Risk factors for early neonatal sepsis in the term baby

Abstract

Introduction: Neonatal sepsis is a clinical syndrome with systemic signs and symptoms of infection within the first 4 weeks of life. Objectives: To determine the incidence of perinatal sepsis in term babies born at Sri Jayewardenepura General Hospital (SJGH), to evaluate the disease pattern of term sick neonates born at SJGH and to estimate and compare the incidence of maternal risk factors, individually and in combination with the control group. Method: A retrospective case control study was carried out from September 2014 to August 2015 on all term babies born at SJGH showing clinical and biochemical evidence of sepsis. The information was collected from the clinical records. The Chi Square test was used to assess significant associations. The level of significance was 0.05. Results: Out of 3,482 term deliveries 161 (4.6%) showed biochemical and/or microbiological evidence of sepsis. The control group consisted of 120 term neonates. Septicaemia was diagnosed in 6 (0.2%) term neonates. Congenital pneumonia was diagnosed in 15 (0.45%) neonates. Twenty five (15%) mothers of the sick neonates had prolonged rupture of membranes (PROM) lasting 18 hours and more. Fifty seven (35%) of the mothers had a labour room stay of 9 hours or more. One hundred and eighteen (73%) mothers had 3 or more vaginal examinations. Thirty four (21.1%) mothers underwent induction of labour. Six (3.7%) had maternal fever. Three (1.8%) had foul smelling liquor and 2 (1.2%) had both. Two (1.2%) had high vaginal swab (HVS) positive for Group B Streptococcus (GBS). Conclusions: Neonates with biochemical evidence of sepsis showed a statistically significant incidence of PROM lasting 18 hours or more, labour room stay more than 9 hours and 3 or more vaginal examinations. There was no significant difference in occurrence of labour induction, maternal fever, HVS positivity for GBS and foul smelling liquor.