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Risk Factors for Neonatal Sepsis and Perinatal Death among Infants Enrolled in the Prevention of Perinatal Sepsis Trial, Soweto, South Africa.
MedLine Citation:
PMID:  22565291     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Factors associated with neonatal sepsis, an important cause of child mortality, are poorly described in Africa. We characterized factors associated with early (days 0-2 of life) and late-onset (days 3-28) sepsis and perinatal death among infants enrolled in the Prevention of Perinatal Sepsis (PoPS) Trial, (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa. METHODS:: Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized PoPS-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P<0.15 were evaluated using multivariable logistic regression. RESULTS:: 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis (IAP); 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis, and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery (adjusted relative risk, aRR: 2.6; 95% confidence interval, CI: 1.4-4.8); low birthweight (<1500 g: aRR=6.5, 95% CI: 2.4-17.3); meconium stained amniotic fluid (MSAF) (aRR=2.8, 95% CI: 2.2-3.7); and first birth (aRR=1.8; 95% CI: 1.4-2.3). Preterm, low birthweight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR=2.4, 95% CI: 1.1-5.0) was associated with late onset sepsis. CONCLUSIONS:: Preterm and low birthweight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. IAP did not protect against all-cause sepsis or death underscoring the need for alternate prevention strategies.
Authors:
Stephanie J Schrag; Clare L Cutland; Elizabeth R Zell; Locadiah Kuwanda; Eckhart J Buchmann; Sithembiso C Velaphi; Michelle J Groome; Shabir A Madhi;
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-4
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  -     ISSN:  1532-0987     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Centers for Disease Control and Prevention, Atlanta, USA 2Department of Science and Technology/ National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Soweto, South Africa 3Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Soweto, South Africa 4Department of Paediatrics, Division of Neonatology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Soweto, South Africa.
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