Abstract
Because jaundice may be an early manifestation of neonatal sepsis, empiric antibiotic therapy is frequently initiated, often in the absence of microbiological confirmation. The clinical significance of blood culture positivity in jaundiced neonates, however, remains insufficiently characterized. To evaluate the association between blood culture positivity and adverse clinical outcomes among neonates admitted with jaundice and to assess implications for antibiotic stewardship in a resource limited NICU. This retrospective observational cohort study included 89 neonates admitted with jaundice to a tertiary NICU in Tripoli, Libya, between January and June 2025. Associations between Blood Culture Positivity and Adverse Outcomes were evaluated using bivariate analysis and multivariable logistic regression adjusting for prematurity and low birth weight. Blood cultures were obtained in 38 neonates (42.7%), of whom (14.6%) had culture-confirmed bacteremia. Klebsiella spp. and Staphylococcus spp. were the most frequently isolated organisms. Culture-positive infants had significantly higher rates of early-onset sepsis compared with culture-negative or untested infants (38.5% vs. 5.3%, p<0.01). After adjustment, blood culture positivity remained independently associated with the composite adverse outcome (adjusted OR 28.4; 95% CI 7.9–102.0; p<0.001). Conclusion: Blood culture positivity identifies a high-risk subgroup of jaundiced neonates with substantially increased odds of adverse outcomes. Despite universal empiric antibiotic use, more than half of infants were not cultured, highlighting an important stewardship gap to improve neonatal outcomes in resource-limited NICUs.