Factors Associated with Neonatal Healthcare-Associated Infections (HAIs) in India: A Protocol for Systematic Review and Meta-analysis

Introduction: Neonatal healthcare-associated infections (HAIs) is one of the leading causes of preventable neonatal mortality in developing nations. This systematic review aims to critically appraise and consolidate the list of risk factors associated with neonatal HAIs in India. Materials and methods: We will conduct electronic medical database searches. Studies in the English language, reporting outbreak/ surveillance/ risk factor/ determinants, reporting HAIs among neonates in India, using CDC or WHO driven diagnosis will be considered for inclusion. Two independent authors will screen the title, abstract and full text of the articles from databases. Articles quality will be assessed using National Heart, Lung and Blood Institute criteria and GRADE method. Narrative synthesis, along with descriptive statistics, adopting a random-effects model for meta-analysis anticipating heterogeneity, will be carried out. If the number of studies is more (>10), we will assess publication bias using the funnel plot and degree of symmetry by Egger's test. Discussion: The burden of neonatal HAIs in South Asian countries, and India is high. It is one of the leading causes of neonatal mortality. There is a dearth of knowledge related to factors contributing to neonatal HAIs in India. The protocol provides a detailed methodology followed by a precise, appropriate statistical analytics tool to be used. Systematic review registration: PROSPERO CRD42017072861 KEYWORDS: Systematic review, Protocol, Neonate, Nosocomial Infection, Healthcare-Associated Infections, India, Determinant, Risk Factor, Epidemiology, NICU