Risk Factors Associated with Neonatal Sepsis: A Case Study at a Specialist Hospital in Ghana

The burden of neonatal sepsis and its risk factors in Africa. a systematic review and meta-analysis

BACKGROUND

Neonatal sepsis is a significant cause of newborn mortality in low- and middle-income countries (LMICs). Together, infections, complications of preterm birth, and intrapartum-related conditions contribute to nearly 90% of all neonatal deaths. Africa experiences high rates of neonatal deaths due to sepsis, with insufficient prevention efforts. Understanding the burden of neonatal sepsis is essential to reducing these deaths in the region. This study aims to estimate the pooled magnitude of neonatal sepsis and identify its associated risk factors in Africa.

METHOD

For this study, we gathered data by searching various databases until August 20, 2024, including PubMed/MEDLINE, PubMed Central, Hinari, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. Full-text articles in English, both published and unpublished, from 2000 to 2024 were included. However, sources like citations without abstracts or full texts, unidentified reports, editorials, summaries of research, meta-analyses, and qualitative studies were not included in the study. We evaluated the quality of the selected papers using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. Data extraction was completed in Microsoft Excel, and analysis was conducted using STATA V.17 Statistical Software. We assessed study heterogeneity with the I2 statistic and the Cochrane Q test. Publication bias was evaluated both visually through a funnel plot and statistically through Egger's regression and Begg's tests. Subgroup analyses were performed to identify sources of heterogeneity, and a sensitivity analysis was conducted to find any outlier studies.

RESULT

This review includes 49 studies with 87,548 neonates. The overall magnitude of neonatal sepsis in Africa was found to be 40.98% (95% confidence interval (CI): 30.50% to 51.46%) P: 0.00. The study found that factors such as prolonged rupture of membranes (Odds ratio (OR) 4.11, 95% CI: 2.81-5.41) P: 0.00, a history of the urinary tract or sexually transmitted infections (OR 3.28, 95% CI: 1.97-4.58) P: 0.00, low birth weight (< 2500 g) (OR 6.95, 95% CI: 3-10.89) P: 0.00, an Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score below 7 at the first minute (OR 7.56, 95% CI: 3.39-11.73) P: 0.00, preterm birth (OR 5.38, 95% CI: 3.23-7.5) P: 0.00, and neonates who were resuscitated at birth (OR 3.26, 95% CI: 1.96-4.56) P: 0.00.

CONCLUSION

The magnitude of neonatal sepsis in Africa remains high. This study identified several contributing factors, including prolonged rupture of membranes, a history of urinary tract or sexually transmitted infections, low birth weight (< 2500 g), an APGAR score below 7 at one minute, preterm birth, and resuscitation at birth. These findings underscore the importance of routinely screening for risk factors such as prolonged membrane rupture and maternal infections. Enhancing antenatal care, training providers in early neonatal sepsis management, and enforcing infection control measures.

Prevalence and factors associated with neonatal sepsis in Mali: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and risk factors for neonatal sepsis among neonates admitted to selected health facilities in the Bamako district and Koulikoro region in Mali.

DESIGN

This is a prospective cross-sectional study. Data were analyses using bivariate and multivariate logistic regression.

SETTING

This facility-based study was conducted in four health facilities consisting of two hospitals and two reference health centres in Mali.

PARTICIPANTS

The study participants comprised 795 randomly selected neonates and their indexed mother.

OUTCOME MEASURES

The primary outcome of the study was the prevalence of sepsis in the considered health facilities. The other variables of interest were risk factors for sepsis.

RESULTS

The prevalence of neonatal sepsis among the study population was 21.00%. More than 74% of sepsis cases were early onset (<72 hours). Neonatal age <7 days (AOR=2.79, 95% CI 1.59 to 4.89, p=0.000), low birth weight <2500 g (AOR=2.88, 95% CI 1.41 to 5.86, p=0.003), Apgar score <7 (AOR=4.03, 95% CI 3.09 to 5.24, p=0.000), mother with no education (AOR=2.24, 95% CI 1.15 to 4.33, p=0.02), maternal fever (AOR=2.31, 95% CI 1.53 to 3.53, p=0.000), prolonged rupture of membranes (AOR=1.87, 95% CI 1.01 to 3.54, p=0.04) and prolonged labour (AOR=2, 95% CI 1.03 to 3.88, p=0.04) were significantly associated with neonatal sepsis.

CONCLUSION

The prevalence of sepsis in Mali is still high. Given the country's current security context, the findings in this study can support prevention activities, particularly given the limited resources available. It is essential to facilitate antenatal and postnatal visits, to promote in-facility births and rigorous monitoring of neonates at high risk of sepsis. Furthermore, it would be beneficial for future research on neonatal sepsis to include neonates born at home.

Neonatal Sepsis: A Comprehensive Review

Neonatal sepsis remains a significant cause of neonatal morbidity and mortality globally. At present, no clear consensus definition for sepsis in neonates exists, even though a positive blood culture is considered as the gold standard for definitive diagnosis. The accurate and timely diagnosis of sepsis in neonates presents significant difficulties, since "culture negative" or "suspected" sepsis varies widely worldwide. Antibiotic overuse and resistance are emerging problems, but on the other hand, under-recognition of sepsis and delayed antibiotic treatment could have serious or even fatal adverse outcomes in this vulnerable population. In the context of rapid recognition of sepsis and timely initiation of appropriate antibiotic therapy, various sepsis risk assessment tools have been developed, a variety of biomarkers are in clinical use or under research for future use, and new diagnostic techniques are under evaluation. In this review, we summarize the most recent data on neonatal sepsis, the utility of sepsis risk assessment tools for term and preterm infants with sepsis, and current diagnostic and preventive tools.

Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study

BACKGROUND

Babies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.

METHODS

We conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.

RESULTS

We enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8-21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2-65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6-40), primiparity (AOR = 4.8, 95% CI: 1.1-21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5-12) were associated with EONS.

CONCLUSIONS

Prime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

Association Between Vitamin D Deficiency and Sepsis in Term Neonates: A Case-Control Study

Background Neonatal sepsis remains a major global health challenge, contributing significantly to morbidity and mortality in term neonates. Despite advancements in neonatal care, the early identification and prevention of sepsis continue to pose challenges. Emerging research suggests that vitamin D, traditionally recognized for its role in bone health, also plays a crucial role in immune regulation. Objectives To evaluate and compare serum vitamin D levels in term neonates with sepsis and without sepsis. Methods The study included 60-term neonates, with 30 neonates diagnosed with sepsis as cases and 30 healthy-term neonates as controls. Detailed history and clinical examination were performed for all subjects. Sepsis was diagnosed based on clinical and laboratory criteria. Serum vitamin D levels were assessed using the chemiluminescent microparticle immunoassay (CMIA) technique. Results The mean serum vitamin D levels in the sepsis group were significantly lower (16.0 ng/mL ± 10.5) compared to the control group (29.07 ng/mL ± 8.4) with a p-value <0.01. There was no significant difference in gender distribution (p=0.79), socioeconomic status (p=0.752), or maternal age (p=0.349) between the groups. Significant differences were found in the mode of delivery (p=0.037), presence of meconium-stained liquor (p=0.001), intrapartum antibiotic administration (p=0.0006), and resuscitation requirements (p=0.0004). APGAR scores at one minute were significantly lower in the sepsis group (p=0.001). Clinical features among sepsis cases included poor activity (40%), tachypnoea (46.6%), tachycardia (43.3%), and hyperthermia (40%). Conclusion A strong association between vitamin D deficiency and the severity of sepsis was observed, with deficient neonates showing higher rates of severe, early-onset sepsis.

Early onset neonatal sepsis and its associatited factors: a cross sectional study

BACKGROUND

Sepsis is the 3rd leading cause of neonatal mortality in Ethiopia contributing to 16% of neonatal death. In a hospital study, neonatal sepsis was the leading diagnosis at admission and the second leading cause of neonatal death at the neonatal intensive care unit. Among other factors repeated vaginal examination during labor is known to contribute to sepsis in low-income settings. However, there is limited evidence in the Ethiopian setting.

OBJECTIVE

The objective of this study was to examine the association between early-onset neonatal sepsis and repeated vaginal examinations.

METHODS

The study was conducted at Gandhi Memorial Hospital, a public maternity and newborn care hospital. We followed 672 mother-newborn pairs by phone until 7 days of age to detect clinical sepsis. Data were analyzed using SPSS version 20 software. Adjusted odds ratio risk (AOR) with a corresponding 95% confidence interval (CI) was used to show the strength of associations and variables with p-value < 0.05 were considered to be statistically significant.

RESULTS

The incidence of early-onset neonatal sepsis was found to be 20.83% (95% CI 17.60, 24.00). Having a frequent vaginal examination (four or more times) during labor and delivery, prolonged rupture of membranes, induced labor and gestational age < 37 weeks were strongly associated with the development of early-onset neonatal sepsis, (AOR 2. 69;95 CI: 1.08, 6.70) AOR 5.12(95% CI 1.31, 20.00), AOR of 5.24 (95% CI 1.72, AOR4.34 (95% CI 1.20, 15.68), 16.00), respectively.

