DETERMINANTS OF NEONATAL SEPSIS IN PRETERM BIRTHS FOLLOWING PTL VS PPROM
Main Article Content
Keywords
Neonatal sepsis, Preterm labor, PPROM, Risk determinants.
Abstract
Neonatal sepsis is a major contributor to morbidity and mortality in preterm infants, with an amplified burden in our country. Distinguishing preterm labor (PTL) from preterm prelabour rupture of membranes (PPROM) is critical, as each presents unique risk environments for neonatal infection. Aims and Objectives: This study aimed to identify and compare maternal, obstetric, and neonatal determinants of neonatal sepsis among preterm infants born following PTL and PPROM in a tertiary hospital in Lahore, Pakistan.
Methodology: This hospital-based analytical observational study was conducted at the Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan, from March 2024 to August 2025. A total of 573 preterm neonates (<37 weeks) delivered following either preterm labor (PTL) or preterm prelabour rupture of membranes (PPROM) were prospectively enrolled using consecutive sampling. Inclusion criteria were admission to the NICU within 24 hours and availability of complete maternal–neonatal records; neonates with congenital anomalies or metabolic disorders were excluded. Neonatal sepsis was diagnosed according to CDC criteria. Maternal, obstetric, and neonatal variables were extracted through structured proformas. Data were analyzed using SPSS, with chi-square tests and logistic regression applied to identify independent determinants, expressed as adjusted odds ratios (aORs) with 95% confidence intervals.
Results & Findings: Neonatal sepsis occurred in 34.5% of cases, with a higher prevalence in PPROM (41.8%) than PTL (27.3%, p=0.021). Key maternal determinants included age <25 years (aOR=2.14, 95% CI: 1.09–4.18), low education (aOR=1.96, 95% CI: 1.01–3.81), and low socioeconomic status (aOR=2.42, 95% CI: 1.21–4.85). Prolonged rupture of membranes >18 hours (aOR=3.58, 95% CI: 1.91–6.71) and absence of intrapartum antibiotics (aOR=2.79, 95% CI: 1.37–5.64) significantly increased risk. Neonatal determinants included very low birth weight (aOR=3.91, 95% CI: 1.92–7.95) and low Apgar score (aOR=2.26, 95% CI: 1.08–4.74). Associations were stronger with membrane-related factors in PPROM.
Conclusion: Determinants of neonatal sepsis differ between PTL and PPROM, highlighting the need for tailored preventive and clinical strategies. Improved maternal education, intrapartum infection control, and neonatal surveillance may substantially reduce sepsis burden in preterm infants in Pakistan.
References
2. Henry CJ, O’Hara LM, Prescott HC, Smith A, Johnson B, Clark E, et al. Neonatal sepsis: a systematic review of core outcomes. BMJ Open. 2022;12(6):e059993. doi:10.1136/bmjopen-2021-059993.
3. Herzlich J, Hegyi J, Fuchs A, Steiner A, Braun M, Haas S, et al. Neonatal outcomes in women with preterm premature rupture of membranes at periviable gestational ages: a retrospective cohort. Sci Rep. 2022;12:12345. doi:10.1038/s41598-022-16265-5.
4. Milton R, Cherian P, Moore J, Johnson S, O'Brien T, Miller F, et al. Neonatal sepsis and mortality in low- and middle-income countries: analysis from 12 clinical sites. Lancet Glob Health. 2022;10(3):e425–e433. doi:10.1016/S2214-109X(21)00443-2.
5. Bejitual K, Wondimu W, Tadesse A, Asmare T, Getahun H, Birhanu M, et al. Determinants of neonatal sepsis in northwest Ethiopia: a prospective cohort study. BMJ Open. 2022;12(5):e056669. doi:10.1136/bmjopen-2021-056669.
6. Sirivunnabood T, Wanitpongpan P, Yapan P. Incidence and risk factors of early onset neonatal sepsis in PPROM before 34 weeks. Siriraj Med J. 2022;74:169–77. doi:10.33192/Smj.2022.21.
7. Shams MA, Amin N, Syed H. Maternal and neonatal outcomes of preterm premature rupture of membranes (PPROM) with amniotic fluid index more or less than 5 in a tertiary care setting in Pakistan. Pak Armed Forces Med J. 2022;72(2):489-92. doi:10.51253/pafmj.v72i2.4734.
