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Prevalence and risk factors for neonatal sepsis among very preterm infants in China: a systematic review and

Yuanyuan Li1, Xin Guo2, Kanghua Zhou3

  • 1Neonatology, The People's Hospital of Baoan Shenzhen, Shenzhen, Guangdong, China.

Frontiers in Pediatrics
|April 17, 2026
PubMed

Insights

Neonatal sepsis is a major threat to very preterm infants (VPIs) in China. Key risk factors for early-onset sepsis (EOS) include lower gestational age, lower birth weight, chorioamnionitis, and premature rupture of membranes.

Area of Science:

  • Neonatal Medicine
  • Public Health
  • Epidemiology

Background:

  • Neonatal sepsis presents a significant health risk to very preterm infants (VPIs) in China.
  • Limited nationwide data exists on the incidence and risk factors of neonatal sepsis in VPIs.
  • This study addresses the data gap to inform prevention strategies.

Purpose of the Study:

  • To systematically review and meta-analyze the incidence of neonatal sepsis in VPIs in China.
  • To identify significant risk factors associated with early-onset sepsis (EOS) in VPIs.
  • To provide evidence for developing improved prevention and management strategies.

Main Methods:

  • A comprehensive search of multiple databases (PubMed, Embase, Scopus, CNKI, etc.) was conducted up to March 31, 2025.
  • Study quality was assessed using the Newcastle-Ottawa Scale (NOS).
  • Meta-analysis was performed using Stata 18.0, with heterogeneity assessed by Cochran's Q and I² statistics, and publication bias evaluated using funnel plots and Egger's test.

Main Results:

  • The systematic review included 43 studies with 138,613 VPIs.
  • Incidence rates were 16.41% for unclassified sepsis, 16.11% for early-onset sepsis (EOS), and 15.10% for late-onset sepsis (LOS).
  • Significant risk factors for EOS included lower gestational age, lower birth weight, chorioamnionitis, premature rupture of membranes (PROM), antenatal antibiotic administration, and endotracheal intubation.

Conclusions:

  • Neonatal sepsis imposes a substantial burden on Chinese VPIs, with heterogeneous incidence.
  • Key risk factors for EOS in VPIs are identified as lower gestational age, lower birth weight, chorioamnionitis, PROM, antenatal antibiotic use, and endotracheal intubation.
  • Findings support the development of risk prediction models and stratified management for EOS in VPIs.
Abstract

Keywords:
Chinaprevalencerisk factorssepsisvery preterm infants

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