Nasopharyngeal colonization at birth and the development of early-onset neonatal sepsis

Main Article Content

Andi Dwi Bahagia Febriani
Nilam Sartika Putri
Ema Alasiry
Dasril Daud


Background Neonatal sepsis is one of the major causes of morbidity and mortality in neonates. Exposure to maternal bacteria during pregnancy or delivery allows for colonization of the normal upper airway. Such bacteria become the major ecological species in the infant. If the colonizing bacteria invade the bloodstream, early-onset neonatal sepsis (EONS) could occur.

Objective To evaluate for an association between colonization of the newborn nasopharynx and EONS, as well as for agreement between nasopharyngeal swab culture and blood culture isolate results.

Methods This prospective cohort study was conducted in Dr. Wahidin Sudirohusodo General Hospital and Ibnu Sina Hospital, Makassar, South Sulawesi. Nasopharyngeal swab culture was taken within 2 hours of life from newborns who met the inclusion criteria, then they were followed up for signs of EONS. Blood culture was taken from subject with EONS.

Results Of the 100 newborns, 69 (69%) had nasopharyngeal bacterial colonization, of whom 5.8% (4/69) experienced EONS. Of the remaining 31 (31%) without colonization, 9.7% (3/31) experienced EONS. There was no significant difference in frequency of EONS between newborns with and without nasopharyngeal colonization. Although Gram-negative bacteria were predominant among colonized newborns, there was no significant difference to numbers of Gram-positive bacteria as a causative agent of EONS. Only one patient with EONS had the same bacterial species in both the nasopharynx and blood culture isolate.

Conclusion  Newborn nasopharyngeal colonization at birth is not associated with EONS.

Article Details

How to Cite
Febriani ADB, Putri NS, Alasiry E, Daud D. Nasopharyngeal colonization at birth and the development of early-onset neonatal sepsis. PI [Internet]. 12Oct.2020 [cited 26Jan.2021];60(6). Available from:
Received 2020-04-21
Accepted 2020-10-12
Published 2020-10-12


Nussbaum C, Gloning A, Pruenster M, Frommhold D, Bierschenk S, Genzel-Boroviczeny O, et al. Neutrophil and endothelial adhesive function during human fetal ontogeny. J Leukoc Biol. 2013;93:175–84. DOI: 10.1189/jlb.0912468.
2. Yang MJ, Sun PL, Wen KC, Chao KC, Chang WH, Chen CY, et al. Prevalence of maternal group B streptococcus colonization and vertical transmission in low-risk women in a single institute. J Chinese Med Assoc. 2012;75:25–8. DOI: 10.1016/j.jcma.2011.10.011.
3. Febriani ADB, Handriyati1 A, Alasiry E, Daud D. The correlation between the mother’s vaginal bacterial colonization and incidence of early onset neonatal sepsis. Curr Pediatr Res. 2017;21:105–11.
4. UNICEF, BAPPENAS. The Situation of Children and Women in Indonesia 2000-2010: Working Towards Progress with Equity Under Decentralisation. 2011.
5. Anderson-Berry AL, Bellig LL, Ohning BL. Neonatal Sepsis: Background, Pathophysiology, Etiology [Internet]. Neonatal sepsis. 2015 [cited 2019 Jul 23]. Available from:
6. Pusponegoro TS. Sepsis pada Neonatus (Sepsis Neonatal). Sari Pediatr. 2017;2:96. DOI: doi:10.14238/sp2.2.2000.96-102.
7. Nitsch-Osuch A, Choroszy-Król I, Kuchar E, Korzeniewski K, Zycińska K, Wardyn K. Microbiological spectrum and susceptibility pattern of clinical isolates from the neonatal unit in a single medical center. Adv Clin Exp Med. 2015;24:15-22. DOI: 10.17219/acem/38170.
8. García-Rodríguez JA, Fresnadillo Martínez MJ. Dynamics of nasopharyngeal colonization by potential respiratory pathogens. J Antimicrob Chemother. 2002;50 Suppl S:59-73. DOI: 10.1093/jac/dkf506.
9. Kerur BM, Vishnu Bhat B, Harish BN, Habeebullah S, Uday Kumar C. Maternal genital bacteria and surface colonization in early neonatal sepsis. Indian J Pediatr. 2006;73:29-32. DOI: 10.1007/BF02758256.
10. Marchant EA, Boyce GK, Sadarangani M, Lavoie PM. Neonatal sepsis due to coagulase-negative staphylococci. Clin Dev Immunol. 2013;2013. DOI: 10.1155/2013/586076.
11. Leshem E, Maayan-Metzger A, Rahav G, Dolitzki M, Kuint J, Roytman Y, et al. Transmission of staphylococcus aureus from mothers to newborns. Pediatr Infect Dis J. 2012;31:360-3. DOI: 10.1097/INF.0b013e318244020e.
12. Chan GJ, Lee ACC, Baqui AH, Tan J, Black RE. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: A systematic review and meta-analysis. BMC Infect Dis. 2015;15:1-16. DOI: 10.1186/s12879-015-0813-3.
13. Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010;107:11971-5. DOI: 10.1073/pnas.1002601107.
14. Makhoul IR, Sprecher H, Sawaid R, Jakobi P, Smolkin T, Sujov P, et al. Early-onset group B streptococcus sepsis in high risk neonates born after prolonged rupture of membranes. Isr Med Assoc J. 2009;11:34-8. PMID: 19344010.
15. Malik A, Kothari C, Paulose A, Fogel J, Boxer H, Brinda Doraiswamy. Neonatal Nasopharyngeal Colonization with Group B Streptococcus and its Association with Clinical Sepsis. Am J Perinatol. 2016;33:800-7. DOI: 10.1055/s-0036-1572432.
16. Parm U, Metsvaht T, Sepp E, Ilmoja M-L, Pisarev H, Pauskar M, et al. Risk factors associated with gut and nasopharyngeal colonization by common Gram-negative species and yeasts in neonatal intensive care units patients. Early Hum Dev. 2011;87:391-9. DOI: 10.1016/j.earlhumdev.2011.02.007.
17. Juniatiningsih A, Aminullah A, Firmansyah A. Profil Mikroorganisme Penyebab Sepsis Neonatorum di Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo Jakarta. Sari Pediatr. 2016;10:60. DOI: 10.14238/sp10.1.2008.60-5.
18. Ramesh Bhat Y, Baby LP. Early onset of neonatal sepsis: Analysis of the risk factors and the bacterial isolates by using the BacT alert system. J Clin Diagnostic Res. 2011;5:1385-8. DOI: 10.1186/1824-7288-37-32.
19. Ety Apriliana, Prambudi Rukmiono, Devi Nulia Erdian FT. Bakteri Penyebab Sepsis Neonatorum Dan Pola Kepekaannya Terhadap Antibiotika. Lemb Penelit Univ Lampung. 2013;583-91.