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

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 29 th March to 7 th 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.