A Systematic Literature Review to Identify Potential Risk Factors and Causative Organisms for Neonatal Sepsis in Indian Neonates
Author(s)
Samreen Kour, M.Tech.1, Ayushman Ghosh, Ph.D.1, Divya Sussana Patil, Ph.D.2, Elstin Anbu Raj, M.Pharm.2, Edlin Glane Mathias, Ph.D.2, Tushar Pyne, Ph.D.1.
1Indence Health, Kolkata, India, 2Manipal Academy of Higher Education, Manipal, India.
1Indence Health, Kolkata, India, 2Manipal Academy of Higher Education, Manipal, India.
OBJECTIVES: Neonatal sepsis (NS) is the leading cause of mortality and developmental problems among neonates in India. The India Newborn Action Plan (INAP) 2014, aimed for strategic and accelerated reduction of preventable newborn deaths and stillbirths. This systematic literature review (SLR) aims to synthesize evidence on risk factors and causative organisms associated with NS in India.
METHODS: This SLR was conducted as per the PRISMA 2020 guidelines. The protocol was developed and registered in PROSPERO (CRD42024596266). Real-world studies on NS published from 2010-2024 were retrieved from PubMed, Scopus, Embase, CINAHL, and Web of Science to identify potential risk factors of mortality. Studies reporting on ≥3 risk factors were prioritized. Ranking of the risk factors was emphasized based on their frequency of occurrence in prioritized studies.
RESULTS: Of initial 5,842 hits retrieved; 64 studies were included post full-text screening. Prioritization based on ≥3 risk factors yielded 24 studies, involving 9,139 patients. Premature rupture of membrane (PROM) emerged as a major maternal risk factor in 14 studies, followed by foul-smelling liquor/amniotic fluid, breastfeeding, and exposure to antibiotics and steroids as reported in five studies, each. Major neonatal risk factors included low birthweight (15 studies), prematurity (7 studies), and mechanical ventilation (6 studies). Klebsiella pneumoniae and Staphylococcus were the commonly reported pathogens (15 studies). After the implementation of INAP, number of studies in India investigating on risk factors and causative organisms for NS increased significantly, rising from 3 studies pre-INAP to 12 studies post-INAP. Furthermore, the number of studies reported from neonatal intensive care units (20 studies) were higher, compared to those from sick neonatal care units (2 studies).
CONCLUSIONS: PROM and low birthweight were found to be major risk factors for neonatal mortality. Further research is needed to better understand these risk factors and to develop targeted management strategies for NS in India.
METHODS: This SLR was conducted as per the PRISMA 2020 guidelines. The protocol was developed and registered in PROSPERO (CRD42024596266). Real-world studies on NS published from 2010-2024 were retrieved from PubMed, Scopus, Embase, CINAHL, and Web of Science to identify potential risk factors of mortality. Studies reporting on ≥3 risk factors were prioritized. Ranking of the risk factors was emphasized based on their frequency of occurrence in prioritized studies.
RESULTS: Of initial 5,842 hits retrieved; 64 studies were included post full-text screening. Prioritization based on ≥3 risk factors yielded 24 studies, involving 9,139 patients. Premature rupture of membrane (PROM) emerged as a major maternal risk factor in 14 studies, followed by foul-smelling liquor/amniotic fluid, breastfeeding, and exposure to antibiotics and steroids as reported in five studies, each. Major neonatal risk factors included low birthweight (15 studies), prematurity (7 studies), and mechanical ventilation (6 studies). Klebsiella pneumoniae and Staphylococcus were the commonly reported pathogens (15 studies). After the implementation of INAP, number of studies in India investigating on risk factors and causative organisms for NS increased significantly, rising from 3 studies pre-INAP to 12 studies post-INAP. Furthermore, the number of studies reported from neonatal intensive care units (20 studies) were higher, compared to those from sick neonatal care units (2 studies).
CONCLUSIONS: PROM and low birthweight were found to be major risk factors for neonatal mortality. Further research is needed to better understand these risk factors and to develop targeted management strategies for NS in India.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH9
Topic
Epidemiology & Public Health, Study Approaches
Disease
Infectious Disease (non-vaccine), Pediatrics