Early-onset Neonatal Sepsis Research Articles

Association between Red Blood Cell Distribution Width (RDW) and Early-Onset Neonatal Sepsis

Background: Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge. The aim of this study was to find out the association between RDW and early onset Neonatal Sepsis. Methods: This case-control study was conducted at the Paediatrics inpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka, from May 2019 to November 2019. Results: In this study shows mean postnatal age was 1.86±0.730days and gestational age was 38.83±1.59 weeks in case group besides mean postnatal age was 1.88±0.738 days and gestational age was 39.06±1.78weeks in control group. Mean birth weight of case group was 3240±135.44gm and control group was 3346.66±139.57gm. The mean heamoglobin was 12.76±0.85, WBC was 20.12±1.27, RBC was 4.63±0.77, MCV was 85±0.97, platelet was 232±11.86, CRP was 21±0.77 and RDW Percentage was 21.83±2.39 in case group whereas mean heamoglobin was 12.86±0.83, WBC was 14.81±1.23, RBC was 4.85±0.71, MCV was 82.23±1.19, platelet was 280±14.26, CRP was 3.55±0.70 and RDW Percentage was 15.23±1.85 in control group. The ROC analysis of RDW% in the diagnosis of neonatal sepsis found an AUC of 0.967 (95%CI 0.867- 0.017) which is statistically significant (p<0.001). A cut-off value of ≥ 20.60 showed an 86.6% sensitivity and 95% specificity. Conclusion: RDW indices were higher in neonate present with early onset of neonatal sepsis. There is a strong correlation between RDW and CRP in the early onset of neonatal sepsis.

Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study

BackgroundBabies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.MethodsWe conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.ResultsWe enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8–21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2–65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6–40), primiparity (AOR = 4.8, 95% CI: 1.1–21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5–12) were associated with EONS.ConclusionsPrime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

Incidence of Retinopathy of Prematurity in Early Onset Neonatal Sepsis

Background: Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. Early-onset neonatal sepsis, has been identified as a potential contributing factor to the incidence of ROP. Aim of the study: The aim of this study was to assess the incidence of retinopathy of prematurity in early onset neonatal sepsis. Methods: This cross-sectional study was conducted in Department of Ophthamology and Neonatal Intensive Care Unit (NICU), Dr. Sirajul Islam Medical College & Hospital Ltd., Dhaka, Bangladesh from June 2022 to July 2024. Total 300 preterm neonates with ROP were included in this study. Then, they were divided into two groups- group A: 150 patients with early onset neonatal sepsis and group B: 150 patients with late onset neonatal sepsis. Result: The mean gestational age in Group A was significantly lower (28.9 ± 2.3 weeks) than Group B (30.1 ± 2.2 weeks) (p < 0.01). Maternal infections were higher in Group A (50%). Oxygen therapy duration was longer in Group A (14 ± 3 days) than in Group B (10 ± 2 days) (p < 0.01). Group A had more cases of ROP (70% vs. 57%, p = 0.02). Risk factors for ROP included gestational age <28 weeks (OR = 2.10), oxygen therapy (OR = 1.60), and mechanical ventilation (OR = 1.45). Conclusion: This study concludes that neonates with early-onset neonatal sepsis had higher incidence and severity of ROP, with key risk factors being low gestational age, prolonged oxygen therapy, mechanical ventilation, and maternal infections.

Mode of delivery in chorioamnionitis: impact on neonatal and maternal outcomes

BackgroundThe impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section.MethodsSingleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section.ResultsAfter chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5–13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1–18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified.ConclusionsThe rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section.

Soluble TREM-1 is not a useful biomarker in the diagnosis of early-onset neonatal sepsis.

Aim: Sepsis remains a significant cause of morbidity and mortality in neonates. We aimed to investigate the use and reliability of the soluble triggering receptor expressed on myeloid cells (sTREM-1) biomarker for suspected early onset of neonatal sepsis (EONS).Materials & methods: 52 patients with suspected EONS and 30 healthy newborns were analyzed for sTREM-1 and other biomarkers.Results: It revealed that elevated levels of C-reactive protein (CRP), neutrophil (%), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR) and lactate, as well as decreased lymphocyte (%) were statistically significant for EONS. However, there was no statistically significant difference in sTREM-1 levels between the groups.Conclusion: Although no significant difference in sTREM-1 levels was found between the groups, further research involving repeated measurements and larger sample sizes is necessary to evaluate its practical utility in clinical settings.

