Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention

ABSTRACT

Introduction: Sepsis accounts for up to one-third of neonatal deaths in the world each year. The World Health Organization acknowledges neonatal sepsis as a major global health concern, and that the highest burden occurs in low- and middle-income countries (LMICs). Despite major research and clinical progress in this area, we still lack accurate diagnostic tools for neonatal sepsis, complicating the management of this condition.

Areas covered: The purpose here is to review the latest data on the incidence, diagnosis, prevention, and management of neonatal sepsis in LMIC. We discuss the limitations of current diagnostic tests – including their lack of availability – and how this may influence global estimates of cases. We review the benefits of antenatal, intrapartum, and post-natal preventive measures. We briefly discuss the management, highlighting the emergence of antimicrobial resistance. Finally, we expose some high priority areas.

Expert opinion: Neonatal sepsis is a challenging condition requiring a multifaceted approach to address the major diagnostic issues, but also the underlying socio-economic causes that nourish epidemic cases in LMIC. Focusing on antibiotics as a main pillar of intervention is likely to engender antimicrobial resistance, eventually hindering the appreciable gains LMICs have achieved in neonatal health outcomes.

KEYWORDS:

• Neonatal sepsis
• low- and middle-income countries
• neonatal sepsis epidemiology
• neonatal sepsis diagnosis and antimicrobial resistance

Article highlights

• Sepsis is a major global killer, with estimated 3 million neonatal cases and between 500,000 and 900,000 neonatal deaths per year worldwide.

• Global mortality estimates are fraught with major diagnostic uncertainty, which limits our understanding of its epidemiology and associated risk factors.

• Management options remain rudimentary in newborns, mainly consisting of early antibiotics and supportive treatment, which is problematic in view of the growing antimicrobial resistance.

• Efforts should focus on prevention and the strengthening of primary health systems, addressing underlying socio-economic disparities and considering cultural nuances.

Acknowledgments

Our team is funded by a grant from Grand Challenges Canada; PML is supported by Investigator Awards from the BC Children’s Hospital Research Institute and the Michael Smith Foundation for Health Research.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.