Neonatal Malaria in the Gambia

BACKGROUND: Neonatal malaria was thought to be uncommon, even in malaria endemic areas. Neonates with febrile illness and / or related symptoms are often presumed to have neonatal septicaemia and examination of blood films for malaria parasites is rarely included in the initial work-up of these babies. OBJECTIVE: To determine the existence, or otherwise, and the clinical features of malaria in neonates with clinical features suggestive of septicaemia. PATIENTS AND METHODS: In a prospective study, all consecutive babies admitted in the neonatal unit of the Royal Victoria Hospital over an eighth month period with an initial diagnosis of neonatal septicaemia were screened for malaria in addition to an extensive sepsis work-up. Malaria parasitaemia was diagnosed on Giemsa stained blood smears. RESULTS: One hundred and five babies admitted in the neonatal unit of the Royal Victoria Hospital, The Gambia with an initial diagnosis of neonatal septicaemia were studied. Fourteen (13.3%) of these babies had positive blood smears for malaria parasites and bacterial cultures of their blood, cerebrospinal fluid and urine yielded no pathogen. Plasmodium falciparum was the only species identified in all the babies. A male preponderance was obtained with a male: female ratio of 2.5:1. Malaria occurred more commonly in babies aged more than one week, thus suggesting that acquired rather than congenital malaria was the more common form of neonatal malaria in the area. All the babies with malaria were admitted within the rainy season period. The principal clinical features observed in these babies were fever, refusal to feed, maternal fever in the last trimester, excessive crying, difficulty in breathing, vomiting, hepatomegaly, abdominal distension and irritability. A similar picture was observed among babies with proven neonatal septicaemia. In addition, depressed primitive reflexes was found to be more common in babies with septicaemia (p=0.01). CONCLUSIONS: These data show that neonatal malaria is not uncommon in The Gambia and that the clinical features are akin to those of neonatal septicaemia.