CONCLUSION

Frequent digital vaginal examination prolonged rupture of membranes, induced labor and gestational age < 37 weeks significantly increases the risk of early onset neonatal sepsis. We also recommend further study using neonatal blood culture to better diagnose early onset neonatal sepsis objectively.

Prevalence, perinatal outcomes and factors associated with neonatal sepsis in Nigeria

OBJECTIVE

To examine the prevalence, perinatal outcomes and factors associated with neonatal sepsis in referral-level facilities across Nigeria.

DESIGN

Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme in 54 referral-level hospitals across Nigeria.

SETTING

Records covering the period from 1 September 2019 to 31 August 2020.

POPULATION

Mothers admitted for birth during the study period, and their live newborns.

METHODS

Analysis of prevalence and sociodemographic and clinical factors associated with neonatal sepsis and perinatal outcomes. Multilevel logistic regression modelling identified factors associated with neonatal sepsis.

MAIN OUTCOME MEASURES

Neonatal sepsis and perinatal outcomes.

RESULTS

The prevalence of neonatal sepsis was 16.3 (95% CI 15.3-17.2) per 1000 live births (1113/68 459) with a 10.3% (115/1113) case fatality rate. Limited education, unemployment or employment in sales/trading/manual jobs, nulliparity/grand multiparity, chronic medical disorder, lack of antenatal care (ANC) or ANC outside the birthing hospital and referral for birth increased the odds of neonatal sepsis. Birthweight of <2500 g, non-spontaneous vaginal birth, preterm birth, prolonged rupture of membranes, APGAR score of <7 at 5 min, birth asphyxia, birth trauma or jaundice were associated with neonatal sepsis. Neonates with sepsis were more frequently admitted to a neonatal intensive care unit (1037/1110, 93.4% vs 8237/67 346, 12.2%) and experienced a higher rate of death (115/1113, 10.3% vs 933/67 343, 1.4%).

CONCLUSIONS

Neonatal sepsis remains a critical challenge in neonatal care, underscored by its high prevalence and mortality rate. The identification of maternal and neonatal risk factors underscores the importance of improved access to education and employment for women and targeted interventions in antenatal and intrapartum care.

Magnitude of neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Hawassa Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia, 2020

BACKGROUND

Neonatal sepsis is one of the most common causes of disease and death among neonates globally. And it made a great contribution to neonatal admission to intensive care units. To mitigate the ongoing neonatal crisis and accomplish the goal of sustainable development through a decrease in neonatal mortality, information from various regions is needed. Despite the considerable burden of neonatal sepsis in our setting, no prior studies were conducted in the study area. So, this study aimed to assess the magnitude and associated factors of neonatal sepsis among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia.

METHODS

A hospital-based cross-sectional study was carried out among 287 neonates from March 1, 2020, to April 25, 2020. An interviewer-administered structured questionnaire was used to collect the data. The data were cleaned, coded, and entered into Epi Data 3.1 software and exported to Statistical Package for Social Science (SPSS) software version 23.0 for analysis. Binary logistic regression analyses were performed to identify variables having a significant association with neonatal sepsis. A p-value of ≤ 0.05 was considered statistically significant during multivariable logistic regression.

RESULTS

The study found that the magnitude of neonatal sepsis was 56%. The mean age of neonates was 3.2(SD±2.2) days. Around two-fifths (39%) of neonates were in the gestational age of <37 completed weeks. A quarter of mothers(25.8%) were delivered through cesarean section. During labor, 251 (87.5%) mothers had ≤4 digital vaginal examinations. Moreover, the finding revealed that mothers who delivered by cesarean section [AOR = 2.13, 95% CI (1.090-4.163)]. neonates who had been resuscitated at birth [AOR = 4.5, 95% CI (2.083-9.707)], and neonates who had NG tube inserted [AOR = 4.29, 95% CI (2.302-8.004)] were found to be significantly associated with neonatal sepsis.

CONCLUSIONS

The current study shows that neonatal sepsis was prevalent among more than half of the neonates admitted to the NICU. Therefore, designing strategies to enhance the aseptic techniques of professionals in the provision of care and actively and collaboratively working with cluster health facilities is highly recommended.

Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study

BACKGROUND

Sepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country.

METHODS

This case-control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture.

RESULTS

Forty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml).

CONCLUSION

In the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Knowledge and use of chorhexidine gel in umbilical cord care among postpartum women at Poly General Hospital, Enugu, Southeast Nigeria: a cross-sectional study

BACKGROUND

Sepsis in the first week or two of life is a major cause of newborn deaths. People from diverse cultural backgrounds use different substances for umbilical cord care. Evidence-based umbilical cord care practices have a large potential to lower infant morbidity and mortality linked to infection. This study investigated the knowledge and use of chlorhexidine gel for umbilical cord care.

METHODS

A cross-sectional descriptive survey was employed among 191 postpartum women at the Poly General Hospital Asata, Enugu, selected through simple random sampling. A researcher-developed questionnaire was used for data collection.

RESULTS

More than one-half (n=101; 52.1%) had poor knowledge of chlorhexidine gel use in umbilical cord care. There was no significant association between educational status and knowledge of chlorhexidine gel use in umbilical cord care among the participants (p=0.072). Only 89 (46.6%) had ever used chlorhexidine gel for umbilical cord care, while 49 (25.7%) used chlorhexidine gel for their last child. Parity was not significantly associated with the use of chlorhexidine gel (p=0.736). Both educational status (p=0.019) and knowledge of chlorhexidine use for umbilical cord care (p<0.001) were found to be significantly associated with its use.

CONCLUSIONS

There was poor knowledge of chlorhexidine gel use for umbilical cord care among the participants. Use of chlorhexidine gel in this population is still suboptimal. Healthcare providers should continue to provide information on chlorhexidine gel use in umbilical cord care in order to optimise its knowledge and use. Other factors associated with the use of chlorhexidine gel for umbilical cord care should be explored.

Breast problems and associated factors among lactating women in Northeast Ethiopia, 2022

Breastfeeding is the cornerstone of child and maternal health. However, maternal breast problems during breastfeeding have been frequently reported as one of the reasons for early discontinuation of breastfeeding. Despite the importance of having knowledge on breast problems magnitude and its associated factors in the clinical practices and designing effective interventions, there is limited data on this topic. Therefore, this study aimed to assess the prevalence and associated factors of breast problem among postnatal lactating women in Legambo district, south wollo zone, North East Ethiopia, in 2022. A community-based cross sectional study was conducted among 610 lactating mothers in Legambo district. Multi-stage sampling was employed to select study participants. Interviewer administered, WHO B-R-E-A-S-T-Feeding, observational checklist and maternal self-reported breast problem questionnaires were used to collect the data. Epi-Data version 3.1 was used for data entry and export to SPSS version 25.0 for analysis. Descriptive statistics and bi-variable and multivariable analysis was carried out. On the multivariable logistic regression, variables with p-value < 0.5 were considered as they had statistically significant association with breast problem. The overall prevalence of breast problems among postnatal lactating women was 54.3% (95%, CI 49.3-59.3%). Primipara (AOR = 5.09; 95% CI 3.40-7.62), preterm infant (AOR = 2.12; 95% CI 1.22-3.66), home delivery (AOR = 3.67; 95% CI 1.62-8.30), ineffective breastfeeding techniques (AOR = 2.45; 95%CI 1.61-3.74), caesarean section delivery (AOR = 2.05;95%CI :1.15-3.64) and mixed type of feeding (AOR = 1.97:95%CI 1.34-2.89) were factors showed significant association. The prevalence of breast problems was 54.3%. Relevant factors related to an increase risks are being primipara, cesarean section delivery, home delivery, preterm birth, ineffective breastfeeding techniques and mixed type of feeding.

Investigation of Factors Influencing Infant Mortality at Greater Accra Regional Hospital, Ghana

Background

Annually, 5.4 million children under five face mortality, with 2.5 million deaths in the first month, 1.6 million between one and eleven months, and 1.3 million aged one to four. Despite global strides, sub-Saharan Africa, including Ghana, grapples with persistent high child mortality. This study employs statistical methods to pinpoint factors driving under-five mortality in the Greater Accra Regional Hospital.

Methods

The data was acquired from Greater Accra Regional Hospital, Ghana, spanning January to December 2020. The data comprised all under-five deaths recorded in the hospital in 2020. The statistical tools employed were the chi-square test of association and the multinomial logistic regression model.

Results

In 2020, there were 238 cases of under-five mortality recorded in the hospital, with males constituting the majority (55%). About 85% of these cases occurred within the first month of birth, primarily attributed to respiratory distress, prematurity, and sepsis. Notably, meconium aspiration was the least common among grouped diagnoses. The test of association and multinomial logistic model emphasised the child's age, birth type, and weight at birth as significant factors influencing child mortality. Conversely, attributes like sex, marital status, and mother's age displayed no notable association with the diagnosis of death.

