Risk factors of neonatal sepsis in India: A systematic review and meta-analysis

Shruti Murthy; Myron Anthony Godinho; Vasudeva Guddattu; Leslie Edward Simon Lewis; N Sreekumaran Nair

doi:10.1371/journal.pone.0215683

Risk factors of neonatal sepsis in India: A systematic review and meta-analysis

PLoS One. 2019 Apr 25;14(4):e0215683. doi: 10.1371/journal.pone.0215683. eCollection 2019.

Authors

Shruti Murthy¹, Myron Anthony Godinho², Vasudeva Guddattu¹, Leslie Edward Simon Lewis³, N Sreekumaran Nair⁴

Affiliations

¹ Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
² WHO Collaborating Centre for eHealth, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³ Department of Paediatrics, Neonatology Unit, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
⁴ Department of Medical Biometrics & Informatics (Biostatistics), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

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.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Age Factors
Birth Weight
Gestational Age
Humans
Incidence
India / epidemiology
Infant
Infant, Newborn
Neonatal Sepsis / epidemiology*
Neonatal Sepsis / etiology
Premature Birth / epidemiology*
Respiration, Artificial / adverse effects
Risk Factors
Sex Factors

Grants and funding

SM, guided by VG (PhD supervisor), was awarded the 2017 ISID Research Grant from International Society for Infectious Diseases (ISID) (http://www.isid.org/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.