Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations

Abstract

Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance – making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.

Keywords:

• neonate
• low- and middle-income countries
• antimicrobial resistance
• outcomes
• sepsis

Abbreviations

LMIC, Low- and middle-income country; HIC, High-income country; CSF, Cerebrospinal fluid; CRP, C-reactive protein; EOD, Early-onset disease; LOD, Late-onset disease; NICE, National Institute for Health and Care Excellence; GBS, Group B Streptococcus; CONS, Coagulase-negative Staphylococci; PCT, Procalcitonin; RR, Relative risk; bCPAP, Bubble continuous positive airway pressure; NG, Nasogastric; IV, Intravenous; TPN, Total parenteral nutrition; FICare, Family-integrated care; KMC, Kangaroo mother care; NICU: Neonatal intensive care unit.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Wellcome Trust (reference 228357/Z/23/Z) as part of the CREATE PhD Scheme.