Clinical characteristics of neonates with positive umbilical cord blood culture and negative peripheral blood culture: differentiation between clinical early-onset sepsis and contamination.
- 1Department of Clinical Laboratory, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
- 2Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
Abstract
Early-onset sepsis (EOS) is a major cause of neonatal morbidity and mortality. Umbilical cord blood culture (UCBC) has been proposed as an alternative diagnostic tool. Nevertheless, among neonates with positive UCBC but negative peripheral blood culture, some receive a clinical diagnosis of EOS whereas others are categorized as contamination. The differentiation between these two groups remains unclear. This study aimed to compare perinatal and clinical characteristics between clinical EOS and UCBC contamination in this specific cohort. This single-center retrospective study enrolled neonates delivered between January and December 2023. Among 23,000 live births, 2,083 high-risk neonates underwent UCBC. Subjects with positive UCBC and negative peripheral blood cultures were included. In this cohort, the diagnosis of clinical EOS was assigned by treating clinicians with knowledge of UCBC results, and defined as the presence of clinical manifestations with or without elevated C-reactive protein (CRP) or procalcitonin (PCT). contamination was defined by discordant aerobic/anaerobic cultures, isolation of common skin flora in the absence of clinical symptoms, or normal inflammatory markers. A random sample of 100 neonates with negative UCBC served as descriptive controls. Perinatal and clinical variables were compared across the three groups. Among the 2,083 neonates, 96 (4.6%) had positive UCBC, with all corresponding peripheral blood cultures yielding negative results. Of these 96 infants, 54 were clinically diagnosed with EOS and 42 with contamination. Neonates with clinical EOS had significantly lower gestational age (31.0 vs. 39.3 weeks), lower birth weight (1,545 vs. 3,285 g), and a higher proportion of premature rupture of membranes (PROM) ≥18 h (29.6% vs. 9.5%) compared with contamination (all P<0.05). Escherichia coli was the predominant pathogen in both groups (33.3% vs. 19.0%). Discordant aerobic/anaerobic culture results were also frequently observed in the contamination group (19.0%). In neonates with positive UCBC and negative peripheral blood culture, clinical EOS is associated with lower gestational age, lower birth weight, and prolonged PROM compared with contamination. UCBC results should be interpreted cautiously alongside these perinatal factors and clinical manifestations.
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BibTeX
@article{xu2026clinical,
title = {{Clinical characteristics of neonates with positive umbilical cord blood culture and negative peripheral blood culture: differentiation between clinical early-onset sepsis and contamination.}},
author = {Wenya Xu and Yanni Sun and Xiaoxiao Zhang and Lingbo Wang and Bo Zhu},
journal = {Translational pediatrics},
year = {2026},
month = oct,
doi = {10.21037/tp-2026-0658},
url = {https://europepmc.org/article/MED/42996368},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical characteristics of neonates with positive umbilical cord blood culture and negative peripheral blood culture: differentiation between clinical early-onset sepsis and contamination.
AU - Wenya Xu
AU - Yanni Sun
AU - Xiaoxiao Zhang
AU - Lingbo Wang
AU - Bo Zhu
PY - 2026
DA - 2026/10/19
JO - Translational pediatrics
DO - 10.21037/tp-2026-0658
UR - https://europepmc.org/article/MED/42996368
AB - Early-onset sepsis (EOS) is a major cause of neonatal morbidity and mortality. Umbilical cord blood culture (UCBC) has been proposed as an alternative diagnostic tool. Nevertheless, among neonates with positive UCBC but negative peripheral blood culture, some receive a clinical diagnosis of EOS whereas others are categorized as contamination. The differentiation between these two groups remains unclear. This study aimed to compare perinatal and clinical characteristics between clinical EOS and UCBC contamination in this specific cohort. This single-center retrospective study enrolled neonates delivered between January and December 2023. Among 23,000 live births, 2,083 high-risk neonates underwent UCBC. Subjects with positive UCBC and negative peripheral blood cultures were included. In this cohort, the diagnosis of clinical EOS was assigned by treating clinicians with knowledge of UCBC results, and defined as the presence of clinical manifestations with or without elevated C-reactive protein (CRP) or procalcitonin (PCT). contamination was defined by discordant aerobic/anaerobic cultures, isolation of common skin flora in the absence of clinical symptoms, or normal inflammatory markers. A random sample of 100 neonates with negative UCBC served as descriptive controls. Perinatal and clinical variables were compared across the three groups. Among the 2,083 neonates, 96 (4.6%) had positive UCBC, with all corresponding peripheral blood cultures yielding negative results. Of these 96 infants, 54 were clinically diagnosed with EOS and 42 with contamination. Neonates with clinical EOS had significantly lower gestational age (31.0 vs. 39.3 weeks), lower birth weight (1,545 vs. 3,285 g), and a higher proportion of premature rupture of membranes (PROM) ≥18 h (29.6% vs. 9.5%) compared with contamination (all P<0.05). Escherichia coli was the predominant pathogen in both groups (33.3% vs. 19.0%). Discordant aerobic/anaerobic culture results were also frequently observed in the contamination group (19.0%). In neonates with positive UCBC and negative peripheral blood culture, clinical EOS is associated with lower gestational age, lower birth weight, and prolonged PROM compared with contamination. UCBC results should be interpreted cautiously alongside these perinatal factors and clinical manifestations.
SN - 2224-4336
SN - 2224-4344
ER -