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The association between early-onset sepsis and neonatal encephalopathy

Journal of Perinatology volume 42, pages 354–358 (2022)Cite this article

Subjects

Abstract

Objective

We evaluated the association between early-onset sepsis and neonatal encephalopathy in a low-middle-income setting.

Methods

We undertook a retrospective study in newborns with gestational age ≥35 weeks and/or birth weight ≥2500 grams, diagnosed with neonatal encephalopathy. Early-onset sepsis was defined as culture-confirmed sepsis or probable sepsis.

Results

Of 10,182 hospitalised newborns, 1027 (10.1%) were diagnosed with neonatal encephalopathy, of whom 52 (5.1%) had culture-confirmed and 129 (12.5%) probable sepsis. The case fatality rate for culture-confirmed sepsis associated neonatal encephalopathy was threefold higher compared to neonatal encephalopathy without sepsis (30.8% vs. 10.5%, p < 0.001). Predictors of mortality for culture-confirmed sepsis associated neonatal encephalopathy included severe neonatal encephalopathy (aOR 6.51, 95%CI: 1.03–41.44) and seizures (aOR 10.64, 95%CI: 1.05–107.39).

Conclusion

In this setting, 5% of neonatal encephalopathy cases was associated with culture-confirmed sepsis and a high case fatality rate.

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Fig. 1: Newborns with neonatal encephalopathy at or referred to CHBAH from January 2016 to June 2018.
Fig. 2: Incidence and organism specific prevalence of culture-confirmed sepsis associated neonatal encephalopathy.

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Acknowledgements

We are thankful to the VIDA and CHBAH Neonatal Department for their help and access to databases. The electronic database upon which this study was partly based, is funded and managed by VIDA on behalf of the Department of Paediatrics at CHBAH.

Funding

SAM is funded in part by National Research Foundation/ Department of Science and Technology: South African Research Chair Initiative in Vaccine Preventable Diseases and South Africa Medical Research Council. ZD is in part funded by the Carnegie Corporation of New York (Grant number B8749). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the paper.

Author information

Author notes

  1. These authors contributed equally: Shabir A. Madhi, Ziyaad Dangor.

Authors and Affiliations

  1. Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Kathleen P. Car, Firdose Nakwa, Sithembiso C. Velaphi, Sanjay G. Lala & Ziyaad Dangor

  2. South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Fatima Solomon, Alane Izu, Shabir A. Madhi & Ziyaad Dangor

  3. Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Fatima Solomon, Alane Izu, Shabir A. Madhi & Ziyaad Dangor

  4. Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, UK

    Cally J. Tann

  5. Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda

    Cally J. Tann

  6. Institute for Women’s Health, University College London, London, UK

    Cally J. Tann

  7. Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Sanjay G. Lala

Authors
  1. Kathleen P. Car
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Contributions

KPC, FN, SAM and ZD conceptualised and designed the study, designed the data collection instruments, carried out analyses, drafted the initial paper, and reviewed and revised the paper. SCV and CJT assisted with the study design and analysis, and critically reviewed the paper for important intellectual content. FS, AI and SGL designed the data collection instruments, collected data, and reviewed and revised the paper. FS, AI and SAM maintain the database used in the study, and critically reviewed the paper for important intellectual content. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ziyaad Dangor.

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Competing interests

The authors declare no competing interests.

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Supplementary information

Supplementary Table 1: ICD-10 codes from a discharge summary database for physician diagnosed neonatal encephalopathy

41372_2021_1290_MOESM2_ESM.docx

Supplementary Table 2: Clinical and laboratory characteristics of neonates with culture-confirmed sepsis associated neonatal encephalopathy.

41372_2021_1290_MOESM3_ESM.docx

Supplementary Table 3: Clinical and laboratory characteristics of neonates with probable sepsis associated neonatal encephalopathy

41372_2021_1290_MOESM4_ESM.docx

Supplementary Table 4: Clinical and laboratory characteristics of neonates with overall sepsis (confirmed + probable) associated neonatal encephalopathy

41372_2021_1290_MOESM5_ESM.docx

Supplementary Table 5: Prevalence and incidence estimates of neonates with neonatal encephalopathy (NE) stratified by early-onset sepsis (EOS) and organisms cultured

41372_2021_1290_MOESM6_ESM.docx

Supplementary Table 6: Predictors of mortality in neonates with overall (confirmed + probable) sepsis associated neonatal encephalopathy

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Car, K.P., Nakwa, F., Solomon, F. et al. The association between early-onset sepsis and neonatal encephalopathy. J Perinatol 42, 354–358 (2022). https://doi.org/10.1038/s41372-021-01290-5

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