Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities

Abstract

Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low- and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.

Factors associated with early onset neonatal sepsis among neonates in public hospitals of Sidama region, Southern Ethiopia, 2021: Unmatched case control study

“…Early onset neonatal sepsis (cases): Neonates who were within one week of delivery were present with at least one of IMNCI criteria (Convulsion, respiratory rate>60 breath/min, sever chest in drawing, nasal flaring, grunting, bulging fontanels, pus draining from ear, redness around umbilicus extending to the skin, Temperature >37.5 °C or <35.5 °C, Lethargic or unconscious, Reduced movements, Not able to feed, Not attaching to breast and No sucking at all] and along with at least 2 of the hematological criteria; total leukocyte count (<4000 or >12000 cells/m, absolute neutrophil count (<1500 cells/mm3 or >7500 cells/mm3), erythrocyte sedimentation rate (ESR) (>15/1h) and platelet count (<150 or >440 cells/m3 were used for diagnosis of case [ 2 , 25 ].…”

“…A systemic infection that occurs within the first 28 days of life after birth is defined as neonatal sepsis [ 1 ]. Early neonatal sepsis appears within the first seven days of life, whereas late neonatal sepsis appears after the eighth day of life [ 2 , 3 ]. Every year, approximately 4 million children die in their first four weeks of life around the world, with 99% of deaths occurring in low- and middle-income countries and 75% of deaths considered preventable [ 4 ].…”

Mortality Risk Factors of Early Neonatal Sepsis During COVID-19 Pandemic

“…1 The global incidence of neonatal sepsis is 2824 per 100,000 live births according to data estimated in a recent meta-analysis. 2 The COVID-19 pandemic had an effect on all areas of medicine and the lives of humanity. For the period of 2021, a 7.0% increase in infant mortality was noted in Kazakhstan and amounted to 8.35 per 1000 live births against 7.79 for the same period in 2020, according to the report of the Ministry of Health of the Republic of Kazakhstan for 2021.…”

Early-Onset Neonatal Sepsis in Turkey: A Single-Center 7-Year Experience in Etiology and Antibiotic Susceptibility

“…The incidence of EOS was 0.32–0.97 per 1000 live births in Europe, comparable to reports from the USA (1.08/1000) and Australia (0.67/1000) [ 1 , 2 , 3 , 4 , 5 ]. However, its incidence remains higher in developing countries, where data is scarce [ 6 , 7 ]. In a systematic review by Khalil et al, EOS incidence in middle-income countries was 3.3–15.7 per 1000 live births in the Middle East region [ 6 ].…”

“…Although it has been shown that E. coli has become the most frequently detected pathogen in EOS of extremely preterm infants, the leading microorganism for EOS is still GBS in developed countries [ 4 , 8 ]. Evidence indicates that the pathogen distribution of EOS differs among developing and middle-income countries in the Middle East region and Asia, where GBS is less frequently reported, while Gram-negative pathogens, such as Klebsiella pneumoniae and E. coli , are the major pathogens and are less likely to be susceptible to currently recommended empirical antibiotic therapy [ 6 , 7 , 9 ].…”