Development Of Neonatal Sepsis Research Articles

Antimicrobial therapy in newborns: from theory to practice

Currently, there are no uniform accurate statistical data on the development of neonatal sepsis. This critical condition is difficult to diagnose in the early stages due to the lack of reliable markers with high prognostic value, and the use of currently available sepsis markers with high specificity and/or sensitivity is limited to large tertiary level obstetric hospitals. In this regard, as part of the early diagnosis of neonatal sepsis, issues related to amultifactorial assessment of the risk of neonatal sepsis becoming relevant, on the basis of which indications for prescribing therapy for the prevention of this condition will be justified. The most common etiological cause of sepsis is numerous pathogens: bacteria, viruses and fungi. This again leaves difficulties in choosing the right therapeutic tactics, especially within the framework of antibiotic therapy, the protocols of which vary from hospital to hospital not only in our country, but throughout the world. Based on the practice of domestic and foreign colleagues, it is necessary to discuss protocols for the management of patients with such acomplex diagnosis as sepsis.

Determinants of neonatal sepsis among neonates admitted to neonatal intensive care units in ethiopian hospitals: A systematic review and meta-analysis

ObjectiveSeveral studies have identified risk factors for neonatal sepsis, but they are limited to specific geographical areas with results that may not be generalizable to other populations. Hence, the objective of this study was to determine the contributing factors, representative at a national level, that influence the occurrence of neonatal sepsis in neonates receiving hospital care in Ethiopia. Methods and materialsA thorough search was conducted across PubMed/Medline, Hinari, Cochrane Library, and Google Scholar to identify relevant studies. The pooled odds ratio was estimated using the random effect model. The heterogeneity among the included studies was evaluated using the I2 and Cochrane Q-statistics tests. Egger's tests used to assess publication bias. ResultsA total of 19 studies comprising 6190 study participants were included. Neonatal sepsis was positively associated with several factors, namely: prolonged premature rupture of membrane (OR: 3.85, 95% CI: 2.31–6.42), low first minute APGAR score (OR: 3.74, 95% CI: 1.29–10.81), low fifth minute APGAR score (OR: 4.17, 95% CI: 1.76–9.91), delayed initiation of breastfeeding (OR: 3.41, 95% CI: 2.18–5.36), and infection of the maternal urinary tract (OR: 3.17, 95% CI: 1.87–5.35). ConclusionDuration of rupture of membrane, APGAR score, time of initiation of breastfeeding, and urinary tract infection have a role in the development of neonatal sepsis.

Early neonatal sepsis caused by <i>Haemophilus influenzae</i>

Neonatal sepsis still remains a serious problem of modern health care, being one of the main causes of neonatal and infant mortality, as well as disability in surviving children. Due to the high risk of adverse outcomes, the problem of early neonatal sepsis (ENS), especially in preterm infants, attracts special attention. At the same time, if in the previous decades the main causative agents of ENS were Escherichia coli and Streptococcus group B, then in recent years it has been noted that while maintaining the leading value in the etiological structure of Escherichia coli, the frequency of detection of Haemophilus influenzae began to increase. The article contains a review of modern publications on the role of Haemophilus influenzae in the formation of perinatal losses, as well as the significance of this pathogen in the development of neonatal sepsis. The article also presents a clinical case report of ENS caused by Haemophilus influenzae. Particular attention is paid to the issues of timely diagnosis of ENS, which is possible only with a comprehensive analysis of the results of clinical and laboratory-instrumental examination.

Association between innate immunity gene polymorphisms and neonatal sepsis development: a systematic review and meta-analysis.

