Effect of duration of rupture of membranes on early-onset neonatal sepsis and short-term outcomes

Vollständiger Abstract

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Background: Early-onset neonatal sepsis (EOS) remains a major contributor to neonatal mortality, disproportionately affecting low- and middle-income countries. Prolonged rupture of membranes (ROM) is a recognized risk factor, but integrated Indian data linking graded ROM duration, culture-confirmed sepsis and biomarkers such as red cell distribution width (RDW) remain limited. To evaluate the effect of ROM duration on EOS and short-term outcomes and the diagnostic utility of RDW, alone and combined with blood culture, for identifying at-risk neonates. Methods: This prospective observational study enrolled 195 neonates born to mothers with recognized intrapartum risk factors at a tertiary care institution in Tamil Nadu, India, from April 2024-October 2025. Maternal and neonatal data, blood cultures and complete blood counts including RDW were recorded and analyzed using chi-square/Fisher's exact and t-test/Mann-Whitney U tests; ROC analysis determined the optimal RDW cut-off. Results: Prolonged ROM was present in 40.0% of mothers; 53.8% of neonates had ROM ≥12 hours. Respiratory distress was the commonest feature (34.9%); 34.9% screened positive for sepsis. Cord culture positivity was 24.6% versus 20.5% for peripheral culture. Gram-negative organisms predominated (Pseudomonas 29.2%, Acinetobacter 22.9%). RDW was higher in septic neonates (19.1±2.4% vs. 16.7±1.8%; p