Risk Factors of Neonatal Sepsis in India: A Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Apr 26

PMID 31022223

Citations 49

Authors

Shruti Murthy

Myron Anthony Godinho

Vasudeva Guddattu

Leslie Edward Simon Lewis

N Sreekumaran Nair

Affiliations

Soon will be listed here.

Abstract

Background: The incidence of neonatal sepsis in India is the highest in the world. Evidence regarding its risk factors can guide clinical practice and prevention strategies.

Objective: To review, assess and synthesize the available literature from India on the risk factors of sepsis among neonates.

Methodology: A systematic review was conducted. We searched PubMed, CINAHL, Scopus, Web of Science, Popline, IndMed, Indian Science Abstracts and Google Scholar from inception up to March 23, 2018 to identify observational analytical studies reporting on risk factors of laboratory-confirmed neonatal sepsis in India. Two authors independently screened studies (title, abstract and full-text stages), extracted data, and assessed quality. A random-effects meta-analysis was performed as substantial heterogeneity was anticipated. Subgroup and sensitivity analyses were additionally performed. Effect size in our review included odds ratio and standardized mean difference.

Results: Fifteen studies were included from 11,009 records, of which nine were prospective in design. Birthweight and gestational age at delivery were the most frequently reported factors. On meta-analyses, it was found that male sex (OR: 1.3, 95% CI: 1.02, 1.68), out born neonates (OR: 5.5, 95% CI: 2.39, 12.49), need for artificial ventilation (OR: 5.61; 95% CI: 8.21, 41.18), gestational age <37 weeks (OR: 2.05; 95% CI:1.40, 2.99) and premature rupture of membranes (OR:11.14, 95% CI: 5.54, 22.38) emerged as risk factors for neonatal sepsis. Included studies scored lowest on exposure assessment and confounding adjustment, which limited comparability. Inadequacy and variation in definitions and methodology affected the quality of included studies and increased heterogeneity.

Conclusions: Male neonates, outborn admissions, need for artificial ventilation, gestational age <37 weeks and premature rupture of membranes are risk factors for sepsis among neonates in India. Robustly designed and reported research is urgently needed to confirm the role of other risk factors of neonatal sepsis in India.

Citing Articles

The burden of neonatal sepsis and its risk factors in Africa. a systematic review and meta-analysis.

Wondifraw E, Wudu M, Tefera B, Wondie K BMC Public Health. 2025; 25(1):847.

PMID: 40033243 PMC: 11877888. DOI: 10.1186/s12889-025-22076-w.

Systematic Review: Maternal Risk Factors, Socioeconomic Influences, Neonatal Biomarkers and Management of Early-Onset Sepsis in Late Preterm and Term Newborns-A Focus on European and Eastern European Contexts.

Vulcanescu A, Siminel M, Dinescu S, Boldeanu M, Dijmarescu A, Manolea M Life (Basel). 2025; 15(2).

PMID: 40003700 PMC: 11856718. DOI: 10.3390/life15020292.

Characteristics and Associated Risk Factors of Neonatal Sepsis: A Retrospective Study From Saudi Arabia.

Al Ghadeer H, Alabdallah R, AlKhalaf G, Aldandan F, Almohammed H, Al Busaeed M Cureus. 2025; 16(12):e76517.

PMID: 39872571 PMC: 11771527. DOI: 10.7759/cureus.76517.

Prevalence of neonatal sepsis and associated factors among neonates admitted in the neonatal intensive care unit at Lira Regional Referral Hospital, Northern Uganda.

Katugume B, Muzungu J, Okello N, Kigongo E, Namutebi D PLoS One. 2025; 20(1):e0315794.

PMID: 39804938 PMC: 11730428. DOI: 10.1371/journal.pone.0315794.

Johnson J, Mathew M Forensic Sci Med Pathol. 2025; .

PMID: 39760817 DOI: 10.1007/s12024-024-00936-y.

