CHLAMYDIA AS A CAUSE OF LATE NEONATAL PNEUMONIA AT KENYATTA NATIONAL HOSPITAL, NAIROBI

Background: Neonatal pneumonia is a common cause of morbidity and mortality allover the world. The problem is known to be higher in resource poor third worldcountries. Organisms (such as chlamydia) not covered by routine laboratory tests andregular antibiotic regimes may frequently contribute towards the causation of lateneonatal pneumonia. It is therefore useful to gather epidemiological evidence to guidein the routine diagnosis and treatment of such infections.Objective: To determine the prevalence of chlamydia associated pneumonia amonginfants developing the disease between the 7th and 30th days of life (late neonatalpneumonia).Design: Cross sectional survey.Setting: Newborn Unit, Kenyatta National Hospital.Subjects: Fifty two newborns clinically diagnosed as having late neonatal pneumonia.They were all subjected to chest X-rays to confirm the clinical diagnosis. Nasopharyngealaspirates for chlamydia antigen detection tests were then performed on all patients. Thestudy was undertaken during the months of September through to November 2000.Main outcome measures: The proportion of newborns with late neonatal pneumonia thathave chlamydia trachomantis as the sole or contributory causative agent.Results: Fifty two newborns of postnatal age between seven and 30 days were recruited.Their sex distribution was about 1:1. Thirty three (63.5%) of these infants were foundwith chlamydia in their upper airways. Thirty out of 47 available chest X-rays, representing63.8% had evidence of interstitial pneumonitis. Chlamydia associated pneumonia indicatedby the presence of both interstitial pneumonia and colonization of the upper air wayswas present in 24 out of 47 patients, 51% of the total cases of late neonatal pneumonia.When X-rays alone were compared with our gold standard for the diagnosis of chlamydiapneumonia (radiology and colonization), we computed a sensitivity of 100%, specificity73%, negative predictive value 100% and positive predictive value of 80%. Mode ofdelivery, birth weight and gestation had no association with nasopharyngeal colonizationby chlamydia or actual diagnosis of chlamydia pneumonia.Conclusion: The prevalence of chlamydia associated infection among newborns with lateneonatal pneumonia at Kenyatta National Hospital is 51%, eight times more than thatreported elsewhere. Chest X-rays appear to be a reliable diagnostic tool in this group.The use of antichlamydial drugs in addition to the regular antibiotics whenever adiagnosis of late neonatal pneumonia is made is justifiable