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Updated: Dec 10, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Association of Intrapartum Risk Factors and Infant Clinical Indicators with Culture Confirmed Early Onset Neonatal
Sumanth Gandra1, Shravan K Ranga2, D Taylor Hendrixson3
1Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA.
Insights
Infant clinical indicators, not intrapartum risk factors, are linked to early-onset neonatal sepsis (EONS) confirmed by culture. This finding is crucial for identifying at-risk newborns in rural settings.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Public Health
Background:
- Early-onset neonatal sepsis (EONS) is a significant cause of neonatal morbidity and mortality.
- Identifying reliable predictors for EONS is crucial, especially in resource-limited settings.
- The National Institute for Health and Care Excellence (NICE) criteria are used to assess neonatal risk.
Purpose of the Study:
- To determine the association between intrapartum risk factors and infant clinical indicators with culture-positive EONS.
- To evaluate predictive models for EONS in a rural secondary healthcare facility.
- To understand the impact of routine intrapartum prophylactic antibiotics on EONS rates.
Main Methods:
- A prospective observational study was conducted over 15 months.
- Neonates meeting NICE criteria within 72 hours of birth were included.
- Univariate and multivariable logistic regression analyses were performed.
Main Results:
- Of 236 neonates at risk, 32 (13.8%) had culture-positive EONS.
- Klebsiella and Acinetobacter species were the most common pathogens.
- The number of infant clinical indicators, absolute neutrophil count, and C-reactive protein levels were associated with culture-positive EONS.
Conclusions:
- Infant clinical indicators are more strongly associated with culture-confirmed EONS than intrapartum risk factors.
- A predictive model incorporating clinical indicators may aid in early EONS detection.
- Findings are relevant for rural healthcare facilities with established antibiotic protocols.
Objective:
The aim of this study is to determine the association of intrapartum risk factors and infant clinical indicators using the National Institute for Health and Care Excellence (NICE) criteria with culture-positive early-onset neonatal sepsis (EONS) from a rural secondary healthcare facility where intrapartum prophylactic antibiotics are routinely administered to high-risk mothers.
Methods:
A single-center prospective observational study was conducted between July 2017 and September 2018. All intramural neonates with at least one NICE criteria at less than 72 h of life, were included. Univariate logistic regression and multivariable logistic backward elimination analyses were conducted to investigate individual risk factors and predictive models for culture proven EONS.
Results:
Of 236 newborns who were at risk for EONS by NICE criteria, 32 (13.8%) had positive blood cultures. Klebsiella species (n = 13, 39.4%) and Acinetobacter species (n = 11, 33.3%) were the most common isolated bacteria. In univariate analysis, the number of infant clinical indicators were associated with culture positive EONS (OR 1.36; 95% CI 1.01-1.81), but not the number of intrapartum risk factors (OR 0.76; 95% CI 0.4-1.29). The multivariate logistic regression with backward elimination procedure suggested that a model including absolute neutrophil count [adjusted OR (aOR) 0.81; 95% CI 0.72-0.92], C-reactive protein (aOR 1.24; 95% CI 1.08-1.43) and the number of clinical indicators (aOR 1.29; 95% CI 0.93-1.80) could be useful to predict culture positive EONS in our setting.
Conclusion:
In this maternal and neonatal cohort, infant clinical indicators rather than intrapartum risk factors were associated with culture confirmed EONS.
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