ASSOCIATION OF RISK FACTORS AND OUTCOMES OF EARLY ONSET NEONATAL SEPSIS AMONG PRETERM NEONATES

Abstract

Background: Early-onset neonatal sepsis (EONS) is a major cause of morbidity and mortality among preterm neonates, particularly in resource-limited settings. Identification of maternal and neonatal risk factors is essential for early diagnosis, timely intervention, and improved clinical outcomes. Objective: To determine the risk factors of early-onset neonatal sepsis, assess early outcomes, and evaluate the association between identified risk factors and outcomes among preterm neonates. Study Design: Case–control study. Setting: The Department of Pediatrics, Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: From 16 February 2025 to 16 May 2025. Methods: A total of 176 preterm neonates were included, comprising 88 cases with early-onset neonatal sepsis and 88 age-matched controls without sepsis. Cases were defined as neonates aged birth to seven days presenting with clinical features of sepsis confirmed by hematological criteria, while controls were healthy preterm neonates without sepsis. Data were collected on potential risk factors, including mode of delivery, premature rupture of membranes (PROM), prolonged rupture of membranes (>18 hours), maternal urinary tract infection, low birth weight, meconium-stained amniotic fluid, and low Apgar score at five minutes. Clinical outcomes, including recovery, mortality, and length of hospital stay, were also recorded. Statistical analysis was performed using SPSS, and comparisons between groups were made using appropriate significance tests, with p ≤ 0.05 considered statistically significant. Results: Premature rupture of membranes occurred in 63.6% of cases compared with 44.3% of controls (p = 0.01). Maternal urinary tract infection was observed in 34.1% of cases versus 18.2% of controls (p = 0.01), while prolonged rupture of membranes occurred in 29.5% of cases compared with 13.6% of controls (p = 0.01). Low birth weight was present in 81.8% of cases versus 63.6% of controls (p = 0.007). Meconium-stained amniotic fluid was noted in 31.8% of cases compared with 13.6% of controls (p = 0.004), and a low Apgar score at five minutes occurred in 42.0% of cases compared with 26.1% of controls (p = 0.02). Among septic neonates, 73.9% recovered, mortality was observed in 5.7%, and 67.0% required a hospital stay of seven days or longer. Conclusion: Premature rupture of membranes, maternal urinary tract infection, prolonged rupture of membranes, low birth weight, meconium-stained amniotic fluid, and low Apgar score were significant risk factors for early-onset neonatal sepsis among preterm neonates. Early identification and management of these factors may improve neonatal outcomes and reduce sepsis-related morbidity and mortality.