Objective: To determine the independent risk factors of early onset neonatal sepsis (EONS) in a setting where intra-partum antibiotic prophylaxis (IAP) is used as a policy for known risk factors.
Design: Prospective cohort study
Setting: Level III neonatal unit in a developing country
Patients: Consecutive mother-infant dyads (gestation ≤34 weeks) with no major neonatal malformations.
Interventions: Ten putative maternal and neonatal risk factors and use of IAP were assessed. Neonates were followed until 72 hrs for signs of EONS. Blood cultures were drawn on clinical suspicion of EONS and/or prior to starting prophylactic antibiotics for high risk asymptomatic neonates.
Main outcome: Culture-proven EONS (onset <72 hours).
Results: 601 mother-infant dyads were enrolled [mean (SD) gestation= 31.8 (2) weeks; mean (SD) birth weight 1559.4 (452) grams]. The best fitted multivariate logistic regression model had 6 independent risk factors [adjusted OR (95% CI)]: vaginal examinations ≥3 [9.5 (3, 31)], clinical chorioamnionitis [8.8 (2, 43)], birth weight <1500 gms [2.8 (2, 5)], male sex [2.7 (2, 5)], gestation <30 weeks [2 (1, 4)] and no IAP [2 (1.04, 4)]. Regression coefficients were converted into scores: 6, 6, 3, 3, 2 and 2 respectively. Internal prediction accuracy was 86.5% and c-statistic 0.75 (95% CI 0.70, 0.81, p<0.001).
Conclusions: Vaginal examinations ≥3, clinical chorioamnionitis, birth weight <1500 gms, male sex, gestation <30 weeks and no intra-partum antibiotics were independent risk factors of EONS among preterm infants ≤34 weeks.
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