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Pediatr Res. 2013 Dec;74 Suppl 1:73-85. doi: 10.1038/pr.2013.207.

Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010.

Author information

1
1] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK [2] KEMRI-Wellcome Trust Centre for Geographic Medicine and Research-Coast, Kilifi, Kenya.
2
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
3
Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
4
Bill and Melinda Gates Foundation, Seattle, Washington.
5
1] KEMRI-Wellcome Trust Centre for Geographic Medicine and Research-Coast, Kilifi, Kenya [2] Department of Psychiatry, University of Oxford, Oxford, UK.
6
St George's Hospital, London, UK.
7
Emory and Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
8
1] Saving Newborn Lives/Save the Children, Washington, DC [2] Centre for Maternal Reproductive & Child Health, London School of Hygiene and Tropical Medicine, London, UK.

Abstract

BACKGROUND:

Survivors of neonatal infections are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified and yet important for program priority setting. Systematic reviews and meta-analyses were undertaken and applied in a three-step compartmental model to estimate NDI cases after severe neonatal bacterial infection in South Asia, sub-Saharan Africa, and Latin America in neonates of >32 wk gestation (or >1,500 g).

METHODS:

We estimated cases of sepsis, meningitis, pneumonia, or no severe bacterial infection from among estimated cases of possible severe bacterial infection ((pSBI) step 1). We applied respective case fatality risks ((CFRs) step 2) and the NDI risk among survivors (step 3). For neonatal tetanus, incidence estimates were based on the estimated deaths, CFRs, and risk of subsequent NDI.

RESULTS:

For 2010, we estimated 1.7 million (uncertainty range: 1.1-2.4 million) cases of neonatal sepsis, 200,000 (21,000-350,000) cases of meningitis, 510,000 cases (150,000-930,000) of pneumonia, and 79,000 cases (70,000-930,000) of tetanus in neonates >32 wk gestation (or >1,500 g). Among the survivors, we estimated moderate to severe NDI after neonatal meningitis in 23% (95% confidence interval: 19-26%) of survivors, 18,000 (2,700-35,000) cases, and after neonatal tetanus in 16% (6-27%), 4,700 cases (1,700-8,900).

CONCLUSION:

Data are lacking for impairment after neonatal sepsis and pneumonia, especially among those of >32 wk gestation. Improved recognition and treatment of pSBI will reduce neonatal mortality. Lack of follow-up data for survivors of severe bacterial infections, particularly sepsis, was striking. Given the high incidence of sepsis, even minor NDI would be of major public health importance. Prevention of neonatal infection, improved case management, and support for children with NDI are all important strategies, currently receiving limited policy attention.

PMID:
24366464
PMCID:
PMC3873707
DOI:
10.1038/pr.2013.207
[Indexed for MEDLINE]
Free PMC Article

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