Determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit of Arba-Minch general hospital, southern Ethiopia

Abstract

Introduction Neonatal sepsis can be either early (<7 Days) or late-onset ≥7days) neonatal sepsis depending on the day of the occurrence. Despite the decrement in early onset neonatal sepsis, there is still an increment in late-onset neonatal sepsis. Ethiopian demography and health survey report showed an increment in neonatal mortality in 2019/20. Objective The objective of this study was to assess the determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit at Arba-Minch general hospital, southern Ethiopia. Methods An institution based study was conducted from March 1, 2021, to June 30, 2021 in Arba-Minch general hospital. Cases were neonates diagnosed with late-onset neonatal sepsis with their index mother chart and controls were neonates admitted with other diagnoses at the same period. Cases and controls were selected consecutively. Data extraction tool and interview which was developed by reviewing different kinds of literature was used to collect data. Data were entered by using Epi data version 3.1software and transformed to Statistical Package for Social Sciences version 25 software for analysis. The binary logistic regression model was used to assess determinants and variables with a p-value <0.2 were transformed to multivariable logistic regression then, a p-value < 0.05 with 95% confidence interval were used to declare significant association with the outcome variable. Result A total of 180 subjects (60 cases and 120 controls) were included in this study. The mean age of neonates was 12.1 days with standard deviations of 4.3. Multivariable logistic regression analysis showed that; history of either sexually transmitted disease /urinary tract infection [AOR = 9.4; 95%CI(3.1–28.5)], being preterm (gestational age of <37 weeks) [AOR = 4.9; 95%CI (1.7–13.7)], use of endotracheal intubation/mechanical intubation [AOR = 8.3; 95%CI (1.8–26.4)]and either mixed types of infant feeding option or formula feeding before admission [AOR = 12.7; 95%CI(3.7–42.8)]were significantly associated with late-onset neonatal sepsis. Conclusion and recommendations This study revealed that antenatal, intrapartum and postpartum factors have shown an association with late-onset neonatal sepsis. It is recommended to strengthen counseling and advice to mothers with specific risk factors of late-onset neonatal sepsis.

Determining the main risk factors associated with neonatal death from sepsis in Neonatal Intensive Care Unit (NICU) in Benghazi Medical Centre (BMC) during 2020

“…Nationally, according to a report from Tripoli medical center, 65.3% of the neonatal deaths occurred in the first week of neonatal life, while 21.5% died the late neonatal period. In mainly from prematurity and its complications such as sepsis (2) .The sepsis or as it known as blood stream infection could be bacterial, viral, or fungal (3). this infection clearly occur when these pathogenic microorganisms enter into the bloodstream in the first 28 days of neonatal life causing devastating systemic infection known as neonatal sepsis (NS) (3).…”

“…In mainly from prematurity and its complications such as sepsis (2) .The sepsis or as it known as blood stream infection could be bacterial, viral, or fungal (3). this infection clearly occur when these pathogenic microorganisms enter into the bloodstream in the first 28 days of neonatal life causing devastating systemic infection known as neonatal sepsis (NS) (3). Systemic signs of circulatory collapse characterize neonatal sepsis (4).Severe sepsis invasions leading to one, two, or more organ dysfunctions such as cardiovascular organ dysfunction or acute respiratory distress syndrome, which is without timely treatment, can rapidly lead to tissue damage, organ failure, and death(5).…”

“…The higher rates of EOS in the developing countries is reported to be high as a result of inadequate antenatal care, high rate of birth at home, unhygienic birth and umbilical cord care practices, and late recognition of conditions that pose a risk of infection in the mother or baby(13) . Late onset neonatal sepsis (LOS) occurs after 72 hours from the neonatal birth until 28 days of their life (3) More importantly, understanding the causes of death in NICU and highlighting the modifiable factors associated with death could possibly reduce infant mortality (10) .As this emphasized by the WHO estimations that found that, the early detection and treatment of the cases can prevent about 84% of neonatal sepsis-related mortality (18) . Thus, The aim of this study was to assess the contributing factors of death from sepsis (early and late) among neonates died in NICU at Benghazi Medical Centre in 2020.…”