A rare case of early-onset neonatal sepsis caused by Proteus mirabilis in the first infant of tetrachorionic triamniotic triplets

Early-onset neonatal sepsis (EОNS) is one of the most severe diseases of the neonatal period and is often coupled to extremely unfavorable outcomes. In many ways, the severity of the condition and the results of newborn nursing depend on the etiology of the bacterial process. The major EОNS pathogens are traditionally considered to be Streptococcus group B and E. coli, much less common are other Gram-negative bacteria including casuistic cases caused by caused by Proteus mirabilis (P. mirabilis). The article provides a review on the P. mirabilis role in developing neonatal sepsis with pathogen-specific disease course and outcomes. In addition, we describe a clinical case of P. mirabilis-caused EОNS not only primarily characterized by the rarity of its causative agent, but also that it proceeded with a more favorable brain damage in contrast to similar cases described worldwide and because the neonatal EОNS developed in one of triplets, with two other babies being asymptomatic despite that P. mirabilis was also detected.

Utility of doppler ultrasound in early-onset neonatal sepsis: A case-control study.

Early-onset sepsis is one of the leading causes of neonatal morbidity and mortality worldwide and timely diagnosis is, therefore, of paramount importance. As there is a lack of literature regarding early alteration of the cerebral blood flow (CBF) in neonatal sepsis, our study aimed to appraise changes in the CBF velocities and Doppler indices in neonates with early-onset neonatal sepsis (EONS) and to assess its diagnostic accuracy. A total of 99 neonates were recruited in the study; 56 neonates with EONS, and the age-matched 43 neonates without any manifestations of sepsis. A Transcranial Doppler examination and cerebral hemodynamics were assessed in neonates during the first seventy-two hours of life. Doppler indices and CBFV were measured in the anterior cerebral artery (ACA), and middle cerebral artery (MCA), of either side. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. A significantly lower resistance in Resistivity (RI) and Pulsatility (PI) indices, a significant high end-diastolic velocity (EDV), and relatively higher peak systolic velocity (PSV) in both ACA and MCA have been documented within 72 hours of birth in neonates with EONS compared to the control group of neonates without sepsis. Our Study revealed that assessment of CBF at early hours of birth by Transcranial Doppler examination showed alteration in cerebral hemodynamics in neonates with EONS with an increase in the CBF and a decrease in the resistance. It can be adopted as a bedside, noninvasive tool with immediate diagnostic value.

Early onset neonatal sepsis and its associatited factors: a cross sectional study

BackgroundSepsis is the 3rd leading cause of neonatal mortality in Ethiopia contributing to 16% of neonatal death. In a hospital study, neonatal sepsis was the leading diagnosis at admission and the second leading cause of neonatal death at the neonatal intensive care unit. Among other factors repeated vaginal examination during labor is known to contribute to sepsis in low-income settings. However, there is limited evidence in the Ethiopian setting.ObjectiveThe objective of this study was to examine the association between early-onset neonatal sepsis and repeated vaginal examinations.MethodsThe study was conducted at Gandhi Memorial Hospital, a public maternity and newborn care hospital. We followed 672 mother-newborn pairs by phone until 7 days of age to detect clinical sepsis. Data were analyzed using SPSS version 20 software. Adjusted odds ratio risk (AOR) with a corresponding 95% confidence interval (CI) was used to show the strength of associations and variables with p-value < 0.05 were considered to be statistically significant.ResultsThe incidence of early-onset neonatal sepsis was found to be 20.83% (95% CI 17.60, 24.00). Having a frequent vaginal examination (four or more times) during labor and delivery, prolonged rupture of membranes, induced labor and gestational age < 37 weeks were strongly associated with the development of early-onset neonatal sepsis, (AOR 2. 69;95 CI: 1.08, 6.70) AOR 5.12(95% CI 1.31, 20.00), AOR of 5.24 (95% CI 1.72, AOR4.34 (95% CI 1.20, 15.68), 16.00), respectively.ConclusionFrequent digital vaginal examination prolonged rupture of membranes, induced labor and gestational age < 37 weeks significantly increases the risk of early onset neonatal sepsis. We also recommend further study using neonatal blood culture to better diagnose early onset neonatal sepsis objectively.

Early-Onset Neonatal Sepsis and Respiratory Distress in a Newborn with Congenital Diaphragmatic Hernia: A Case Report

Early-Onset Neonatal Sepsis and Respiratory Distress in a Newborn with Congenital Diaphragmatic Hernia: A Case Report

Update to the Neonatal Early-Onset Sepsis Calculator Utilizing a Contemporary Cohort.

