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Cited by 253Neonatal and Maternal InfectionsMaternal and Neonatal HealthcarePreterm Birth and Chorioamnionitis

Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis

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Chan, Grace J., Lee, Anne CC, Baqui, Abdullah H., Tan, Jingwen, Black, Robert E.·2013·PLoS Medicine
DOI 10.1371/journal.pmed.1001502PMC PMC3747995
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Abstract

BACKGROUND: Neonatal infections cause a significant proportion of deaths in the first week of life, yet little is known about risk factors and pathways of transmission for early-onset neonatal sepsis globally. We aimed to estimate the risk of neonatal infection (excluding sexually transmitted diseases [STDs] or congenital infections) in the first seven days of life among newborns of mothers with bacterial infection or colonization during the intrapartum period. METHODS AND FINDINGS: We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, and the World Health Organization Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection published from January 1, 1960 to March 30, 2013. Studies were included that reported effect measures on the risk of neonatal infection among newborns exposed to maternal infection. Random effects meta-analyses were used to pool data and calculate the odds ratio estimates of risk of infection. Eighty-three studies met the inclusion criteria. Seven studies (8.4%) were from high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of laboratory-confirmed and clinical signs of infection, as well as for colonization and risk factors. The odds ratio for neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 6.6 (95% CI 3.9-11.2). Newborns of mothers with colonization had a 9.4 (95% CI 3.1-28.5) times higher odds of lab-confirmed infection than newborns of non-colonized mothers. Newborns of mothers with risk factors for infection (defined as prelabour rupture of membranes [PROM], preterm <37 weeks PROM, and prolonged ROM) had a 2.3 (95% CI 1.0-5.4) times higher odds of infection than newborns of mothers without risk factors. CONCLUSIONS: Neonatal infection in the first week of life is associated with maternal infection and colonization. High-quality studies, particularly from settings with high neonatal mortality, are needed to determine whether targeting treatment of maternal infections or colonization, and/or prophylactic antibiotic treatment of newborns of high risk mothers, may prevent a significant proportion of early-onset neonatal sepsis. Please see later in the article for the Editors' Summary.

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  • Several studies have confirmed the role of maternal colonization in the subsequent development of neonatal sepsis, particularly for group B Streptococcus but also for ESBL-E.

    “Several studies have confirmed the role of maternal colonization in the subsequent development of neonatal sepsis (particularly for group B Streptococcus, but also for ESBL-E) (Chan et al., 2013;Kaba et al., 2016;Denkel et al., 2014;Rettedal et al., 2015).”

    From Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis (2017) · cites this paper as Chan et al., 2013

    The Results (Meta-analyses; page not specified) report higher odds of neonatal infection among newborns of mothers colonized with group B Streptococcus, supporting that part of the claim. The passages on other pathogens discuss E. coli colonization but do not identify ESBL-E or establish an association between maternal ESBL-E colonization and neonatal sepsis. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Maternal colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa represents a risk for subsequent neonatal colonization and/or infection with ESBL-E.

    “The prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high-and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.”

    From Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis (2017) · cites this paper as Chan et al., 2013

    The Results (Meta-analyses; page not provided) associate maternal colonization with neonatal colonization, including for E. coli, and the Discussion describes evidence of mother-to-newborn transmission. The paper does not identify ESBL-producing Enterobacteriaceae or establish this specific risk among pregnant or post-partum women in Africa. (LLM, conf=0.86)

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Authors
Chan, G. J., Lee, A. C., Baqui, A. H., Tan, J., & Black, R. E.
Affiliations
  • Johns Hopkins University (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Chan, Grace J.
ORCID
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PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2013-08-20
Volume
10
Issue
8
Pages
e1001502
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1001502
PMC
PMC3747995
OpenAlex
W2083307534
Cited by
253
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en
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  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • Johns Hopkins University
  • National Institutes of Health
  • National Center for Research Resources (KL2RR025006)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
Keywords
early-onset neonatal infection, neonatal sepsis, maternal infection, maternal colonization, vertical transmission, intrapartum period, premature rupture of membranes, preterm premature rupture of membranes, prolonged rupture of membranes, neonatal mortality, risk factors
MeSH terms
Anti-Bacterial Agents, Bacterial Infections, Female, Humans, Infant, Newborn, Infant, Newborn, Diseases, Pregnancy, Pregnancy Complications, Infectious, Infectious Disease Transmission, Vertical

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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