The aim of this meta-analysis was to analyze all available data from studies investigating associations between polymorphisms in genes responsible for innate immunity and neonatal sepsis development. A comprehensive literature search, reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-S guidelines, was performed with no language restriction. Studies derived using the PICO (population, intervention, comparison and outcomes) strategy, with data on the genotype distribution for innate immunity gene polymorphisms in newborns withandwithout sepsis. Data were analyzed using Review Manager. The Cochran-Mantel-Haenszel test was used to calculate odds ratios with 95% confidence intervals. Heterogeneity was tested using the I2 index. From a total of 9428 possibly relevant articles, 33 qualified for inclusion in this systematic review. According to the STrengthening the REporting of Genetic Association Studies, 23 studies were found to be of moderate quality, while 10 were of low quality. The results showed an association of the mannose-binding lectin (MBL) exon1 genetic polymorphism with the risk of culture-proven sepsis. Toll-like receptor (TLR) 4 rs4986791 genotype distribution suggests its association with the increased risk of culture-proven sepsis. The certainty of evidence per GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) varied from very low to low. Publication bias was not detected. Out of the 11 investigated single-nucleotide polymorphisms, this meta-analysis found a possible association between the risk for culture-proven sepsis and MBL exon1 and TLR4 rs4986791polymorphisms. There is an evident need for larger well-designed, multicentric observational studies investigating inflammatory gene polymorphisms in neonatal sepsis.

The Role of Prophylactic Antibiotics in Newborn Born through Meconium Stained Amniotic Fluid (MSAF)

Objective: The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in newborn born through meconium stained amniotic fluid (MSAF). Method: Total 200 babies born through meconium stained amniotic fluid were included in this study. 100 babies randomized to group a (antibiotic group) received first line antibiotics for 3 days and 100 babies to group B (no antibiotic group) in which no antibiotics were given. Both group A and B evaluated clinically and by lab parameters (sepsis screen and blood cultures) for development of sepsis. Both groups received similar supportive management. The primary outcome measure was the development of infection. Details of clinical progress during were recorded. All neonates were monitored for development of complications Result: The patient profiles were similar in both groups. The overall incidence of suspect sepsis was 9 % in the study population with no significant difference between group A and group B (7 %vs. 11 %, p=0.322). Incidence of culture-proven sepsis was also not significantly different between the two groups (5% vs. 7 %, p=0.3546). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. Final outcome and duration of stay was also not significantly different in both group A and group B. Conclusion: This study shows that there was no statistically significant difference in the incidence of development of infection, complication and final outcome in neonates born through meconium stained amniotic fluid when treated with or without antibiotics.

Preterm Neonatal Sepsis: Associated Risk Factors and Microbial Profiles at Kitale County Hospital New-born Unit, Western Kenya

Neonatal sepsis is a major concern with maternal and neonatal risk factors greatly being associated with development of neonatal sepsis. In this study, we sort to determine the associated risk factors and microbial profiles at Kitale County Hospital (KCH) new-born unit in Western Kenya. Data was collected from 181 eligible preterm neonates and cultured using standard protocols. A prevalence of 22.7% was found with majority of Gram positive 35 (85.4%) while Gram negative were 6 (14.6%). Coagulase Negative Staphylococcus (CoNS) were 31 (75.6%) with Staphylococcus epidermidis 19 (46.3%) being the majority . Mode of delivery, Prolonged Rupture of Membranes (PROM), foetal distress, low birth weight and poor breast feeding were major risk factors associated with neonatal sepsis at KCH. There is therefore need to assess the correlation between the specific maternal and neonatal risk factors with common circulating bacterial profiles at KCH new born unit. Keywords: Preterm neonate, Neonatal sepsis, New-born unit, Microbial profiles and characteristics. Western Kenya. DOI: 10.7176/JHMN/89-06 Publication date: May 31 st 2021

Clinical Application of Serum Inflammatory Factors Combined with Dynamic Detection in the Diagnosis and Treatment of Neonatal Sepsis.

