ABSTRACT
OBJECTIVE: To define perinatal factors associated with early-onset neonatal sepsis. STUDY DESIGN: Maternal and neonatal variables were analysed retrospectively in 343 infants born before 35 weeks using univariate and multivariate statistical analysis. RESULTS: Logistic regression analysis identified risk factors for probable neonatal sepsis: gestational age at delivery (odds ratio 0.9, 95% confidence interval (CI) 0.91-0.96), premature rupture of the membranes (odds ratio 2.9, 95% CI 1.004-8.56), Apgar score after 1 min (odds ratio 0.7, 95% CI 0.53-0.96), and histological chorioamnionitis and/or funisitis (odds ratio 4.1, 95% CI 1.36-12.12). There was a strong association between probable sepsis and intracranial haemorrhage of the infant (odds ratio 4.3, 95% CI 1.07-17.40). Funisitis had a high specificity (91%) and positive predictive value (82%) for the detection of neonatal sepsis < or =32 weeks. CONCLUSIONS: Independent obstetrical risk factors for early-onset neonatal sepsis in premature infants may help to identify newborns who benefit from maternal antibiotic prophylaxis before birth. The histological examination of the umbilical cord can be used as an additional diagnostic test to detect newborns at risk of infection.
Subject(s)
Infant, Premature, Diseases/etiology , Sepsis/etiology , Antibiotic Prophylaxis , Chorioamnionitis/complications , Enterobacter/isolation & purification , Escherichia coli/isolation & purification , Female , Fetal Membranes, Premature Rupture/complications , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/microbiology , Logistic Models , Odds Ratio , Pregnancy , Pseudomonas aeruginosa/isolation & purification , Retrospective Studies , Risk Factors , Sepsis/microbiology , Sepsis/pathology , Sepsis/prevention & control , Staphylococcus aureus/isolation & purification , Staphylococcus epidermidis/isolation & purification , Streptococcus agalactiae/isolation & purification , Umbilical Cord/pathologyABSTRACT
OBJECTIVE: The study was conducted to identify medical, obstetrical and social risk factors associated with early preterm births (<32+0 gestational weeks). STUDY DESIGN: The Statewide Perinatal Survey of Bavaria is a collection of perinatal data from all Bavarian maternity units using a uniform numbered questionnaire. Data on 106345 singleton births from the 1994 Survey were analysed using univariate and multivariate logistic regression analysis. RESULTS: In the multivariate analysis, early preterm birth was associated with premature rupture of the membranes (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.37-1.86), treatment for infertility (OR 1.7, 95% CI 1.19-2.34), previous induced abortion (OR 1.8, 95% CI 1.57-2.13), maternal age >35 years (OR 1.8, 95% CI 1.47-2.16), premature cervical dilatation (OR 2.3, 95% CI 1.86-2.94), a history of stillbirth (OR 3.2, 95% CI 2.13-4.83), a history of preterm birth (OR 3.3, 95% CI 2.45-4.48), maternal age <18 years (OR 3.4, 95% CI 2.03-5.61), malpresentation (OR 3.9, 95% CI 3.10-4.93), preeclampsia (OR 4.0, 95% CI 3.20-4.94), uterine bleeding (OR 5.0, 95% CI 4.08-6.02), preterm labour (OR 7.0, 95% CI 5.94-8.22), and chorioamnionitis (OR 22.3, 95% CI 17.40-28.66). CONCLUSION: These data identify a subgroup of women at an increased risk for early preterm birth and may benefit from an intensified prenatal care. Risk factors related to the obstetrical history, genital infections, preeclampsia and maternal age are the most relevant for early preterm birth.
