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Open Access Highly Accessed Research article

Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up

Yelda A Leal1*, José Álvarez-Nemegyei2, Juan R Velázquez3, Ulises Rosado-Quiab4, Nidia Diego-Rodríguez5, Etna Paz-Baeza6 and Jorge Dávila-Velázquez

Author Affiliations

1 Unidad de Investigación Médica Yucatán (UIMY), Unidad Médica de Alta Especialidad de Mérida, Instituto Mexicano del Seguro Social (IMSS), Calle 34 #439 x 41, Col. Industrial (Ex-terrenos del Fénix, Hospital T1), 97150, Mérida, Yucatán, México

2 Facultad de Medicina Universidad Anáhuac Mayab Mérida, Yucatán, México

3 Departamento de Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, México

4 Coordinación de Vigilancia Epidemiológica, Unidad de Salud Pública, Dirección de Prestaciones Médicas; IMSS, Ciudad de México, México

5 Servicio de Neonatología de la Unidad Médica de Alta Especialidad de Mérida, IMSS, Mérida, Yucatán, México

6 Cunero Patológico, Hospital General Regional #1, IMSS, Mérida, Yucatán, México

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BMC Pregnancy and Childbirth 2012, 12:48  doi:10.1186/1471-2393-12-48

Published: 12 June 2012

Abstract

Background

Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. Thus, we used a historic cohort design to assess the association between a series of neonates and their mothers, in addition to hospital evolution features and the risk and prognosis of neonatal sepsis (defined by Pediatric Sepsis Consensus [PSC] criteria) in 11,790 newborns consecutively admitted to a Neonatology Service in Mérida, Mexico, between 2004 and 2007.

Results

Sepsis was found in 514 of 11,790 (4.3%) newborns; 387 of these cases were categorized as early-onset (<72 h) (75.3%) and 127, as late-onset (>72 h) (24.7%). After logistic regression, risk factors for sepsis included the following: low birth weight; prematurity; abnormal amniotic fluid; premature membrane rupture (PMR) at >24 h; respiratory complications, and the requirement of assisted ventilation, O2 Inspiration fraction (IF) >60%, or a surgical procedure. Some of these factors were differentially associated with early- or late-onset neonatal sepsis. The overall mortality rate of sepsis was 9.5%. A marked difference in the mortality rate was found between early- and late-onset sepsis (p >0.0001). After Cox analysis, factors associated with mortality in newborns with sepsis comprised the following: prematurity; low birth weight; low Apgar score; perinatal asphyxia, and the requirement of any invasive medical or surgical procedure.

Conclusions

The incidence of neonatal sepsis in southeastern Mexico was 4.3%. A different risk and prognostic profile between early- and late-onset neonatal sepsis was found.

Keywords:
Neonatal sepsis; Early-onset neonatal sepsis; Late-onset neonatal sepsis; Risk factors; Prognostic factors; Mortality