Maternal and neonatal determinants of newborn sepsis: A case-control study in resource-limited settings

BACKGROUND: Neonatal sepsis continues to remain a serious threat, with multiple maternal and neonatal risk factors. Understanding these determinants will empower clinicians in comparable settings to apply targeted interventions, ultimately reducing newborn morbidity and mortality. AIM: To assess maternal and infant risk factors, the aim is to develop evidence-based strategies for preventing neonatal sepsis. METHODS: A total of 453 neonates and their mothers were enrolled, of which 146 were cases. Clinical, demographic, and obstetric data were analyzed including maternal infection history, delivery conditions, neonatal characteristics, and respiratory support requirements. Statistical associations were assessed using multivariable logistic regression analysis to determine independent risk factors. RESULTS: Male sex (adjusted odd ratio [AOR] = 1.9; 95% confidence interval [CI]: 1.03-3.5), forceps-assisted vaginal delivery (AOR = 3.4; 95%CI: 1.1-14.9), fewer than four antenatal care visits (AOR = 2.9; 95%CI: 1.4-6.5), prolonged labor > 24 hours (AOR = 6.2; 95%CI: 2.8-17), rupture of membranes > 18 hours (AOR = 3.0; 95%CI: 1.6-6.8), and maternal urinary tract infection (AOR = 3.5; 95%CI: 2.4-29.4) significantly increased neonatal sepsis risk. Unclean vaginal examinations (AOR = 4.2; 95%CI: 1.6-11) and foul-smelling amniotic fluid (AOR = 10.3; 95%CI: 1.9-56.4) were among the strongest risk factors. Among neonatal factors prematurity (AOR = 4.3; 95%CI: 2.8-6.6), low birth weight ≤ 1500 g (AOR = 3.6; 95%CI: 2.2-5.7), birth asphyxia (AOR = 4.3; 95%CI: 2.4-7.6), and small-for-gestational-age status (AOR = 2.1; 95%CI: 1.1-4) were significant predictors. Respiratory support showed a strong correlation, with surfactant administration (AOR = 9.7; 95%CI: 4.1-22.9), continuous positive airway pressure) (AOR = 15.4; 95%CI: 9.4-25.1), and invasive ventilation (AOR = 53; 95%CI: 12.7-89) as the highest risk factors. Extended newborn intensive care unit stays (> 7 days: AOR = 38.9; > 15 days: AOR = 30) further elevated the likelihood of sepsis, likely due to nosocomial exposure. CONCLUSION: The findings highlight the importance of enhanced prenatal care, timely labor management, strict hygiene protocols, and focused neonatal monitoring to reduce neonatal sepsis incidence. Addressing modifiable risk factors, including maternal infections and respiratory interventions, could significantly improve neonatal outcomes in resource-limited settings.