Background:To investigate the clinical application value of the combination of the inflammatory factors and dynamic detection in the diagnosis and treatment of neonatal sepsis by detecting serum inflammatory factor C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels before and after treatment of neonatal infection.Methods:A total of 138 neonates with different degrees of infection were randomly enrolled, including 88 cases in the sepsis group and 50 cases in the virus infection group. Another 50 non-infected newborns in the same period were enrolled as the normal control group. Venous blood of all subjects for CRP, PCT, IL-6 detection, and send bacterial blood culture for sepsis and virus infection groups were collected at the same time. In the recovery period, venous blood of children in sepsis group was collected again to review CRP, PCT, IL-6, and differences in each test index of each group were compared.Results:The serum CRP, PCT, IL-6 levels in the sepsis group were significantly higher than those in the virus infection group (all P <0.05); serum CRP, PCT, IL-6 levels in the sepsis group were significantly lower than before treatment (P <0.05); the sensitivity and accuracy of the combined detection of indicators for the diagnosis of neonatal sepsis were significantly improved.Conclusion:The inflammatory factors CRP, PCT, and IL-6 are closely related to the occurrence and development of neonatal sepsis. Combined detection can effectively improve the diagnostic accordance rate, which is beneficial to the early diagnosis and early clinical intervention of neonatal sepsis.

Invasive devices as risk factors for neonatal sepsis in neonatal intensive care units

This study aimed to evaluate the impact of invasive devices as risk factors for the development of neonatal sepsis in Neonatal Intensive Care Units. Hospital-based retrospective cohort study performed in two Neonatal Intensive Care Units in Ponta Grossa, Paraná, Brazil. Documentary data were collected through consultation of electronic medical charts of all patients admitted to two hospitals and of the patients with diagnosis of sepsis in another hospital. Health conditions at admission and outcomes were evaluated. Frequencies of the reasons for admission and the outcomes were calculated. In the association analysis, exposure variables were calculated with odds ratio and confidence intervals (95%). The frequency of sepsis was 39%, and 45.7% of the cases were of early-onset sepsis and 54.3% of late-onset sepsis. The mortality rate associated with sepsis was 9.9%. The use of invasive devices was observed to increase by 6 times the risk of neonatal sepsis. Peripherally inserted central catheter and phlebotomy were the devices causing higher risk. The high incidence of late-onset sepsis, its association with the use of invasive devices and the higher mortality rate among newborns with sepsis suggest the presence of fragilities in neonatal care and the need to seek alternatives of neonatal approach to avoid new cases of neonatal sepsis and consequent death.

Modern approaches to diagnosis and treatment of early-onset neonatal sepsis

Early-onset neonatal sepsis (EOS) remains the leading cause of morbidity and mortality, especially among premature babies. Therefore, accurate diagnosis, prompt monitoring of the course of the disease and an effective therapeutic strategy are a guarantee of improving the quality of medical care for newborns, as well as an important reserve for reducing perinatal losses. The aim of the work to summarize modern views on the diagnosis and treatment of early-onset neonatal sepsis in newborns with perinatal pathology. Results and their discussion. An analytical review of modern literature data on problematic issues of EOS diagnostics is carried out. The approaches are stated and the main directions of EOS management at the present stage are formulated. It was revealed that the lack of a consensus definition of neonatal sepsis, the nonspecificity of clinical data is a limiting factor in the timely accurate identification of the septic process. Insufficient diagnostic value of existing laboratory tests leads to defects in the registry and monitoring of this disease, the inability to conduct an objective assessment of the existing epidemiological and microbiological situation in the health care system and the subsequent effective implementation of preventive measures. Conclusions. In the conditions of modern scientific realities, none of the existing laboratory tests can sufficiently reliably confirm or deny the presence of EOS in a newborn child, which determines the search for new promising laboratory tests with high diagnostic and prognostic potential. The optimal treatment strategy for newborns with EOS is broad-spectrum antibiotics. However, today the global problem of excessive irrational prescribing of antibacterial drugs is associated with the formation of multidrug-resistant strains of bacteria, as well as the development of long-term adverse effects, which requires improved diagnostic and treatment algorithms for children who are in the risk group of the development of neonatal sepsis by implementing a comprehensive approach using modern accurate tests in the dynamics of the disease

Risk Factors Assessment and Clinical Profile of Neonatal Sepsis in Blood Culture Proven Neonates.

