Risk Factors for Neonatal Sepsis and Perinatal Death Among Infants Enrolled in the Prevention of Perinatal Sepsis Trial, Soweto, South Africa
Risk Factors for Neonatal Sepsis and Perinatal Death Among Infants Enrolled in the Prevention of Perinatal Sepsis Trial, Soweto, South Africa
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DOI：
10.1097/inf.0b013e31825c4b5a
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发表时间：
2012-08-01
影响因子：
3.6
通讯作者：
Madhi, Shabir A.
中科院分区：
文献类型：
--
作者：
Schrag, Stephanie J.;Cutland, Clare L.;Madhi, Shabir A.
背景：在非洲，与新生儿败血症（儿童死亡的一个重要原因）相关的因素知之甚少。我们对参加南非索韦托预防围产期败血症试验（ClinicalTrials.gov 的 NCT00136370）的婴儿中与早发型（出生后第 0-2 天）和晚发型（第 3-28 天）败血症和围产期死亡相关的因素进行了分析。方法：对 8011 名登记的母亲及其新生儿进行二次分析。提取产前和分娩记录，并对新生儿病房进行监测，以预防围产期败血症入院新生儿。终点定义需要临床和实验室迹象。使用多变量逻辑回归评估与 P < 0.15 的终点相关的所有单变量因素。结果：约 10.5% (837/8011) 的妇女接受了产时抗生素预防； 3.8% 的入组婴儿为早产儿，而住院分娩的婴儿为 15%。在 8129 名婴儿中，289 名患有早发性败血症，34 名患有晚发性败血症，49 名患有培养确诊的新生儿败血症，71 名在围产期死亡。与早发性脓毒症相关的因素包括早产[调整后相对风险（aRR）= 2.6； 95%置信区间（CI）：1.4-4.8]；低出生体重（< 1500 g：aRR = 6.5，95% CI：2.4-17.3）；胎粪染色羊水 (MSAF)（aRR = 2.8，95% CI：2.2-3.7）和第一胎（aRR = 1.8；95% CI：1.4-2.3）。早产、低出生体重、MSAF 和第一胎与围产期死亡和培养证实的败血症类似。 MSAF（aRR = 2.4，95% CI：1.1-5.0）与迟发性脓毒症相关。结论：早产和低出生体重是重要的脓毒症危险因素。 MSAF 和第一胎也与败血症和死亡相关，值得进一步探索。产时抗生素预防并不能预防全因败血症或死亡，这凸显了采取替代预防策略的必要性。
Background: Factors associated with neonatal sepsis, an important cause of child mortality, are poorly described in Africa. We characterized factors associated with early-onset (days 0-2 of life) and late-onset (days 3-28) sepsis and perinatal death among infants enrolled in the Prevention of Perinatal Sepsis Trial (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa.Methods: Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized Prevention of Perinatal Sepsis-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P < 0.15 were evaluated using multivariable logistic regression.Results: About 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis; 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery [ adjusted relative risk (aRR) = 2.6; 95% confidence interval (CI): 1.4-4.8]; low birth weight (< 1500 g: aRR = 6.5, 95% CI: 2.4-17.3); meconium-stained amniotic fluid (MSAF) (aRR = 2.8, 95% CI: 2.2-3.7) and first birth (aRR = 1.8; 95% CI: 1.4-2.3). Preterm, low birth weight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR = 2.4, 95% CI: 1.1-5.0) was associated with late-onset sepsis.Conclusions: Preterm and low birth weight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. Intrapartum antibiotic prophylaxis did not protect against all-cause sepsis or death, underscoring the need for alternate prevention strategies.