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

Abstract

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.

Risk factors for neonatal sepsis in Lubumbashi, Democratic Republic of Congo: A retrospective case-control study

“…In the present study, 42.6% of cases were born to mothers who had a history of genitourinary tract infections during pregnancy with a higher likelihood of developing sepsis compared to newborns to mothers who had no genitourinary tract infection (AOR = 42.6). This finding is consistent with those made by several authors who have reported that maternal genitourinary tract infections were an important factor in the development of NS [3,7,9,16,17]. This could be explained by the fact that, if they are not treated during the third trimester of pregnancy, maternal genitourinary tract infections can be associated with NS following colonization of the birth canal by infectious agents [9,16].…”

“…Neonatal sepsis (NS) is defined as a systemic inflammatory response syndrome in the presence or following a suspected or confirmed infection with or without associated bacteremia, documented by a positive blood culture during the first 28 days of life [1][2][3]. Globally, NS contributes significantly to neonatal morbidity and mortality and is a major public health challenge [4].…”

“…The leading causes of neonatal death worldwide are infections (35%), premature births (28%), intrapartum complications (24%) and asphyxia (23%). In developing countries, sepsis is the most common cause of neonatal death each year and is probably responsible for 30-50% of all neonatal deaths [3,4]. The survival of newborns is a matter of great concern to the world and specially to developing countries.…”

“…Thus, it is essential to identify the risk factors for NS early in order to allow diagnostic orientation and treatment aimed at reducing neonatal morbidity and mortality. The implementation of some clinical approaches is also effective in reducing the incidence of NS [3,10].…”

Risk Factors of Early-Onset Neonatal Sepsis A Systematic Review and Meta-Analysis

“…Our metaanalysis included ten risk factors that were present in at least two studies. These risk factors included: at least three per vaginal (PV) examinations during labor and delivery in two studies 19,24 ; chorioamnionitis, based on clinical and laboratory diagnosis, in ve studies 9,14,22,24,26 ; premature rupture of membranes (PROM) (> 12 h, > 18 h, and > 24 h) in six studies 10,11,14,21,26,29 ; caesarean section in two studies 16,21 ; birth weight in ve studies (< 1500 g and < 2500 g) 11,15,16,24,25 ; GA in 11 studies (< 32 weeks and < 37 weeks; two studies did not specify the GA) 10,11,14-16,18,24,26−29 ; the presence of central venous catheter (CVC) in three studies 13,15,20 ; neonatal resuscitation in three studies 10,19,23 ; sex in two studies 13,19 ; and APGAR score in four studies (1 and 5 min). 10,16,22,26 0.002), respectively (Fig.…”