Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis

• Published in: PLoS medicine 2013-08, Vol.10 (8), p.e1001502-e1001502
• Main Authors: Chan, Grace J, Lee, Anne C C, Baqui, Abdullah H, Tan, Jingwen, Black, Robert E
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial infections; Bacterial Infections - therapy; Diseases; Female; Health risk assessment; Humans; Infant, Newborn; Infant, Newborn, Diseases - drug therapy; Infant, Newborn, Diseases - epidemiology; Infants (Newborn); Infections; Infectious Disease Transmission, Vertical - statistics & numerical data; Medicine; Meta-analysis; Methods; Mortality; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - epidemiology; Sexually transmitted diseases; STD; Studies
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1001502

Neonatal infections cause a significant proportion of deaths in the first week of life, yet little is known about risk factors and pathways of transmission for early-onset neonatal sepsis globally. We aimed to estimate the risk of neonatal infection (excluding sexually transmitted diseases [STDs] or congenital infections) in the first seven days of life among newborns of mothers with bacterial infection or colonization during the intrapartum period. We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, and the World Health Organization Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection published from January 1, 1960 to March 30, 2013. Studies were included that reported effect measures on the risk of neonatal infection among newborns exposed to maternal infection. Random effects meta-analyses were used to pool data and calculate the odds ratio estimates of risk of infection. Eighty-three studies met the inclusion criteria. Seven studies (8.4%) were from high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of laboratory-confirmed and clinical signs of infection, as well as for colonization and risk factors. The odds ratio for neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 6.6 (95% CI 3.9-11.2). Newborns of mothers with colonization had a 9.4 (95% CI 3.1-28.5) times higher odds of lab-confirmed infection than newborns of non-colonized mothers. Newborns of mothers with risk factors for infection (defined as prelabour rupture of membranes [PROM], preterm