Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis

Abstract

ObjectiveCurrent knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors.MethodsWe performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs.ResultsThe search yielded 6314 publications, of which 240 studies (N = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17–19%). The CFR was highest for low-income countries [25% (95% CI, 7–43%)], followed by lower-middle [25% (95% CI, 7–43%)], upper-middle [21% (95% CI, 18–24%)] and lowest for high-income countries [12% (95% CI, 11–13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time.ConclusionYoung infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions.Systematic Review Registration[www.crd.york.ac.uk/prospero], identifier [CRD42020164321].

Predictors of Mortality in Early Neonatal Sepsis: A Single-Center Experience

“…With more than 1.2 million cases per year [ 22 ] and 25% of fatal outcomes worldwide [ 23 ], it remains among the leading causes of childhood mortality. It is important to acknowledge that 84% of infant deaths due to sepsis are preventable [ 24 ], and the understanding of its risk profile may contribute to the development of risk-prediction models aimed at improving the overall survival of this group of patients.…”

“…The incidence of a fatal outcome increases as birth weight decreases. In a systematic review with a meta-analysis of 240 studies, the highest case fatality rate of 24% was observed in the group of patients with very low birth weight (<1500 g), while the incidence rate was the lowest, at 15%, in infants with a birth weight ≥2500 g [ 24 ]. The average birth weight in our case group was 882.8 ± 372.2, indicating the possibility of a high mortality rate.…”

Myocardial dysfunction as a component of multiple organ discrepancy with neonatal sepsis

“…ƍ ƄƊźƠƇźƏ ƟƁ ƋſƊſžƇƟƆ Ɵ ƇƂƁƖƄƂƆ ƊƟżƇſƆ žƈƏƈžƍ [5]. ŭƋƌźƇƈżƅſƇƈ, Ɠƈ ƆƟƈƄźƊžƟźƅƖƇź žƂƋƎƍƇƄƐƟƙ (ŦŞ) ƉƊƂ ƇſƈƇźƌźƅƖƇƈƆƍ ƋſƉƋƂƋƟ (ŧū) ƉƊƂƁżƈ-žƂƌƖ žƈ žżƈƊźƁƈżƈŽƈ ƁŻƟƅƖƒſƇƇƙ ƉƈƄźƁƇƂƄź Ɔź-ƅƘƄƈżƂƏ żƌƊźƌ [11], ź ƉƟžƌƊƂƆźƇƇƙ žƈƋƌźƌƇƖƈŽƈ ƋſƊƐſżƈŽƈ żƂƄƂžƍ Ɲ ƇźžƁżƂƑźƃƇƈ żźƀƅƂżƂƆ ƉƊſ-žƂƄƌƈƊƈƆ żƂƀƂżźƇƇƙ ƏżƈƊƂƏ Ƈź ŧū [9].…”

Reducing Antibiotic Exposure at the Beginning of Life

“…Concerns centered around the particular vulnerability of the newborn to infections led to a range of programs targeting early-onset sepsis (EOS), usually applying a low threshold to treat. In highincome countries, the mortality associated with EOS in term and near-term newborns is low, 2 and powering trials to prevent and treat EOS for such outcomes is becoming almost impossible.…”

“…Concerns centered around the particular vulnerability of the newborn to infections led to a range of programs targeting early-onset sepsis (EOS), usually applying a low threshold to treat. In high-income countries, the mortality associated with EOS in term and near-term newborns is low, and powering trials to prevent and treat EOS for such outcomes is becoming almost impossible. Conversely, available evidence indicates that overtreatment with antibiotics remains highly common, exposing large numbers of neonates to antibiotics with unwanted effects, such as drug-related toxic effects, alteration of the neonatal microbiome, unnecessary hospitalizations, and increasing antimicrobial resistance.…”