article · PLoS ONE
Neonatal mortality remains a critical global health challenge and is a leading cause of newborn deaths in Ethiopia. Sepsis is among the primary drivers of these deaths, yet identifying the factors that heighten this risk is essential for timely screening and intervention. A study conducted in two public referral hospitals in Northwest Ethiopia evaluated 231 newborns to identify significant predictors of neonatal sepsis. Through comparisons between confirmed sepsis cases and control patients, several maternal and birth factors were identified. High-risk predictors included prolonged membrane rupture of 18 hours or more, maternal urinary tract infection during pregnancy, receiving three or fewer antenatal care visits, and fever during delivery. Neonatal factors such as meconium-stained amniotic fluid, low first-minute APGAR scores, delivery resuscitation, and nasogastric tube insertion also significantly raised sepsis risk.
Neonatal sepsis is a leading cause of newborn illness and death, particularly in low-resource hospital settings. Identifying specific clinical predictors allows healthcare workers to spot vulnerable infants early, initiate targeted treatment promptly, and improve newborn survival rates.
The findings can inform the design of clinical risk-scoring tools, screening checklists, or digital triage protocols for maternal and neonatal healthcare providers in referral hospitals. This represents early-stage clinical research, requiring integration into clinical guidelines or hospital health software before practical deployment.
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BACKGROUND: Despite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of Northwest Ethiopia. METHODS: Institutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018. Neonates who fulfill the preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by simple random sampling method. Data were collected using structured pretested questionnaire through a face to face interview with index mothers and by reviewing neonatal record using checklist. The collected data were entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Binary and multivariable logistic regression analyses were employed. Statistical significance was declared at P<0.05. RESULT: Multivariable logistic regression analysis showed that, duration of rupture of membrane ≥ 18hours was significantly associated with sepsis (AOR = 10.4, 95%CI = 2.3-46.5). The other independent predictors of neonatal sepsis were number of maternal antenatal care service ≤3 (AOR = 4.4, 95%CI = 1.7-11.5), meconium stained amniotic fluid (AOR = 3.9, 95%CI = 1.5-9.8), urinary tract infection during pregnancy (AOR = 10.8, 95% CI = 3.4-33.9), intranatal fever (AOR = 3.2, 95% CI = 1.1-9.5), first minute APGAR score <7 (AOR = 3.2, 95% CI = 1.3-7.7), resuscitation at birth (AOR = 5.4, 95% CI = 1.9-15.5), nasogastric tube insertion (AOR = 3.7, 95% CI = 1.4-10.2). CONCLUSION: Neonatal invasive procedures, ANC follow up during pregnancy, different conditions during birth like meconium stained amniotic fluid, low APGAR score and resuscitation at birth were the independent predictors of neonatal sepsis.
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DOI: 10.1371/journal.pone.0234472
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