The Kaiser Permanente Neonatal Early-Onset Sepsis (EOS) Calculator has been an effective tool for risk stratification to safely reduce newborn antibiotic exposure. The calculator was derived from data on infants born between 1993 and 2007. Since that time, US obstetric practice has adopted universal antepartum screening for group B Streptococcus and intrapartum antibiotic prophylaxis guidance has changed. Our objective was to update the EOS calculator using a contemporary birth cohort and determine the effect of these changes on EOS case ascertainment and antibiotic recommendations. The study included infants born at ≥35 weeks' gestation at 14 hospitals between January 2010 and December 2020 (n = 412 595 infants, EOS cases = 113). Model coefficients were re-estimated and the point estimates of the likelihood ratios for clinical status used to calculate the posterior probability of EOS. We compared the number of EOS cases correctly identified by each model (sensitivity) and the proportion of infants for whom empirical antibiotics are recommended. The original model had a sensitivity of 0.76 (95% confidence interval 0.63-0.85), while the updated model had a sensitivity of 0.80 (95% confidence interval 0.68-0.89), P = .15. The recommended empirical antibiotic use was 3.5% with the original model and 3.7% with the updated model, P < .0001. For each additional case identified by the updated model, an additional 158 infants would be treated with antibiotics. Both the original and updated EOS calculators are effective tools for quantifying EOS risk among infants born at ≥35 weeks' gestation.

EFFICACY OF EARLY-ONSET SEPSIS CALCULATOR IN THE PREDICTION OF ANTIBIOTICS USAGE AMONG NEONATES: A LOCAL SETTING STUDY

Early-onset sepsis (EOS) in neonates is a critical condition that requires timely diagnosis and appropriate management to prevent adverse outcomes. However, overuse of antibiotics in neonates can lead to complications, including antimicrobial resistance. The EOS calculator is a clinical tool designed to assess the risk of sepsis in neonates, helping to guide antibiotic use. Its efficacy in predicting antibiotic administration in high-risk neonates needs further evaluation. Objective: To evaluate the efficacy of the EOS calculator in predicting the use of antibiotics in neonates admitted to the neonatal intensive care unit (NICU) at a tertiary care hospital. Methods: This comparative cross-sectional study was conducted in the Pediatrics Department of Combined Military Hospital, Peshawar, from August 2020 to June 2022. A total of 982 neonates admitted to the NICU due to a high risk of infection were included. Upon admission, the attending clinician applied the EOS calculator to each neonate. However, the results were kept confidential, and routine management, including antibiotic administration, was carried out based on clinical signs and relevant investigations. The use of antibiotics within 72 hours of admission was compared to the recommendations of the EOS calculator. Statistical analysis used chi-square tests to assess the association between antibiotic use and the EOS calculator's recommendations. Results: Out of the 982 neonates included, 590 (60.1%) were male, and 392 (39.9%) were female, with a mean age of 1.38±4.53 days. Within 72 hours of admission, 562 (57.2%) neonates did not receive antibiotics according to local protocols. A statistically significant association was observed between the clinical use of antibiotics and the recommendations of the EOS calculator (p-value &lt;0.001), demonstrating that the calculator could effectively predict antibiotic needs. Conclusion: The EOS calculator proved to be an effective tool in predicting the likelihood of sepsis in neonates at high risk of infection. Its use can guide clinicians in making informed decisions about antibiotic administration, reducing unnecessary antibiotic exposure while ensuring timely treatment for those who need it. Incorporating the EOS calculator into neonatal sepsis management protocols can enhance patient outcomes and help prevent the overuse of antibiotics in neonates.

