Abstract
BackgroundAlthough neonatal infections cause a significant proportion of deaths in the first week of life, little is known about the burden of neonatal disease originating from maternal infection or colonization globally. This paper describes the prevalence of vertical transmission – the percentage of newborns with neonatal infection among newborns exposed to maternal infection.MethodsWe searched Pubmed, Embase, Scopus, Web of Science, Cochrane Library, and WHO Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection. Studies that measured prevalence of bacterial vertical transmission were included. Random effects meta-analyses were used to pool data to calculate prevalence estimates of vertical transmission.Results122 studies met the inclusion criteria. Only seven studies (5.7%) were from very high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of infection (lab-confirmed, clinical signs), colonization, and risk factors of infection. The prevalence of early onset neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 17.2% (95%CI 6.5-27.9). The prevalence of neonatal lab-confirmed infection among newborns of colonized mothers was 0% (95% CI 0.0-0.0). The prevalence of neonatal surface colonization among newborns of colonized mothers ranged from 30.9-45.5% depending on the organism. The prevalence of neonatal lab-confirmed infection among newborns of mothers with risk factors (premature rupture of membranes, preterm premature rupture of membranes, prolonged rupture of membranes) ranged from 2.9-19.2% depending on the risk factor.ConclusionsThe prevalence of early-onset neonatal infection is high among newborns of mothers with infection or risk factors for infection. More high quality studies are needed particularly in high neonatal mortality settings to accurately estimate the prevalence of early-onset infection among newborns at risk.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0813-3) contains supplementary material, which is available to authorized users.
Highlights
Neonatal infections cause a significant proportion of deaths in the first week of life, little is known about the burden of neonatal disease originating from maternal infection or colonization globally
For the maternal colonization and neonatal colonization analysis, we examined pathogen-specific subgroups with Staphylococcus aureus, non-group B Streptococcus species, Group B streptococcus, Klebsiella pneumoniae, Escherichia coli, Ureaplasma species, Mycoplasma hominis, and multiple organisms
Twenty-eight studies (23.0%) had data on women who did not use intrapartum antibiotics; 51 studies (41.8%) reported some antibiotic use in a subset of women for prophylaxis or treatment; and 43 studies (35.2%) did not specify whether antibiotics were used
Summary
Neonatal infections cause a significant proportion of deaths in the first week of life, little is known about the burden of neonatal disease originating from maternal infection or colonization globally. Chan et al BMC Infectious Diseases (2015) 15:118 reducing the incidence of early-onset neonatal sepsis. These interventions are rare or absent in resource-poor settings, which have the highest rates of neonatal mortality. To develop research priorities and strategies for prevention, we need to better understand the prevalence of neonatal infections that are maternally acquired. In this systematic review and meta-analysis, we estimate the prevalence of early-onset neonatal infection in cases where the pregnant woman was infected or colonized with bacterial pathogens (hereafter referred to “vertical transmission”) to better understand the global rates of vertical transmission. We used a relaxed inclusion criteria to include studies that at minimum measured maternal infections and neonatal infections without necessarily having the comparison group of women without maternal infections
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