Low Birth Weight, Lack of Breastfeeding Fuel Infection Rates in India.
Although India has increased the percentage of babies born in hospitals and other facilities, 6 percent of infants have possible serious bacterial infection (PSBI), with low birth weight, mothers who present late to antenatal care, and the lack of early initiation of breastfeeding among key risk factors, according to a study led by a School of Public Health researcher.
The study, BMC Public Health, examined the incidence of PSBI in 20 rural primary health centers around Nagpur, India. Of 37,379 live singleton births, 2,123 met the criteria for PSBI, and 493 of those babies died. Among infants with PSBI, breathing problems were the most common symptom reported, followed by fever and feeding problems.
The research team, led by Patricia Hibberd, professor and chair of global health, found that the risk of infection was increased for mothers who were younger than 20 years old; had never given birth before or had more than two prior viable pregnancies; had no antenatal care or had a first care visit during the second or third trimester; or had received corticosteroids during pregnancy. Infant characteristics associated with PSBI included low birth weight, lack of early initiation of breastfeeding, and male gender.
“Since neonatal infections are the third most common cause of neonatal deaths worldwide and the leading cause of death in the late neonatal period (7-27 days), achieving significant reductions in neonatal mortality requires improvements in the identification and treatment of neonatal infections,” the study team wrote.
Infants and mothers at high risk “could be targeted for interventions, before and after delivery, to improve early recognition of signs and symptoms of PSBI and prompt referral.” In addition, the authors said, the findings suggest the need for “a renewed focus” on promoting early initiation of breastfeeding.
Serious bacterial infection, such as meningitis, pneumonia and sepsis, is a significant cause of illness and death in newborns. Worldwide, there were an estimated 6.9 million cases in 2012, and each year, serious bacterial infection is responsible for one-fifth of neonatal deaths. Diagnosis is challenging even in high-resource settings because signs and symptoms are often non-specific, the authors said.
“Early diagnosis and treatment could save hundreds of thousands of lives,” they wrote.
In an unexpected finding, the researchers found an association between C-section delivery and PSBI, with a lower rate of infection among babies born by C-section. Differences in breastfeeding may have contributed to that finding, the authors said.
They also urged further study of antenatal corticosteroids during pregnancy and their association with neonatal infection, saying use of the steroids is being “scaled up in low-resource settings.”
The research was supported by funding from the National Institutes of Health. The lead author of the study was Marie Wang of Boston Children’s Hospital and Massachusetts General Hospital. Co-authors were from Lata Medical Research Foundation in India and RTI International.