PROPORTION OF EARLY ONSET SEPSIS IN LOCAL NICU AND IDENTIFICATION OF MATERNAL RISK FACTORS

Early onset neonatal sepsis (EOS) remains a significant cause of morbidity and mortality in neonatal intensive care units (NICUs). Identifying maternal risk factors associated with EOS is crucial for early diagnosis and prevention. Objective: To evaluate the prevalence of early onset sepsis in neonates admitted to the local neonatal intensive care unit (NICU) and identify maternal risk factors associated with neonatal sepsis. Methods: A comparative cross-sectional study was conducted at the Pediatrics Department, Combined Military Hospital Peshawar, from January 2021 to May 2022. One thousand neonates admitted to the NICU due to any indication were included. A consultant paediatrician or neonatologist diagnosed neonatal sepsis based on clinical signs and laboratory findings. Maternal factors such as age, premature rupture of membranes (PROM), maternal fever, and chorioamnionitis were analyzed for their association with early onset sepsis. Data were statistically analysed using SPSS, with p-value &lt;0.001 considered significant. Results: Out of 1000 neonates, 690 (69%) were male and 310 (31%) were female. The mean maternal age was 33.38 ± 4.53 years. EOS was observed in 123 neonates (12.3%), while 877 (88.7%) neonates showed no signs of sepsis. PROM and chorioamnionitis were significantly associated with early-onset sepsis (p-value &lt;0.001). Conclusion: Early onset neonatal sepsis is a common condition in neonates admitted to the NICU. Neonates born to mothers with PROM or chorioamnionitis were at a significantly higher risk of developing EOS. These findings emphasise the importance of addressing maternal risk factors in reducing the incidence of neonatal sepsis.

Role of Gastric Aspirate Polymorphs in Diagnosis of Early Onset Neonatal Sepsis

Role of Gastric Aspirate Polymorphs in Diagnosis of Early Onset Neonatal Sepsis

Impact of a Neonatal Early-onset Sepsis Risk Calculator on Antibiotic Use in a Regional Australian Hospital

Impact of a Neonatal Early-onset Sepsis Risk Calculator on Antibiotic Use in a Regional Australian Hospital

Congenital Sepsis with Candida albicans-A Rare Event in the Neonatal Period: Report of Two Cases and Literature Review.

Candida spp. is rarely found in neonatal early-onset sepsis (EOS) etiology. However, candidemia is associated with increased mortality and morbidity, as in late-onset sepsis. Congenital candidiasis may present as a mucocutaneous infection or, more rarely, as a systemic infection in term and preterm infants. This paper presents case reports of two cases of congenital systemic candidiasis (CSC) caused by Candida albicans and a review of the data in the literature. An electronic search of PubMed, Scopus, and Google Scholar was performed to identify publications on congenital candidiasis. Both neonates were male, born vaginally, with risk factors for congenital candidiasis. One of the infants was born at term and presented with an almost generalized maculopapular rash at birth and congenital candidemia; parenteral fluconazole was used successfully. The other infant was born prematurely at 28 weeks of gestation; blood culture, gastric aspirate, and maternal vaginal cultures sampled at birth were positive for C. albicans. Liver and kidney involvement became apparent on the third day of life, while lung involvement was clinically evident on the fourth day. Prolonged parenteral fluconazole was administered due to multiple organ involvement and persistent candidemia. Our experience with the presented cases, similar to data in the literature, suggests that CSC may occur at any gestational age, with various clinical pictures, sometimes mimicking bacterial sepsis, and even in the absence of the rash. Careful anamnesis and a high index of suspicion are important for the prompt recognition and treatment of CSC, optimizing the short- and long-term outcomes. Further research should focus on CSC to improve its diagnosis.

Evaluating Risk Factors for Early-onset Neonatal Sepsis

Neonatal sepsis is a systemic infection that occurs in infants at 28 days of life and is a significant cause of morbidity and death in newborns. Early-onset neonatal sepsis (EONS) occurs within 72 hours after birth and is often associated with infections contracted before or during childbirth. The study aims to evaluate the risk factors of EONS. The study design was a case-control retrospective observational study that evaluated the medical records of neonates who were admitted to the neonatal care unit of Al Islam Hospital Bandung from January 2020 to December 2022. This study assessed the impact of independent variables such as gestational age, birth weight, premature rupture of membrane (PROM), miconeal amniotic fluid, APGAR score of 5 minutes, and the mother's white blood cell count elevation (&gt;15,000/µl). The logistic regression analyses were employed to analyze the data. The logistic regression analyses were employed to analyze the data. The study included 3,103 neonates, of whom 124 met the inclusion criteria. Thirty-nine patients (31.35%) were diagnosed with sepsis, while 85 patients (68.55%) did not have sepsis. Based on bivariate analysis, EONS was significantly linked to low birth weight (p=0.027, 95% CI=0.184 to 0.902, OR=2.455), PROM (p=0.000, 95% CI=4.359 to 26.582, OR=10.764), and the mother's white blood cell count elevation (p=0.002, 95% CI=1.560 to 7.622, OR=3.448). On multivariate analysis, the risk factors were significantly associated (p&lt;0.05), which had an influence of 38.4% on EONS (Nagelkerke R square=0.384). In conclusion, the risk factors for EONS were low birth weight, PROM, and elevation of white blood cell count in the mother, which increased by 38.4% with EONS.

