Predictors of death in infants with probable serious bacterial infection

BACKGROUND: Bacterial infections account for a significant proportion of neonatal and infant mortality globally. We aimed to identify predictors of death in infants with probable serious bacterial infection (PSBI) defined as signs/symptoms of possible serious bacterial infection along with baseline C-reactive protein (CRP) >= 12 mg/l. METHODS: We did a secondary analysis using the data collected from 700 infants with PSBI who participated in a randomized controlled trial in India in which zinc or placebo was given in addition to the standard antibiotics. Logistic regression was used to estimate the associations between relevant variables and death within 21 days. RESULTS: Those infants who were fed cow's milk or formula before the illness episode had 3.7 fold (95% confidence interval (Cl) 1.5-9.3) and 5.3-fold (95% Cl 2.0-13.6) higher odds of death, respectively. Lethargy (odds ratio (OR) 2.4, 95% Cl 1.1-5.4) and CRP (OR 1.9, 95% Cl 1.1-3.3) were also independent predictors of death. In the model including only clinical features, female gender (OR 2.25, 95% Cl 1.0-5.0), abdominal distention (3.7, 95% Cl 1.1-12.3), and bulging fontanelle (5.8, 95% Cl 1.1-30.5) were also independent predictors for death. CONCLUSION: Formula or cow milk feeding prior to the illness, lethargy at the time of presentation, and high serum CRP levels predicted death in infants with PSBI.