Abstract
Survey of 14,488 consecutive livebirths at the Grace Maternity Hospital, 1976-78, revealed that 52.3% of neonatal deaths occurred in 198 VLBW infants (500-1499g). Infection was the assigned cause of death in 20 of the 83 VLBW infants who died, of whom 12 had late onset disease and 8 had CONPN. One infant died of HMD with CONPN. Fifty-two VLBW infants had ROM>24 hr, of whom none was identified as having intrauterine infection. Of 5 infants with unknown ROM, 1 had CONPN. Of 141 infants with ROM < 24hr, 8 had CONPN all of whom had ROM <8hr. The 9 VLBW infants with CONPN died with the diagnosis confirmed at autopsy. All 9 placentae demonstrated chorioamnionitis and 7 funisitis. All 9 infants were severely depressed at birth and died by 31 hr of age, 7 by 5 hr. E Coli, Listeria and Group B Strep were implicated in 3 infants, but no organisms were isolated in 6. The 9 infants with CONPN had a lower mean birthweight than VLBW infants without CONPN (794 ± 175 g S.D. vs 1116 ± 266 g, p<0.001) and a lower gestational age (25.5 ± 2.0 wk vs 29.4 ± 3.5 wk, p<0.001) where this was known. When ROM was known, the 8 infants with CONPN had a shorter duration of ROM than infants without CONPN (3.0 ± 3,3 hr vs 54.2 ± 135.2 hr, p <0.001). We speculate that intrauterine infection in the absence of ruptured membranes led to premature labour and delivery in these VLBW infants with congenital pneumonia.
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