Maternal factors predisposing to early-onset Neonatal sepsis at Kenyatta National Hospital Maternity unit

Abstract

Background: Neonatal sepsis, defined as sepsis within the first 28 days of life, is a major risk factor for neonatal mortality and accounts for about 1 million deaths annually. Early onset neonatal sepsis is acquired from the mother during passage through a colonised genital tract during birth. The incidence of early onset neonatal sepsis (sepsis in neonates less than 7 days old) differs in the general population and is estimated to be between I-I'D cases per 1000 live births.A study done in Kilifi, Kenya documented a prevalence of early neonatal sepsis of 13.5%. Objective: To determine maternal factors predisposing to occurrence of early onset neonatal sepsis among mothers of 3 day old neonates admitted at the KNH New Born Unit (NBU). Study design: This was a hospital based case- control study. Methodology: Cases were defined as mothers of 3 day old neonates admitted in the Kenyatta National Hospital New Born Unit with a diagnosis of early onset neonatal sepsis and controls were mothers of 3 day old neonates admitted in the KNH maternity unit without a diagnosis of neonatal sepsis. Data for this study was collected using structured questionnaires, inpatient progress notes from mothers and neonates' files and laboratory microbiology results of vaginal swabs and urine cultures from the mothers. An access database was designed for data entry and SPSS version 15.0 was used for data analysis. Setting: The study was conducted at the Kenyatta National Hospital's maternity unit. V 111 Results: During the study period a total of 100 mothers met the eligibility criteria and were enrolledin the study. Of these 50 mothers comprised the cases and the other 50 made up the control group. Factors found to predispose to early onset neonatal sepsis were PROM (p value=0.002)and maternal genital colonisation (P-value< 0.001), maternal bacteriuria (P-value< 0.001), Commonest isolates were E.coli, Acinetobacter, and Candida. Socio-demographic and obstetric factors that were statistically significant between cases and controls were employment (p value=O.O19), onset of labour (p value=0.026), meconium staining of liquor (p value=O.026) andmode of delivery (p value=0.021). Conclusion: Maternal genito-urinary colonisation , bacteriuria and PROM predispose of early onsetneonatal sepsis in the maternity unit of KNH.