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

Abstract

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 sociodemographic, 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 checkup had more than threefold risk of infection (aOR-3.45, 95% CI, 1.82-6.56, p-value< 0.001). Babies born through caesarean section had more than twofold risk (aOR-2.06, 95% CI, 1.48-2.87, p-value< 0.001) and babies with birth asphyxia had more than threefold 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.

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

“…Babies born to mothers with a prolonged decision-to-delivery time interval had increased odds of EONS. Similar ndings, where longer decision-to-delivery interval has been associated with poor perinatal outcomes, including EONS, were reported in other sub-Saharan African countries, including Rwanda, and Kenya; and in Nepal [23][24][25]. This interval is crucial for feto-maternal outcomes in category-1 emergency caesarean sections and can lead to delays in emergency obstetric care, prolonging labor and increasing the risk of neonatal sepsis [26].…”

Bacteriological Profile and Detection of β-Lactamase Producing Bacteria Isolated from Blood Samples of Neonates

“…Neonatal bacterial sepsis is a leading cause of death in developing countries like Nepal. Neonates are more susceptible to severe infections and the progression of the disease is more rapid due to developmental immunodeficiency and also, a significant proportion of infections may arise early after vertical transmission from the mother resulting in a high case fatality rate (Budhathoki et al 2020).…”

Sepsis neonatal: factores de riesgo, sintomatología clínica y marcadores diagnósticos.

“…Chavarro (Associated factors to neonatal sepsis development in a third-level children's hospital in Colombia., 2020), Abdur (Rafi et al, 2020), Barasa (Masaba & Mmusi-Phetoe, 2020), Barreto (González et al, 2020), Baquero (Baquero et al, 2020), Sudar (Budhathoki et al, 2020), en sus investigación en relación a los factores de riesgo implicado con la sepsis neonatal, concuerdan que los principales riesgos son las infecciones urinarias de la mujer durante la etapa de gestación. Según la literatura las infecciones se dan más en los recién nacidos prematuros que en los recién nacidos a término.…”