Intrapartum antibiotics and risk factors for early onset sepsis.
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.


METHODS
Prospective cohort study.


METHODS
Level III neonatal unit in a developing country.


METHODS
Consecutive mother-infant dyads (gestation < or =34 weeks) with no major neonatal malformations.


METHODS
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.


RESULTS
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 > or =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 > or =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 < or =34 weeks' gestation.
Dutta
Sourabh
S
Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. sourabhdutta@yahoo.co.in
Reddy
Rajeshwar
R
Sheikh
Samir
S
Kalra
Jaswinder
J
Ray
Pallab
P
Narang
Anil
A
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D001724:Birth Weight; D002821:Chorioamnionitis / Q000209:etiology; D005260:Female; D006801:Humans; D007194:India; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D018743:Perinatal Care; D010808:Physical Examination; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000517:prevention & control*; D012737:Sex Factors
D000900:Anti-Bacterial Agents