Prevalence and risk factors of neonatal sepsis in the neonatal intensive care unit at Soroti Regional Referral hospital, Uganda: a retrospective study.

Abstract

Background Neonatal sepsis remains a leading cause of newborn mortality globally, accounting for approximately 15% of neonatal deaths in 2018. The burden is particularly high in low-resource settings, with a reported prevalence of 29.92%. This study aimed to determine the prevalence and associated risk factors of neonatal sepsis among neonates aged 0–28 days admitted to the Neonatal Intensive Care Unit (NICU) at Soroti Regional Referral Hospital in Uganda, to inform targeted interventions. Methods We conducted a retrospective cross-sectional study among neonates aged 0 to 28 days admitted to the Neonatal Intensive Care Unit (NICU) of Soroti Region Referral Hospital. Systematic random sampling was used to select medical charts for review. Data on exposure and outcome variables were extracted using a structured abstraction tool. The primary outcome was neonatal sepsis. Modified Poisson regression was employed to identify factors associated with neonatal sepsis, reported as adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05. Results Among the 276 neonates included, the median age was 2 days (interquartile range of 1.0–4.0), and the prevalence of neonatal sepsis was 35.5%. The factors significantly associated with Neonatal Sepsis included the Appearance, Pulse, Grimace, Activity, and Respiration (Apgar) Score < 7 (aPR = 1.35, 95% CI; 1.04–1.76, P = 0.025), breech presentation (aPR = 1.79, 95%CI; 1.26–2.53, P = 0.001), Premature rupture of membranes (aPR = 1.78, 95%CI; 1.35–2.36, P < 0.001), Maternal Intrapartum infection (aPR = 1.78, 95% CI; 1.30–2.40, P < 0.001), presence foul-smelling amniotic fluid during delivery (aPR = 1.39, 95%CI; 1.06–1.81, P = 0.016), prolonged labour > 8 hours (aPR = 1.32, 95%CI; 1.00-1.72, P = 0.047), undergoing invasive procedures (aPR = 1.38, 95% CI; 1.03-1.82, P = 0.033) and febrile illness during pregnancy (aPR = 2.18, 95%CI; 1.54–3.08, P < 0.001). Conclusion Neonatal sepsis was significantly associated with an Apgar Score < 7, having a breech delivery, Premature rupture of membranes, Intrapartum infection, foul-smelling amniotic fluid, undergoing invasive procedures, prolonged labour > 8 hours, and febrile illness during pregnancy. These findings underscore the need for improved antenatal care, high-quality obstetric and neonatal care as potential strategies to reduce the burden of neonatal sepsis. Strengthening early identification and targeted interventions for high-risk neonates is critical to improving neonatal outcomes in resource-limited settings.