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Clinical characteristics of neonates with positive umbilical cord blood culture and negative peripheral blood culture: differentiation between clinical early-onset sepsis and contamination

Year: 2026

Type: article

Abstract: Background: 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. Methods: 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. Results: 19.0%). Discordant aerobic/anaerobic culture results were also frequently observed in the contamination group (19.0%). Conclusions: 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.

Source: Translational Pediatrics

DOI: 10.21037/tp-2026-0658

Authors: Wenya Xu, Yanni Sun, Xiaoxiao Zhang, Lingbo Wang, Bo Zhu

Institutions: Women's Hospital, School of Medicine, Zhejiang University, Zhejiang University, Zhejiang Center for Disease Control and Prevention

Language: English

Topic: Neonatal and Maternal Infections

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7223383155

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