Assessment of the Association of Repeated Vaginal Examination with Early Onset Neonatal Sepsis Hospital Based Follow Up Study

Abstract

Abstract Background: Sepsis is the 3rd leading cause of neonatal mortality in Ethiopia contributing for 16 % of neonatal death. Ina hospital study neonatal sepsis was the leading diagnosis at admission and second leading cause of neonatal death at the neonatal intensive care unit. Among other factors repeated vaginal examination during labor is known to contribute for sepsis in low-income settings. However, there is limited evidence in the Ethiopian setting. Objective: The objective of this study was to examine the association between number of vaginal examination and early onset neonatal sepsis. Methods: The study was conducted at Gandhi memorial Hospital, a public maternity and newborn care hospital. We followed 672 mother newborn pairs by phone until 7 days of age to detect clinical sepsis. Data were analyzed using SPSS version 20 software. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was used to show strength of associations and variables with p value <0.05 were considered to be statistically significant. Results: The incidence of early onset neonatal sepsis was found to be 20.83% (95% CI 17.60, 24.00). Having a frequent vaginal examination (four or more times) during labor and delivery was strongly associated with development of early onset neonatal sepsis, (ARR 2. 69 ;95 CI: 1.08, 6.70 ) after controlling for some common other risk factors including premature rupture of membrane and induced labor. Conclusion: Frequent digital vaginal examination significantly increases the risk of early onset neonatal sepsis. Health professionals caring for laboring mother must limit the number of vaginal examinations to reduce the risk of neonatal sepsis which has a huge negative implication on the survival of the newborns. We also recommend further study using either cord blood or neonatal blood culture to better diagnose early onset neonatal sepsis objectively.