Predictors of mortality in outborns with neonatal sepsis: A prospective observational study

• Published in: The Nigerian postgraduate medical journal Vol. 26; no. 4; pp. 216 - 222
• Main Authors: Meshram, Rajkumar, Gajimwar, Vishal, Bhongade, Swapnil
• Format: Journal Article
• Language: English
• Published: Nigeria Wolters Kluwer India Pvt. Ltd 01.10.2019; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Antibiotics; Birth Weight; Blood - microbiology; Cyanosis; Developing countries; Female; Gestational Age; Hospitals; Humans; Hypothermia; Incidence; India - epidemiology; Infant mortality; Infant, Newborn; Intensive care; LDCs; Male; mortality predictors; Neonatal care; neonatal sepsis; Neonatal Sepsis - etiology; Neonatal Sepsis - mortality; Observational studies; outborn neonate; Pregnancy; Prospective Studies; Risk Factors; Seizures; Sepsis; Socioeconomic factors; Ventilators; India; outborn neonate; Mortality predictors; neonatal sepsis
• ISSN: 1117-1936; 2468-6875
• DOI: 10.4103/npmj.npmj_91_19

Background: Neonatal sepsis-related mortalities are the outcome of a complex interaction of maternal-foetal colonisation, transplacental immunity and physical and cellular defence mechanisms of neonates. Objective: The objective of this study was to evaluate the risk factors of mortality in outborn neonatal sepsis. Materials and Methods: A 1-year prospective observational study was undertaken at a tertiary care centre. All referred neonates with maternal and neonatal risk factors of sepsis were enrolled. Blood culture, sepsis screen and other relevant investigations were performed. Results: The mortality rate of neonatal sepsis among outborns was 38.24%. The common presentations of these neonates were respiratory distress, lethargy and hypothermia. On univariate analysis, significant risk factors for mortality included male sex (P = 0.05), weight on admission <1500 g (P < 0.001), hypothermia (P = 0.003), respiratory distress (P = 0.04), cyanosis (P = 0.001), convulsions (P = 0.02), prolonged capillary refill time (P < 0.001), thrombocytopenia (P < 0.001), abnormal radiological finding (P = 0.01), cerebrospinal fluid cellularity (P = 0.002) and positive C-reactive protein (P < 0.001). Maternal factors such as hypertension in pregnancy (P = 0.001) and antepartum haemorrhage (P = 0.03) were associated with statistically significant mortality. Gestational age (odds ratio [OR]: 0.49, confidence interval [CI]: 0.26-0.90, P = 0.02), weight on admission (OR: 1.57, CI: 1.08-2.27, P = 0.01), age at admission (OR: 0.89, CI: 0.78-0.99, P = 0.04), distance travelled with neonate (OR: 1.01, CI: 1.00-1.01, P = 0.003), duration of hospital stay (OR: 0.69, CI: 0.63-0.74, P < 0.001), hypothermia (OR: 1.87, CI: 1.01-3.42, P = 0.04), convulsion (OR: 2.88, CI: 1.33-6.20, P = 0.007), cyanosis (OR: 2.39, CI: 1.07-5.35, P = 0.03) and prolonged capillary refill time (OR: 3.34, CI: 1.78-6.24, P < 0.001) were the independent predictors of mortality in neonatal sepsis. Conclusion: Gestational age; birth weight; long distance travelled with neonate and presentation with hypothermia, cyanosis, convulsions and prolonged capillary refill time were the independent risk factors for mortality in neonatal sepsis among outborns.