Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up
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. 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.
Sepsis 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.
The 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.
- Ahman E, Zupan J: Neonatal and Perinatal Mortality: Country, Regional and Global Estimates. France: World Health Organization Press; 2007.
- Edmond K, Zaidi A: New approaches to preventing, diagnosing, and treating neonatal sepsis. PLoS Med 2010, 7:e1000213. CrossRef
- Lawn JE, Wilczynska-Ketende K, Cousens SN: Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 2006, 35:706–718. CrossRef
- Lawn JE, Kerber K, Enweronu-Laryea C, Massee BO: Newborn survival in low resource settings–are we delivering? Br J Obstet Gynaecol 2009,116(Suppl 1):49–59.
- Qazi SA, Stoll BJ: Neonatal sepsis: a major global public health challenge. Pediatr Infect Dis J 2009,28(1 Suppl):S1-S2.
- Yu VY: Global, regional and national perinatal and neonatal mortality. J Perinat Med 2003, 31:376–379. CrossRef
- de Salud S: Instituto Nacional de Estadística y Geografía. Mexico: INEGI. Annual Report; 2009.
- Secretaria de Salud: Programa Nacional de Salud 2007–2012. Mexico: 1st edition Secretaria de Salud Press; 2007.
- Rodriguez-Weber MA, Lopez-Candiani C, Rredondo-Garcia JL, Gutierrez-Castrellon P, Sanchez-Arriaga F: Neonatal sepsis morbidity and mortality in a tertiary care hospital. Salud Publica Mex 2003, 45:90–95. CrossRef
- Osorno CL, Acosta MA, Davila VJ, Gomez GM, Diego RN, Echeverria EM: Neonatal mortality in a regional perinatal hospital in Merida, Yucatan, 1995–2004. II. Analysis of causes and risk factors. Ginecol Obstet Mex 2006, 74:453–461.
- Barros FC, Bhutta ZA, Batra M, Hansen TN, Victora CG, Rubens CE: Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions. BMC Pregnancy Childbirth 2010,10(Suppl1):S3. CrossRef
- Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT: Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed 2005, 90:F220-F224. CrossRef
- Auriti C, Ronchetti MP, Pezzotti P, Marrocco G, Quondamcarlo A, Seganti G, Bagnoli F, De Felipe C, Buonocore G, Arioni C, Serra G, Bacolla G, Corso G, Mastropasqua S, Mari A, Corchia C, Di Lallo D, Ravá L, Orzalesi M, Di Ciommo V: Determinants of nosocomial infection in 6 neonatal intensive care units: an Italian multicenter prospective cohort study. Infect Control Hosp Epidemiol 2010, 31:926–933. CrossRef
- Lott JW: State of the science: neonatal bacterial infection in the early 21st century. J Perinat Neonatal Nurs 2006, 20:62–70.
- Seale AC, Mwaniki M, Newton CR, Berkley JA: Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa. Lancet Infect Dis 2009, 9:428–438. CrossRef
- Neal PR, Kleiman MB, Reynolds JK, Allen SD, Lemons JA, Yu PL: Volume of blood submitted for culture from neonates. J Clin Microbiol 1986, 24:353–356.
- Darmstadt GL, Batra M, Zaidi AK: Parenteral antibiotics for the treatment of serious neonatal bacterial infections in developing country settings. Pediatr Infect Dis J 2009,28(1 Suppl):S37-S42.
- Kurlat I, Stoll BJ, McGowan JE Jr: Time to positivity for detection of bacteremia in neonates. J Clin Microbiol 1989, 27:1068–1071.
