Abstract
BackgroundPossible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide. We studied risk factors for PSBI in a large rural population in central India where facility deliveries have increased as a result of a government financial assistance program.MethodsWe studied 37,379 pregnant women and their singleton live born infants with birth weight ≥ 1.5 kg from 20 rural primary health centers around Nagpur, India, using data from the 2010–13 population-based Maternal and Newborn Health Registry supported by NICHD’s Global Network for Women’s and Children’s Health Research. Factors associated with PSBI were identified using multivariable Poisson regression.ResultsTwo thousand one hundred twenty-three infants (6 %) had PSBI. Risk factors for PSBI included nulliparity (RR 1.13, 95 % CI 1.03–1.23), parity > 2 (RR 1.30, 95 % CI 1.07–1.57) compared to parity 1–2, first antenatal care visit in the 2nd/3rd trimester (RR 1.46, 95 % CI 1.08–1.98) compared to 1st trimester, administration of antenatal corticosteroids (RR 2.04, 95 % CI 1.60–2.61), low birth weight (RR 3.10, 95 % CI 2.17–4.42), male sex (RR 1.20, 95 % CI 1.10–1.31) and lack of early initiation of breastfeeding (RR 3.87, 95 % CI 2.69–5.58).ConclusionInfants who are low birth weight, born to mothers who present late to antenatal care or receive antenatal corticosteroids, or born to nulliparous women or those with a parity > 2, could be targeted for interventions before and after delivery to improve early recognition of signs and symptoms of PSBI and prompt referral. There also appears to be a need for a renewed focus on promoting early initiation of breastfeeding following delivery in facilities.Trial registrationThis trial is registered at ClinicalTrials.gov (NCT01073475).Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3688-3) contains supplementary material, which is available to authorized users.
Highlights
Possible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide
Much has been published on possible serious bacterial infection (PSBI) in India over the last twenty years, the effect of the recent rapid change to high rates of facility delivery in India on risk factors for PSBI in the community remains less clear
Because we found an unexpected association between C-section delivery and PSBI in the multivariate analysis that was not present in the univariate analysis, we assessed whether each of the other variables in the model could have modified the effect of delivery mode on PSBI
Summary
Possible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide. We studied risk factors for PSBI in a large rural population in central India where facility deliveries have increased as a result of a government financial assistance program. Serious bacterial infection, such as meningitis, pneumonia and sepsis, is a significant cause of morbidity and mortality in neonates. Risk factors for neonatal infection in resource-limited settings have mostly been studied in children admitted to facilities and have examined the outcome of clinical or culture-confirmed sepsis. Much has been published on PSBI in India over the last twenty years, the effect of the recent rapid change to high rates of facility delivery in India on risk factors for PSBI in the community remains less clear
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
