Comparison of risk factors, clinical characteristics, laboratory findings and bacterial etiology between early-onset and late-onset neonatal sepsis in Sana'a City, Yemen.

Background: Sepsis is a major cause of neonatal mortality worldwide. However, its risk factors, clinical characteristics, laboratory findings, and bacterial etiology vary across countries. Therefore, this study compared these factors between early-onset sepsis (EOS) and late-onset sepsis (LOS) in Sana'a city, Yemen.

Methods: A prospective, cross-sectional study was conducted among 156 neonates with suspected sepsis in Sana'a. Data about risk factors, clinical characteristics, and laboratory findings were collected using a data collection sheet, and blood samples were collected for culture according to established procedures. The data were then analyzed at a significance level of < 0.05.

Results: Of neonates with suspected sepsis, 65.4% had LOS and 34.6% had EOS. However, sepsis was confirmed in 62.2% of cases. Compared to EOS, preterm birth (OR = 4.1, 95% CI: 1.27-13.02; P = 0.013), and exteremely low birthweight (ELBW) and very low birthweight (VLBW) (OR = 4.7, 95% CI: 1.02-22.19; P = 0.033) were significantly associated with a higher risk of LOS, while premature rupture of membranes (PROM) was significantly associated with a lower risk of LOS (OR = 0.2, 95% CI: 0.03-0.99; P = 0.043). Jaundice was significantly more common in neonates with EOS, while apnea was significantly more common in those with LOS. However, no significant differences were found between EOS and LOS in terms of other clinical characteristics, leukocyte and platelet counts, or C-reactive protein (CRP). Gram-positive cocci were the most frequent bacterial isolates (63.9%), with coagulase-negative staphylococci (CoNS) being the predominant species (63.6% in EOS and 42.2% in LOS). Gram-negative bacilli were isolated from 36.1% of cases and were more common in LOS (77.1%) than in EOS (22.9%), with Klebsiella species being the most predominant (19.6%).

Conclusion: Most neonatal sepsis cases in Sana'a are LOS, mostly commonly caused by Gram-positive cocci and associated with preterm birth and ELBW and VLBW. Differences in risk factors associated with EOS and LOS highlight the need for targeted preventive measures in neonatal care settings.