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

In 2020, neonatal sepsis was recognized as the leading cause of neonatal death. The birth route canaffect the variety of microbial flora in neonates. Microbial colonization through the birth canal is vital to reducesusceptibility to infection. This study aims to identify the association between the birth route and early and late-onsetneonatal sepsis in term infants. This hospital-based case-control study was carried out on term infants diagnosed with neonatal sepsis at theNICU of a tertiary referral hospital in East Java from 1 January 2019 to 31 December 2019. Preterm neonates wereexcluded as they may be more likely to develop neonatal sepsis. The Chi-square test and odds ratio (OR) with aconfidence interval of 95% (CI=95%) were used to analyze data. P-value <0.05 was considered statistically significant.  Of 54 patients with neonatal sepsis recruited, the majority had early-onset sepsis (63.0%) and cesareansection (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). Terminfants born via C-section were 3.25 times more at risk (95% CI 1.00 – 10.60) of early-onset neonatal sepsis thaninfants delivered vaginally.  C-section delivery can increase the risk of early-onset neonatal sepsis in term infants.