Risk factors and predictors of mortality in culture proven neonatal sepsis

To determine the risk factors associated with culture-proven neonatal sepsis and identify predictors of mortality among them.

This prospective observational study was conducted in a tertiary care teaching hospital in South India over a period of 2 y. All admitted inborn and out born neonates with clinically suspected sepsis were included in the study. Blood culture was done for all neonates. Various factors associated with sepsis and mortality were identified. Chi-square test or Fisher's exact test was used to compare two groups. The results of these tests were confirmed with logistic regression analysis.

Of the 120 neonates, only 50 (41.6%) had a positive blood culture. Premature rupture of membranes (PROM) >24 h, Apgar score <6 at 5 min, birth weight ≤1.5 kg and mechanical ventilation were found to be the independent risk factors for culture-proven sepsis based on logistic regression analysis. Twenty-one (42%) of the 50 neonates with culture-proven sepsis died, while only 15 (21.4%) of the 70 neonates who were blood culture negative died (Relative risk, 1.69; 95% confidence interval, 1.13 to 2.53; P value 0.0263). Birth weight ≤1.5 kg, shock and lethargy were proved to be independent predictors of mortality.

The mortality rate was significantly high in neonates with a culture-proven sepsis compared to those with a negative blood culture. PROM >24 h, Apgar score <6 at 5 min, birth weight ≤1.5 kg and mechanical ventilation were independent risk factors for culture-proven sepsis, while lethargy, shock and birth weight ≤1.5 kg were independent predictors of mortality.