Abstract
BackgroundNeonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. Thus, we used a historic cohort design to assess the association between a series of neonates and their mothers, in addition to hospital evolution features and the risk and prognosis of neonatal sepsis (defined by Pediatric Sepsis Consensus [PSC] criteria) in 11,790 newborns consecutively admitted to a Neonatology Service in Mérida, Mexico, between 2004 and 2007.ResultsSepsis was found in 514 of 11,790 (4.3 %) newborns; 387 of these cases were categorized as early-onset (<72 h) (75.3 %) and 127, as late-onset (>72 h) (24.7 %). After logistic regression, risk factors for sepsis included the following: low birth weight; prematurity; abnormal amniotic fluid; premature membrane rupture (PMR) at >24 h; respiratory complications, and the requirement of assisted ventilation, O2 Inspiration fraction (IF) >60 %, or a surgical procedure. Some of these factors were differentially associated with early- or late-onset neonatal sepsis. The overall mortality rate of sepsis was 9.5 %. A marked difference in the mortality rate was found between early- and late-onset sepsis (p >0.0001). After Cox analysis, factors associated with mortality in newborns with sepsis comprised the following: prematurity; low birth weight; low Apgar score; perinatal asphyxia, and the requirement of any invasive medical or surgical procedure.ConclusionsThe incidence of neonatal sepsis in southeastern Mexico was 4.3 %. A different risk and prognostic profile between early- and late-onset neonatal sepsis was found.
Highlights
Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported
Neonates with sepsis accounted for 12,884 follow-up days, which was significantly longer when compared with neonates without sepsis (3.3 ± 12.6 patient/day) p
When we evaluated the clinical factors associated with poor prognosis in 514 neonates with sepsis, we found that prematurity, low birth weight, perinatal asphyxia, and an Apgar score of ≤5, as well as invasive medical procedures, are mortality-associated factors (Table 5)
Summary
Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. In Yucatán, a state in southeastern Mexico, a study performed between 2000 and 2004 at the Neonatal Intensive Care Unit of the Mexican Institute of Social Security (IMSS) in Mérida, the neonatal mortality rate was 10.3/1,000 [10]. Identifying the risk and prognosis factors prevailing in the different geographical contexts has become a crucial issue for optimizing neonatal care. Because there is scarce information on these topics in the geographical context in which the study was carried out, we performed a retrospective study in newborns between 2004 and 2007 that was aimed at assessing the association between neonates and maternal clinical and demographical factors, in addition to clinical course features and the risk for neonatal sepsis
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