Download PDF
J Pediatr Infect Dis 2021; 16(06): 269-277
DOI: 10.1055/s-0041-1732472
Original Article

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

Chintha Jayasinghe
1   Ministry of Health, Sri Lanka
,
Chrishantha Abeysena 
2   Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

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.

Keywords

neonates - pregnancy - prevention - risk - sepsis

Note

The Ethics Review Committee of the Faculty of Medicine, University of Kelaniya granted ethical clearance. Informed written consent was obtained from the mothers prior to data collection. Permissions were obtained from the Regional Director of Health Services of the Gampaha District.


Authors' Contributions

C.J. participated in the design of the study, coordinated data collection, performed the statistical analysis, and helped to draft the manuscript. C.A. participated in the design of the study, performed the statistical analysis, interpreted the data, and drafted the first version of the manuscript. Both authors read and approved the final manuscript.




Publication History

Received: 04 December 2020

Accepted: 14 June 2021

Article published online:
29 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390 (10100): 1151-1210
    CrossrefPubMedGoogle Scholar
  • 2 Gonzalez RM, Gilleskie D. Infant mortality rate as a measure of a country's health: a robust method to improve reliability and comparability. Demography 2017; 54 (02) 701-720
    CrossrefPubMedGoogle Scholar
  • 3 United Nations. Levels & trends in child mortality estimates developed by the UN inter-agency group for child mortality estimation report 2020. Accessed 2020 at: https://www.unicef.org/reports/levels-and-trends-child-mortality-report-2020
    Google Scholar
  • 4 World Health Organisation. Neonatal sepsis - a major killer to be tackled in communities. Accessed 2020 at: https://www.who.int/maternal_child_adolescent/news_events/news/2009/19_01/en/
    Google Scholar
  • 5 Seale AC, Blencowe H, Manu AA. et al; pSBI Investigator Group. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. Lancet Infect Dis 2014; 14 (08) 731-741
    CrossrefPubMedGoogle Scholar
  • 6 Lawn JE, Blencowe H, Oza S. et al; Lancet Every Newborn Study Group. Every Newborn: progress, priorities, and potential beyond survival. Lancet 2014; 384 (9938): 189-205
    CrossrefPubMedGoogle Scholar
  • 7 Liu L, Oza S, Hogan D. et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016; 388 (10063): 3027-3035
    CrossrefPubMedGoogle Scholar
  • 8 World Health Organisation. Every newborn: an action plan to end preventable deaths. Accessed 2014 at: https://www.who.int/initiatives/every-newborn-action-plan
    Google Scholar
  • 9 Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed 2005; 90 (03) F220-F224
    CrossrefPubMedGoogle Scholar
  • 10 Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med 2018; 6 (03) 223-230
    CrossrefPubMedGoogle Scholar
  • 11 Thaver D, Zaidi AKM. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J 2009; 28 (Suppl. 01) S3-S9
    CrossrefPubMedGoogle Scholar
  • 12 World Health Organization. Handbook: IMCI integrated management of childhood illness. Geneva: World Health Organization.. Accessed 2005 at: http://www.who.int/iris/handle/10665/42939
    Google Scholar
  • 13 Kumar R, Kumari A, Kumari A, Verma N. Evaluation of perinatal factors in neonatal sepsis at tertiary centre. Int J Reprod Contracept Obstet Gynecol 2017; 6 (11) 4981-4985
    CrossrefPubMedGoogle Scholar
  • 14 Utomo MT. Risk factors of neonatal sepsis: a preliminary study in Dr. Soetomo Hospital. Indonesian Journal of Tropical and Infectious Disease 2010; 1 (01) 23-26
    CrossrefPubMedGoogle Scholar
  • 15 Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH. Risk factors for neonatal sepsis. Obstet Gynecol 1996; 87 (02) 188-194
    CrossrefPubMedGoogle Scholar
  • 16 Schrag SJ, Cutland CL, Zell ER. et al; PoPS Trial Team. Risk factors for neonatal sepsis and perinatal death among infants enrolled in the prevention of perinatal sepsis trial, Soweto, South Africa. Pediatr Infect Dis J 2012; 31 (08) 821-826
    CrossrefPubMedGoogle Scholar
  • 17 Department of Census and statistics. Sri Lanka Demographic and Health Survey, Colombo, Department of Census and Statistics. Accessed 2012 at: http://www.statistics.gov.lk/Health/StaticalInformation
    Google Scholar
  • 18 Ministry of Healthcare and Nutrition. Annual Health Statistics. Sri Lanka: 2011
