title: Risk factors for possible serious bacterial infection in a rural cohort of young infants in central India.
abstract: Possible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide. We studied risk factors for PSBI in a large rural population in central India where facility deliveries have increased as a result of a government financial assistance program.
  
  
  
  We studied 37,379 pregnant women and their singleton live born infants with birth weight ≥ 1.5 kg from 20 rural primary health centers around Nagpur, India, using data from the 2010-13 population-based Maternal and Newborn Health Registry supported by NICHD's Global Network for Women's and Children's Health Research. Factors associated with PSBI were identified using multivariable Poisson regression.
  
  
  
  Two thousand one hundred twenty-three infants (6 %) had PSBI. Risk factors for PSBI included nulliparity (RR 1.13, 95 % CI 1.03-1.23), parity > 2 (RR 1.30, 95 % CI 1.07-1.57) compared to parity 1-2, first antenatal care visit in the 2nd/3rdtrimester (RR 1.46, 95 % CI 1.08-1.98) compared to 1sttrimester, administration of antenatal corticosteroids (RR 2.04, 95 % CI 1.60-2.61), low birth weight (RR 3.10, 95 % CI 2.17-4.42), male sex (RR 1.20, 95 % CI 1.10-1.31) and lack of early initiation of breastfeeding (RR 3.87, 95 % CI 2.69-5.58).
  
  
  
  Infants who are low birth weight, born to mothers who present late to antenatal care or receive antenatal corticosteroids, or born to nulliparous women or those with a parity > 2, could be targeted for interventions before and after delivery to improve early recognition of signs and symptoms of PSBI and prompt referral. There also appears to be a need for a renewed focus on promoting early initiation of breastfeeding following delivery in facilities.
  
  
  
  This trial is registered at ClinicalTrials.gov ( NCT01073475 ).
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, USA. marie.wang@childrens.harvard.edu.|Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA. marie.wang@childrens.harvard.edu.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Wang
authors.affiliation: Lata Medical Research Foundation, Nagpur, Maharashtra, India.
authors.forename: Archana B
authors.initials: AB
authors.lastname: Patel
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Arlington
authors.affiliation: Lata Medical Research Foundation, Nagpur, Maharashtra, India.
authors.forename: Amber
authors.initials: A
authors.lastname: Prakash
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D001724:Birth Weight; D001942:Breast Feeding; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D019035:Rural Health Services; D012424:Rural Population; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Cohort; India; Possible serious bacterial infection; Young infant