Associations between maternal bacteremia during the peripartum period and early-onset neonatal sepsis: a retrospective cohort study

IntroductionEarly-onset neonatal sepsis (EONS) significantly impacts neonatal morbidity and mortality, with maternal bacteremia during the peripartum period being a potential risk factor. This study aims to explore the association between peripartum maternal bacteremia and EONS.MethodsA retrospective cohort study at the Women's Wellness and Research Center in Doha, Qatar (2015–2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS.ResultsAmong the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 − 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 − 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 − 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 − 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 − 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 − 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 − 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 − 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates.ConclusionThis study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis.

Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP. Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, Embase, and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥stage 3, type I, aggressive [posterior] ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birth weight, small for gestational age, maternal steroid use, necrotizing enterocolitis, LOS, and mechanical ventilation duration. Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 0.96-3.79, p = 0.067) but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR = 2.21; 95% CI: 1.68-2.90), and no significant confounders influencing this effect size were found in the meta-regression analysis. Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP. · This meta-analysis reveals a 2.2-fold increased risk of severe ROP in neonates with proven EOS.. · Future studies should distinguish between EOS and LOS when investigating risk factors of ROP.. · Treatment decisions should be adapted where possible in neonates with EOS before ROP screening begins..

Utilizing Predictive Factors as a Screening Tool for Early-Onset Sepsis in Neonates.

Neonatal early-onset sepsis (EOS) is a severe condition that affects newborns within the first three days of life, with high mortality rates, particularly in low- and middle-income countries (LMICs). In Vietnam, the diagnosis and management of EOS are challenged by ambiguous clinical signs and limited access to blood culture testing facilities. Early identification of at-risk neonates using a predictive risk factor model is crucial for improving neonatal care and reducing mortality. This study aims to identify maternal and neonatal risk factors associated with EOS and develop a predictive screening tool to facilitate the early detection of at-risk neonates in Vietnam. A nested case-control study was conducted on 225 neonates at the central neonatal unit in a principal tertiary hospital in southwestern Vietnam over a two-year period. Risk factors were identified using univariable and multivariable logistic regression analyses. A predictive nomogram was developed and evaluated for discrimination, calibration, and decision curve analysis (DCA). The study identified eight significant risk factors for EOS, including maternal genital infections during the third trimester, urinary tract infections (UTIs) during pregnancy, hypertension during pregnancy, insufficient maternal weight gain, rupture of membranes (ROM) ≥18 hours, meconium-stained amniotic fluid, first-minute APGAR score <7, and preterm birth <34 weeks. The predictive model demonstrated excellent discrimination with an area under the curve (AUC) of 0.913 (95% CI: 0.876-0.95, p<0.001) and good calibration (Hosmer-Lemeshow test with χ²(df)=5.496 (5), p=0.358). The model-based nomogram showed high sensitivity (82.7%) and specificity (83.3%) at an optimal cutoff of 0.25. The DCAillustrates the model's good clinical utility, providing a higher net benefit across most threshold probability ranges (0.0-0.96). This study presents a robust predictive model for the early identification of neonates at risk of EOS in Vietnam, based on key maternal and neonatal risk factors. The model, with demonstrated accuracy and reliability, holds significant potential for improving neonatal outcomes through timely interventions. Future research should aim at external validation and inclusion of broader clinical data to enhance the model's applicability and generalizability.

Use and utility of C-reactive protein (CRP) in neonatal early-onset sepsis: a secondary analysis of a prospective surveillance study.

Characterize C-reactive protein (CRP) within 72 postnatal hours in early-onset sepsis (EOS). Secondary analysis of a prospective surveillance study of neonates with EOS 2015-2017. We examined CRP use by center and neonatal characteristics, and CRP levels by time, neonatal characteristics, clinical signs, and pathogen. CRP was obtained for 96/235 neonates with EOS, which varied by center (p < 0.001). 71/95 had CRP > 10 mg/L (1 missing). Neonatal characteristics with and without CRP did not differ. There was no relationship between CRP level and timing (p = 0.41) or neonate characteristics. Median CRP was higher with ≥5 vs <5 clinical signs (56, 23 mg/L; p = 0.002), and was not different in Gram-positive vs Gram-negative sepsis (43, 51 mg/L; p = 0.37) or preterm neonates who died vs survived (38, 28 mg/L; p = 0.37). Among neonates with EOS, CRP use varied by center. CRP levels did not differ by time, neonate characteristics, pathogen, or death. ClinicalTrials.gov ID Early-Onset Sepsis an NICHD/CDC Surveillance Study (EOSII): NCT02410486.