EARLY-ONSET NEONATAL SEPSIS: MATERNAL RISK FACTORS AND INTRAPARTUM PREVENTION

Abstract

Early-onset neonatal sepsis remains a severe condition whose risk is strongly shaped by events occurring before and during birth. This narrative review aimed to analyze maternal risk factors associated with early-onset neonatal sepsis and to discuss intrapartum preventive strategies, with emphasis on Group B Streptococcus, intraamniotic infection, intrapartum fever, prolonged rupture of membranes, and preterm birth. PubMed/MEDLINE, SciELO, and current guidance from obstetric, pediatric, and international health organizations were consulted, prioritizing recent guidelines, systematic reviews, surveillance studies, and including Brazilian data and normative documents. The evidence shows that maternal Group B Streptococcus colonization is the best-established modifiable pathway for pathogen-specific prevention, while intraamniotic infection, fever, membrane rupture duration, and prematurity interact to increase neonatal risk. Universal culture-based screening followed by indicated intrapartum antibiotic prophylaxis reduces early-onset Group B Streptococcus disease, but residual cases occur after negative screening and prophylaxis does not prevent infections caused by other organisms, particularly Escherichia coli in preterm infants. Prevention therefore depends on accurate antenatal screening, timely indication and selection of intrapartum antimicrobials, recognition and treatment of suspected intraamniotic infection, avoidance of unnecessary antibiotic exposure, and reliable obstetric-neonatal communication. A risk-continuum approach is more clinically coherent than isolated maternal risk-factor checklists.