Predictors of Neonatal Sepsis in Resource-Limited Intensive Care Settings

Abstract

Neonatal sepsis remains disproportionately common and disproportionately fatal in resource-limited intensive care settings, with a recent 49-study African meta-analysis placing overall prevalence near 41%. This short communication synthesizes recent literature on the predictors of neonatal sepsis in these settings, spanning maternal, perinatal, neonatal, and iatrogenic risk factors as well as the diagnostic and microbiological context in which those predictors must be applied. Prolonged rupture of membranes, inadequate antenatal care, foul-smelling amniotic fluid, and maternal genitourinary infection carry pooled and adjusted odds ratios in the range of 3 to 10 for neonatal sepsis, while low birth weight, prematurity, low Apgar score, and escalating exposure to invasive devices such as mechanical ventilation and umbilical catheters carry similarly elevated, and in some cohorts markedly higher, odds. Diagnostic prediction models validated in low- and middle-income countries report reasonable pooled accuracy, but the great majority have not been tested in the lowest-resource settings, and the biomarker combinations with the strongest documented performance are frequently unavailable where sepsis burden is highest. Compounding this gap, the gram-negative organisms that dominate resource-limited NICUs are increasingly resistant to first-line empirical antibiotics. Interventions that act directly on modifiable predictors, including hand hygiene, infection-prevention bundles, and kangaroo mother care, have documented benefit and do not depend on laboratory capacity many units lack, positioning them as the most immediately actionable response to the predictor evidence reviewed here.