Sunday Times

An­other deadly out­break claimed lives of nine ba­bies

- By KATHARINE CHILD Health · Medicine · Babies · Kids · Parenting · Family · University of the Witwatersrand · Aaron Motsoaledi

● Nine ba­bies died at a Jo­han­nes­burg hos­pi­tal from a dis­ease at­tack­ing the in­testines of in­fants, only a few months be­fore a kleb­siella out­break killed six new­borns in a Vosloorus hos­pi­tal.

The out­break of necro­tis­ing en­te­ro­col­i­tis at the Rahima Moosa Mother & Child Hos­pi­tal in Corona­tionville — which in­fected 41 ba­bies be­tween mid-March and July — was kept un­der wraps.

The cause is still un­known, de­spite ex­ten­sive test­ing of ba­bies’ sam­ples, nurses’ hands, hos­pi­tal sur­faces and even for­mula milk pow­der.

The dis­ease, which dam­ages the in­testines of ba­bies and can cause parts of their gut to die, af­fects pre­ma­ture ba­bies and oc­curs from time to time, said Pro­fes­sor Ne­lesh Goven­der, head of the Cen­tre for Op­por­tunis­tic, Trop­i­cal and Hos­pi­tal In­fec­tions at the Na­tional In­sti­tute for Com­mu­ni­ca­ble

Dis­eases (NICD).

“Pre­ma­ture new­born ba­bies are at high risk for a va­ri­ety of in­fec­tions in hos­pi­tals be­cause of their im­ma­ture im­mune sys­tems,” said Goven­der. When cases start to mount, in­ves­ti­ga­tions are needed, he said.

In mid-March a pae­di­a­tri­cian de­scribed as “as­tute” by Goven­der called on the NICD to in­ves­ti­gate the cause.

Be­tween mid-March and mid-May, 30 ba­bies got sick at Rahima Moosa hos­pi­tal and six died. An­other three ba­bies died within weeks.

The NICD was un­able to find the cause. It is no­to­ri­ously dif­fi­cult to do so, and the dis­ease is not al­ways in­fec­tious.

Tests found bac­te­rial and fun­gal in­fec­tions in about half of the sick ba­bies.

But al­most half of those who got sick had no bac­te­ria or fun­gal in­fec­tions, ac­cord­ing to NICD doc­u­ments.

By July 20 there were 41 cases in to­tal — 37 pre­ma­ture ba­bies and four full-term ba­bies.

The NICD staff went into Rahima Moosa hos­pi­tal and strength­ened in­fec­tion con­trol pro­ce­dures in the ICU and wards for pre­ma­ture ba­bies.

This in­cluded in­sist­ing on nurses, mothers, clean­ers and doc­tors do­ing reg­u­lar hand­wash­ing and disinfecti­ng their hands be­tween see­ing pa­tients.

Swabs were taken of nurses’ and mothers’ hands, but no links to the out­break were found.

The NICD said af­ter the in­fec­tion con­trol was strength­ened, the num­ber of cases de­clined by mid-May.

Goven­der said: “The de­cline of cases is wel­comed but un­ex­plained.”

Guy Richards, pro­fes­sor of crit­i­cal care at Wits Univer­sity, said fol­low­ing strict hand­hy­giene prin­ci­ples in busy hos­pi­tals was a global prob­lem.

“It is some­thing that is rapidly for­got­ten no mat­ter what you do.”

Tests of hos­pi­tal for­mula were also done by the NICD, and two types of bac­te­ria were found in the pow­dered milk used in the hos­pi­tal. But Goven­der said: “The lab­o­ra­tory re­sults for milk sam­ples ob­tained as part of this out­break in­ves­ti­ga­tion do not war­rant fur­ther in­ves­ti­ga­tion.”

The NICD does not know if milk played a role as it does not have enough data.

“In summary, the re­sults of a com­pre­hen­sive out­break in­ves­ti­ga­tion did not iden­tify the pre­cise cause of this out­break.” A pae­di­a­tri­cian who spoke to the Sun­day Times, ask­ing not to be named, said in­fec­tious-dis­ease out­breaks would keep hap­pen­ing across the prov­ince due to over­crowded wards.

He said doc­tors were at their “wits’ end” as neona­tal ICU units were all over­crowded.

In the kleb­siella out­break, six ba­bies died of the 11 who were in­fected at Vosloorus’s Thelle Mo­go­er­ane Hos­pi­tal.

Gaut­eng health spokesper­son Le­se­mang Matuka con­ceded that the prov­ince’s hos­pi­tals were “se­verely over­crowded”. He said hos­pi­tals, staff and re­sources had not ex­panded to keep up with the dou­bling of the Gaut­eng pop­u­la­tion over the past 14 years.

“We are a vic­tim of our own suc­cess,” said Matuka, a ref­er­ence to what he said was a huge num­ber of preg­nant mothers trav­el­ling to Gaut­eng to use the prov­ince’s hos­pi­tals.

Health min­is­ter Aaron Mot­soaledi, com­ment­ing on the kleb­siella out­break, said that Gaut­eng needed six more hos­pi­tals to cope with the num­ber of ba­bies born in the prov­ince.

 ??  ?? Rahima Moosa Mother & Child Hos­pi­tal in Corona­tionville, Jo­han­nes­burg.
Rahima Moosa Mother & Child Hos­pi­tal in Corona­tionville, Jo­han­nes­burg.
 ??  ?? Health min­is­ter Aaron Mot­soaledi
Health min­is­ter Aaron Mot­soaledi

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