Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Physiology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
BMC Pregnancy Childbirth. 2024 Oct 28;24(1):707. doi: 10.1186/s12884-024-06903-3.
Babies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.
We conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.
We enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8-21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2-65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6-40), primiparity (AOR = 4.8, 95% CI: 1.1-21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5-12) were associated with EONS.
Prime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.
在低收入环境中，通过剖宫产分娩的婴儿面临更高的早发性新生儿败血症（EONS）风险，其死亡率高于晚发性败血症。然而，导致这些环境中剖宫产婴儿发生 EONS 的产妇因素，包括乌干达，并没有得到很好的记录。我们确定了与乌干达姆巴拉拉地区转诊医院（MRRH）行剖宫产分娩的足月婴儿 EONS 相关的产妇因素。
我们在 2019 年 12 月至 2020 年 3 月在 MRRH 进行了一项不匹配的病例对照研究。病例为在 72 小时内发生 EONS 的剖宫产足月婴儿。对照组为无 EONS 的剖宫产足月婴儿。我们为两组均招募了母婴对，通过结构化问卷获取产妇数据。EONS 的诊断采用世卫组织婴幼儿综合管理儿童疾病算法。病例连续招募，对照组通过简单随机抽样以 1:2 的比例招募。我们排除了母亲病得太重而无法同意的新生儿。我们使用多变量逻辑回归分析来确定与 EONS 相关的产妇因素。
我们共纳入 52 例病例和 104 例对照。母亲的平均年龄为 27（±5.5）岁。与非转诊母亲所生的新生儿相比，来自转诊母亲的新生儿发生 EONS 的可能性更高（AOR=6.2，95%CI：1.8-21）。此外，紧急剖宫产的决策到分娩时间＞1 小时（AOR=16，95%CI：4.2-65）、产前出血（AOR=8.0，95%CI：1.6-40）、初产妇（AOR=4.8，95%CI：1.1-21）和胎膜破裂后阴道检查次数＞3 次（AOR=4.3，95%CI：1.5-12）与 EONS 相关。
在 MRRH 行剖宫产分娩的足月婴儿中，初产妇、产前出血、胎膜破裂后多次阴道检查、决策到分娩时间长、转诊状态与 EONS 相关。为降低 EONS 风险，临床医生应限制胎膜破裂后阴道检查次数，或在需要多次检查时考虑预防性使用抗生素。对初产妇、转诊、产前出血、胎膜破裂后多次阴道检查和决策到分娩时间长的婴儿进行筛查，有助于及时发现 EONS 并及时干预。在该环境中实施减少剖宫产决策到分娩时间的标准程序可以降低 EONS 的风险。