Neonatal sepsis refers to infection occurring within the neonatal period i.e. the first 28 days of life for a term baby, and up to 4 weeks beyond the expected date of delivery in a preterm baby. Neonatal sepsis is still a major cause of morbidity and mortality during the first year of life.Assessment of risk factors and clinical profile of neonatal sepsis was done on 42 cases with blood culture proved neonatal sepsis of total 102 cases with clinically suspected neonatal sepis admitted to the Neonatal Intensive Care Units (NICUs) in El Menoufia and El Kalyoubia governorates hospitals versus 30 age and sex matched healthy controls. Complication during labour, Birth weight and Gestation age were the common risk factors were associated with the development of neonatal sepsis where Respiratory distress, Lethargy, Poor feeding, abdominal distension, Apnea and Cyanosis were the most common clinical signs represent clinical profile of neonatal sepsis.

Neonatal Vitamin D status and the risk of neonatal sepsis.

Objective:To evaluate the maternal and neonatal 25-hydroxyvitamin D [25(OH)D] levels and the effect of 25(OH)D levels on the development of neonatal sepsis.Methods:This prospective study was performed in the neonatal intensive care unit of Medicine Hospital/Biruni University between November 2017 and September 2018. Fifty one term infants with sepsis group and 56 term infants with control group were included in this study. Blood samples for whole blood count, CRP, Ca, P, ALP, 25(OH)D and culture were obtained from all neonates.Results:Mean vitamin D levels for the neonates and their mothers were found to be 12.4±8.5 ng/ml and 13±8.7 ng/ml, respectively. There was a significant correlation between maternal and newborn 25(OH)D levels (r=0.72, p<0.01). The number of the newborns with vitamin D deficiency was significantly higher in the sepsis group (n=31, 60.8%) than in the control group (n=30, 53.6%; p=0.00), corresponding to significantly lower levels of vitamin D in the sepsis group (11±5.5 ng/ml vs. 13.8±10.6 ng/ml; p=0.012). Similarly, maternal vitamin D levels was significantly lower in the sepsis group than in the control group (10.8±5.6 ng/ml vs. 14.9±10 ng/ml; p=0.001).Conclusion:Our findings suggest that there may be an association between vitamin D deficiency and neonatal sepsis

Comparison of conservative &amp; aggressive management of PPROM at 34-36 weeks gestation in terms of development of neonatal sepsis &amp; RDS

Objective : To compare the conservative and aggressive management of Preterm prelabor rupture of membranes (PPROM) at 34-36 weeks gestation in terms of development of neonatal sepsis and respiratory distress syndrome (RDS). Method : 194 pregnant women with PPROM at gestational age 34-36 weeks admitted in labour ward were included in the study conducted from 2009-2010 in department of Obstetrics & Gynaecology, SMS Medical College, India. Random allocation to conservative & aggressive management group was done by offering Chit Box Method assigning 97 cases in each group. In conservative management cases were hospitalised & provided bed rest, Daily fetal monitoring, Maternal vitals monitoring, Oral tab erythromycin 500 mg T.D.S for 7 days, Daily WBC count and c-reactive protein estimation. Expectant management was abandoned if there was clinical evidence of labour, infection or fetal distress. In aggressive management induction of labour was done by Tab Misoprostol 25 mg orally, at 4-6 hour intervals, for a maximum of 5 doses. Caesarean delivery was performed for standard obstetrical indication and for failed induction. After delivery neonatal care was provided by neonatologist. Results : Out of 97 cases in aggressive management group 4 (4.12%) newborn babies suffered from neonatal sepsis and out of 97 newborn babies in conservative management group 14 (14.43%) babies had neonatal sepsis. Out of 97 cases in aggressive management group 15 (15.46%) newborn suffered from RDS and out of 97 cases in conservative management group 12 (12.34%) newborn suffered from RDS. Conclusion : Rate of neonatal sepsis was higher in conservative management group than aggressive management group. Thus there was significant association observed for neonatal sepsis in between aggressive management and conservative management group. The rate of RDS was lower in conservative management group as compared to aggressive management group. But there is no significant association were observed between RDS in both conservative and aggressive management group.

