The Effect of Premature Rupture of Membranes on Neonatal Sepsis: A Propensity Score Matched Analysis

Abstract Introduction: Premature rupture of membranes (PROM), defined as rupture of the fetal membranes before the onset of labour, complicates about 5–10% of pregnancies and is associated with increased risk of neonatal infection and sepsis. PROM compromises the protective intra-amniotic barrier and facilitates ascending microbial invasion, elevating the likelihood of neonatal sepsis, particularly with prolonged rupture or preterm PROM. Despite advances in maternal and neonatal care, evidence on the causal effect of PROM on neonatal sepsis remains limited by confounding in observational studies, highlighting the need for robust analytical approaches to better inform clinical management. Methods A cross-sectional study was conducted in three hospitals in the North Wollo and Wagehemira zones of the Amhara National Regional State, Ethiopia, reviewing 1037 neonatal records from October 2023 to June 2024. Propensity score matching was used to estimate the effect of premature rupture of membranes (PROM) on neonatal sepsis by balancing observed confounders between exposed and unexposed groups. Propensity scores were estimated using logistic regression including key maternal and neonatal covariates, and matching was performed with a caliper-based approach. Covariate balance was assessed using standardized mean differences (< 0.1 indicating adequate balance), and the effect of PROM on neonatal sepsis was estimated in the matched sample using logistic regression. Analysis was performed in R with significance set at p < 0.05. Results Among 1 037 neonates, 238 (23%) were born to mothers with PROM. In the unmatched analysis, neonates exposed to PROM had an 18.51% higher risk of neonatal sepsis compared with those unexposed (44.11% vs 25.61%, p < 0.001). After propensity score matching, the ATT values in the treated and control groups were 45.79% and 25.63%, respectively, indicating that neonatal sepsis among births to mothers with PROM was 20.17% higher than births to mothers without PROM. Conclusions After adjusting for key maternal and neonatal characteristics, PROM was associated with a substantially increased risk of neonatal sepsis. These results underscore the need for early identification and management of PROM in antenatal and delivery care to reduce sepsis risk. Strengthening maternal infection screening, timely referral, and appropriate clinical care may help mitigate this burden.