Conclusion

The study on child mortality at the Greater Accra Regional Hospital unveils key factors shaping child health outcomes, emphasising the role of age, birth type, and weight. While specific demographics show no significant association, identified predictors are vital for targeted interventions. Proposed strategies encompass education programs, improved care, birthing practices, and data-driven policies.

Risk factors of multidrug-resistant organisms neonatal sepsis in Surabaya tertiary referral hospital: a single-center study

BACKGROUND

Bacterial organisms causing neonatal sepsis have developed increased resistance to commonly used antibiotics. Antimicrobial resistance is a major global health problem. The spread of Multidrug-Resistant Organisms (MDROs) is associated with higher morbidity and mortality rates. This study aimed to determine the risk factors for developing MDRO neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2020-2022.

METHODS

A cross-sectional study was performed on 113 eligible neonates. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Univariate and multivariate analysis with multiple logistic regression were performed to find the associated risk factors for developing multidrug-resistant organism neonatal sepsis. A p-value of < 0.05 was considered significant.

RESULTS

Multidrug-resistant organisms were the predominant aetiology of neonatal sepsis (91/113, 80.5%). The significant risk factors for developing MDRO neonatal sepsis were lower birth weight (OR: 1.607, 95% CI: 1.003 - 2.576, p-value: 0.049), history of premature rupture of the membrane (ProM) ≥ 18 (OR: 3.333, 95% CI: 2.047 - 5.428, p-value < 0.001), meconium-stained amniotic fluid (OR: 2.37, 95% CI: 1.512 - 3.717, p-value < 0.001), longer hospital stays (OR: 5.067, 95% CI: 2.912 - 8.815, p-value < 0.001), lower Apgar scores (OR: 2.25, 95% CI: 1.442 - 3.512, p-value < 0.001), and the use of respiratory support devices, such as invasive ventilation (OR: 2.687, 95% CI: 1.514 - 4.771, p-value < 0.001), and non-invasive ventilation (OR: 2, 95% CI: 1.097 - 3.645, p-value: 0.024).

CONCLUSIONS

Our study determined various risk factors for multidrug-resistance organism neonatal sepsis and underscored the need to improve infection control practices to reduce the existing burden of drug-resistant sepsis. Low-birth-weight, a maternal history of premature rupture of the membrane lasting more than 18 hours, meconium-stained amniotic fluid, longer hospital stays, a low Apgar score, and the use of ventilators were the risk factors for developing drug-resistant neonatal sepsis.

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

Objectives

This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa.

Methods

This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias.

Results

A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis.

Conclusion

The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).

Sepsis Risk Factors in Neonatal Intensive Care Units of Public Hospitals in Southeast Ethiopia, 2020: A Retrospective Unmatched Case-Control Study

Background

Neonatal sepsis is a significant contributor to neonatal morbidity and mortality worldwide. It is more prevalent in developing countries. Thus, understanding the risk factors for neonatal sepsis is critical to minimizing the incidence of infection, particularly in Ethiopia. The purpose of this study was to identify the risk factors for neonatal sepsis in neonates admitted to neonatal intensive care units of public hospitals in Southeast Ethiopia in 2020.

Method

An institution-based, retrospective unmatched case-control study was conducted on 97 cases and 194 controls in neonatal intensive care units of public hospitals in Southeast Ethiopia. A pretested, structured questionnaire was used to collect the data. Data was entered using EpiData 3.1 and analyzed using SPSS version 23. Bivariable and multivariable logistic regression analyses were performed to identify associated factors. An adjusted odds ratio with a 95% confidence interval was used to determine the degree of association, and statistical significance was declared at a p value of < 0.05.

Results

In this study, 97 cases and 194 controls were included. About two-thirds (63.9%) of cases were with early onset neonatal sepsis (<7 days). Mode of delivery with spontaneous vaginal delivery (AOR:5.032; 95% CI (1.887-13.418)), type of birth attendant (traditional birth attendant) (AOR: 4.407 95% CI (1.213,16.004)), history of STI/UTI (AOR:2.543; 95% CI (1.313,4.925)), intrapartum fever (AOR:4.379; 95% CI (2.170,8.835)), APGAR score at the 5thminute < 7 (AOR:4.832; 95% CI (1.862,12.537)), neonate received resuscitation (AOR:3.830; 95% CI (1.753,8.369)), low birth weight (AOR:6.101; 95% CI (2.124,17.525)) were the identified risk factors for neonatal sepsis.

Conclusion

Both maternal and neonatal factors contribute to the risk of neonatal sepsis. Spontaneous vaginal delivery, birth attended by the traditional birth attendant, history of STI/UTI, presence of intrapartum fever, low APGAR score at the 5th minute, neonate receiving resuscitation, and low birth weight were identified as independent risk factors for neonatal sepsis. Prompt identification of the aforementioned factors and management should be sought for all newborns.

Predictors of the onset of neonatal sepsis at the Neonatal Intensive Care Unit of a tertiary hospital in Ghana: A cross-sectional study

Background and Aim

Neonatal sepsis is a systemic inflammatory response to infection during the first 4 weeks of an infant's life. It is a significant cause of neonatal morbidity and mortality in low- and middle-income countries. This study aimed to determine the predictors of the onset of sepsis at the Neonatal Intensive Care Unit of the Tamale Teaching Hospital, Ghana.

Methods

A cross-sectional study was conducted among 275 mothers and their singleton neonates diagnosed clinically with sepsis. A univariate and multivariate logistic regression analysis adjusted for maternal occupational status was performed to determine the maternal and neonatal predictors of early-onset (EOS) and late-onset sepsis (LOS), respectively.

Results

Single motherhood (AOR = 1.882, 95% CI = 0.926-3.822, p = .08) and home delivery (AOR = 3.667, 95% CI = 0.584-23.026, p = .17) were predictors of EOS, with single motherhood being the predictor for LOS (AOR = 2.906, 95% CI = 0.715-11.805, p = .14) in a univariate analysis. When maternal occupation was adjusted for in a multivariate analysis, single mother (AOR = 2.167, 95% CI = 1.010-4.648, p = .04) was the main predictor of EOS, with low neonatal birth weight being the main predictor of LOS (AOR = 0.193, 95% CI = 0.038-0.971, p = .04).

Conclusion

Maternal marital status is a significant predictor of both EOS and LOS, with predictors of EOS being lower gestational age and low birth weight, while for LOS, low birth weight is the main predictor. Findings from this study can serve as a commencement point for developing predictive models for the onset of sepsis in neonates in the study facility.

Risk and diagnostic factors and therapy outcome of neonatal early onset sepsis in ICU patients of Saudi Arabia: a systematic review and meta analysis

Background

Neonatal early onset sepsis (NEOS) is a serious and potentially life-threatening condition affecting newborns within the first few days of life. While the diagnosis of NEOS was based on clinical signs and symptoms in the past, recent years have seen growing interest in identifying specific diagnostic factors and optimizing therapy outcomes. This study aims to investigate the diagnostic and risk factors and therapy outcomes of neonatal EOS in ICU patients in Saudi Arabia, with the goal of improving the management of neonatal EOS in the country.

Methods

This method outlines the protocol development, search strategy, study selection, and data collection process for a systematic review on neonatal early onset sepsis in Saudi Arabian ICU patients, following the PRISMA 2020 guidelines. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is a well-established guideline that provides a framework for conducting systematic reviews and meta-analyses in a transparent and standardized manner. It aims to improve the quality and reporting of such research by ensuring clear and comprehensive reporting of study methods, results, and interpretations. The search strategy included electronic databases (PubMed, Embase, Google Scholar, Science Direct, and the Cochrane Library) and manual search of relevant studies, and data were extracted using a standardized form.

Results

The systematic review included 21 studies on neonatal sepsis in Saudi Arabia, with varying study designs, sample sizes, and prevalence rates of sepsis. Group B streptococcus and E. coli were the most commonly isolated pathogens. Various diagnostic factors and risk factors were reported, including hematological parameters, biomarkers, and blood cultures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute critical checklist.

Conclusions

The review identified a number of risk and diagnostic factors and therapy outcomes for neonatal sepsis. However, most of the studies were having small scale cohort groups. Further research with controlled study designs is needed to develop effective prevention and management strategies for neonatal sepsis in Saudi Arabia.

Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review

Background and Objectives: Group B streptococcus (GBS) is the leading cause of infections in neonates with high fatality rates. GBS is caused by the streptococcus bacterium known as streptococcus agalactiae, which is highly contagious and can be transmitted from pregnant women to infants. GBS infection can occur as an early onset or late-onset infection and has different treatment strategies. Antibiotics are effective in treating GBS infections at early stages. The aim of this systematic review was to summarize the clinical characteristics and treatment strategies for GBS, with a focus on antibiotics. Material and Methods: The findings of this review were reported in accordance with the PRISMA 2020 guidelines and a flow diagram of the study selection process, a summary of the included studies, a description of the study characteristics, a summary of the results, a discussion of the implications of the findings, and a conclusion are included. Overall, the authors followed a rigorous methodology to ensure that this review is comprehensive and inclusive of relevant studies on GBS infection and its treatment. Results: Overall, 940 studies were reviewed and only the most relevant 22 studies were included in the systematic review. This review describes the characteristics of patients in different studies related to early onset GBS disease and presents various treatment strategies and outcomes for GBS infection in pediatrics. The studies suggest that preventive measures, risk-based intrapartum antibiotic prophylaxis, and maternal vaccination can significantly reduce the burden of GBS disease, but late-onset GBS disease remains a concern, and more strategies are required to decrease its rate. Improvement is needed in the management of the risk factors of GBS. A conjugate vaccine with a serotype (Ia, Ib, II, III, and V) has been proven effective in the prevention of GBS in neonates. Moreover, penicillin is an important core antibiotic for treating early onset GBS (EOD). Conclusions: This systematic review summarizes the treatment comparison for GBS infections in neonates, with a primary focus on antibiotics. IAP (intrapartum antibiotic prophylaxis) according to guidelines, antenatal screening, and the development of a conjugate vaccine may be effective and could lower the incidence of the disease.

A case control study of maternal and neonatal risk factors associated with neonatal sepsis

Introduction

Neonatal Sepsis is a significant leading cause of infant death around the world, particularly in developing nations. The study aimed to identify maternal and neonatal risk factors linked to neonatal sepsis.

Methods

A hospital-based case-control study was conducted in the ICU. Cases were neonates diagnosed as having sepsis by clinical criteria and laboratory findings. Controls were admitted neonates who were neither suspected nor diagnosed with sepsis. Data on mothers and babies, as well as laboratory findings, were gathered and analyzed.

Results

A total of 174 cases and 348 controls were included in the study. Maternal age, parity, route of delivery, PROM, prematurity, birth weight, neonatal gender and age were significantly associated with the risk of sepsis (p < 0.05). However, the bivariate logistic model revealed that the most influential predictors of neonatal sepsis were premature rupture of membranes, Gestational age, Neonatal age, birth weight, and mode of delivery.

Conclusion

Both maternal and neonatal variables were found to have a significant association with the risk of neonatal sepsis; thus, empowering mothers to pursue antenatal care may allow the detection of risk factors for undesirable delivery consequences such as neonatal sepsis, as well as appropriate management to mitigate those risks.

Clinical Risk Factors for Early-Onset Sepsis in Neonates: An International Delphi Study

Background

Despite growing evidence, there is still uncertainty about potentially modifiable risk factors for neonatal early-onset sepsis (EOS). This study aimed to identify potential clinical risk factors for EOS based on a literature review and expert opinions.

Methods

A literature search was conducted in PubMed (MEDLINE), Cochrane, Embase, and Scopus databases. Articles in English, published up to May 2021, on clinical risk factors for neonatal EOS were included. Initially, a questionnaire on risk factors for EOS was developed and validated. The fuzzy Delphi method (FDM) was used to formulate the final version of the questionnaire. The validity of the risk factors was assessed using the Chi square test. P<0.05 was considered statistically significant.

Results

In the review phase, 30 risk factors were approved by two neonatologists and included in the FDM phase. In total, 25 risk factors met the consensus criteria and entered the validation phase. During the observational study, 114 neonates (31 with and 83 without EOS) were evaluated for two months. The results of the Chi square test showed that cesarean section was not a significant risk factor for EOS (P=0.862). The need for mechanical ventilation and feed intolerance was observed in about 70% of neonates with EOS, and therefore considered significant risk factors for EOS (P<0.001). Finally, 26 potential clinical risk factors were determined.

Conclusion

Neonatal-related risk factors for EOS were birth weight, one-min Apgar score, and prematurity. Maternal-related risk factors were gestational age and urinary tract infection. Delivery-related risk factors were premature rupture of membranes, chorioamnionitis, and intrapartum fever.

Risk factors for neonatal sepsis among neonates in the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital and Adare General Hospital in Hawassa City, Ethiopia

Background

Neonatal sepsis (NS) is a serious blood bacterial infection in children of 28 days or younger, manifested by systemic signs and symptoms of infection. Neonatal sepsis has become one of the leading causes of admission and death in developing countries like Ethiopia. Understanding different risk factors for neonatal sepsis is essential for early diagnosis and treatment. So, this study aimed to assess the risk factors for neonatal sepsis among neonates at Hawassa University Comprehensive Specialized Hospital and Adare General Hospital in Hawassa City, Ethiopia.

Methods and materials

A case-control study design was employed on 264 neonates (66 cases and 198 controls) in Hawassa University Comprehensive Specialized Hospital and Adare General Hospital from April to June 2018. Data were collected by interviewing the mothers and reviewing neonates' medical records. The data were edited, cleaned, coded, and entered into Epi info version 7 and were transported and analyzed using SPSS version 20. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the significance of the associations.

Result

A total of 264 neonates (66 cases and 198 controls) with 100% response rate. The mean (±SD) age of mothers was 26 ± 4.042 years. The majority (84.8%) of the cases were found in children under 7 days, with a mean age of 3.32 days ± 3.376 SD. Factors such as prolonged rupture of the membrane [AOR = 4.627; 95% CI (1.997-10.72)], history of the urinary tract or sexually transmitted infections [AOR = 2.5; 95% CI (1.151-5.726)], intrapartum fever [AOR = 3.481; 95% CI (1.18-10.21)], foul smelling liquor [AOR = 3.64; 95% CI (1.034-12.86)], and low APGAR score in the fifth minute [AOR = 3.38; 95% CI (1.107-10.31)] were the independent predictors of neonatal sepsis.

Conclusion

Prolonged rupture of the membrane, intrapartum fever, urinary tract infection, foul-smelling liquor, and low APGAR score were independent risk factors of neonatal sepsis, and this study also observed that the onset of neonatal sepsis was higher in the first week of a neonate's life. Routine sepsis evaluation must focus on neonates born with the aforementioned characteristics and make interventions for babies born with these risk factors.

Bacterial etiology and risk factors among newborns suspected of sepsis at Hawassa, Ethiopia

Neonatal sepsis is a systemic infection that occurs at an early age. Its etiology varies from one region to the other. The contribution of sepsis to neonatal mortality and morbidity is significant in resource-limited countries; however, there is limited information about the etiology of sepsis in Sidama Regional State, Ethiopia. The aim of this study was to determine the prevalence of bacterial caused newborn sepsis, associated factors, and the antimicrobial susceptibility profile of bacteria. A hospital-based prospective cross-sectional study was conducted among 392 sepsis suspected newborns admitted to the neonatal intensive care unit of Hawassa University Comprehensive Specialized Hospital from March 2021 to November 2021. Blood specimens were collected and bacteria were isolated using the standard culture method. The drug resistance profile of bacteria was evaluated using the disk diffusion method. The socio-demographic and clinical parameters of participants were gathered using a questionnaire. Binary logistic regression was used to determine the determinants of sepsis. A variable with a p < 0.05 was considered a significant determinant of neonatal sepsis with a 95% confidence level. The prevalence of sepsis caused by bacteria among newborns was 143 (36.5%); 95% CI (31.3-41.4). The predominant bacteria was Klebsiella species (n = 61; 42.65%), followed by non-lactose fermenting Gram-negative bacteria (n = 27; 18.88%) and Enterococcus species (n = 26; 18.18%). The overall proportions of antimicrobial resistance of Gram-negative bacteria range from 10.2 to 99.1%. All Klebsiella species were resistant to ceftriaxone. Ppremature rupture of membrane [AOR = 12.7 (95% CI 6.430-25.106)], absence of respiratory support [AOR = 3.53 (95% CI 1.840-6.759)], sex of newborns [AOR = 2.10 (1.214-3.560)] and reason for admission [AOR = 3.17 (95% CI 1.278-7.859)] were significantly associated with culture-confirmed neonatal sepsis. This study indicated the contribution of bacteria in causing sepsis among newborns; the majority of them were Gram-negative bacteria. Most recovered bacteria were resistant to commonly used antibiotics. Pre-term, mode of delivery and types of respiratory support were significantly associated with the occurrence of sepsis caused by bacteria.

Incidence of Sepsis and Its Determinants among Neonates Admitted in Level III Neonatal Unit - A Prospective Observational Study

Introduction: Neonates are prone for sepsis due to their immature immune system. Sepsis is preventable if we aware of the maternal and neonatal risk factors. This study aimed to identify the incidence of sepsis and its risk factors. Methods: A prospective observational study was carried out among 288 neonates in level III Neonatal unit. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to neonatal and maternal demographic and clinical characteristics, incidence of sepsis, risk factors of sepsis were collected by direct observation and from medical record. Data regarding number of skin pricks for blood sample and intravenous cannulation and number of handling of the baby were collected from Tally counters. Data were analysed using chi square test, t-test and logistic regression with SPSS software version 25. Results: The incidence of sepsis was 34.7% in level III neonatal unit. Culture positive sepsis constituted 7.3%, urinary tract infection 0.3%, meningitis 7 % and probable sepsis 26.4%. Neonatal factors like extreme preterm, extreme low birth weight, gestational age, birth weight, duration of stay in level III neonatal unit, number of handling, number of skin pricks, duration of intravenous line, duration of tube feeds, mechanical ventilation and maternal premature rupture of membrane were associated with neonatal sepsis significantly. Conclusion: Incidence of neonatal sepsis can be minimized by concentrating on modifiable risk factors and implementing the protocol of minimum handling and minimal skin pricks for the neonates.

