The Association between Birth Route and Early/Late-onset Neonatal Sepsis in Term Infants: A Case-control Study in the NICU of a Tertiary Hospital in East Java, Indonesia

Background: In 2020, neonatal sepsis was recognized as the leading cause of neonatal death. The birth route can affect the variety of microbial flora in neonates. Microbial colonization through the birth canal is vital to reduce susceptibility to infection. This study aims to identify the association between the birth route and early and late-onset neonatal sepsis in term infants. Methods: This hospital-based case-control study was carried out on term infants diagnosed with neonatal sepsis at the NICU of a tertiary referral hospital in East Java from 1 January 2019 to 31 December 2019. Preterm neonates were excluded as they may be more likely to develop neonatal sepsis. The Chi-square test and odds ratio (OR) with a confidence interval of 95% (CI=95%) were used to analyze data. P-value 0.05 was considered statistically significant. Results: Of 54 patients with neonatal sepsis recruited, the majority had early-onset sepsis (63.0%) and cesarean section (C-section) delivery (66.7%). A significant association between birth route and neonatal sepsis onset (p=0.046) was found. However, no significant association was observed between birth route and neonatal sepsis (p=0.321). Term infants born via C-section were 3.25 times more at risk (95% CI 1.00 – 10.60) of early-onset neonatal sepsis than infants delivered vaginally. Conclusion: C-section delivery can increase the risk of early-onset neonatal sepsis in term infants.