Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up

Abstract

Background Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. Thus, we used a historic cohort design to assess the association between a series of neonates and their mothers, in addition to hospital evolution features and the risk and prognosis of neonatal sepsis (defined by Pediatric Sepsis Consensus [PSC] criteria) in 11,790 newborns consecutively admitted to a Neonatology Service in Mérida, Mexico, between 2004 and 2007. Results Sepsis was found in 514 of 11,790 (4.3 %) newborns; 387 of these cases were categorized as early-onset (<72 h) (75.3 %) and 127, as late-onset (>72 h) (24.7 %). After logistic regression, risk factors for sepsis included the following: low birth weight; prematurity; abnormal amniotic fluid; premature membrane rupture (PMR) at >24 h; respiratory complications, and the requirement of assisted ventilation, O 2 Inspiration fraction (IF) >60 %, or a surgical procedure. Some of these factors were differentially associated with early- or late-onset neonatal sepsis. The overall mortality rate of sepsis was 9.5 %. A marked difference in the mortality rate was found between early- and late-onset sepsis (p >0.0001). After Cox analysis, factors associated with mortality in newborns with sepsis comprised the following: prematurity; low birth weight; low Apgar score; perinatal asphyxia, and the requirement of any invasive medical or surgical procedure. Conclusions The incidence of neonatal sepsis in southeastern Mexico was 4.3 %. A different risk and prognostic profile between early- and late-onset neonatal sepsis was found.

Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

“…Thus, it is not just PPROM that is associated with neonatal sepsis, but the decrease in the volume of AF also favors perinatal infection. 8,19,20 We can also point out the difficulty in diagnosing chorioamnionitis because adverse perinatal outcomes often occur without clinical or laboratory signs of infection. 1,17 Authors analyzing the placentas of puerperal woman who had PROM found a poor correlation between histological chorioamnionitis (59%) and clinical chorioamnionitis (42%).…”

Risk Factors and Immediate Outcome of Early Onset Neonatal Sepsis

“…But the gold standard for diagnosing early onset sepsis is the isolation of causative organism from blood. 4 Worldwide, the neonatal mortality rate varies from 2.8 to 4 million deaths each year with 95% of the deaths occurring indeveloping countries 5 Refusal to feed and jaundice were the most common findings, being present in 77(64.2%) each of the studied cases (Table -3 Various maternal factors which showed statistical significance with mortality were maternal fever (p= 0.032), primiparity (p= 0.013), prolonged rupture of membrane (PROM) >18 hours (p=0.006), meconium stained amniotic fluid (p=0.007), maternal age< 20yrs (p= 0.000), foul smelling liquor (P= 0.000)[ I/T ratio -immature to total neutrophil ratio; CRP -C-reactive protein; ESR -erythrocyte sedimentation rate…”

Evaluation of perinatal factors in neonatal sepsis at tertiary centre

“…This was higher to that reported in previous studies done in India and Mexico. 11,12 The higher rate of sepsis is due to illiteracy, low socioeconomic condition and due to poor antenatal care. In our study there was male predominance almost double to female because of sex specific custom practiced in the society, higher proportion of males were brought to the hospital and the locus of the gene for synthesis of immunoglobulins lies at X-chromosome.…”