- McIntire DD, Leveno KJ: Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008, 111:35–41. CrossRef
- Cohen-Wolkowiez M, Moran C, Benjamin DK, Cotten CM, Clark RH, Benjamin DK, Smith PB: Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J 2009, 28:1052–1056. CrossRef
- Goldstein B, Giroir B, Randolph A: International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005, 6:2–8. CrossRef
- Noori S, Seri I: Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev 2005, 81:399–404. CrossRef
- Musoke RN, Revathi G: Emergence of multidrug-resistant gram-negative organisms in a neonatal unit and the therapeutic implications. J Trop Pediatr 2000, 46:86–91. CrossRef
- Moreno MT, Vargas S, Poveda R, Saez-Llorens X: Neonatal sepsis and meningitis in a developing Latin American country. Pediatr Infect Dis J 1994, 13:516–520. CrossRef
- Tallur SS, Kasturi AV, Nadgir SD, Krishna BV: Clinico-bacteriological study of neonatal septicemia in Hubli. Indian J Pediatr 2000, 67:169–174. CrossRef
- Brilli RJ, Goldstein B: Pediatric sepsis definitions: past, present, and future. Pediatr Crit Care Med 2005,6(3 Suppl):S6-S8. CrossRef
- Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, Nampala PM, Lawn JE: Science in Action: Sub-Saharan Africa's mothers, newborns, and children: where and why do they die? PLoS Med 2010, 7:e1000294. CrossRef
- Cooper C, Ferguson J, Gilbert GL, Gill A, Issacs D: Neonatal infection-early onset. In Reducing harm to patients from health care associated infection: the role of surveillance. 1st edition. Edited by: Cruickshank M, Ferguson J. Sydney: Australian Commission on Safety and Quality in Health Care; 2008:109–116.
- Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney RE Jr, Cotton M, Fisher RG, Alexander KA: Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001, 107:1272–1276. CrossRef
- Hira V, Sluijter M, Estevao S, Horst-Kreft D, Ott A, De GR, Hermans PW, Kornelisse RF: Clinical and molecular epidemiologic characteristics of coagulase-negative staphylococcal bloodstream infections in intensive care neonates. Pediatr Infect Dis J 2007, 26:607–612. CrossRef
- Khashu M, Osiovich H, Henry D, Al KA, Solimano A, Speert DP: Persistent bacteremia and severe thrombocytopenia caused by coagulase-negative Staphylococcus in a neonatal intensive care unit. Pediatrics 2006, 117:340–348. CrossRef
- Cheung GY, Rigby K, Wang R, Queck SY, Braughton KR, Whitney AR, Teintze M, DeLeo FR, Otto M: Staphylococcus epidermidis strategies to avoid killing by human neutrophils. PLoS Pathog 2010, 6:e1001133. CrossRef
- Li M, Lai Y, Villaruz AE, Cha DJ, Sturdevant DE, Otto M: Gram-positive three-component antimicrobial peptide-sensing system. Proc Natl Acad Sci USA 2007, 104:9469–9474. CrossRef
- Gill SR, Fouts DE, Archer GL, Mongodin EF, Deboy RT, Ravel J, Paulsen IT, Kolonay JF, Brinkac L, Beanan M, Dodson RJ, Daugherty SC, Madupu R, Angiuoli SV, Durkin AS, Haft DH, Vamathevan J, Khouri H, Utterback T, Lee C, Dimitrov G, Jiang L, Qin H, Weidman J, Tran K, Kang K, Hance IR, Nelson KE, Fraser CM: Insights on evolution of virulence and resistance from the complete genome analysis of an early methicillin-resistant Staphylococcus aureus strain and a biofilm-producing methicillin-resistant Staphylococcus epidermidis strain. J Bacteriol 2005, 187:2426–2438. CrossRef
- Otto M: Quorum-sensing control in Staphylococci a target for antimicrobial drug therapy? FEMS Microbiol Lett 2004, 241:135–141. CrossRef
- Yao Y, Sturdevant DE, Otto M: Genomewide analysis of gene expression in Staphylococcus epidermidis biofilms: insights into the pathophysiology of S. epidermidis biofilms and the role of phenol-soluble modulins in formation of biofilms. J Infect Dis 2005, 191:289–298. CrossRef
- Dimitriou G, Fouzas S, Giormezis N, Giannakopoulos I, Tzifas S, Foka A, Anastassiou DE, Spiliopoulou I, Mantagos S: Clinical and microbiological profile of persistent coagulase-negative staphylococcal bacteraemia in neonates. Clin Microbiol Infect 2011, 17:1684–1690. CrossRef
- Gill SR, McIntyre LM, Nelson CL, Remortel B, Rude T, Reller LB, Fowler VG Jr: Potential associations between severity of infection and the presence of virulence-associated genes in clinical strains of Staphylococcus aureus. PLoS One 2011, 6:e18673. CrossRef
- Committee of Integrated Management of Childhood Illnesses: Handbook IMCI of World Health Organization. 12th edition. Italy: 2000.
