Risk factors of neonatal sepsis in India: A systematic review and meta-analysis

Murthy, Shruti; Godinho, Myron Anthony; Guddattu, Vasudeva; Lewis, Leslie; Nair, N. Sreekumaran

doi:10.1371/journal.pone.0215683

Cited by 126 publications

(100 citation statements)

References 56 publications

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“…Premature neonates were at higher risk of neonatal sepsis. This finding is in agreement with the several findings from studies conducted in referral hospitals of Ghana [18], Ethiopia [15] and Tanzania [8]. This could be explained by the fact that premature babies are at a higher risk of infection because of their immature immune system.…”

Section: Discussionsupporting

confidence: 93%

“…Premature rupture of membrane (PROM) [8] [17], history of maternal urinary tract infection (UTI) during pregnancy, gestational age < 37 weeks, Apgar score < 7 at 5 th minute, history of artificial ventilation of the newborn, not crying immediately at birth [15] [18], delay in care seeking, and lack of access to well-trained health workers [10] [19] were identified as major contributing factors of neonatal sepsis. In the African region, lack of adequate resources delays in the diagnosis and prompt treatment of neonatal sepsis, major contributing factor to the high morbidity and mortality rates among the neonates.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Predictors of Neonatal Sepsis among Neonates Admitted at the Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya

Okube¹,

Komen²

2020

OJOG

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Background: Neonatal sepsis is one of the primary causes of neonatal morbidity and mortality especially in developing countries. Despite the availability of different preventive interventions, in Kenya, the burden of neonatal sepsis remains critically high. Aim: To determine the prevalence and predictors of neonatal sepsis among newborns admitted at the newborn unit of Kenyatta National Hospital, Kenya. Methods: This is a hospital-based, cross-sectional study design carried out among 196 neonates and their mothers at the new born unit of Kenyatta National Hospital. A systematic random sampling technique was employed to select the study subjects. Data on the possible contributing factors of neonatal sepsis was collected using a semi-structured questionnaire. Statistical analyses were performed using the statistical package for the Social Sciences (SPSS: version 22). Data were descriptively analyzed into frequencies and proportions. The chi-square test of independence and binary logistic regression were employed to determine associations between the dependent (neonatal sepsis) and various independents variables. A multiple logistic regression model was carried out to determine the variables independently contributed to the occurrence of neonatal sepsis. Results: Our study revealed that the prevalence of neonatal sepsis was 28.6%. Neonates born of single mothers (AOR = 5.454, p = 0.012), mothers with history of UTI (AOR = 2.969, p = 0.013), PROM (AOR = 6.124, p = 0.001) and anaemia (AOR = 3.379, p = 0.010) were at higher risk to develop neonatal sepsis. Prematurity (AOR = 6.402, p < 0.001), low Apgar score at 5 th minutes (AOR = 8.212, p < 0.001) and history of invasive procedure (AOR = 2.464, p = 0.046) were the neonatal factors independently associated with neonatal sepsis. Conclusion and Recommendations: The prevalence of neonatal sepsis in Kenyatta National Hospital is high. This is another piece of evidence showing both maternal and neonatal-related factor had a significant effect on the risk How to cite this paper: Okube, O.T. and Komen, M. (2020) Prevalence and Predictors of Neonatal Sepsis among Neonates

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Prevalence and Predictors of Neonatal Sepsis among Neonates Admitted at the Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya

Okube¹,

Komen²

2020

OJOG

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“…This study showed that delay in initiation of breastfeeding, having neonatal health problems, neonate's low birth weight, being preterm, and nighttime delivery was identified factors that significantly raise the risk of neonatal hypothermia. Similar findings were also reported from previous meta-analysis studies [39][40][41].…”

Section: Discussionsupporting

confidence: 92%

Prevalence of neonatal hypothermia and its associated factors in East Africa: a systematic review and meta-analysis

