Risk factors for sclerema neonatorum in preterm neonates in Bangladesh

Amna Zeb, Rebecca E. Rosenberg, Asm Nawshad Uddin Ahmed, Samir K. Saha, Mak Azad Chowdhury, Saifuddin Ahmed, Gary L. Darmstadt

Research output: Contribution to journalArticle

Abstract

BACKGROUND: This study presents a retrospective analysis of risk factors for sclerema neonatorum in preterm neonates in Bangladesh. METHODS: Preterm neonates admitted to Dhaka Shishu Hospital in Bangladesh were enrolled in a clinical trial to evaluate the effects of topical treatment with skin barrier-enhancing emollients on prevention of sepsis and mortality. Four hundred ninety-seven neonates were enrolled in the study and 51 (10.3%) developed sclerema neonatorum. We explored risk factors for sclerema neonatorum by comparing patients with and without sclerema neonatorum. Diagnosis of sclerema neonatorum was based on the presence of uniform hardening of skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up and pinched into a fold. Cultures of blood and cerebrospinal fluid were obtained in all neonates with clinical suspicion of sepsis. RESULTS: In multivariate analysis, lower maternal education (OR: 1.94; 95% CI: 1.02-3.69; P = 0.043), and signs of jaundice (OR: 2.82; 95% CI: 1.19-6.69; P = 0.018) and poor feeding (OR: 4.71; 95% CI: 1.02-21.74; P = 0.047) on admission were risk factors for developing sclerema neonatorum. The incidence rate ratio of sepsis in neonates who developed sclerema neonatorum was 1.81 (95% CI: 1.16-2.73; P = 0.004), primarily due to Gram-negative pathogens, and risk of death in infants with sclerema neonatorum was 46.5-fold higher (P <0.001, 95% CI: 6.37-339.81) than for those without sclerema neonatorum. CONCLUSIONS: Sclerema neonatorum was a relatively common, grave condition in this setting, heralded by poor feeding, jaundice, and bacteremia, and signaling the need for prompt antibiotic treatment.

Original languageEnglish (US)
Pages (from-to)435-438
Number of pages4
JournalPediatric Infectious Disease Journal
Volume28
Issue number5
DOIs
StatePublished - May 2009

Fingerprint

Sclerema Neonatorum
Bangladesh
Newborn Infant
Sepsis
Jaundice
Skin
Emollients
Subcutaneous Tissue
Bacteremia

Keywords

  • Low birth weight
  • Neonatal sepsis
  • Preterm
  • Sclerema neonatorum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Zeb, A., Rosenberg, R. E., Ahmed, A. N. U., Saha, S. K., Chowdhury, M. A., Ahmed, S., & Darmstadt, G. L. (2009). Risk factors for sclerema neonatorum in preterm neonates in Bangladesh. Pediatric Infectious Disease Journal, 28(5), 435-438. https://doi.org/10.1097/INF.0b013e3181951af4

Risk factors for sclerema neonatorum in preterm neonates in Bangladesh. / Zeb, Amna; Rosenberg, Rebecca E.; Ahmed, Asm Nawshad Uddin; Saha, Samir K.; Chowdhury, Mak Azad; Ahmed, Saifuddin; Darmstadt, Gary L.

In: Pediatric Infectious Disease Journal, Vol. 28, No. 5, 05.2009, p. 435-438.

Research output: Contribution to journalArticle

Zeb, A, Rosenberg, RE, Ahmed, ANU, Saha, SK, Chowdhury, MA, Ahmed, S & Darmstadt, GL 2009, 'Risk factors for sclerema neonatorum in preterm neonates in Bangladesh', Pediatric Infectious Disease Journal, vol. 28, no. 5, pp. 435-438. https://doi.org/10.1097/INF.0b013e3181951af4
Zeb, Amna ; Rosenberg, Rebecca E. ; Ahmed, Asm Nawshad Uddin ; Saha, Samir K. ; Chowdhury, Mak Azad ; Ahmed, Saifuddin ; Darmstadt, Gary L. / Risk factors for sclerema neonatorum in preterm neonates in Bangladesh. In: Pediatric Infectious Disease Journal. 2009 ; Vol. 28, No. 5. pp. 435-438.
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abstract = "BACKGROUND: This study presents a retrospective analysis of risk factors for sclerema neonatorum in preterm neonates in Bangladesh. METHODS: Preterm neonates admitted to Dhaka Shishu Hospital in Bangladesh were enrolled in a clinical trial to evaluate the effects of topical treatment with skin barrier-enhancing emollients on prevention of sepsis and mortality. Four hundred ninety-seven neonates were enrolled in the study and 51 (10.3{\%}) developed sclerema neonatorum. We explored risk factors for sclerema neonatorum by comparing patients with and without sclerema neonatorum. Diagnosis of sclerema neonatorum was based on the presence of uniform hardening of skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up and pinched into a fold. Cultures of blood and cerebrospinal fluid were obtained in all neonates with clinical suspicion of sepsis. RESULTS: In multivariate analysis, lower maternal education (OR: 1.94; 95{\%} CI: 1.02-3.69; P = 0.043), and signs of jaundice (OR: 2.82; 95{\%} CI: 1.19-6.69; P = 0.018) and poor feeding (OR: 4.71; 95{\%} CI: 1.02-21.74; P = 0.047) on admission were risk factors for developing sclerema neonatorum. The incidence rate ratio of sepsis in neonates who developed sclerema neonatorum was 1.81 (95{\%} CI: 1.16-2.73; P = 0.004), primarily due to Gram-negative pathogens, and risk of death in infants with sclerema neonatorum was 46.5-fold higher (P <0.001, 95{\%} CI: 6.37-339.81) than for those without sclerema neonatorum. CONCLUSIONS: Sclerema neonatorum was a relatively common, grave condition in this setting, heralded by poor feeding, jaundice, and bacteremia, and signaling the need for prompt antibiotic treatment.",
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AU - Darmstadt, Gary L.

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N2 - BACKGROUND: This study presents a retrospective analysis of risk factors for sclerema neonatorum in preterm neonates in Bangladesh. METHODS: Preterm neonates admitted to Dhaka Shishu Hospital in Bangladesh were enrolled in a clinical trial to evaluate the effects of topical treatment with skin barrier-enhancing emollients on prevention of sepsis and mortality. Four hundred ninety-seven neonates were enrolled in the study and 51 (10.3%) developed sclerema neonatorum. We explored risk factors for sclerema neonatorum by comparing patients with and without sclerema neonatorum. Diagnosis of sclerema neonatorum was based on the presence of uniform hardening of skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up and pinched into a fold. Cultures of blood and cerebrospinal fluid were obtained in all neonates with clinical suspicion of sepsis. RESULTS: In multivariate analysis, lower maternal education (OR: 1.94; 95% CI: 1.02-3.69; P = 0.043), and signs of jaundice (OR: 2.82; 95% CI: 1.19-6.69; P = 0.018) and poor feeding (OR: 4.71; 95% CI: 1.02-21.74; P = 0.047) on admission were risk factors for developing sclerema neonatorum. The incidence rate ratio of sepsis in neonates who developed sclerema neonatorum was 1.81 (95% CI: 1.16-2.73; P = 0.004), primarily due to Gram-negative pathogens, and risk of death in infants with sclerema neonatorum was 46.5-fold higher (P <0.001, 95% CI: 6.37-339.81) than for those without sclerema neonatorum. CONCLUSIONS: Sclerema neonatorum was a relatively common, grave condition in this setting, heralded by poor feeding, jaundice, and bacteremia, and signaling the need for prompt antibiotic treatment.

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