References

Bedford Russell A, Kumar R . Early onset neonatal sepsis: diagnostic dilemmas and practical management. Arch Dis Child Fetal Neonatal Ed. 2014; 100(4):F350-4. DOI: 10.1136/archdischild-2014-306193. View

Sundaram V, Kumar P, Dutta S, Mukhopadhyay K, Ray P, Gautam V . Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: changes over the last decade. Jpn J Infect Dis. 2009; 62(1):46-50. View

Fleischmann-Struzek C, Goldfarb D, Schlattmann P, Schlapbach L, Reinhart K, Kissoon N . The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018; 6(3):223-230. DOI: 10.1016/S2213-2600(18)30063-8. View

Sonego M, Pellegrin M, Becker G, Lazzerini M . Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS One. 2015; 10(1):e0116380. PMC: 4312071. DOI: 10.1371/journal.pone.0116380. View

Benitz W, Wynn J, Polin R . Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr. 2015; 166(4):1070-4. PMC: 4767008. DOI: 10.1016/j.jpeds.2014.12.023. View

Wynn J, Wong H, Shanley T, Bizzarro M, Saiman L, Polin R . Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med. 2014; 15(6):523-8. PMC: 4087075. DOI: 10.1097/PCC.0000000000000157. View

Shane A, Sanchez P, Stoll B . Neonatal sepsis. Lancet. 2017; 390(10104):1770-1780. DOI: 10.1016/S0140-6736(17)31002-4. View

Tewari V, Jain N . Monotherapy with amikacin or piperacillin-tazobactum empirically in neonates at risk for early-onset sepsis: a randomized controlled trial. J Trop Pediatr. 2014; 60(4):297-302. DOI: 10.1093/tropej/fmu017. View

Vijayakanthi N, Kitchanan S, Arasan D . Ventilator associated pneumonia (VAP) in neonatal intensive care unit--an emerging problem. Indian J Pediatr. 2014; 82(1):96. DOI: 10.1007/s12098-014-1561-x. View

10.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

11.

Dutta S, Reddy R, Sheikh S, Kalra J, Ray P, Narang A . Intrapartum antibiotics and risk factors for early onset sepsis. Arch Dis Child Fetal Neonatal Ed. 2009; 95(2):F99-103. DOI: 10.1136/adc.2009.163220. View

12.

Chinn S . A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med. 2000; 19(22):3127-31. DOI: 10.1002/1097-0258(20001130)19:22<3127::aid-sim784>3.0.co;2-m. View

13.

Santhanam S, Arun S, Rebekah G, Ponmudi N, Chandran J, Jose R . Perinatal Risk Factors for Neonatal Early-onset Group B Streptococcal Sepsis after Initiation of Risk-based Maternal Intrapartum Antibiotic Prophylaxis-A Case Control Study. J Trop Pediatr. 2017; 64(4):312-316. DOI: 10.1093/tropej/fmx068. View

14.

Sankar M, Agarwal R, Deorari A, Paul V . Sepsis in the newborn. Indian J Pediatr. 2008; 75(3):261-6. DOI: 10.1007/s12098-008-0056-z. View

15.

Chan G, Lee A, Baqui A, Tan J, Black R . Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med. 2013; 10(8):e1001502. PMC: 3747995. DOI: 10.1371/journal.pmed.1001502. View

16.

Roy P, Kumar A, Kaur I, Faridi M . Gender differences in outcomes of low birth weight and preterm neonates: the male disadvantage. J Trop Pediatr. 2014; 60(6):480-1. DOI: 10.1093/tropej/fmu042. View

17.

Furyk J, Swann O, Molyneux E . Systematic review: neonatal meningitis in the developing world. Trop Med Int Health. 2011; 16(6):672-9. DOI: 10.1111/j.1365-3156.2011.02750.x. View

18.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007; 4(10):e296. PMC: 2020495. DOI: 10.1371/journal.pmed.0040296. View

19.

Pradhan R, Jain P, Paria A, Saha A, Sahoo J, Sen A . Ratio of neutrophilic CD64 and monocytic HLA-DR: A novel parameter in diagnosis and prognostication of neonatal sepsis. Cytometry B Clin Cytom. 2015; 90(3):295-302. DOI: 10.1002/cyto.b.21244. View

20.

Basmaci R, Bielicki J, Daniels R, Kissoon N, Ellis S, Balasegaram M . Management of children with multidrug-resistant sepsis in low-income and middle-income countries. Lancet Child Adolesc Health. 2018; 2(1):8-10. DOI: 10.1016/S2352-4642(17)30153-0. View