Effect of duration of rupture of membranes on early-onset neonatal sepsis and short-term outcomes
DOI:
https://doi.org/10.18203/2349-3291.ijcp20262970Keywords:
Biomarker, Chorioamnionitis, Early-onset neonatal sepsis, Gram-negative sepsis, Neonatal outcomes, Rupture of membranes, Red cell distribution width, Tertiary care, Umbilical cord blood cultureAbstract
Background: Early-onset neonatal sepsis (EOS) remains a major contributor to neonatal mortality, disproportionately affecting low- and middle-income countries. Prolonged rupture of membranes (ROM) is a recognized risk factor, but integrated Indian data linking graded ROM duration, culture-confirmed sepsis and biomarkers such as red cell distribution width (RDW) remain limited. To evaluate the effect of ROM duration on EOS and short-term outcomes and the diagnostic utility of RDW, alone and combined with blood culture, for identifying at-risk neonates.
Methods: This prospective observational study enrolled 195 neonates born to mothers with recognized intrapartum risk factors at a tertiary care institution in Tamil Nadu, India, from April 2024-October 2025. Maternal and neonatal data, blood cultures and complete blood counts including RDW were recorded and analyzed using chi-square/Fisher's exact and t-test/Mann-Whitney U tests; ROC analysis determined the optimal RDW cut-off.
Results: Prolonged ROM was present in 40.0% of mothers; 53.8% of neonates had ROM ≥12 hours. Respiratory distress was the commonest feature (34.9%); 34.9% screened positive for sepsis. Cord culture positivity was 24.6% versus 20.5% for peripheral culture. Gram-negative organisms predominated (Pseudomonas 29.2%, Acinetobacter 22.9%). RDW was higher in septic neonates (19.1±2.4% vs. 16.7±1.8%; p<0.001), with AUC 0.81 at cut-off 18.0%. Combining RDW with cord culture raised accuracy to 84.6%.
Conclusions: Prolonged ROM is a graded, dose-dependent risk factor for culture-confirmed EOS. RDW is a rapid, low-cost adjunct that, combined with cord blood culture, enhances diagnostic accuracy and supports bedside risk stratification in resource-constrained neonatal units.
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