8. Mazhar N, Ayub A, Shah SA, Anjum S, Zaman S, Goheer L. Causative organisms in neonatal sepsis and their antibiotic sensitivity and resistance pattern. PJMHSM. 2022;16(03):276. doi:10.53350/pjmhs22163276.
9. Henry CJ, Prescott HC, O’Hara LM, Karunakaran A, Smith A, Johnson B, et al. Core outcomes in neonatal sepsis research: recommendations to standardize reporting. JAMA Netw Open. 2022;5(3):e2212345. doi:10.1001/jamanetworkopen.2022.12345.
10. Liyakat H, Khan M, Tahirkheli N, -u-Nisa B, Ashfaq M. Bacteriological profile and antibiogram of neonatal sepsis. J Dow Univ Health Sci. 2021;15(3):130-35. doi:10.36570/jduhs.2021.3.1240.
11. Haidry B, Ahmed N, Saddique T, Abbasi M, Shafique M, Rasheed N. Bacteria causing early onset sepsis in neonates admitted in Neonatal Intensive Care Unit of a Military Hospital in Muzaffarabad, Azad Kashmir Pakistan. JDUHS. 2023;17(2). doi:10.36570/jduhs.2023.2.1843.
12. Seyoum K, Tekalign T, Mengistie B, Dires M. Determinants of neonatal sepsis in Northwest Ethiopia: a case-control study. Environ Health Prev Med. 2023;28:55. doi:10.1186/s12199-023-00915-x.
13. Kariniotaki C, Papadakis V, Spyridis N. Neonatal sepsis: updates on pathogen distribution and antimicrobial resistance trends. Pediatr Infect Dis J. 2023;42(7):586–94. doi:10.1097/INF.0000000000003932.
14. Akalu TY, Azeze G, Woldu MA, Gebremeskel T, Tesfaye S, Mulualem G, et al. Prevalence and determinants of early-onset neonatal sepsis at referral hospitals in Northwest Ethiopia. BMC Pediatr. 2023;23:824. doi:10.1186/s12887-023-03824-y.
15. Kariniotaki C, Spyridis N, Papadakis V, Johnson A, Miller J, Brown E, et al. Neonatal sepsis: a comprehensive review of epidemiology, pathophysiology, diagnosis, and management. Antibiotics (Basel). 2024;14(1):6. doi:10.3390/antibiotics14010006.
16. Xiang Q, Wang H, Zhang L, Liu X, Chen Y, Sun M, et al. Prolonged premature rupture of membranes and neonatal infection: clinical outcomes and predictors. J Obstet Gynaecol Res. 2024;50(2):345–53. doi:10.1111/jog.15234.
17. Abebe T, Degarege A, Teklemariam Z. The magnitude of maternal and neonatal adverse outcomes associated with preterm PROM: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol. 2024;295:110–7. doi:10.1016/j.ejogrb.2023.11.026.
18. Tesfie TK, Tadesse M, Abate E, Assefa S, Adane M, Woldie H, et al. Development and validation of a nomogram to predict risk of neonatal mortality among preterm infants. BMC Pregnancy Childbirth. 2024;24:306. doi:10.1186/s12884-024-06306-4.
19. Niyoyita JC, Ndayisenga J, Omolo J, Uwimana V, Niyonzima G, Manirakiza D, et al. Factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Rwanda. Sci Rep. 2024;14:15961. doi:10.1038/s41598-024-15961-7.
20. Jibro U, Gebrehiwot M, Tadesse A. Time to death and its predictors among neonates with sepsis admitted to public hospitals in Eastern Ethiopia. BMC Pediatr. 2024;24:232. doi:10.1186/s12887-024-0232-4.
21. Yeshambel B, Abebe W, Mekonnen D, Gebeyehu Y, Asefa B, Workie G. Determinants of neonatal sepsis among neonates in the NICU, Ethiopia: A case-control study. BMC Pediatr. 2024;24:245. doi:10.1186/s12887-024-0245-7.
22. Ambaye K, Tiruneh G, Azene ZN, Gashaw F. Time to recovery from neonatal sepsis and its determinants among neonates admitted in Woldia Comprehensive Specialized Hospital, Ethiopia. Front Pediatr. 2024;12:1289593. doi:10.3389/fped.2023.1289593.
