In addition to an infection with Clostridium tetani infection with other pathogenic germs can also happen, when the infant’s umbilucus is taken care of by the dukun. During the period July 1, 1954 till July 1, 1958 12 newborn infants suffering from septicemia were admitted in the two childbirth wards in Jogjakarta mentioned above. Six out of this number were coming from the villages outside the town, while the other infants were born and lived in the town of Jogjakarta. One infant was taken to the hospital because he suffered from atresia ani while on examination this child also appeared to suffer from speticemia of the newborn. Mortality among the patients suffering from septicemia. Two patients suffered a the same time from tetanus and septicemai of the newborn. Mortality among the patients suffering from septicemia of the newborn was 100%. Within the first 24 hours after admission already 6 out of these 12 patients died. In the classification of the causes of death the patients who died of septicemia are grouped in the section: all other cause of death.
Table VIII – 8.
Review of the clinical signs in 12 cases of septicemia of the newborn.
As the possibilities to make a blood culture are limited in Jogjakarta (only in the morning of working days on appointment) it was not possible to examine the blood of all these patients in this way. Of three infants a blood culture was made and twice the result appeared to be positive. In the first case: Escheria paracoli and in the second case Bacteroides funduliformis Zbergey) was isolated from the blood of the patient. The micro-organisms which are in the greater part of the cases the causing agents in septicemia are according to the literature: streptococci, staphylococci, E. coli and Ps.aeruginosa.
The clinical features fo septicemia are more variable than those of tetanus of the newborn. The most striking clinical signs in these patients were symptoms of inflammation around the umbilicus, jaundice, high fever, petechiae, ecchymoses and sometimes sclerema and/or necrosis of the skin. The frequency of these symptoms differs. In the table below the frequency of these different symptoms is mentioned.
Some times only a slight redness with a bit of purulent fluid is found on the umbilicus while in other cases the skin around the umbilicus was swollen, red and there was infiltration of the peri-umbilical tissue. The patients were seriously ill at the time of admission. The average age of these patients was somewhat higher than of the patients suffering from tetanus of the newborn. Only three patients were younger than 7 days while the other patients were 8-22 days old.
Because septicemia of the newborn is a rare disease also in these regions we like to mention two case histories here:
SARWANA. A Javanese boy of eleven days old. Born on April 12, 1956 and admitted in Bethesda’s children’s ward on Apirl 23, 1956. The delivery happened with dukun’s assistance. Since April 21 he had been stiff. During the examination of this premature baby of 2,170 gram it appeared to be very ill and to suffer from trismus, sardonic grin and spasm of the muscles. The umbilicus excreted a little bit of yellow pus. The infant looked very red. All the capillaries in the skin were widened. When the skin was a little bit pressed it was possible to establish jaundice. Also the scierae were yellow with jaudice. Fever 39ºC. There was sclerema of the skin of both legs. In the mouth was oral moniliasis (thrush) on tongue and lips. A blood culture was made and after 3 times 24 hours this culture appeared to be positive. Beacteroides funduliformis Bergey was isolated from the blood.
This infant suffered at the same time from : Tetanus of the newborn.
Septicemia of the newborn.
Oral moniliasis.
Prematurity.
The course of the diseases was as follows: The general condition was and remained bad during the days in hospital. On the second day of admission the sclerema was extended over the whole body. The tetanus convulsions were only noticeable from disturbances in the respiration. The infant was not able to move in his sclerematours skin. Some petechiae and ecchymoses developed on the skin of abdomen, neck and back. The abdomen was distended and a peritonitis was very probable. The jaudice increased. In the blood a leucocytosis of 20,500 was observed. In the blood smear only a few thrombocytes were noticed. In the urine bilirubine was presents. The infant died after two days. The abdomen was opened and a considerable amount of gas and pus was discharged. The pus which was taken by life from the umbilicus and examined, appeared to contain streptococcus haemolyticus, Proteus anindologenes, and staphylococcus. In the pus which was taken postmartem from the abdomen appeared to be present: E. coli, Proteus anindologenes and Bacteroides funduliformis (Bergey). In a small part of the liver which was taken out the pathologist found only a slight fatty infiltration.
MUDJIJAH. A Javanese girl of 8 days old. Born at home with assistance of the dukun. She was admitted with a bodyweight of 2,770 gram. On the day of admission the infant was dozy. There was a high fever, 40.2ºC and jaundice. The liver was palpable 2 cm below the right costal margin. Around the umbilicus the skin was read and a little bit pus was visible. In the blood was a leucocytosis of 34,000. Before a blood culture was taken the patient died on the second day after admission. The opportunity for a post-mortem examination was used. Small parts of the kidney, liver, lung and the peri-umbilical skin were examined by the pathologist (B. soetarso). It appeared that the skin around the umbilicus showed signs of acute inflammation. In the liver were signs of albuminous degeneration. In this case the diagnosis Septicemia was made, although there was no blood culture which could confirm this diagnosis.
One of the pictures shown on the pages after chapter X concerns a patient with septicemia of the newborn. The child Sardjijem was admitted ten days after birth. On the fifth day of life this girl fell ill and became gradually yellower with increasing jaundice. There was a fever (39ºC). There developed a necrosis of the skin of the left and later on also of the right upper leg. The necrosis extended nearly over the whole surface of both upper legs. The blood circulation of both legs appeared seriously impeded. Both legs were swollen by oedema and cyanotic. It was supposed that thrombosis of the venae umbilicalis had advanced and had reached and occluded the vessel of both legs. The coagulation of the blood was disturbed. Small wounds were bleeding more than 10 minutes. The blood culture was negative. After two days the child died in hospital. Postmortem examination was not permitted.