title: Risk factors for sclerema neonatorum in preterm neonates in Bangladesh.
abstract: BACKGROUND
  This study presents a retrospective analysis of risk factors for sclerema neonatorum in preterm neonates in Bangladesh.
  
  
  METHODS
  Preterm neonates admitted to Dhaka Shishu Hospital in Bangladesh were enrolled in a clinical trial to evaluate the effects of topical treatment with skin barrier-enhancing emollients on prevention of sepsis and mortality. Four hundred ninety-seven neonates were enrolled in the study and 51 (10.3%) developed sclerema neonatorum. We explored risk factors for sclerema neonatorum by comparing patients with and without sclerema neonatorum. Diagnosis of sclerema neonatorum was based on the presence of uniform hardening of skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up and pinched into a fold. Cultures of blood and cerebrospinal fluid were obtained in all neonates with clinical suspicion of sepsis.
  
  
  RESULTS
  In multivariate analysis, lower maternal education (OR: 1.94; 95% CI: 1.02-3.69; P = 0.043), and signs of jaundice (OR: 2.82; 95% CI: 1.19-6.69; P = 0.018) and poor feeding (OR: 4.71; 95% CI: 1.02-21.74; P = 0.047) on admission were risk factors for developing sclerema neonatorum. The incidence rate ratio of sepsis in neonates who developed sclerema neonatorum was 1.81 (95% CI: 1.16-2.73; P = 0.004), primarily due to Gram-negative pathogens, and risk of death in infants with sclerema neonatorum was 46.5-fold higher (P < 0.001, 95% CI: 6.37-339.81) than for those without sclerema neonatorum.
  
  
  CONCLUSIONS
  Sclerema neonatorum was a relatively common, grave condition in this setting, heralded by poor feeding, jaundice, and bacteremia, and signaling the need for prompt antibiotic treatment.
authors.affiliation: Department of International Health, International Center for Advancing Neonatal Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Amna
authors.initials: A
authors.lastname: Zeb
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rosenberg
authors.forename: Nawshad Uddin
authors.initials: NU
authors.lastname: Ahmed
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Azad
authors.initials: A
authors.lastname: Chowdhury
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt