Maternal-infant Characteristics of Preterm and Term Neonates With Bloodstream Infections in Lower-tier Hospitals in South Africa: A Cross-sectional Study.

BACKGROUND

Bloodstream infections (BSI) are an important cause of neonatal deaths in low- and middle-income countries.

METHODS

We conducted a cross-sectional study of culture-confirmed BSI in neonates aged <28 days at 6 lower-tier South African hospitals (October 2019 to September 2020), comparing maternal-infant characteristics between preterm and term babies.

RESULTS

Of 907 BSI episodes, clinical data were available for 676 neonates. Median gestational age was 33 weeks [interquartile ranges (IQR), 29-37 weeks], with 70% (472/676) of neonates born preterm. Preterm neonates had longer median hospital stays than term neonates [19 days (IQR, 9-36) vs. 11 days (IQR, 6-17), P < 0.001], more BSI episodes during days 3-27 of life [72% (343/472) vs. 57% (119/204); P < 0.001] and higher maternal HIV prevalence [38% (177/463) vs. 24% (49/200); P = 0.001]. Fewer mothers of preterm versus term neonates attended antenatal clinic appointments [86% (367/426) vs. 94% (166/176); P = 0.004]. Crude mortality was higher among preterm versus term neonates [31% (146/472) vs. 8.3% (17/204); P < 0.001], with a higher BSI-attributable mortality (defined as death within 3 days of a BSI) [21% (97/472) vs. 5.4% (11/204); P < 0.001]. Preterm neonates had 3.7 times higher adjusted odds of death (1·71-8·14; P = 0.001) than term neonates.

CONCLUSIONS

Preterm neonates with a BSI were more likely to die than those who were term. Neonatal units should implement interventions to prevent horizontal transmission of infections among these small, sick neonates. Targeted antenatal and intrapartum interventions are needed to prevent preterm births as a root cause.