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.
References
Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child. 2021;106(8):745–52.
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6(3):223–30.
Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21–47.
Raturi A, Chandran S. Neonatal sepsis: aetiology, pathophysiology, diagnostic advances and management strategies. Clin Med Insights Pediatr. 2024;25;18:1337.
Truong N, Menon R, Richardson L. The Role of Fetal Membranes during Gestation, at Term and Preterm Labor. Placenta Reprod Med. 2023;31:4.
Herbst A, Källén K. Time between membrane rupture and delivery and septicemia in term neonates. Obstet Gynecol. 2007;110(3):612–8.
Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, et al. International multicentre term prelabor rupture of membranes study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol. 1997;177(5):1024–9.
Farhadi R, Yaghobian M, Saravi BM. Clinical Findings Leading to the Diagnosis of Sepsis in Neonates Hospitalized in Imam Khomeini and Bu Ali Hospitals, Sari, Iran: 2011-2012. Glob J Health Sci. 2014;6(4):298–303.
Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015;61(1):1–13.
Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol. 2008;198(6):700-5.
Drassinower D, Friedman AM, Običan SG, Levin H, Gyamfi-Bannerman C. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis. Am J Obstet Gynecol. 2016;214(6):743.
Bhat Y R, Lewis LES, K E V. Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: an audit from a center in India. Ital J Pediatr. 2011;11:37-2.
Patel D, Nimbalkar A, Sethi A, Kungwani A, Nimbalkar S. Blood culture isolates in neonatal sepsis and their sensitivity in Anand District of India. Indian J Pediatr. 2014;81(8):785–90.
Roy M, Bhatt M, Maurya V, Arya S, Gaind R, Chellani H. Changing trend in bacterial etiology and antibiotic resistance in sepsis of intramural neonates at a tertiary care hospital. J Postgrad Med. 2017;63(3):162–8.
Mandot S, Gandhi JS. Umbilical cord blood culture versus peripheral venous blood culture in early onset neonatal sepsis. Int J Contemp Pediatrics. 2017;4:53-6.
Kalathia MB, Shingala PA, Parmar PN, Parikh YN, Kalathia IM. Study of Umbilical Cord Blood Culture in Diagnosis of Early-onset Sepsis Among Newborns with High-risk Factors. J Clin Neonatol. 2013;2(4):169–72.
Tonbul A, Tayman C, Catal F, Kara S, Tatli MM. Red cell distribution width (RDW) in the newborn: normative data. J Clin Lab Anal. 2011;25(6):422–5.
Deka A. Red cell distribution width as a diagnostic marker in neonatal sepsis. Int J Contemp Pediatr. 2020;21;7(4):820–5.
Martin SL, Desai S, Nanavati R, Colah RB, Ghosh K, Mukherjee MB. Red cell distribution width and its association with mortality in neonatal sepsis. J Matern-Fetal Neonatal Med. 2019;32(12):1925–30.
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