Maternal and Perinatal Determinants of Neonatal Sepsis in Asia: An Exploratory Meta-Analysis

Abstract

Introduction: Neonatal sepsis is a leading cause of newborn death in Asia, but the pooled evidence on its maternal and perinatal determinants is dominated by African cohorts. This study synthesised Asian observational evidence on these determinants.

Methods: PubMed/MEDLINE was searched for case-control, cohort, and cross-sectional studies reporting odds ratios for maternal or perinatal determinants of clinically or culture-diagnosed neonatal sepsis in Asian populations. Ten studies from six countries were included. Because the outcome was dichotomous, effects were pooled as odds ratios using a DerSimonian-Laird random-effects model; risk of bias was appraised with ROBINS-I.

Results: Premature rupture of membranes (odds ratio 2.47, 95% CI 1.63-3.73; I-squared 0%) and maternal urinary tract infection (odds ratio 4.33, 95% CI 2.38-7.86; I-squared 5%) were significantly and consistently associated with neonatal sepsis. Maternal or intrapartum fever (odds ratio 1.98, 95% CI 0.75-5.24) and caesarean delivery (odds ratio 1.44, 95% CI 0.74-2.83) were not significant and were heterogeneous. The direction of every pooled effect matched an independent Ethiopian meta-analysis.

Conclusion: In Asian settings, premature rupture of membranes and maternal urinary tract infection were the most credible and consistent maternal determinants of neonatal sepsis, supporting antenatal screening and timely intrapartum management.