Objective To determine the independent risk factors for early onset neonatal sepsis (EONS) in a setting where the policy is to use intrapartum antibiotic prophylaxis (IAP) 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 Thirteen putative maternal and neonatal risk factors and use of IAP were assessed. Neonates were followed until 72 h of life 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 at <72 h).
Results 601 mother–infant dyads were enrolled (mean (SD) gestation=31.8 (2) weeks; mean (SD) birth weight 1559.4 (452) g). The best fitted multivariable logistic regression model had six independent risk factors (adjusted OR (95% CI)): vaginal examinations ≥3 (9.5 (3 to 31)), clinical chorioamnionitis (8.8 (2 to 43)), birth weight <1500 g (2.8 (2 to 5)), male sex (2.7 (2 to 5)), gestation <30 weeks (2 (1 to 4)) and no IAP (2 (1.04 to 4)). Regression coefficients were converted into scores of 6, 6, 3, 3, 2 and 2, respectively. Internal prediction accuracy was 86.5% and c statistic was 0.75 (95% CI 0.70 to 0.81, p<0.001).
Conclusions Vaginal examinations ≥3, clinical chorioamnionitis, birth weight <1500 g, male sex, gestation <30 weeks and no intrapartum antibiotics were independent risk factors for EONS among preterm infants of ≤34 weeks’ gestation.
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Competing interests None.
Ethics approval This study was conducted with the approval of the Institute Ethics Committee of the Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Patient consent Parental consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.