Antenatal inflammatory markers as early warning tools for neonatal sepsis: implications for nursing practice in low-resource settings

Background . Early-onset neonatal sepsis (EONS) remains a leading cause of neonatal morbidity and mortality, particularly in low-resource settings. Maternal inflammation may play a crucial role in priming the neonatal immune response. This study investigated the predictive value of maternal and neonatal inflammatory biomarkers for neonatal sepsis. Aim : To evaluate the predictive value of maternal and umbilical cord inflammatory biomarkers for early detection of early-onset neonatal sepsis. Materials and Methods . A total of 117 mother-infant pairs comprising 82 neonates with sepsis and 35 non-septic neonates were enrolled. Maternal venous blood was collected at 37–39 weeks of gestation and umbilical cord blood at delivery. C-reactive protein (CRP), procalcitonin (PCT), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α) were quantified using ELISA. Neonates were monitored for 28 days for clinical or culture-confirmed sepsis. Diagnostic performance of biomarkers was assessed using ROC-analysis in one-factor models of logistic regression. Results . Maternal and cord levels of CRP, PCT, IL-6, and TNF-α were significantly higher among neonates who developed EONS compared to non-septic infants. Maternal CRP and IL-6 demonstrated strong predictive ability, while cord CRP and PCT showed excellent diagnostic quality (AUC 0.90 and 0.88, respectively). Multivariate analysis identified maternal CRP and ANC visits in EONS. Conclusion . Maternal and umbilical cord inflammatory markers, especially CRP and IL-6, provide clinically useful early indicators of EONS risk. Integrating maternal biomarker screening into routine antenatal assessment may facilitate earlier detection and intervention in resource-limited neonatal care settings.