Prevalence and risk factors for neonatal sepsis among very preterm infants in China: a systematic review and meta-analysis

Background: Neonatal sepsis poses a significant risk to very preterm infants (VPIs, gestational age < 32 weeks) in China, with limited nationwide data on its incidence and risk factors. This study aimed to address this gap through a systematic review and meta-analysis to inform prevention strategies. Methods: statistics, while publication bias was evaluated with funnel plots and Egger's test. Subgroup analyses were conducted to identify sources of heterogeneity. Results: = -0.46, 95% CI: (-0.64, -0.27)], chorioamnionitis (OR 3.10, 95% CI: 2.72-3.54), premature rupture of membranes (PROM) (OR 1.51, 95% CI: 1.12-2.04), administration of antenatal antibiotics (OR 1.38, 95% CI: 1.22-1.56), and the requirement for endotracheal intubation (OR 5.87, 95% CI: 3.84-8.97). Conclusions: Sepsis imposes a substantial burden on Chinese VPIs, characterized by a highly heterogeneous incidence. The principal risk factors for EOS include lower gestational age, lower birth weight, chorioamnionitis, PROM, antenatal antibiotic administration, and endotracheal intubation. These findings furnish essential evidence for the development of risk prediction models and stratified management strategies for EOS in VPIs. Systematic trial registration: The systematic review and meta-analysis were registered with PROSPERO (ID: CRD420251018993).