- Bryce J, Black RE, Walker N, Bhutta ZA, Lawn JE, Steketee RW: Can the world afford to save the lives of 6 million children each year? Lancet 2005, 365:2193–2200. CrossRef
- Thaver D, Zaidi AK: Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J 2009,28(1 Suppl):S3-S9.
- Chacko B, Sohi I: Early onset neonatal sepsis. Indian J Pediatr 2005, 72:23–26. CrossRef
- Oddie S, Embleton ND: Risk factors for early onset neonatal group B streptococcal sepsis: case–control study. Br Med J 2002, 325:308. CrossRef
- Hákansson S, Kallen K: Impact and risk factors for early-onset group B streptococcal morbidity: analysis of a national, population-based cohort in Sweden 1997–2001. Br J Obstet Gynaecol 2006, 113:1452–1458. CrossRef
- Cheng YW, Nicholson JM, Nakagawa S, Bruckner TA, Washington AE, Caughey AB: Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation? Am J Obstet Gynecol 2008, 199:370–377. CrossRef
- Ballot DE, Chirwa TF, Cooper PA: Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg. BMC Pediatr 2010, 10:30. CrossRef
- Hafed BM, Bilikova E, Kovacicova G, Koprnova J, Svetlansky I, Chovancova D, Huttova M, Krcmery V: Prognostic factors for 246 neonates with infections. Clin Infect Dis 2003, 36:1203–1205. CrossRef
- Kermorvant-Duchemin E, Laborie S, Rabilloud M, Lapillonne A, Claris O: Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care Med 2008, 9:186–191. CrossRef
- Sharma P, McKay K, Rosenkrantz TS, Hussain N: Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants. BMC Pediatr 2004, 4:9. CrossRef
- Rubaltelli FF, Dani C, Reali MF, Bertini G, Wiechmann L, Tangucci M, Spagnolo A: Acute neonatal respiratory distress in Italy: a one-year prospective study. Italian Group of Neonatal Pneumology. Acta Paediatr 1998, 87:1261–1268. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/12/48/prepub
- Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Pregnancy and Childbirth
- Online Date
- June 2012
- Online ISSN
- BioMed Central
- Additional Links
- Neonatal sepsis
- Early-onset neonatal sepsis
- Late-onset neonatal sepsis
- Risk factors
- Prognostic factors
- Author Affiliations
- 1. Unidad de Investigación Médica Yucatán (UIMY), Unidad Médica de Alta Especialidad de Mérida, Instituto Mexicano del Seguro Social (IMSS), Calle 34 #439 x 41, Col. Industrial (Ex-terrenos del Fénix, Hospital T1), 97150, Mérida, Yucatán, México
- 2. Facultad de Medicina Universidad Anáhuac Mayab Mérida, Yucatán, México
- 3. Departamento de Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, México
- 4. Coordinación de Vigilancia Epidemiológica, Unidad de Salud Pública, Dirección de Prestaciones Médicas; IMSS, Ciudad de México, México
- 5. Servicio de Neonatología de la Unidad Médica de Alta Especialidad de Mérida, IMSS, Mérida, Yucatán, México
- 6. Cunero Patológico, Hospital General Regional #1, IMSS, Mérida, Yucatán, México