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Key words: neonatal sepsis; prolonged rupture of membranes; blood culture; prematurity
J Infect Dev Ctries 2014; 8(1):067-073 .doi:10.3855/jidc.3136
(Received 07 November 2012 Accepted 20 February 2013)
Copyright 2014 Alam et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction
According to the World Health Organization,
approximately four million neonates die annually [1]
with a global neonatal mortality rate of 23/1,000 live
births [2]. About a million of these deaths are
attributable to neonatal infections [3]. The incidence of
neonatal sepsis is approximately 1-10/1,000 live births
in developed countries, but it was reported as high as
three times this number in resource-limited developing
countries [4].
Prolonged rupture of membrane (PROM), defined
as rupture of membrane lasting more than 18 hours
before labor, is found in approximately 8%-10% of all
pregnancies [5,6]. PROM is an important risk factor
for both early onset neonatal sepsis (EONS) [7,8] and
preterm births [9]. Many studies have determined that,
besides prematurity being the most common problem,
infection was the most serious event and potential
complication following PROM [9]. This became even
more serious if both were combined [10]. PROM is
significant not only in perinatal morbidity and
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Primigravida
Duration of PROM
Birth weight
Number (%)
< 20 yrs.
20-35 yrs.
> 35 yrs.
18-24 hours
25-48 hours
> 48 hours
Vaginal delivery
< 34 weeks
34-37 weeks
> 37 weeks
< 1,500 grams
1,500-2,500 grams
> 2,500 grams
Leukocytosis
Thrombocytopenia
< 34 weeks
34-37 weeks
> 37 weeks
TLC count ( > 26,000/cm)
< 150,000/cm
100-150,000/cm
50-100,000/cm
< 50,000/cm
31 (7)
313 (73)
84 (20)
144 (34)
268 (63)
125 (29)
35 (8)
265 (62)
39 (9)
74 (17)
28 (7.5)
22 (5)
306 (72)
183 (43)
38 (9)
83 (19)
307 (72)
62 (14)
144 (34)
212 (52)
139 (10)
10 (2)
34 (8)
95 (22)
71 (17)
83 (19)
58 (13)
16 (4)
9 (2)
96 (22)
78 (18)
15 (4)
n = 17
12 (71%)
5 (29.4)
4 (23.5)
2 (11.8)
1 (5.9)
5 (29%)
3 (17.6)
1 (5.9)
1 (5.9)
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Maternal characteristics
No antenatal antibiotics
Duration of PROM (> 48 hours)
Maternal fever
Chorioamnionitis
UTI
Neonatal characteristics
Gestational age (< 34 weeks)
Birth weight (< 1,500 grams)
SGA
Leukocytosis (> 26,000/cm)
Thrombocytopenia (< 150,000/cm)
Raised CRP
P value
Crude OR (CI)
Adjusted OR (CI)
13 (76)
7 (41)
15 (88)
12 (71)
3 (18)
150 (36)
28 (7)
59 (14)
16 (4)
19 (5)
0.001
< 0.001
< 0.001
< 0.001
0.05
5.6 (1.8-17.6)
9.6 (3.3-27.1)
44.7 (10.0-201.0)
59.3 (18.6-188.4)
4.4 (1.2-17.0)
-8.2 (0.7-98.2)
37.0 (3.4-93.3)
4.1 (0.6-26.8)
--
7 (41)
8 (47)
9 (53)
7 (41)
10 (59)
7 (41)
32 (8)
54 (13)
130 (32)
64 (16)
73 (18)
8 (2)
< 0.001
0.001
0.066
0.003
< 0.001
< 0.001
8.3 (3.0-23.3)
5.9 (2.2-15.9)
2.4 (0.8-7.1)
6.4 (2.0-21.0)
6.6 (2.4-18.0)
12.8 (4.1-40.4)
4.1 (0.6-29.8)
9.8 (1.5-65.7)
--2.6 (0.5-13.0)
5.0 (1.1-23.5)
Abbreviations: PROM: prolonged rupture of membrane; UTI: urinary tract infection; SGA: small for gestational age; CRP: C-reactive protein
70
References
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2.
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6.
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7.
8.
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10.
11.
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15.
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17.
18.
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21.
22.
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Corresponding author
Muhammad Matloob Alam
Department of Paediatrics & Child Health, Aga Khan University
Stadium Road, PO Box 3500, Karachi 74800, Pakistan
Phone: (+92-021) 34864795
Fax: (+9221) 34934292
Email: dr.matloobalam@hotmail.com; matloob.alam@aku.edu
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