Maternal and infant risk factors for neonatal sepsis: A comparison between an inner-city county hospital and a health maintenance organization

Abstract

Neonatal sepsis has remained an enigma of diagnosis and treatment. Although a disease with a low incidence, sepsis has a high mortality rate if not promptly treated. We compared the risk factors of infants evaluated for sepsis in a county hospital (n=274), to that of a health maintenance organization (HMO, n=2785). METHODS: A 7 month cohort of inborn babies from San Francisco General Hospital (SFGH) and a 1 year cohort from Kaiser Permanente Nurseries (San Francisco, Oakland, Hayward, Sacramento, Santa Clara, and Walnut Creek) were evaluated. Babies included in the study had a birthweight >1999g and had a CBC for the evaluation of sepsis after delivery. Data were collected by chart review. RESULTS: We found that physicians at the county hospital evaluated infants for sepsis more frequently (32% vs. 15%), and treated the evaluated infants at a higher rate (47% vs. 31%) than at the HMO. Women at SFGH had a higher incidence of chorioamnionitis (23% vs. 20%, p<0.01) and antenatal antibiotic treatment (57% vs. 44%, p<0.01), despite having similar antenatal temperatures. Infant birth weights at SFGH were lower (3252 g vs. 3366 g, p<0.01) despite similar gestational ages. In the infants, absolute neutrophil counts were similar between the two study populations, yet the ratio of the immature white cells to the total white cell count was higher at SFGH (0.266 vs. 0.141, p<0.01). Infants were treated at SFGH at a higher rate (47% vs. 31%, p<0.01). There were 21 infants with proven sepsis (positive blood cultures) at Kaiser and none at SFGH. CONCLUSION: Maternal and infant risk factors are different between an inner-city county hospital and an HMO population. Antenatal antibiotic treatment and neonatal work-up and treatment rates were higher at the inner-city hospital. We speculate that these data highlight how pregnancy outcomes may be influenced by differences in health care access between the populations, including higher rates of routine health care and prenatal visits among HMO participants. We anticipate that perinatal health and health care costs are influenced not only by health care access, but also by socioeconomic factors, such as employment, education, and living conditions.