Factors associated with early onset neonatal sepsis among neonates in public hospitals of Sidama region, Southern Ethiopia, 2021: Unmatched case control study

Background

In Ethiopia, more than one-third of all neonatal mortality are caused by early-onset neonatal sepsis, which is one of the most common reasons for neonatal hospitalization and mortality in developing countries. This study aims to add to the body of knowledge on the determinants of early-onset neonatal sepsis to reduce the prevalence of early-onset neonatal sepsis in the study setting.

Methods

An unmatched case-control study was carried out in public hospitals of Sidama region, Southern Ethiopia. The data was entered into Epi info version 7.2 and analyzed with the Statistical Package for Social Sciences version 25. Binary logistic regression was used to identify the determinants of early-onset neonatal sepsis, and variables in the multivariable logistic regression analysis with a p-value of less than 0.05 were declared significantly associated at a 95% confidence interval.

Results

In this study, 97 neonates with early-onset neonatal sepsis (cases) and 194 neonates without early-onset neonatal sepsis (controls) were included with their index mothers. Early-onset neonatal sepsis was significantly associated with frequency of antenatal care follow-ups (AOR = 0.15, 95% CI: 0.06-0.37), instrumental delivery/assisted vaginal delivery (AOR = 3.35, 95% CI: 1.08-10.44), gestational hypertension (AOR = 2.85, 95% CI: 1.21-6.71), and Apgar score at the fifth minute (AOR = 3.13, 95% CI: 1.23-7.92).

Conclusions

and recommendation: It is better to intervene on those identified factors. Strengthening antenatal care services by giving adequate information to mothers and counseling about the necessity of implementing the World Health Organization's 2016 antenatal care (ANC) recommendations for a positive pregnancy experience to prevent early-onset newborn sepsis.

Risk factors for neonatal sepsis in Sub-Saharan Africa: a systematic review with meta-analysis

OBJECTIVES

To identify the risk factors for neonatal sepsis in Sub-Saharan Africa.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Web of Science, African Index Medicus and ClinicalTrials.gov were searched for observational studies from January 2010 to August 2020.

SETTING

Sub-Saharan Africa, at all levels of healthcare facilities.

PARTICIPANTS

'Neonates' (<28 days of age) at risk of developing either clinical and/or laboratory-dependent diagnosis of sepsis.

OUTCOME MEASURES

Identification of any risk factors for neonatal sepsis.

RESULTS

A total of 36 studies with 23 605 patients from secondary or tertiary level of care facilities in 10 countries were included. Six studies were rated as good quality, 8 as fair and 22 as poor. Four studies were omitted in the meta-analysis due to insufficient data. The significant risk factors were resuscitation (OR 2.70, 95% CI 1.36 to 5.35), low birth weight <1.5 kg (OR 3.37, 95% CI 1.59 to 7.13) and 1.5-2.5 kg (OR 1.36, 95% CI 1.01 to 1.83), low Apgar score at the first minute (OR 3.69, 95% CI 2.34 to 5.81) and fifth minute (OR 2.55, 95% CI 1.46 to 4.45), prematurity <37 weeks (OR 1.91, 95% CI 1.27 to 2.86), no crying at birth (OR 3.49, 95% CI 1.42 to 8.55), male sex (OR 1.30, 95% CI 1.01 to 1.67), prolonged labour (OR 1.57, 95% CI 1.08 to 2.27), premature rupture of membranes (OR 2.15, 95% CI 1.34 to 3.47), multiple digital vaginal examinations (OR 2.22, 95% CI 1.27 to 3.89), meconium-stained amniotic fluid (OR 2.72, 95% CI 1.58 to 4.69), intrapartum maternal fever (OR 2.28, 95% CI 1.18 to 4.39), foul-smelling vaginal discharge (OR 3.31, 95% CI 2.16 to 5.09) and low socioeconomic status (OR 1.93, 95% CI 1.11 to 3.35). We found considerable heterogeneity in the meta-analysis of 11 out of 15 identified risk factors.

CONCLUSION

Multiple risk factors for neonatal sepsis in Sub-Saharan Africa were identified. We revealed risk factors not listed by the WHO guidelines. The included studies overall had high risk of bias and high heterogeneity and thus, additional research of high quality is needed.

PROSPERO REGISTRATION NUMBER

CRD42020191067.

Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa

Background

Bloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria.

Objective

To determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia.

Methods

A cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software.

Results

The prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI.

Conclusion

Pediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.

Admission Outcome and Antimicrobial Resistance Pattern of Bacterial Isolates among Neonates with Suspected Sepsis in Neonatal Intensive Care Unit at Dessie Comprehensive Specialized Hospital, Dessie, Northeastern Ethiopia

Background

Neonatal sepsis is a major cause of morbidity and mortality globally. The aim of this study was to assess admission outcome and antimicrobial susceptibility pattern of bacterial isolates among neonates with suspected sepsis at the Dessie Comprehensive specialized Hospital (DCSH), Northeastern Ethiopia.

Method

Cross-sectional study was conducted from August 2017 to March 2018. Two hundred forty-six neonates were recruited, and each patient's blood specimen was collected aseptically using bottle containing Brain Heart Infusion for blood culture. Both clinical and laboratory data such as bacterial culture growth and antimicrobial susceptibility pattern were collected from the neonate; clinical data from the mothers were also included. Antimicrobial susceptibility testing was performed using Kirby-Bauer disk diffusion method. The data were analyzed using SPSS version 20.

Results

Bacteria were identified from 67 (27.2%) blood cultures. The predominant pathogen was Escherichia coli (35.8%) followed by Staphylococcus aureus (26.8%), and Coagulase Negative Staphylococcus (CoNS) (19.4%). The isolated bacteria showed resistance to Ampicillin 55 (82%), third-generation Cephalosporins 21 (58.3%) and other tested antimicrobials. Overall, 68.6% bacterial isolates demonstrated Multidrug resistance (MDR) and total registered mortality rate was 12/246 (4.8%). Both neonatal factors such as neonatal temperature, septic umbilicus and utilization of indwelling medical device during delivery; and maternal factors such as age, antenatal urinary tract infection (UTI), mode of delivery and prolonged rupture of membrane (PROM) had shown statistically significant association with bacterial sepsis.

Conclusion

The rate of bacterial growth was found to be high; E. coli and S. aureus were the predominant organisms. Both maternal and neonatal related data were strong predictors for bacterial infection of the neonate. Therefore, improving infrastructures for screening of bacteremia as well as active surveillance in clinical setting needed to ensure proper empirical therapy.

Neonatal Sepsis and Associated Factors Among Neonates Admitted to Neonatal Intensive Care Unit in General Hospitals, Eastern Ethiopia 2020

Introduction:

Globally, the major cause of neonatal mortality and morbidity is neonatal sepsis, which is defined as a clinical course marked by systemic inflammation in the presence of infection in a newborn. There are limited data concerning neonatal sepsis in eastern Ethiopia. As a result, this study aimed to determine the prevalence of neonatal sepsis and associated factors among neonates admitted to intensive care units at general hospitals in Eastern Ethiopia.

Methods:

A hospital-based cross-sectional study with retrospective document review was conducted among newborns hospitalized in neonatal intensive care units. Using simple random sampling, the charts of 356 newborns who were hospitalized between January and December 2019 were included, and data were collected using a pretested checklist. Data were entered into Epi data version 3.1 and analyzed with SPSS version 22.

Results:

The overall prevalence of neonatal sepsis was 45.8% (95% CI 40.7, 51.4). Prolonged rupture of the membrane (AOR = 2.38, 95% CI: [1.27-4.45]), vaginal delivery (AOR = 1.78, 95%, CI: [1.09, 2.96]) APGAR score <7 (AOR = 4.55, 95% CI: [2.49-8.29]), prelacteal feeding (AOR = 3.54, 95% CI: [1.68-8.23]), and mechanical ventilation (AOR = 4.97,95%CI: [2.78-8.89]) were predictors associated with neonatal sepsis.

Conclusion:

In this study, the prevalence of neonatal sepsis was high, and factors associated with neonatal sepsis included prolonged rupture of membrane, mode of delivery, low APGAR score, prelacteal feeding and mechanical ventilation. As a result, maternal and neonatal care should be enhanced to lower the risk of neonatal sepsis.

Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study

BACKGROUND

Neonatal sepsis is a primary cause of neonatal mortality and is an urgent global health concern, especially within low-income and middle-income countries (LMICs), where 99% of global neonatal mortality occurs. The aims of this study were to determine the incidence and associations with neonatal sepsis and all-cause mortality in facility-born neonates in LMICs.

