Predictors of Positive Blood Culture and Death Among Neonates With Suspected Neonatal Sepsis in Abeokuta, South-West Nigeria

Abstract

Neonatal sepsis, a bacterial infection of blood in the first month of life is a common cause of morbidity and mortality in developing countries and factors associated with positive blood culture and perinatal deaths among neonates are rarely described. This study was conducted at the Special Baby Care Unit of Federal Medical Centre, Abeokuta (FMCA), Southwest Nigeria, to identify the predictors of positive blood culture and deaths due to neonatal sepsis among neonates admitted with clinical diagnosis of septicemia between January and April 2013. Data on socio-demographic characteristics, peripatal events and clinical characteristics of neonates were collected on proforma designed for the study. Blood culture was done on Brain Heart Infusion broth and Thioglycolate broth followed by identification of isolates using conventional methods. Serum Procalcitonin (PCT) and Serum C reactive protein (CRP) Levels were determined by immunochromatographic and immuno-turnidimetric assay respec-tively. The neonates were monitored until discharge from the hospital. Among 180 neonates admitted during the study period, there were 85 cases of clinically suspected sepsis. Forty (47.1%) were males and 45(52.9%) were females while 55 (63.5%) neonates and 30 (36.5%) neonates presented with early and late onset sepsis respectively. Positive blood culture was found in 19 (22.4%) of the neo-nates; 14 (73.7%) of neonates with positive blood cultures had early onset neonatal sepsis and 5 (26.3%) had late onset sepsis. Factors that predicted positive blood culture in both early and late onset neonatal sepsis were mode of delivery (p=0.033), estimated gestational age (p=0.039), and CRP (p=0.000). None of the clinical characteristics was found to be statistically significant with positive blood culture. Deaths occurred in 27 (36%) of neonates. The case-fatality rate was 29%. Predictors of death were booking status (p=0.011), birth after prolonged labour (p=0.014), place of delivery (p=0.001), place of antenatal care (p=0.021), respiratory distress (p=0.034), poor cry (p=0.040), con-vulsion (p=0.011) and PCT (p=0.001). Our findings suggest that mode of delivery and estimated ges-tational age are significantly associated with positive blood culture in both early and late onset neona-tal sepsis. Mortality from neonatal sepsis is high in this study. Booking status, place of delivery, place of antenatal care significantly contributed to mortality suggesting that antenatal and perinatal care remains associated with neonatal mortality.