    Google Scholar
  • 19 Karunasekera KA, Pathirana D. A preliminary study on neonatal septicaemia in a tertiary referral hospital paediatric unit. Ceylon Med J 1999; 44 (02) 81-86
    PubMedGoogle Scholar
  • 20 Oddie S, Embleton ND. Risk factors for early onset group B streptococcal sepsis. BMJ 2002; 325: 308-311
    CrossrefPubMedGoogle Scholar
  • 21 Mugalu J, Nakakeeto MK, Kiguli S, Kaddu-Mulindwa DH. Aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital, Uganda. Afr Health Sci 2006; 6 (02) 120-126
    PubMedGoogle Scholar
  • 22 Haque KN, Khan MA, Kerry S, Stephenson J, Woods G. Pattern of culture-proven neonatal sepsis in a district general hospital in the United Kingdom. Infect Control Hosp Epidemiol 2004; 25 (09) 759-764
    CrossrefPubMedGoogle Scholar
  • 23 Adair CE, Kowalsky L, Quon H. et al. Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study. CMAJ 2003; 169 (03) 198-203
    PubMedGoogle Scholar
  • 24 Ministry of Healthcare and Nutriti. on, 2006–2007.. Annual Report on Family Health. Sri Lanka: . Accessed 2021 at: http://www.gov.pe.ca/photos/original/doh_ar06-07heal.pdf
    Google Scholar
  • 25 Kumar R. Abortion in Sri Lanka: the double standard. Am J Public Health 2013; 103 (03) 400-404
    CrossrefPubMedGoogle Scholar
  • 26 Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P, Reingold A, Schuchat A. Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics 2006; 118 (02) 570-576
    CrossrefPubMedGoogle Scholar
  • 27 Gebremedhin D, Berhe H, Gebrekirstos K. Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: unmatched case control study. PLoS ONE 2016; 11 (05) e0154798
    CrossrefPubMedGoogle Scholar
  • 28 Rafi MA, Miah MMZ, Wadood MA, Hossain MG. Risk factors and etiology of neonatal sepsis after hospital delivery: a case-control study in a tertiary care hospital of Rajshahi, Bangladesh. PLoS One 2020; 15 (11) e0242275
    CrossrefPubMedGoogle Scholar
  • 29 Nyma Z, Rahman M, Hasan SMM. et al. Prevalence and associated risk factors of sepsis among neonates admitted into neonatal intensive care units of public hospitals in Dhaka. Cureus 2020; 12 (03) e7461
    PubMedGoogle Scholar
  • 30 Dutta S, Reddy R, Sheikh S, Kalra J, Ray P, Narang A. Intrapartum antibiotics and risk factors for early onset sepsis. Arch Dis Child Fetal Neonatal Ed 2010; 95 (02) F99-F103
    CrossrefPubMedGoogle Scholar
  • 31 Mersha A, Worku T, Shibiru S, Bante A, Molla A, Seifu G. Neonatal sepsis and associated factors among newborns in hospitals of Wolaita Sodo Town, Southern Ethiopia. Res Rep Neonatol 2019; 9: 1-8
    PubMedGoogle Scholar
  • 32 Adatara P, Afaya A, Salia SM. et al. Risk factors for neonatal sepsis: a retrospective case-control study among neonates who were delivered by caesarean section at the trauma and specialist Hospital, Winneba, Ghana. BioMed Res Int 2018; 2018: 6153501
    CrossrefPubMedGoogle Scholar
  • 33 Leal YA, Álvarez-Nemegyei J, Velázquez JR. et al. Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up. BMC Pregnancy Childbirth 2012; 12: 48
    CrossrefPubMedGoogle Scholar
  • 34 Murthy S, Godinho MA, Guddattu V, Lewis LES, Nair NS. Risk factors of neonatal sepsis in India: a systematic review and meta-analysis. PLoS One 2019; 14 (04) e0215683
    CrossrefPubMedGoogle Scholar
  • 35 Adatara P, Afaya A, Salia SM. et al. Risk factors associated with neonatal sepsis: a case study at a specialist hospital in Ghana. ScientificWorldJournal 2019; 2019: 9369051
    CrossrefPubMedGoogle Scholar
  • 36 Raqib R, Alam DS, Sarker P. et al. Low birth weight is associated with altered immune function in rural Bangladeshi children: a birth cohort study. Am J Clin Nutr 2007; 85 (03) 845-852
    CrossrefPubMedGoogle Scholar
  • 37 Stoll BJ, Schuchat A. Maternal carriage of group B streptococci in developing countries. Pediatr Infect Dis J 1998; 17 (06) 499-503
    CrossrefPubMedGoogle Scholar
  • 38 Salem SY, Sheiner E, Zmora E, Vardi H, Shoham-Vardi I, Mazor M. Risk factors for early neonatal sepsis. Arch Gynecol Obstet 2006; 274 (04) 198-202
    CrossrefPubMedGoogle Scholar
  • 39 Jabiri A, Wella HL, Semiono A, Sariah A, Protas J. Prevalence and factors associated with neonatal sepsis among neonates in Temeke and Mwananyamala Hospitals in Dares Salaam, Tanzania. Tanzan J Health Res 2016;18(04) DOI: 10.4314/thrb.v18i4.4
    Google Scholar
  • 40 Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet 2008; 371 (9607): 135-142
    CrossrefPubMedGoogle Scholar