METHODS

The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) study recruited mothers and their neonates into a prospective observational cohort study across 12 clinical sites from Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Data for sepsis-associated factors in the four domains of health care, maternal, birth and neonatal, and living environment were collected for all mothers and neonates enrolled. Primary outcomes were clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality in neonates during the first 60 days of life. Incidence proportion of livebirths for clinically suspected sepsis and laboratory-confirmed sepsis and incidence rate per 1000 neonate-days for all-cause mortality were calculated. Modified Poisson regression was used to investigate factors associated with neonatal sepsis and parametric survival models for factors associated with all-cause mortality.

FINDINGS

Between Nov 12, 2015 and Feb 1, 2018, 29 483 mothers and 30 557 neonates were enrolled. The incidence of clinically suspected sepsis was 166·0 (95% CI 97·69-234·24) per 1000 livebirths, laboratory-confirmed sepsis was 46·9 (19·04-74·79) per 1000 livebirths, and all-cause mortality was 0·83 (0·37-2·00) per 1000 neonate-days. Maternal hypertension, previous maternal hospitalisation within 12 months, average or higher monthly household income, ward size (>11 beds), ward type (neonatal), living in a rural environment, preterm birth, perinatal asphyxia, and multiple births were associated with an increased risk of clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality. The majority (881 [72·5%] of 1215) of laboratory-confirmed sepsis cases occurred within the first 3 days of life.

INTERPRETATION

Findings from this study highlight the substantial proportion of neonates who develop neonatal sepsis, and the high mortality rates among neonates with sepsis in LMICs. More efficient and effective identification of neonatal sepsis is needed to target interventions to reduce its incidence and subsequent mortality in LMICs.

FUNDING

Bill & Melinda Gates Foundation.

Risk Factors and Clinical Outcomes of Neonatal Sepsis in Manado Tertiary Referral Hospital: A Single-center Study

BACKGROUND: Neonatal sepsis remains a major cause of morbidity and mortality among newborn infants, both term and preterm. Even with effective treatment, the outcome is still uncertain, with inflated health-care cost due to prolonged length of stay in the Neonatal Intensive Care Unit. AIM: This study aimed to evaluate risk factors and their association with clinical outcomes of neonatal sepsis in a tertiary referral hospital in Manado, Indonesia. METHODS: This is a single-center retrospective cohort study of 365 neonatal sepsis subjects, conducted between January 2016 and December 2018. Risk factors were divided into two groups: Neonatal-related and maternal-related risk factors. Clinical outcomes analyzed were survival outcome (discharged or death) and hospital length of stay. Logistic regression, Mann–Whitney, and Kruskal–Wallis test were used in statistical analysis. RESULTS: From all risk factors, the highest mortality rate was found in neonates with sclerema (83.1%), and the lowest mortality rate in neonates without tachypnea (11.6%). Further multivariate statistical analysis revealed two risk factors associated with mortality, such as tachypnea (OR 4.94, 95% CI 2.257–10.841; p < 0.001) and sclerema (OR 34.47, 95% CI 15.135‒78.509; p < 0.001). Further analysis also reported several risk factors associated with prolonged length of stay, such as very low birth weight (p < 0.001), premature rupture of the membrane (p = 0.009), preterm gestational age (p < 0.001), and non-hospital delivery location (p = 0.013). CONCLUSION: In neonatal sepsis, the presence of tachypnea and sclerema was significant risk factors for mortality. Meanwhile, premature rupture of the membrane, very low birth weight, preterm gestational age, and non-hospital delivery location were risk factors associated with prolonged length of stay.

Pattern of hospital antibiotic use in term neonates using WHO Access, Watch and Reserve Classification (AWaRe)

BACKGROUND AND OBJECTIVE

Pakistan has high neonatal mortality rate and antibiotic utilization data in hospitalized term neonates from Pakistan is lacking. The study aimed to determine the pattern of hospital antibiotic use in term neonates using World Health Organization (WHO) Access, Watch, and Reserve classification (AWaRe).

METHODS

This cross-sectional chart review study was conducted at the neonatal unit of Pediatric Medicine Department of University Hospital over a period of one year from 1^st January 2020 to 31^st December 2020. Hospitalized full term newborns up to 28-days of life, of either gender were consecutively included in the study. Data on demographic characteristics, admission diagnoses and antibiotic prescribed (class, agent and duration) were extracted from clinical charts. Descriptive statistics in the form of mean ± SD and frequency and percentages were calculated.

RESULTS

A total of 2276 term neonates consisting of 69% (n=1570) males were included in the study. Antibiotic prescription rate was 92.8%. Most common reason for admission was birth asphyxia (36.1%) followed by sepsis (33%). Most commonly prescribed antibiotic Ampicillin (84%) belonged to Access group of WHO - AWaRe classification. More than 97% of prescriptions were two or more antimicrobial combinations belonging to Watch group. Ampicillin and Cefoperazone was the most commonly prescribed (42.8%) two drug combination. Meropenem and vancomycin was prescribed to 20% of the neonates - mostly for sepsis and pneumonia. Mortality rate was 7.7% in current study.

CONCLUSION

High antibiotic prescription rate particularly from Watch-group is demonstrated in this study. There is high need of antimicrobial stewardship program in neonatal units.

Prediction modelling in the early detection of neonatal sepsis

BACKGROUND

Prediction modelling can greatly assist the health-care professionals in the management of diseases, thus sparking interest in neonatal sepsis diagnosis. The main objective of the study was to provide a complete picture of performance of prediction models for early detection of neonatal sepsis.

METHODS

PubMed, Scopus, CINAHL databases were searched and articles which used various prediction modelling measures for the early detection of neonatal sepsis were comprehended. Data extraction was carried out based on Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Extricate data consisted of objective, study design, patient characteristics, type of statistical model, predictors, outcome, sample size and location. Prediction model Risk of Bias Assessment Tool was applied to gauge the risk of bias of the articles.

RESULTS

An aggregate of ten studies were included in the review among which eight studies had applied logistic regression to build a prediction model, while the remaining two had applied artificial intelligence. Potential predictors like neonatal fever, birth weight, foetal morbidity and gender, cervicovaginitis and maternal age were identified for the early detection of neonatal sepsis. Moreover, birth weight, endotracheal intubation, thyroid hypofunction and umbilical venous catheter were promising factors for predicting late-onset sepsis; while gestational age, intrapartum temperature and antibiotics treatment were utilised as budding prognosticators for early-onset sepsis detection.

CONCLUSION

Prediction modelling approaches were able to recognise promising maternal, neonatal and laboratory predictors in the rapid detection of early and late neonatal sepsis and thus, can be considered as a novel way for clinician decision-making towards the disease diagnosis if not used alone, in the years to come.

Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda

Introduction

Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths.

Objective(s)

To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates suspected to sepsis at Kilembe mines hospital.

Methods

We conducted a descriptive cross-sectional study, where purposive sampling technique was used and blood was drawn from 122 neonates suspected to sepsis attending Kilembe Mines Hospital during the period (July to November 2020). Specimens were inoculated in Brain heart infusion broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by Gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Associations were tested using Chi square with Fisher’s exact or Yates correction tests where necessary and statistical significance was set at P < 0.05. Stata (version 14) used for statistical analysis.

Results

Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than Gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against Gram negative isolates. Risk factors of neonatal septicaemia were mother’s age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500 g, Apgar score 1st and 5th min ≥6 and resuscitation.

Conclusion

Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.

Risk Factors for Neonatal Sepsis in Secondary and Tertiary Care Hospitals of a District in Sri Lanka: A Case–Control Study

Objective The aim of this study was to determine the risk factors for neonatal sepsis.

Methods A case–control study was performed in secondary and tertiary care hospitals of a district in Sri Lanka. Neonates who diagnosed with sepsis based on clinical criteria or culture positivity were taken as the case group (n = 240) and neonates born during the same period who had not been diagnosed with sepsis were taken as the control group (n = 240). The controls were recruited from the community. The study instruments were, pretested interviewer administered questionnaire, a check list and record sheets. Multiple logistic regression analysis was performed. The results were expressed as odds ratios (OR) with the 95% confidence intervals (CI).

Results The independent risk factors for neonatal sepsis were history of abortions, still birth, and early neonatal deaths (OR: 6.78; 95% CI: 3.2–14.3), registration of pregnancy after 8 weeks of gestation (OR: 1.91; 95% CI: 1.07–3.4), total antenatal clinic visits ≤4 (OR: 7.18; 95% CI: 2.1–24.5), history of maternal fever prior to the week of delivery (OR: 2.74; 95% CI: 1.25–6.0) leaking amniotic fluid >18 hours (OR: 10.0; 95% CI: 2.1–47.4), performed >3 vaginal examinations before delivery (OR: 3.28; 95% CI: 2.1–24.5), meconium stained amniotic fluid (OR: 10.57; 95% CI: 3.7–29.7), mode of delivery by cesarean section, forceps or vacuum (OR: 2.33; 95% CI: 1.4–3.9), time of birth of the neonate being during on-call hours (OR: 2.12; 95% CI: 1.3–3.5), being a male baby (OR: 1.74; 95% CI: 1.1–2.8), and birth weight <2,500 g (OR: 5.17; 95% CI: 2.8–9.6) of neonates.

