Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis of observational studies

Figures & data

Figure 1. Flow diagram.

Table 1. The basic information of the included studies.

Study	Research area	Research time	Study design	Cases	Controls	NOS
Xu 2012 [7]	Fujian, China	2010.1–2011.12	Case control study	153	150	8
Dai 2018 [8]	Wenzhou, China	2013.12–2017.6	Case control study	129	159	7
Tian 2020 [9]	Zhejiang, China	2018.1–2019.8	Case control study	216	350	7
Zhuang 2020 [10]	Wenzhou, China	2018.12–2019.12	Case control study	80	80	9
Rong 2017[11]	Shijiazhuang, China	2014.10–2015.10	Case control study	100	100	7
Jia 2021 [12]	Taizhou, China	2018.1–2020.1	Case control study	119	357	7
Rong 2015 [13]	Shijiazhuang, China	2013.9–2014.8	Case control study	82	356	7
Wu 2021 [14]	Jiangsu, China	2016–2019	Case control study	168	168	7
Sheng 2018 [15]	Shanghai, China	2016–2017	Case control study	32	88	6
Nayeri 2018 [16]	United States	Not available	Cohort study	92	279	6
Van Kempen 2016 [17]	Netherlands	2002.3–2015.4	Case control study	68	346	8
Dutta 2010 [18]	India	Not available	Case control study	85	516	7
Santhanam 2018 [19]	India	2004–2014	Case control study	71	284	7
Rafi 2020 [20]	Bangladesh	2019.1–2019.12	Case-control study	56	116	8
Rallis 2021 [21]	Greece	2017–2018	Cohort study	81	185	7
Masanja 2020[22]	Tanzania	2017.5–2017.7	Case control study	105	217	8
Puopolo 2011 [23]	United States	1993–2007	Case control study	350	1063	7

Table 2. The results of heterogeneity test and meta-analysis.

Risk factors	Literature sources	Heterogeneity test			Effect model	OR(95%CI)	P-value
		Q	I²(%)	P
Perinatal asphyxia or intrauterine distress	[7,8,12,14,20,22]	2.58	0	0.76	Fixed	3.00(2.18 ∼ 4.13)	<0.01
Meconium contamination of amniotic fluid	[7,9,12,15,19]	13.80	71	<0.01	Random	3.61(1.97 ∼ 6.60)	<0.01
GBS colonization in pregnant women	[10,11,13,23]	14	79	<0.01	Random	3.45(1.45 ∼ 8.21)	<0.01
Chorioamnionitis	[8,10,11,13,15,18,21,22]	19.51	64	<0.01	Random	4.58(2.61 ∼ 8.05)	<0.01
Premature rupture of membranes	[7–9,11–14,17,22]	20.67	61	<0.01	Random	3.25(2.25 ∼ 4.69)	<0.01
Lower gestational age	[11,16–20,20,23]	44.43	89	<0.01	Random	1.55(1.23 ∼ 1.96)	<0.01
Maternal urinary or reproductive tract infection	[12,19,20]	1.20	0	0.55	Fixed	3.61(2.14 ∼ 6.11)	<0.01
Perinatal fever	[12,14,19]	3.25	38	0.20	Fixed	3.59(2.25 ∼ 5.71)	<0.01
Very low birth weight	[12,14,18]	4.29	53	0.12	Random	3.79(2.14 ∼ 6.73)	<0.01
Vaginal examination ≥ 3 times	[18,19,22]	0.45	0	0.80	Fixed	7.95(4.04 ∼ 15.64)	<0.01

Table 3. The final results of meta-analysis.

Risk factors	Literature sources	Heterogeneity test			Effect model	OR (95%CI)	P-value
		Q	I² (%)	P
Perinatal asphyxia or intrauterine distress	[7,8,12,14,20,22]	2.58	0	0.76	Fixed	3.00(2.18 ∼ 4.13)	<0.01
Meconium contamination of amniotic fluid	[7,12,15,19]	7.28	59	0.06	Random	4.51(2.31 ∼ 8.81)	<0.01
GBS colonization in pregnant women	[10,11,23]	3.61	45	0.16	Fixed	2.13(1.48 ∼ 3.05)	<0.01
Chorioamnionitis	[8,10, 11,13,15,18,21,22]	19.51	64	<0.01	Random	4.58(2.61 ∼ 8.05)	<0.01
Premature rupture of membranes	[7–9,11,12,14,17,22]	11.40	39	0.12	Fixed	2.63(2.09 ∼ 3.30)	<0.01
Lower gestational age	[16–18,20]	5.30	43	0.15	Fixed	1.31(1.18 ∼ 1.44)	<0.01
Maternal urinary or reproductive tract infection	[12,19,20]	1.20	0	0.55	Fixed	3.61(2.14 ∼ 6.11)	<0.01
Perinatal fever	[12,14,19]	3.25	38	0.20	Fixed	3.59(2.25 ∼ 5.71)	<0.01
Very low birth weight	[12,14,18]	4.29	53	0.12	Random	3.79(2.14 ∼ 6.73)	<0.01
Vaginal examination ≥ 3 times	[18,19,22]	0.45	0	0.80	Fixed	7.95(4.04 ∼ 15.64)	<0.01

Figure 2. Forest plot of perinatal asphyxia or intrauterine distress.

Figure 3. Funnel plot of perinatal asphyxia or intrauterine distress.

Table 4. The results of Publication bias test.

Risk factors	Egger's test
	t	P-value
Perinatal asphyxia or intrauterine distress	2.15	0.09
Meconium contamination of amniotic fluid	1.81	0.21
GBS colonization in pregnant women	0.51	0.70
Chorioamnionitis	2.65	0.03
Premature rupture of membranes	2.49	0.04
Lower gestational age	16.34	<0.01
Maternal urinary or reproductive tract infection	–6.87	0.09
Perinatal fever	0.67	0.62
Very low birth weight	<0.01	0.99
Vaginal examination ≥3 times	–1.43	0.38

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Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.