Effect of case management on neonatal mortality due to sepsis and pneumonia

M.^Zaidi, Anita K.; Ganatra, Hammad A.; Syed, Sana; Cousens, Simon; Lee, Anne C. C.; Black, Robert; Bhutta, Zulfiqar A.; Lawn, Joy E.
January 2011
BMC Public Health;2011 Supplement 3, Vol. 11 Issue Suppl 3, p1
Academic Journal
Background: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). Methods: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. Results: Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in allcause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies) and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies). Two studies (1 RCT, 1 observational study), evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR= 0.56, 95% CI 0.41-0.77) and 34% (RR =0.66, 95% CI 0.47-0.93), but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents) effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were identified assessing effect of hospital management for neonatal infections and Delphi consensus suggested 80%, and 90% reductions for sepsis and pneumonia-specific mortality respectively. Conclusion: Oral antibiotics administered in the community are effective for neonatal pneumonia mortality reduction based on a meta-analysis, but expert opinion suggests much higher impact from injectable antibiotics in the community or primary care level and even higher for facility-based care. Despite feasibility and low cost, these interventions are not widely available in many low income countries. Funding: This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US.


Related Articles

  • Bacteriological Profile of Neonatal Septicaemia. Bajpai, Ankita // New Indian Journal of Surgery;Oct2011, Vol. 2 Issue 4, p222 

    Neonatal mortality rate is regarded as one of the indicators for measuring the health status of a nation. Septicaemia continues to be a major cause of neonatal mortality and morbidity worldwide. At present, in the developing countries, gram negative bacilli remain the major cause of neonatal...

  • First Outbreak of Nosocomial Legionella Infection in Term Neonates Caused by a Cold Mist Ultrasonic Humidifier. Yiallouros, Panayiotis K.; Papadouri, Thalia; Karaoli, Christina; Papamichael, Elena; Zeniou, Maria; Pieridou-Bagatzouni, Despo; Papageorgiou, Georgios T.; Pissarides, Nicolas; Harrison, Timothy G.; Hadjidemetriou, Andreas // Clinical Infectious Diseases;Jul2013, Vol. 57 Issue 1, p48 

    A cold-mist humidifier in a nursery caused the first outbreak of nosocomial Legionellosis in term neonates. Legionella pneumophila serogroups 3 and 1 infected 28% of exposed neonates, causing severe pneumonia or milder atypical symptoms, conferring a 33% overall mortality.Background To date, all...

  • Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan. Alam, Muhammad Matloob; Saleem, Ali Faisal; Shaikh, Abdul Sattar; Munir, Owais; Qadir, Maqbool // Journal of Infection in Developing Countries;Jan2014, Vol. 8 Issue 1, p67 

    Introduction: Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis (EONS), which is associated with increased neonatal morbidity and mortality. We reported the incidence and associated risk factors of PROM for culture-proven EONS. Methodology:The...

  • Nosocomial sepsis risk score for preterm infants in low-resource settings. Rosenberg, Rebecca E.; Ahmed, ASM Nawshad U.; Saha, Samir K.; Chowdhury, MAK Azad; Ahmed, Saifuddin; Law, Paul A.; Black, Robert E.; Santosham, Mathuram; Darmstadt, Gary L.; Ahmed, A S M Nawshad U; Chowdhury, M A K Azad // Journal of Tropical Pediatrics;Apr2010, Vol. 56 Issue 2, p82 

    Sepsis is a leading cause of mortality for neonates in developing countries; however, little research has focused on clinical predictors of nosocomial infection of preterm neonates in the low-resource setting. We sought to validate the only existing feasible score introduced by Singh et al. in...

  • Neonatal sepsis and multiple skin abscess in a newborn with Down's syndrome: A case report. Kali, Arunava; Umadevi, Sivaraman; Sreenivasan, Srirangaraj; Stephen, Selvaraj // Australasian Medical Journal;2013, Vol. 6 Issue 2, p91 

    Neonatal sepsis is a leading cause of neonatal mortality. Congenital heart disease accounts for additional risk of sepsis in neonates. Here we report a case of Down's syndrome with late onset neonatal sepsis associated with multiple superficial skin abscesses simulating staphylococcal infection....

  • Neonatal Sepsis: An Update. Kale, Anjali; Jaybhaye, Deepali; Bonde, Vijay // Proceedings of the National Academy of Sciences of Armenia. Mech;Winter2014, Vol. 4 Issue 4, p39 

    Sepsis is the most common cause of neonatal mortality. As per National Neonatal-Perinatal Database (NNPD), 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live births. Signs and symptoms of sepsis are nonspecific; therefore empirical antimicrobial therapy is promptly...

  • Incidence, Clinical Characteristics and Attributable Mortality of Persistent Bloodstream Infection in the Neonatal Intensive Care Unit. Hsu, Jen-Fu; Chu, Shih-Ming; Lee, Chiang-Wen; Yang, Pong-Hong; Lien, Reyin; Chiang, Ming-Chou; Fu, Ren-Huei; Huang, Hsuan-Rong; Tsai, Ming-Horng // PLoS ONE;Apr2015, Vol. 10 Issue 4, p1 

    Background: An atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection. Methods: All...

  • Heterologous Immunological Effects of Early BCG Vaccination in Low-Birth-Weight Infants in Guinea-Bissau: A Randomized-controlled Trial. Jensen, Kristoffer Jarlov; Larsen, Nanna; Biering-Sørensen, Sofie; Andersen, Andreas; Eriksen, Helle Brander; Monteiro, Ivan; Hougaard, David; Aaby, Peter; Netea, Mihai G.; Flanagan, Katie L.; Benn, Christine Stabell // Journal of Infectious Diseases;Mar2015, Vol. 211 Issue 6, p956 

    Background. Bacillus Calmette–Guérin (BCG) seems to have beneficial nonspecific effects; early BCG vaccination of low-birth-weight (LBW) newborns reduces neonatal mortality by >40% due to prevention of primarily septicemia and pneumonia.Methods. Within a randomized trial in LBW infants...

  • Neonatal Sepsis: An Update. Kale, Anjali; jaybhaye, Deepali; Bonde, Vijay // Iranian Journal of Neonatology;2014, Vol. 5 Issue 1, p39 

    Sepsis is the most common cause of neonatal mortality. As per National Neonatal-Perinatal Database (NNPD), 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live births. Signs and symptoms of sepsis are nonspecific; therefore empirical antimicrobial therapy is promptly...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics