Risk factors for neonatal sepsis in secondary and tertiary care hospitals of a district in Sri Lanka: A Case-control study

Abstract

OBJECTIVE: The aim of this study was to determine the risk factors for neonatal sepsis. Methods A case-control study was performed in secondary and tertiary care hospitals of a district in Sri Lanka. Neonates who diagnosed with sepsis based on clinical criteria or culture positivity were taken as the case group (n = 240) and neonates born during the same period who had not been diagnosed with sepsis were taken as the control group (n = 240). The controls were recruited from the community. The study instruments were, pretested interviewer administered questionnaire, a check list and record sheets. Multiple logistic regression analysis was performed. The results were expressed as odds ratios (OR) with the 95% confidence intervals (CI). Results The independent risk factors for neonatal sepsis were history of abortions, still birth, and early neonatal deaths (OR: 6.78; 95% CI: 3.2-14.3), registration of pregnancy after 8 weeks of gestation (OR: 1.91; 95% CI: 1.07-3.4), total antenatal clinic visits ≤4 (OR: 7.18; 95% CI: 2.1-24.5), history of maternal fever prior to the week of delivery (OR: 2.74; 95% CI: 1.25-6.0) leaking amniotic fluid >18 hours (OR: 10.0; 95% CI: 2.1-47.4), performed >3 vaginal examinations before delivery (OR: 3.28; 95% CI: 2.1-24.5), meconium stained amniotic fluid (OR: 10.57; 95% CI: 3.7-29.7), mode of delivery by cesarean section, forceps or vacuum (OR: 2.33; 95% CI: 1.4-3.9), time of birth of the neonate being during on-call hours (OR: 2.12; 95% CI: 1.3-3.5), being a male baby (OR: 1.74; 95% CI: 1.1-2.8), and birth weight <2,500 g (OR: 5.17; 95% CI: 2.8-9.6) of neonates. Conclusion Most of the identified risk factors for neonatal sepsis were modifiable. Stringent implementation of guidelines and protocols would prevent neonatal sepsis. © 2021 Georg Thieme Verlag. All rights reserved.