et al. 2020

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Background: Neonatal hypothermia is a global health problem and a major factor for neonatal morbidity and mortality, especially in low and middle-income countries. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of neonatal hypothermia and its associated factors in Eastern Africa. Methods: We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search electronic databases (PubMed, Cochrane Library and Google Scholar; date of last search: 15 October 2019) for studies reporting the prevalence and associated factors of neonatal hypothermia. The data was extracted in the excel sheet considering prevalence, and categories of associated factors reported. A weighted inverse variance random-effects model was used to estimate the magnitude and the effect size of factors associated with hypothermia. The subgroup analysis was done by country, year of publication, and study design. Results: A total of 12 potential studies with 20,911 participants were used for the analysis. The pooled prevalence of neonatal hypothermia in East Africa was found to be 57.2% (95%CI; 39.5-75.0). Delay in initiation of breastfeeding (adjusted Odds Ratio(aOR) = 2.83; 95% CI: 1.40-4.26), having neonatal health problem (aOR = 2.68; 95% CI: 1.21-4.15), being low birth weight (aOR =2.16; 95%CI: 1.03-3.29), being preterm(aOR = 4.01; 95%CI: 3.02-5.00), and nighttime delivery (aOR = 4.01; 95% CI:3.02-5.00) were identified associated factors which significantly raises the risk of neonatal hypothermia. Conclusions: The prevalence of neonatal hypothermia in Eastern Africa remains high. Delay in initiation of breastfeeding, having a neonatal health problem, being low birth weight, preterm, and nighttime delivery were identified associated factors that significantly raises the risk of neonatal hypothermia.

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“…The risk factor of sepsis prior to delivery like preterm pre-labour rupture of membranes (pPROM) >24hours, foul smelling liquor, chorioamnionitis, maternal fever was found to be 11% in U.K cohort as compared to signi cant 43.6% (p<0.001) in Indian cohort. This corroborates with a signi cant postnatal blood culture proven sepsis (1.7% v 32.4%) in Indian cohort, it is known from previous studies the increased incidence of sepsis in Indian context [31].…”

Section: Discussionsupporting

confidence: 88%

Comparitive Study Of Short-Term Outcomes Of Preterm Babies ≤30 Weeks In A Tertiary Care Hospital Between India And The U.K

Diggikar¹,

Nagesh²,

Kumar³

et al. 2020

Preprint

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Large numbers of preterm babies are born in middle income countries and neonatal care is improving in these countries. However, comparative clinical outcomes of preterm babies between a tertiary neonatal unit from middle income country and higher income country is limited. Objective: To compare the clinical profile and short-term outcomes of preterm babies ≤ 30 weeks gestation admitted to a tertiary care hospital in India and the U.K. Design: Retrospective cohort observational study using anonymised data from Electronic Patient Records. Setting: Regional tertiary neonatal intensive care unit (NICU) of Manipal Hospitals, Bangalore, India and Homerton University Hospital, London, UK. Participants: Preterm babies born at ≤ 30 weeks gestation admitted to NICUs over five year period (January 2011 to December 2015). Infants with major congenital abnormalities were excluded. Intervention: This is an observational study and routine care was provided as per departmental standard protocols. Main outcome measures: Comparison of neonatal unit mortality between two centres, infant morbidities till discharge from neonatal unit. Results: A total of 740 babies from the U.K centre and 294 babies from Indian centre were enrolled into the study. The mean gestational age in the U.K cohort was 26.6 ± 2.16 weeks, whereas in Indian cohort was 28.4 ± 1.66 weeks (p,<0.001). A significantly lower number of mothers received antenatal steroid (37% v 73%), and higher number of babies were inborn (78.6%) in Indian centre compared to the UK centre (67.3%; p < 0.001). Incidence of BPD and IVH ≥ grade 2 was significantly lower, and ROP needing treatment was significantly higher in Indian centre. Higher number of babies were treated for ductus arteriosus and incidence of culture positive sepsis was significantly high in Indian cohort babies. Survival of babies born at gestational age > 28 weeks was comparable between the U.K and Indian centres. Survival of babies born at ≤ 28 weeks gestation was lower in Indian centre. Conclusions and relevance: The survival of babies above 28 weeks prematurity was comparable between a tertiary care centre in India and the U.K. However, survival of babies ≤ 28 weeks gestation was lower in Indian centre. Incidence of ROP and sepsis was higher in Indian centre.

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Risk factors of neonatal sepsis in India: A systematic review and meta-analysis

Cited by 126 publications

References 56 publications

Prevalence and Predictors of Neonatal Sepsis among Neonates Admitted at the Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya

Prevalence and Predictors of Neonatal Sepsis among Neonates Admitted at the Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya

Prevalence of neonatal hypothermia and its associated factors in East Africa: a systematic review and meta-analysis

Comparitive Study Of Short-Term Outcomes Of Preterm Babies ≤30 Weeks In A Tertiary Care Hospital Between India And The U.K

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