Profiling the clinical presentation and bacterial causes of fever and hypothermia among neonates at a district hospital in rural Rwanda

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Abstract Purpose Neonatal sepsis remains a significant cause of morbidity and mortality worldwide, particularly in low-resource settings. We explored the clinical presentation and bacteria causing fever and hypothermia among neonates at a rural district hospital in Rwanda. Methods Between 29th March to 7th October 2022, a total of 126 children were enrolled in this cross-sectional study. Clinical data was obtained from children with fever or hypothermia at Butaro District Hospital. Blood culture was done using conventional methods. Positive cultures were sub-cultured onto MacConkey, blood agar, and chocolate, and incubated for 24 hours to confirm the pathogen. Mothers were followed for neonatal outcomes before and after discharge for two weeks. Results Among the neonates, 55.6% were males. The majority were aged 24 hrs and 6 days 99/126(78.6%). All children had fever or hypothermia, tachycardia (84.1%), tachypnea (87.3), poor perfusion (81%), abnormal breathing (70.6%), or abnormal cavities (50%), among others. Many mothers (46%) had at least four ANC visits, and none had a known HIV infection. In our sample of mothers, 7.9% reported a previous history of sepsis, 31.7% delivered by C-section, and 20.6% had a history of sepsis. Blood cultures were positive in 67/126 (53.2%) neonates: 9 for Staphylococcus aureus (7.1%), 49 for coagulase-negative staphylococcus (CNS) (38.9%), 8 for gram-negative rods (6.4%), and 1 for Hemophilus species (0.8%). The mortality rate was reported at 7/126 (5.6%) among these children. Conclusion High positivity rates with CNS were reported among the neonates suggesting further approaches to minimize cross contamination in the neonatology unit.

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