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Updated: Mar 27, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Maternal and neonatal determinants of newborn sepsis: A case-control study in resource-limited settings
Mohd Asif Qureshi1, Mangla Sood2, Pratima Thakur1
1Department of Pediatrics, Indira Gandhi Medical College, Shimla 171001, Himachal Pradesh, India.
Insights
Neonatal sepsis risk factors include male sex, assisted delivery, maternal infections like UTI, and prolonged labor. Interventions like improved prenatal care and hygiene are crucial for reducing newborn mortality.
Area of Science:
- Neonatal Medicine
- Maternal-Child Health
- Infectious Diseases
Background:
- Neonatal sepsis poses a significant threat to newborns globally.
- Identifying maternal and neonatal risk factors is crucial for effective intervention.
- Reducing newborn morbidity and mortality is a key healthcare objective.
Purpose of the Study:
- To investigate maternal and infant risk factors associated with neonatal sepsis.
- To develop evidence-based strategies for the prevention of neonatal sepsis.
- To inform targeted interventions in comparable clinical settings.
Main Methods:
- A case-control study involving 453 neonates and their mothers.
- Analysis of clinical, demographic, and obstetric data.
- Multivariable logistic regression to identify independent risk factors.
Main Results:
- Significant risk factors identified include male sex, forceps-assisted delivery, inadequate antenatal visits, prolonged labor, prolonged rupture of membranes, and maternal urinary tract infection.
- Strong predictors of neonatal sepsis were unclean vaginal examinations and foul-smelling amniotic fluid.
- Neonatal factors such as prematurity, low birth weight, birth asphyxia, and need for respiratory support (surfactant, CPAP, invasive ventilation) were significant.
- Extended NICU stays increased sepsis likelihood, suggesting nosocomial transmission.
Conclusions:
- Enhanced prenatal care, timely labor management, and strict hygiene protocols are vital for reducing neonatal sepsis.
- Addressing modifiable risk factors, including maternal infections and respiratory support strategies, can improve neonatal outcomes.
- Targeted interventions are essential, particularly in resource-limited settings.
Background:
Neonatal sepsis continues to remain a serious threat, with multiple maternal and neonatal risk factors. Understanding these determinants will empower clinicians in comparable settings to apply targeted interventions, ultimately reducing newborn morbidity and mortality.
Aim:
To assess maternal and infant risk factors, the aim is to develop evidence-based strategies for preventing neonatal sepsis.
Methods:
A total of 453 neonates and their mothers were enrolled, of which 146 were cases. Clinical, demographic, and obstetric data were analyzed including maternal infection history, delivery conditions, neonatal characteristics, and respiratory support requirements. Statistical associations were assessed using multivariable logistic regression analysis to determine independent risk factors.
Results:
Male sex (adjusted odd ratio [AOR] = 1.9; 95% confidence interval [CI]: 1.03-3.5), forceps-assisted vaginal delivery (AOR = 3.4; 95%CI: 1.1-14.9), fewer than four antenatal care visits (AOR = 2.9; 95%CI: 1.4-6.5), prolonged labor > 24 hours (AOR = 6.2; 95%CI: 2.8-17), rupture of membranes > 18 hours (AOR = 3.0; 95%CI: 1.6-6.8), and maternal urinary tract infection (AOR = 3.5; 95%CI: 2.4-29.4) significantly increased neonatal sepsis risk. Unclean vaginal examinations (AOR = 4.2; 95%CI: 1.6-11) and foul-smelling amniotic fluid (AOR = 10.3; 95%CI: 1.9-56.4) were among the strongest risk factors. Among neonatal factors prematurity (AOR = 4.3; 95%CI: 2.8-6.6), low birth weight ≤ 1500 g (AOR = 3.6; 95%CI: 2.2-5.7), birth asphyxia (AOR = 4.3; 95%CI: 2.4-7.6), and small-for-gestational-age status (AOR = 2.1; 95%CI: 1.1-4) were significant predictors. Respiratory support showed a strong correlation, with surfactant administration (AOR = 9.7; 95%CI: 4.1-22.9), continuous positive airway pressure) (AOR = 15.4; 95%CI: 9.4-25.1), and invasive ventilation (AOR = 53; 95%CI: 12.7-89) as the highest risk factors. Extended newborn intensive care unit stays (> 7 days: AOR = 38.9; > 15 days: AOR = 30) further elevated the likelihood of sepsis, likely due to nosocomial exposure.
Conclusion:
The findings highlight the importance of enhanced prenatal care, timely labor management, strict hygiene protocols, and focused neonatal monitoring to reduce neonatal sepsis incidence. Addressing modifiable risk factors, including maternal infections and respiratory interventions, could significantly improve neonatal outcomes in resource-limited settings.
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