Some maternal and neonatal factors affecting early and late neonatal sepsis

Abstract

Abstract Background: Neonatal sepsis categorized as early and late onset. Early neonatal sepsis (ENS)  in the first 7 days of life with 85% occurs in the first 24 hours of life. Late neonatal sepsis  (LNS )occurs after the first week of life and is acquired from care giving environment. Aims of study: To explain the effect of some maternal and neonatal factors on early and late neonatal sepsis, like premature rupture of membranes, midwife interference and prematurity. With change in blood investigations, like effect of antibiotics on the results of blood cultures. Methods: We prepared a questionnaire about the name ,age in days, gender with perinatal and maternal history and take blood samples for CBC and differential, blood culture, CRP and ESR to explain the effect of neonatal sepsis on the blood investigation results and identify the specific pathogen causing neonatal sepsis by blood culture. Results: We found that the neonate is more susceptible to ENS in comparison to LNS. Also we found that the blood culture result highly affecting by antibiotics used before culture. The mortality rate is more in ENS in comparison to late type. There was no significant difference in gender, maternal fever and antenatal care, between ENS and LNS groups. Prematurity was higher in ENS group compared to LNS group (44.7%, vs. 29%) respectively; and the difference was significant (p = 0.042). Mode of delivery showed no effect in ENS group (NVD = C/S = 50%); while it seems to be more effective in LNS group as (74.2% vs 25.8%) of patients are C/S, (p = 0.003).Only (13.2%) of ENS subjects were home delivery , while (25.8%) of LNS subjects were home delivery, (p = 0.048). Midwife interference was more effective in LNS subjects than ENS subjects, (35.5%, vs. 18.4%) respectively, (p = 0.019).Premature rupture of membrane was significantly more frequent in ENS subjects than LNS subjects (31.6% vs. 16.1%) respectively, (p = 0.028).Death was more frequent in ENS subjects than LNS subjects; (18.4%, vs. 3.2%) respectively . Conclusion and Recommendation: We found that  the premature neonate more susceptible for neonatal sepsis than full term with premature rapture of membrane more frequently affecting ENS in comparison to late type. we found also that the C-reactive protien and platelets count had high sensitivity to the diagnosis of neonatal sepsis.We recommend antenatal care especially in the third trimester and use of antibiotic prophylaxis if there is a history of leaking liquor and avoid prematurity because premature neonates are more prone to early neonatal sepsis. Antibiotics should be avoided before blood culture aspiration to avoid false negative results.