Chapter 4

RESULTS AND DISCUSSION

This chapter includes presentation, discussion and interpretation of data.

Descriptive Data Analysis

Table 1 shows the age of mothers, who gave birth to babies with early onset

sepsis, during pregnancy. It can be seen in the data that most of the mothers who gave

birth to a baby with early onset sepsis were aged 24-33 years old (151, 61.9%), followed

by mothers aged 34 years old and above (69, 28.3%) and by mothers aged 23 years old

and below (24, 9.8%). Thus, out of the 244 cases of neonatal (early onset) sepsis, it was

found out in the study that 151 or 61 percent were mothers aged 24-33 years old, which is

generally the birthing age range of women. Nonetheless, the study revealed that the

youngest mother was aged 14 and the oldest was 44.

Table 1. Age of Mothers during Pregnancy with Early Onset Sepsis Neonates

Frequency Percent
23 years old and below 24 9.8
24-33 years old 151 61.9
34 years old and above 69 28.3
Total 244 100.0

The result of the study is consistent with the study of Jiang and Ye6 on “1:4

Matched Case-Control Study on Influential Factor of Early Onset Neonatal Sepsis”. In

their study, a 1:4 matched case-control study was adopted and 147 cases of early-onset

neonatal sepsis were enrolled. Conditional logistic regression model was used to analyze

the univariate and multivariate data to estimate the odds ratio (OR) and the 95%
 20

confidence interval (95% CI). Their study underscored that maternal age, which is below

35 years old (OR = 4.835, OR 95% CI = 1.170-19.981), is an influential factor in the

prevalence of early onset neonatal sepsis. This finding holds true as well in the study

because the age bracket of most of the mothers whose child suffered from early onset

neonatal sepsis was between 24 to 33 years old with an overwhelming case of 151/244 or

61.9 percent (of the total cases. When combined with 23 years old and below, it would

result to a whopping 71.7 percent.

Table 2 shows the number of times the mother got pregnant, which was expressed

as “parity”. The data show that early onset sepsis among neonates commonly occurred

among mothers giving birth to their first or second child with 205 cases out of 244 (84%),

only 39 or 16 percent of the cases had mothers in their third birth or more.

Table 2. Number of Times the Mother Got Pregnant with Early Onset Sepsis Neonates

Frequency Percent
First or Second Child 205 84.0
Third Child or Beyond 39 16.0
Total 244 100.0

Related studies were limited as to the relationship of the number of birth that the

mother already had and the early onset sepsis case on the child. However, the study

conducted by Ting Xiao7 et al. in 2017 titled, “The Analysis of Etiology and Risk Factors

for 192 Cases of Neonatal Sepsis”, revealed that mothers at risk of having a baby with

early onset sepsis case were first-timers or mothers giving birth to their first baby. The

study also underscored that the case was likewise significant among mothers giving birth

to their second child but no longer among mothers giving birth to their third child and
 21

beyond. This result was consistent with the study although the study combined mothers

with their first and second child in one group. The results, anyhow, were both significant.

The result can be related as well to the previous findings on the maternal age of

mothers where mothers aged below 35 years old are at risk of having a baby infected with

early onset neonatal sepsis. This is so because first-born or first pregnancy generally

happens before reaching the age of 35 years old.

Table 3 shows the data on the early onset sepsis cases among the neonates with

either infected or not infected mother. The results revealed that among the cases of early

onset sepsis neonates, most of their mothers were not infected (160, 65.5%) or had not

suffered from any infections during pregnancy, while only 84 (34.4%) were infected with

either UTI or URTI.

Table 3. Cases of Infection among Mothers with Early Onset Sepsis Neonates

Frequency Percent
Infected 84 34.4
Not Infected 160 65.6
Total 244 100.0

The result implies that early onset neonatal sepsis may not be a result of an

infected mother as diagnosed during her pregnancy period. In the study, it could not be

determined if all mothers who were diagnosed to have suffered bacterial infections during

pregnancy translates to having an early onset neonatal sepsis case. However, related

studies can prove that infection during pregnancy is a risk factor in early onset neonatal

sepsis.
 22

This particular result supports the study conducted by Chan et al. in 20138 titled,

“Risk of Early-Onset Neonatal Infection with Maternal Infection or Colonization: A

Global Systematic Review and Meta-Analysis”. In their study, they found consistent

evidence of higher levels of early-onset neonatal infection among newborns of mothers

with bacterial infection or colonization compared to newborns of mothers without

infection or colonization. According to them, although the relationship has long been

understood, the magnitude of the disproportionate risk for infection has not yet been

systematically documented. In studies with the most definitive measures of infection

(“lab/lab”), newborns of infected mothers had a seven times higher odds of early-onset

neonatal infection compared to newborns of uninfected mothers. Excluding high-risk-of-

bias studies, the odds of neonatal infection increased to nine times higher among

newborns of infected mothers compared to newborns of uninfected mothers.