A Study to Evaluate the Role of Antepartum and Intrapartum Factors Affecting Early Onset Neonatal Sepsis in Rural Medical College

The study was undertaken to study the maternal risk factors associated in the development of sepsis neonatorum (neonatal sepsis). The study was conducted in 70 neonates. Out of these 70 neonates, 27 were cases of neonatal sepsis and 43 served as controls. The maternal risk factors undertaken in the study were maternal age, parity, premature rupture of membranes (PROM), meconium stained amniotic fluid (MSAF), preeclampsia, foul smelling liquor, antepartum hemorrhage (APH), Intrapartum fever, maternal educational status. Out of these maternal factors, premature rupture of membranes (PROM), meconium stained amniotic fluid (MSAF), Intrapartum fever, Preeclampsia, foul smelling liquor showed statistically significant association with development of neonatal sepsis and maternal factors like maternal age, educational status, parity and antepartum hemorrhage (APH) were not associated with the development of neonatal sepsis.

Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial.

The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to 'Antibiotic' group and 129 to 'No Antibiotic' group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between 'No Antibiotic' and 'Antibiotic' groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32-1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23-2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003).

Predictive Values of Risk Factors in Neonatal Sepsis

Neonatal sepsis is one of the most important causes of mortality and morbidity especially in developing countries. Management of such cases is difficult, costly and need expert centers in many cases. Therefore, identification of the risk factors and their predictive values may help optimizing its management. With the above idea this case-control study was done to see the effects of maternal and neonatal risk factors and to find their predictive values in the development of neonatal sepsis. Fifty cases and fifty suitably matched controls were enrolled in the study and different maternal, natal and newborn factors were compared. Many risk factors were found to have influence in the development of neonatal sepsis. Among them the maternal intrapartum fever, foul smelling liquor, young mother (&lt; 20 yrs), poor income group, prolonged labor, unclean vaginal examination (UVE) and primi mother were much associated with the occurrence of sepsis. Also the neonatal factors, like prematurity, resuscitation at birth and low APGAR score carried the significant risk of developing sepsis. But when relative influence of these risk factors were analyzed over neonatal sepsis in detecting their predictive values, it was found that irregular antenatal check up, prematurity, resuscitation at birth, and maternal intrapartum fever had influenced most in the development of neonatal sepsis in chronological order. DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11324 J Bangladesh Coll Phys Surg 2011; 29: 187-195

Variations in bacterial pathogens causing early onset neonatal septicaemia, according to birth weights - a 5 year study in a referral hospital of West- Bengal

Bacterial sepsis continues to be a major cause of morbidity and mortality in neonates. The features of sepsis being non- specific, a high index of suspicion can only save a precious life. Pathogens of early onset septicaemia may vary, from one country to another and within a country from one place to the other. This study had been undertaken t o understand the variations in the pathogens of early onset neonatal septicaemia according to birth weights ,their susceptibility patterns to commonly used antibiotics in this age of emerging resistance and to utilise this data for better empirical treatment of this potentially fatal conditions. Blood samples from 255 babies belonging to various birth weights and of both sexes with definitive inclusion and exclusion criteria were processeed according to standard laboratory protocols during a five year period, from February 2005-2010, in a rural referral hospital of West Bengal. Culture positivity was found in 63/255 samples (24.70%), comprising of Klebsiella pneumoniae (31.74%) and methicillin sensitive Staphylococcus aureus (31.74%) as predominant isolates. Male: female ratio was 1.25:1. The susceptibility pattern of isolates has been discussed. It is observed that bacteriology of early onset neonatal septicaemia varies according to birth weights. In very low birth weight babies Eshcherichia coli is the predominant organism and culture positivity is highest (87.5%). Where as culture postivity in low birth weight and normal weight babies with sepsis are 32.89% and 29.26% respectively.In low birth weight babies Staphylococcus aureus and in normal weight babies Klebsiella pneumoniae are the predominant organisms. Birth weight of babies and development of neonatal sepsis are significantly associated x2= 7.174, p&lt;0.03. Male babies are more susceptible to develop neonatal sepsis.For initial therapy of early onset neonatal septicemia, Amikacin is the best choice.DOI: http://dx.doi.org/10.3329/bjmm.v4i2.10823

