case of EONS, inflammation of the fetal surface of the placenta is associated with the presence of leucocytes in the gastric aspirate of the neonate [2]. Apparently such gastric aspirate findings are result of access of infective materials of the amniotic liquor to the stomach of the neonate. The organisms in the maternal genital tract ascend up and infect the amniotic fluid [3]. The fetus inhales or ingests the infective amniotic fluid, the microorganisms acquired this way colonise the mucous membrane and proliferate locally before causing the systemic infection. If the gastric contents in the neonate, if removed immediately, should be able to bring down the incidence of sepsis to some extent [4].

Materials and Methods

This study was conducted over a period of 12 months from July 2009 to June 2010. All term newborns of appropriate gestational age, with risk factors for sepsis were enrolled and studied. Babies born during odd days of the month were accommodated in the control group while those delivered during even days of the month were included in the case group.

Neonates with prematurity, birth asphyxia, IUGR were excluded from the study. All babies who were enrolled in the study underwent sepsis screening at 12 hours of life which included: TLC, DLC, ANC, CRP and micro ESR. Blood culture was sent for all the neonates. Sepsis screen was considered positive if any of the above two parameters were positive. Under aseptic precautions infant feeding tube was used and the contents of the stomach was aspirated and sent for bacteriological culture (Figure 1). Data was fed in SPSS software and analysis done using pearson chi square test.

Results

Baseline characteristics

Of the 72 neonates 32 were boy babies and 40 were girl babies. The mean birth weight was 2700 grams. The minimum weight observed was 2500 grams and the maximum weight was 4000 grams. Of the 36 babies in group A 16.6% of them were positive for sepsis screen whereas 19.4% of babies in group B were positive for sepsis screen (Tables 1-3). Clinical features of sepsis were observed only in 2.7% of babies in the study population. Both the babies belong to group B. One baby had refusal to feed and the other had lethargy and mottling. On analysis based on clinical features of sepsis it was found to be statistically insignificant.

Out of 36 babies in the group B, gastric aspirate analysis was positive in 13.8% of the babies, but none of them were aspirate culture positive. A significant correlation has been established between sepsis screen and gastric aspirate analysis.

Discussion

During the one year study, immediate neonatal intervention with SSGL did not alter the course of illness of babies with risk factors of EONS compared with the control group. We have hypothesised that if the swallowed amniotic fluid present in the stomach of neonate is removed by gastric lavage immediately after birth, it would bring down the incidence of EONS to some extent [5,6]. There are three possible reasons why there can be reduction in the incidence of EONS was not statistically significant.

a) One of the possible reasons is that the neutrophils obtained in the gastric aspirate in the first day of life are from mother and do not indicate a fetal inflammatory response. Stained smears and bacterial cultures of neonatal gastric aspirate reflect the flora of the birth canal. Hence gastric aspirate may be a useful screening tool but immediate intervention by SSGL does not alter the outcome, because it is only an exposure of infective material but does not necessarily implicate infection.

b) The second possible reason is that if the study population would have included the preterm babies who are prone to sepsis due to immature immune system, the culture yield would have been better.

c) The third possible reason is that we have included only two risk factors for sepsis and may be by including three or more risk factors would give a different trend in the end point. This study clearly merits further investigation in future larger prospective trials in preterm babies with risk factor for EONS

Our data on the relationship between the maternal risk factors and the occurrence of EONS are consistent with previous observations. Immediate neonatal intervention by saline gastric lavage did not have any role in reducing the incidence of EONS. Our data also supports previous studies showing significant correlation between gastric aspirate analysis and early onset neonatal sepsis.

Hence we conclude by saying that gastric aspirate analysis has clearly a role as a screening tool for babies with risk factors for sepsis.

Conclusion

On comparing the two groups no difference was found in terms of sepsis screen. Immediate neonatal intervention with saline gastric lavage did not reduce the occurrence of EONS in neonates with risk factor for sepsis. However gastric aspirate analysis correlated well with sepsis screen in babies with septicemia.