A separate study by Chan et al.9 in 2015 on “Prevalence of early-onset neonatal

infection among newborns of mothers with bacterial infection or colonization: a

systematic review and meta-analysis” also validates the result of the study. They searched

Pubmed, Embase, Scopus, Web of Science, Cochrane Library, and WHO Regional

Databases for studies of maternal infection, vertical transmission, and neonatal infection.

Studies that measured prevalence of bacterial vertical transmission were included.

Random effects meta-analyses were used to pool data to calculate prevalence estimates of

vertical transmission. Their study highlighted that the prevalence of early-onset neonatal

infection is high among newborns of mothers with infection or risk factors for infection.

Another study by Destaalem Gebremedhin et al.10 in 2015 with the title, “Risk

Factors for Neonatal Sepsis in Public Hospitals of Mekelle City, North Ethiopia, 2015:
 23

Unmatched Case Control Study” validates the significance of maternal infection on early

onset neonatal sepsis. A hospital based case control study was done in public hospitals of

Mekelle City, Tigray region. Cases were neonates who had sepsis with their index

mothers and controls were neonates who hadn’t had sepsis with their index mothers.

Hematologic findings were used to diagnose sepsis once the neonates were being

clinically suspected. Cases and controls were selected using the systematic sampling

technique. Results through multivariable logistic regression analysis showed that one of

the possible risk factors of neonatal sepsis in their study was history of maternal urinary

tract infection or sexually transmitted infection [AOR = 5. 23; 95% CI (1.82, 15.04)].

Meanwhile, Table 4 shows the result on the type of infection suffered by mothers

with neonates who had early onset sepsis. The data revealed that among the infected

mothers, most of them suffered from UTI (45, 53.6%) in the course of their pregnancy

while the rest suffered from URTI (39, 46.4%).

Table 4. Type of Infection Suffered by Mothers with Early Onset Sepsis Neonates

Frequency Percent
UTI 45 53.6
URTI 39 46.4
Total 84 100

Table 5 shows the gestational age of mothers with early onset sepsis neonates.

The result revealed that out of the 84 who were infected, more than half of the cases of

infections were recorded to have taken place during the second quarter of pregnancy (44,

52.4%). This left the two quarters quite far: third quarter (27, 32.1%) and first quarter
 24

(13, 15.5%). This may further mean that in the second quarter of pregnancy, which is

roughly around four to six months, mothers are prone to infections.

Table 5. Gestational Age of Mothers with Early Onset Sepsis Neonates

Frequency Percent
st
1 Quarter 13 15.5
2nd Quarter 44 52.4
3rd Quarter 27 32.1
Total 84 100

This particular result of the study is inconclusive because of the scarcity of related

studies to support this one. The researchers had attempted to search for studies that can

validate this particular result but remained unsuccessful.

Table 6 shows whether the infected mothers with early onset sepsis neonate

received treatment or not. The data revealed that more than four-fifth sought for treatment

(69, 82.1%) while only 15 or 17.9 percent did not seek for a doctor’s prescription. The

result implies that medical treatments do not guarantee an infection-free neonate.

Table 6. Treatment Status of Mothers with Early Onset Sepsis Neonates

Frequency Percent
Treated 69 82.1
Not Treated 15 17.9
Total 84 100

It has been proven and validated that maternal infections translate to early onset

neonatal sepsis but the act of seeking medical prescription or advice or not impacts the

prevalence of the case among neonates remains a question. In the study by Grace Chan et

al.8 on the “Risk of Early-Onset Neonatal Infection with Maternal Infection or

 25

Colonization: A Global Systematic Review and Meta-Analysis,” they emphasized that

neonatal infection in the first week of life is associated with maternal infection and

colonization. However, high-quality studies, particularly from settings with high neonatal

mortality, are needed to determine whether targeting treatment of maternal infections or

colonization may prevent a significant proportion of early-onset neonatal sepsis.

Table 7 shows the type of delivery of mothers with early onset sepsis neonates.

The data revealed that more than half of mothers with early onset sepsis neonates had

delivered their baby through Natural Spontaneous Vaginal Delivery (NSVD) or popularly

known as normal delivery (134, 54.9%) as compared to those who had undergone CS or

Caesarean (110, 45.1%). The result implies that NSVD may be a risk factor to early onset

sepsis among neonates since more than half of the cases had undergone normal delivery.