Conclusion Most of the identified risk factors for neonatal sepsis were modifiable. Stringent implementation of guidelines and protocols would prevent neonatal sepsis.

The diagnostic and prognostic role of MiRNA 15b and MiRNA 378a in neonatal sepsis

BACKGROUND AND OBJECTIVES

Sepsis is one of the major factors for both term and preterm babies with morbidity and mortality. On the basis of recent clinical trials, altered circulating micro-RNAs (miRNAs) may serve as possible biomarkers in sepsis for diagnosis and prognosis. The aim of this research is to assess the diagnostic and prognostic biomarkers of miRNA 15b and miRNA 378a for neonatal sepsis.

SUBJECTS & METHODS

This study was carried out 25 neonates with sepsis admitted to neonatal ICU of Menoufia University Hospital and 25 healthy controls from February 2019 to May 2020. The relative quantification (RQ) of miRNA-15b and miRNA-378a expression was assessed using real time PCR technique. Results: Our results demonstrated that patients with sepsis had significantly higher level of MiRNA-15b than the healthy volunteers. On the other hand, patients with sepsis had significantly lower level of MiRNA-378a than the healthy volunteers. The ROC curve showed that the serum MiRNA-15b was a significant discriminator of sepsis with a combined sensitivity and specificity of 76% and 88% with cutoff point of 3.24. In addition, serum MiRNA-378a was a significant discriminator of sepsis with a combined sensitivity and specificity of 60% and 88% with cutoff point of 0.361. The miRNA-15b expression significantly correlated positive with respiratory rate (r =0.415,p =0.039), WBCs (r = 0.408, p =0.043), and CRP (r =0.407, p=0.043). Likewise, miRNA-378a expression significantly correlated negative with respiratory rate (r =-0.415p =0.024), WBCs (r =- 0.442, p =0.027), and CRP (r =- 0.459, p=0.021).

CONCLUSION

Both MiRNA 15b and 378a are promising biomarker for neonatal sepsis.

Determinants of Neonatal Sepsis among Neonates Admitted to Public Hospitals in Central Ethiopia: Unmatched Case-control Study

Background. Neonatal sepsis is the cause of substantial morbidity and mortality, mostly affecting the developing countries including Ethiopia. Previously conducted studies also highlighted the high prevalence of neonatal sepsis in Ethiopia. Therefore, this study was aimed at assessing the determinants of neonatal sepsis in the central Ethiopia. Method. Institution based un-matched case control study was conducted among 192 cases (neonates with sepsis) and 384 controls (without sepsis) in public hospitals in Central Ethiopia. The data were collected through face-to-face interview using structured questionnaire and extraction from maternal and neonatal charts. Binary logistic regression (bi-variable and multi-variable) model was fitted. Adjusted odds ratio with respect to 95% confidence interval was employed for the strength and directions of the association. Results. Younger maternal-age; 30 to 34 years (AOR = 0.41, 95%CI: 0.19-0.85) and 25 to 29 years (AOR = 0.38, 95%CI: 0.17-0.84), not having antenatal care (ANC) follow-ups (AOR = 1.89, 95%CI: 1.02-3.49), place of delivery; home (AOR = 12.6, 95%CI: 5.32-29.82) and health center (AOR = 2.74, 95%CI: 1.7, 4.41), prolonged duration of labor (AOR = 1.90, 95%CI: 1.22, 2.96), prolonged rupture of membrane 12 to 17 hours (AOR = 3.26, 95%CI: 1.46, 7.26) and ≥18 hours (AOR = 5.18, 95%CI: 1.98, 13.55) were maternal related determinants of neonatal sepsis. Whereas, prematurity (AOR = 2.74, 95%CI: 1.73, 4.36), being resuscitated (AOR = 1.93, 95%CI: 1.22, 3.06) and not having meconium aspiration syndrome (AOR = 2.55, 95%CI: 1.34, 4.83) were identified as neonatal related determinants of neonatal sepsis. Conclusion. Younger maternal age, not having antenatal care follow-up, home, and health center delivery, prolonged duration of labor, prolonged duration of rupture of membrane, prematurity, had resuscitation, and neonates without meconium aspiration syndrome were found to be determinants of neonatal sepsis. Therefore, the concerned stakeholders should consider those identified determinants during an intervention for improvement of neonatal health.

Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019

Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.

Effects of vitamin D on neonatal sepsis: A systematic review and meta-analysis

Vitamin D deficiency is a major public health concern of pregnant women and neonates worldwide, affecting more than half of neonates. Studies report inconsistent and inconclusive effects of vitamin D treatment on neonatal sepsis. This study aimed to provide conclusive evidence regarding the effect of maternal and cord blood vitamin D levels on neonatal sepsis. Data were retrieved from the electronic database (Web of Science, Scopus, CINAHL [EBSCOhost], ProQuest, EMBASE [Ovid], PubMed, Emcare, MEDLINE [Ovid], and gray literature sources [World cat, Mednar, Google scholar and Google]). Joanna Briggs Institute quality assessment tool was utilized for quality assessment while analysis was performed using Open Meta-analyst, Comprehensive Meta-analysis version 3.3.070, and Review Manager version 5.3 software. From the 18 studies included in the study, the overall prevalence of vitamin D deficiency among neonates was 61% (95% CI: 44.3, 77.7); 79.4% (95% CI: 71.6, 87.3) of neonates with sepsis were vitamin D deficient as were 43.7% (23.4, 63.9) of sepsis-free neonates. Neonates born from mothers with low vitamin D levels were at greater risk of developing neonatal sepsis with a weighed mean difference of -8.57 ng/ml (95% CI: -13.09, -4.05). Similarly, neonates with low cord vitamin D levels were at risk for neonatal sepsis with a mean difference of -8.78 ng/ml (95% CI:-11.58, -5.99). The incidence of EONS in full-term newborns was significantly associated with low maternal and cord blood vitamin D levels with weighed mean differences of -11.55ng/ml (95% CI: -17.63, -5.46) & -11.59 ng/ml (95% CI:-16.65, -6.53), respectively. Low levels of vitamin D both in the cord blood and maternal blood were significantly associated with neonatal sepsis. Hence, vitamin D supplementation for pregnant women and newborns could decrease neonatal sepsis.

Epidemiology of neonatal infections in hospitals of Nepal: evidence from a large- scale study

Background

Every year, neonatal infections account for approximately 750,000 neonatal deaths globally. It is the third major cause of neonatal death, globally and in Nepal. There is a paucity of data on clinical aetiology and outcomes of neonatal infection in Nepal. This paper aims to assess the incidence and risk factors of neonatal infection in babies born in public hospitals of Nepal.

Methods

This is a prospective cohort study conducted for a period of 14 months, nested within a large-scale cluster randomized control trial which evaluated the Helping Babies Breathe Quality Improvement package in 12 public hospitals in Nepal. All the mothers who consented to participate within the study and delivered in these hospitals were included in the analysis. All neonates admitted into the sick newborn care unit weighing > 1500 g or/and 32 weeks or more gestation with clinical signs of infection or positive septic screening were taken as cases and those that did not have an infection were the comparison group. Bivariate and multi-variate analysis of socio-demographic, maternal, obstetric and neonatal characteristics of case and comparison group were conducted to assess risk factors associated with neonatal infection.

Results

The overall incidence of neonatal infection was 7.3 per 1000 live births. Babies who were born to first time mothers were at 64% higher risk of having infection (aOR-1.64, 95% CI, 1.30–2.06, p-value< 0.001). Babies born to mothers who had no antenatal check-up had more than three-fold risk of infection (aOR-3.45, 95% CI, 1.82–6.56, p-value< 0.001). Babies born through caesarean section had more than two-fold risk (aOR-2.06, 95% CI, 1.48–2.87, p-value< 0.001) and babies with birth asphyxia had more than three-fold risk for infection (aOR-3.51, 95% CI, 1.71–7.20, p-value = 0.001).

Conclusion

Antepartum factors, such as antenatal care attendance, and intrapartum factors such as mode of delivery and birth asphyxia, were risk factors for neonatal infections. These findings highlight the importance of ANC visits and the need for proper care during resuscitation in babies with birth asphyxia.

Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Primary Hospitals in Central Gondar Zone, Northwest Ethiopia, 2019

BACKGROUND

Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge particularly in developing countries. Studies conducted on the proportion and risk factors of neonatal sepsis in Ethiopia are from referral hospitals, which may not be generalized to primary health care units where a significant proportion of mothers give birth in these health facilities. This study sought to determine the proportion of clinical neonatal sepsis and associated factors in the study areas.

METHODS

Institutional-based cross-sectional study was conducted from March to April 2019, in Amhara regional state, central Gondar zone public primary hospitals in Ethiopia. A total of 352 subjects (mother-neonate pairs) were selected using a systematic random sampling technique and pre-tested and structured questionnaires were used to collect data. Multivariable logistic regression analysis was fitted to identify factors associated with neonatal sepsis. Adjusted odds ratio (AOR) with the corresponding 95% confidence interval (CI) was used to show the strength of associations and variables with p-values of <0.05 were considered as statistically significant.