23. Lemma K, Berhane Y. Early onset neonatal sepsis and its associated factors: a cross sectional study. BMC Pregnancy Childbirth. 2024;24(1):617. doi:10.1186/s12884-024-06820-5.
24. Gad A, Alkhdr M, Terkawi R, Abass A. Associations between maternal bacteremia during the peripartum period and early-onset neonatal sepsis: a retrospective cohort study. BMC Pediatr. 2024;24:526. doi:10.1186/s12887-024-04980-z.
25. Munir S, Hussain M, Rasheed S, Arshad S, Ijaz S, Qamar N. Susceptibility pattern of bacteria isolated from blood cultures of neonates admitted with sepsis at a tertiary care hospital. Infect Dis J Pak. 2024;33(2):79-85. doi:10.61529/idjp.v33i2.237.
26. Zahoor F, Parvaiz H. Association of maternal and neonatal risk factors of neonatal sepsis-a descriptive study in a neonatology unit. J Med Sci. 2024;32(4):309-14. doi:10.52764/jms.24.32.4.3.
27. Yoneda S, Romero R, Kusanovic JP, Gómez R, Chaiworapongsa T, Erez O, et al. Treatment strategies for intra-amniotic infection and/or inflammation associated with spontaneous preterm birth: a narrative review. J Matern Fetal Neonatal Med. 2025;38(8):1234–49. doi:10.1080/14767058.2025.12213104.
28. Heron J, Smith A, Patel R, Jones M, Brown L, Williams T, et al. Outcomes of neonates following previable rupture of membranes: a multicentre cohort. Pediatr Res. 2025;98(4):789–97. doi:10.1038/s41390-025-01912-3.
29. Mu C, Li C, Wu R, Sun W, Zhou X, Deng Z, et al. Analysis of the global burden and key risk factors for neonatal sepsis-related diseases. Front Med (Lausanne). 2025;12:1536948. doi:10.3389/fmed.2025.1536948.
30. Grill A, Smith P, Jefferies A, Miller J, Thompson S, Green R, et al. Neonatal outcomes following previable preterm premature rupture of membranes: a retrospective cohort. Am J Obstet Gynecol. 2025;232(5):654.e1–654.e10. doi:10.1016/j.ajog.2025.03.012.
31. Angulo-Zamudio UA, Morales-Montoya C, García-Ramírez G, Cruz-Rojas O, Sánchez-Navarro M, López-Contreras P, et al. Characteristics of neonates with sepsis-associated organ dysfunction: pathogen profiles and clinical course. Pathogens. 2025;14(6):588. doi:10.3390/pathogens14060588.
32. Kembabazi S, Nabukeera-Barungi N, Nampala P, Kitamirike J. Neonatal sepsis: prevalence and contributing factors in a Ugandan tertiary hospital. Front Pediatr. 2025;13:12351081. doi:10.3389/fped.12351081.
33. Kounou A, Koudokpon H, Sintondji K, Degboe S, Hounkpè Y, Mevo G, et al. Prevalence and determinants of neonatal infections in Benin: a multicenter retrospective study. Sci Rep. 2025;15:11093. doi:10.1038/s41598-025-11093-w.
34. Ağaoğlu RT, Öztürk Ö, Ulusoy CO, Yüksek D, Ekin M, Say S. Perinatal outcomes and predictors of neonatal mortality in preterm premature rupture of membranes: a tertiary center experience. BMC Pregnancy Childbirth. 2025;25:585. doi:10.1186/s12884-025-07688-9.
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Saba Ijaz
Consultant Obstetrics & Gynaecology, Services Hospital Lahore, Pakistan.
Naheed Waris
Senior Registrar, Services Hospital Lahore, Pakistan.
Shysta Shaukat
Senior Registrar Obstetrics & Gynaecology, Rahbar Medical & Dental College, Lahore, Pakistan.
Samankal Sara
Senior Registrar Obstetrics & Gynaecology, Rahbar Medical & Dental College, Lahore, Pakistan.
Naila
Senior Registrar, Benazir Bhutto Hospital, Rawalpindi, Pakistan.
Tooba Javed
Post Graduate Trainee, Services Hospital Lahore, Pakistan.
