Evaluation of neonatal sepsis screening in a tropical area part III: Neonatal sepsis in meconium stained deliveries

Of the 6,060 consecutive live births delivered at the University, Maternity Unit of Guadeloupe (French West Indies) during a 30-month period, 635 newb orns (10.4%) presented with meconium stained (MS) amniotic fluid, of which 595 (94%) received bacteriological screening at birth (light MS, n=543; thi ck MS, n=52). Thirty, (5%) of MS newborns had a bacteraemia (n=13, group B streptococcus, GBS), and 128 (21.5%) a bacterial positive gastric aspirate (n=54, GBS). Sixty-six newborns among Ms babies needed tracheal suctioning (11%) in the delivery room for meconium inhalation. Among these 595 screene d MS newborns, 286 (48%) presented clinical signs of postmaturity, at birth , having therefore an explanation for their MS condition. For the other MS newborns without the postmaturity explanation, we experienced twofold incre ased risk of neonatal sepsis (OR 1.88 for bacteraemia and 2.61 for external carriage p < 0.02, Chi square) as compared with their MS postmature counte rparts. We conclude that when meconium stained deliveries are associated wi th postmaturity, signs, one may not need to initiate prophylactic antibioti c treatment at birth unless they present with other traditional risk factor s for neonatal sepsis such as intrapartum fever and prolonged rupture of me mbranes.