EARLY-ONSET NEONATAL SEPSIS IN PAKISTAN - A CASE-CONTROL STUDY OF RISK-FACTORS IN A BIRTH COHORT

We prospectively evaluated risk factors for early-onset neonatal (EON) sepsis in a case-control study among inborn patients at the Aga Khan University Medical Centre in Karachi between 1990-1993. A total of 38 cases with blood culture proven bacterial sepsis were identified withi n 72 hr of birth (prevalence 5.6 of 1000 live births) and matched with two consecutive gender matched births with no complications. The most common isolates were Staphylococcus aureus (18%), group B Streptococc i (13%), and Klebsiella pneumoniae (13%). Univariate analysis of mater nal risk factors revealed a significant association between maternal u rinary tract infection (UTI) (odds ratio [OR]20, 95% confidence interv al [Cl]2.4-166.9), maternal pyrexia (P < 0.0001), vaginal discharge (P < 0.05), vaginal examinations during labor (P = 0.03), and EON sepsis . The infected newborns also had significantly lower apgar scores at b irth (P < 0.0001) and a significantly greater number were intubated at birth (Fisher's exact test P = 0.04). infected newborn infants were t ransferred out of the labor room earlier than noninfected controls and significantly fewer received exclusive breastfeeds (OR 0.33, 95% CI 0 .1-0.8). Our data suggest the possibility that both vertical transmiss ion from the mother as well as postnatal acquisition of infection from the environment may be of importance in the pathogenesis of EON sepsi s in Karachi. Preventive measures should focus at recognition of high- risk infants, strict asepsis during labor, and early institution of ex clusive breastfeeding.