RESULTS

The overall proportion of neonatal sepsis was 64.8% (95% CI (59.2, 69.2)). Being male neonate (AOR=3.7; 95% CI (1.76, 7.89)), history of urinary tract infections during the index pregnancy (AOR =6, 26; 95% CI (1.16, 33.62)), frequency of per-vaginal examination greater than three during labor and delivery (AOR=6.06; 95% CI (2.45, 14.99)), neonatal resuscitation at birth (AOR=6.1; 95% CI (1.71, 21.84)), place of delivery at the health center (AOR=3.05; 95% CI (1.19, 7.79)), lack of training of health workers on neonatal resuscitation and infection prevention practices (AOR=2.14; 95% CI (1.04, 4.44)), late age of neonate at onset of illness (AOR=0.05; 95% CI (0.01, 0.21)) and maternal age of 30-34 years (AOR=0.19; 95% CI (0.047, 0.81)) were significantly associated with neonatal sepsis.

CONCLUSION

The proportion of neonatal sepsis is high. Maternal, neonatal, and health service related factors were identified for neonatal sepsis. Therefore, training of health workers, provision of health care services as per standards, and monitoring and evaluation of obstetrical/neonatal care during labor and delivery are mandatory.

Predictors of Neonatal Sepsis in Hospitals at Wolaita Sodo Town, Southern Ethiopia: Institution-Based Unmatched Case-Control Study, 2019

Background

Neonatal sepsis plays a significant role in neonates' mortality in developing countries accounting for 30-50% of total deaths each year. Gaining insight into neonatal sepsis predictors will provide an opportunity for the stakeholders to reduce the causes of neonatal sepsis. This research is aimed at determining the predictors of neonatal sepsis at Wolaita Sodo University Teaching Referral Hospital and Sodo Christian General Hospital, Ethiopia, April-July 2019.

Method

This study employed an institution-based unmatched case-control study by selecting neonates in selected hospitals through consecutive sampling technique. The cases of this study are neonates diagnosed with sepsis. The study used a pretested structured questionnaire for a face-to-face interview to collect data from index mothers. Besides, the review of the record was done using checklists. The data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences version 24.0 for analysis. The study used descriptive, bivariate, and multivariate analyses. The odds ratio with 95% confidence interval was used to measure the association's strength. p < 0.05 was the cut-off point for declaration of statistical significance for the multivariate analysis.

Results

Factors significantly associated with neonatal sepsis among neonates were maternal age of 15-20 years and 21-30 years, mothers with low income/wealth, history of urinary tract infections/sexually transmitted infections, presence of intrapartum infections, antenatal care follow‐up < 3 visits, Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score < 7, low birth weight, and the time in which breastfeeding started after delivery < 60 minutes.

Conclusion

Maternal age, wealth/income, maternal urinary tract infections/sexually transmitted infections, intrapartum fever, antenatal care visit ≤ 3 times, Apgar score < 7, low birth weight, and starting time of breastfeeding were independent predictors of neonatal sepsis. Therefore, maternal health education during antenatal care visits, perinatal and newborn care, and early initiation of breastfeeding might decrease neonatal mortality and morbidity due to sepsis.

A Cross-sectional Study of Group B Streptococcus-Associated Sepsis, Coinfections, and Antibiotic Susceptibility Profile in Neonates in Pakistan

BACKGROUND

Neonatal sepsis is a leading cause of morbidity and early-life mortality worldwide, and previous data have reported the highest neonatal mortality rate in Pakistan.

PURPOSE

The present study aimed to decipher the prevalence of group B Streptococcus (GBS)-associated sepsis, coinfections, and antibiotic susceptibility of isolated microbes in neonates.

METHODS

Blood samples of 100 cases of neonatal sepsis were subcultured on blood agar, GBS agar, and MacConkey agar for isolation of GBS and suspected microbes.

RESULTS

Of 100 neonatal blood samples, 85 blood samples were culture-positive, including mixed culture growth (n = 18), 25 samples as early-onset neonatal sepsis (EONS) and 60 as late-onset neonatal sepsis (LONS). Staphylococcus aureus showed high percent positivity (31.4%), followed by Candida sp (16.5%), GBS (14.1%), Klebsiella (14.1%), Staphylococcus epidermidis (11.8%), Pseudomonas (9.4%), Acinetobacter (9.4%), Esherichia coli (8.2%), and Enterococcus (5.9%). GBS was isolated more frequently from EONS than from LONS with 50% coinfections. Mode of delivery, gender, and respiratory distress in neonates were significantly associated with culture-positive sepsis. GBS isolates were highly (91.7%) susceptible to vancomycin, cefotaxime, and chloramphenicol, followed by penicillin (83.3%), ampicillin, and tetracycline (75%). GBS isolates were resistant to erythromycin, clindamycin, ciprofloxacin, and linezolid.

IMPLICATIONS FOR PRACTICE

Our findings evidenced GBS-associated risk factors and antibiotic susceptibility pattern of neonatal sepsis, which will help clinicians in management, control, and treatment of neonatal sepsis.

IMPLICATIONS FOR RESEARCH

The epidemiological evidence of GBS-associated neonatal sepsis, demographic characteristics, risk factor data analysis, and drug resistance pattern has disease prevention implications in neonates in low-income countries including Pakistan.

Neonatal mortality and associated factors in the specialized neonatal care unit Asmara, Eritrea

BACKGROUND

Limited knowledge on the magnitude of neonatal mortality and associated factors is hampering early intervention in African countries.

OBJECTIVE

To determine neonatal mortality and associated factors in the Specialized Neonatal Care Unit Asmara, Eritrea.

METHODS

Medical records of all neonates admitted to the Specialized Neonatal Care Unit in 2016 were reviewed using a cross-sectional study. The most important causes of admission and mortality were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the strength of risk factors associated with neonatal mortality. Variables significant at P < 0.20 level in the univariate analysis were retained in the multivariate model. Model fit was evaluated using Hosmer and Lemeshow test (Chi-square = 12.89, df = 8; P = 0.116), implies the model's estimates fit the data at an acceptable level. Collinearity was assessed using variance inflation factor (VIF) < 4. P-value < 0.05 was considered statistically significant.

RESULTS

Of the 1204 (59.9% boys and 40.1% girls) neonates admitted in 2016, 79 (65.6/1000 live births) died. The major causes of admission were sepsis (35.5%), respiratory distress syndrome (15.4%) and perinatal asphyxia (10%). Major causes of death were respiratory distress syndrome (48.1%); extremely low birth weight (40.9%) and very low birth weight (30.5%). After adjustment, low birth weight (Adjusted odds ratio (AOR) = 4.55, 95% CI,1.97-10.50), very low birth weight (AOR = 19.24, 95% CI, 5.80-63.78), late admission (24 h after diagnosis) (AOR = 2.96, 95% CI, 1.34-6.52), apgar score (in 1 min AOR = 2.28, 95% CI, 1.09-4.76, in 5 min AOR = 2.07, 95% CI, 1.02-4.22), and congenital abnormalities (AOR = 3.95, 95% CI, 1.59-9.85) were significantly associated with neonatal mortality. Neonates that stayed > 24 h in the Specialized Neonatal Care Unit (AOR = 0.23, 95% CI, 0.11-0.46) had a lower likelihood of death. Overall 95.8% of mothers of neonates attended antenatal care and 96.6% were facility delivered. None of the maternal conditions were associated with neonatal mortality in this study.

CONCLUSIONS

Low birth weight, late admission, low apgar scores and congenital abnormalities were significantly associated with neonatal mortality in the Specialized Neonatal Care Unit. Early management of low birth weight, preterm births, and neonatal complications should be the priority issues for controlling local neonatal deaths.

The role of the season at admission in neonatal sepsis: a retrospective chart review of a 1-year data at University of Gondar comprehensive specialized hospital

Objective

Neonatal sepsis is a global public health concern in general and causes a massive burden in developing countries particularly in sub-Saharan Africa. Though it is mostly preventable, neonatal sepsis remained the leading cause of mortality in developing countries. This study was conducted to determine the current proportion and identify factors associated with neonatal sepsis to suggest directions.

Results

In this study 504 randomly selected neonatal charts were reviewed. The proportion of overall neonatal sepsis was 63.69% (95% CI 59.38, 67.79), where early-onset sepsis was 59.33% (95% CI 54.96, 63.55) and late-onset sepsis was 4.17% (95% CI 2.73, 6.31). Maternal intra-partum fever, season of birth and admission, vaginal mode of delivery and preterm gestational age at birth increased the likelihood of overall and early-onset neonatal sepsis. In conclusion of this study, neonatal sepsis remaining the leading cause of morbidity among younger infants. Intra-partum conditions were major contributors to neonatal sepsis. Thus, providing emphasis on associated factors in particular and universal safe obstetric care in general is recommended.