Table 7. Type of Delivery of Mothers with Early Onset Sepsis Neonates

Frequency Percent
NSVD (Normal) 134 54.9
CS (Caesarean) 110 45.1
Total 244 100.0

The result of the study may be validated by the findings of Ting Xiao et al.7 with

title, “The Analysis of Etiology and Risk Factors for 192 Cases of Neonatal Sepsis”. In

their study, they underscored that early-onset sepsis is mainly caused by maternal

infection induced by the premature rupture of membranes and nonsterile delivery of

mothers. Most isolated pathogens come from the mother’s birth canal. Their study further

highlighted that bacterial culture findings in neonatal sepsis (including sepsis in

 26

premature infants) were associated with local bacteria originating from mothers, children,

and hospital, so the importance of improving hospital conditions should be emphasized.

This concludes that normal delivery (NSVD) may be a risk factor on early onset neonatal

sepsis because the mother as well as the neonate are more prone to contact with bacteria

during the delivery.

This is also supported by the study of Francesca Cortese at al. 11 entitled, “Early

and Late Infections in Newborns: Where Do We Stand? A Review” that emphasized the

strong association of maternal factors such as Premature birth (< 37 weeks), premature

and prolonged time (> 18 hours) of membranes rupture, maternal peripartum infection on

early onset neonatal sepsis.

Inferential Data Analysis

A chi-square test of independence was performed to examine the relationship

between the variables considered in the study. Looking at the results shown in Table 8,

only treated and type of infection was significant at p>0.01. This means that those

mothers who received the treatment after suffering from infection during pregnancy were

those who suffered from UTI whereas those who did not receive any treatment were

those who suffered from URTI.

Table 8. Chi-Square Test of Independence among Variables in Each Case

Case Variable n X2 p- value Description

1 Infected 244 0.707 0.702 Not Significant (at >0.05)
Age
2 Infected 244 1.587 0.208 Not Significant (at >0.05)
Parity
 27

3 Infected 244 0.719 0.396 Not Significant (at >0.05)

Type of Delivery
4 AOG 84 3.255 0.196 Not Significant (at >0.05)
Type of Infection
5 Treated 84 16.152 0.000 Significant (at 0.01)
Type of Infection
6 Treated 84 4.467 0.107 Not Significant (at >0.05)
AOG

Chapter 5

SUMMARY OF RESULTS, CONCLUSIONS AND RECOMMENDATIONS

This chapter includes the summary of results, conclusions and recommendations

draw from the study.

Summary of Results

The study aimed to determine the influence of maternal factors on the prevalence

of early onset neonatal sepsis. Maternal factors such as age, parity, maternal infection,

kind of treatment of maternal infection and delivery type were assessed in the study.

The results revealed that most of the mothers who gave birth to a baby with early

onset sepsis were aged 24-33 years old, followed by mothers aged 34 years old and above

and by mothers aged 23 years old and below. The data show that early onset sepsis

among neonates commonly occurred among mothers giving birth to their first or second

child.

The results also revealed that among the cases of early onset neonatal sepsis, most

of their mothers were not infected or had not suffered from any infections during
 28

pregnancy. The data showed that among the infected mothers, most of them suffered

from UTI in the course of their pregnancy while the some suffered from URTI.

The study likewise revealed that out of the 84 who were infected, more than half

of the cases of infections were recorded to have taken place during the second quarter of

pregnancy. Data also showed that more than four-fifth sought for treatment while the

remaining did not seek for a doctor’s prescription. The data also highlighted that more

than half of mothers with early onset sepsis neonates had delivered their baby through

Natural Spontaneous Vaginal Delivery (NSVD) or popularly known as normal delivery

as compared to those who had undergone CS or Caesarean.

Conclusions

In view of the results of the study, the following conclusions were drawn:

1. The maternal age influences the prevalence of early onset neonatal sepsis that is

mothers ageing below 35 years old are considered risk factor.

2. Gestational age of mothers that is giving birth to first or second child influences

the prevalence of early onset neonatal sepsis.

3. Early onset neonatal sepsis happens even mothers did not suffer from any

infections during pregnancy. However, although not conclusive in the study, related

studies validate that maternal infection is a highly potential risk factor of early onset

neonatal sepsis.

4. The kind of infection suffered by the mother does not influence the prevalence

of early onset neonatal sepsis; whether the infection is treated with medical prescription

or not; or whether the infection occurred in the first, second or third quarter of pregnancy.
 29

These results, however, were not supported by related studies as the latter suffer from

scarcity.

5. NSVD or normal delivery influences the prevalence of early onset neonatal

sepsis. In this mode of delivery, mothers are more exposed to bacteria. Vaginal infection

may likely occur which is communicated to the baby.

Recommendations

In consideration of the results of the study, the following recommendations are

forwarded:

1. Cases without early onset neonatal sepsis can also be taken as part of the study

so that comparison can be made and analysis can be more meaningful.

2. Neonatal factors can also be considered so that a more comprehensive analysis

can be done.

3. In view of the results of the study, timely monitoring of the aforementioned

factors should be improved in the clinical setting to prevent the occurrence of neonatal

sepsis.
 30

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