Maternal and Neonatal Characteristics Associated with Neonatal Neutropenia in Hypertensive Pregnancies

The purpose of this study was to identify maternal and neonatal characteristics affecting marked neonatal neutropenia in pregnancies complicated by hypertension. A single institution retrospective chart review over 2 years of singleton and multifetal pregnancies with hypertensive disorders meeting American College of Obstetricians and Gynecologists criteria was performed. Neutropenia and sepsis occurring within the first 16 days of life (DOL) were studied. Neutropenia was defined as an absolute neutrophil count of <1500/microL and sepsis as any positive blood, cerebrospinal fluid, or urine culture. The study group contained neonates with neutropenia. From all other hypertensive pregnancies, a presumed nonneutropenic control group was randomly generated with a 4:1 ratio; these neonates may or may not have had a complete blood count (CBC) performed because they were clinically stable. Multiple gestations were separately analyzed and compared with hypertensive multifetal neonates with confirmed CBCs showing no neutropenia. Chi-square, Mann-Whitney U, and regression analyses were performed. Five hundred forty-three hypertensive pregnancies representing 633 births, 173 (27.3%) of which were from multiple gestations, were studied. There were 32 (5.9%) cases of neutropenia, with 22 (68.8%) from multiple gestations. Of premature multiple gestations, 45.2% born between 24 and 34 weeks' gestation developed neutropenia. The median time to diagnosis of neutropenia was 1.2 hours with 80.6% detected on the first DOL. Resolution of neutropenia occurred within 7 days in 84.4% of surviving neonates. Univariate analysis showed significant associations of neutropenia with gestational age at delivery, multiple gestations, birth weight, severe preeclampsia, and development of neonatal sepsis. When multiple gestations were analyzed, linear regression showed only sepsis to be significantly associated with neutropenia (p = 0.027). Hypertensive disorders of pregnancy and premature delivery are common in multiple gestations and are associated with neutropenia (12.7% versus 2.2% neutropenia in singletons (p < 0.001). Furthermore, multiple gestations with neutropenia had a higher incidence of sepsis than singletons with neutropenia.

An outbreak of Serratia marcescens septicaemia in neonatal intensive care unit in Gaza City, Palestine

We performed a case-control study of Serratia marcescens incidence in the neonatal intensive care unit of a governmental Gaza Strip hospital from January to December 2005. S. marcescens was detected in the blood of 159 confirmed nosocomial cases of septicaemia, 70 (44%) neonates died due to S. marcescens infection and 89 recovered. The main clinical symptoms were hypothermia 38%; jaundice 42%; Apgar score 4 at 1 min in 29% of neonates; and Apgar score 5 at 5 min in 5%. Risk factors significantly associated with S. marcescens infection were birthweight <1,500 g (OR: 1.7; P=0.026); <37 weeks gestational age (OR: 2.0; P=0.002); and use of mechanical ventilation (OR: 2.3; P=0.001). Agar diffusion susceptibility testing indicated that S. marcescens was generally susceptible to imipenem, followed by ciprofloxacin and ofloxacin. We identified potential risk factors associated with development of neonatal sepsis and highlight the importance of appropriate infection control measures to prevent serious infection.

566 Influence of antepartum risk factors on the development of neonatal sepsis

566 Influence of antepartum risk factors on the development of neonatal sepsis

Early onset neonatal group B streptococcal infection in Hong Kong.

AbstractThe attack rates of early onset streptococcal sepsis in Chinese neonates was found to be 0.58 cases per 1000 among 19118 live births at Tsan Yuk Maternity Hospital. This low attack rate is probably due to a low GBS genital carriage rate and the absence of serotype II GBS in local pregnant women. Risk factors found to be associated with neonatal diseases are maternal fever, prolonged rupture of membrane, gestational diabetes mellitus. Prematurity and multiple pregnancy, which are recognised risk factors in Caucasian populations, are not found to have an important influence on the development of neonatal sepsis in Chinese. The clinical features of affected neonates in our series do not differ from the classical description. Mortality and morbidity are associated with neonatal meningitis exclusively.