Neonatal sepsis describes the whole-body inflammatory response due to systemic infections. Such infections may be acquired both before and during delivery, as well as in the postpartum period from infectious agents in the environment.[6] Sepsis that occurs within neonates 72 hours after birth is classified as late-onset sepsis (LOS), as opposed to early-onset sepsis (EOS), which occurs within 72 hours post-birth. LOS is found to be at least 5 times more prevalent than EOS in both developed and developing countries.[7] There is a window of opportunity between birth and occurrence of LOS where methods for timely detection of LOS can be most useful in guiding subsequent medical interventions.[8] Within this window, neonates may have already contracted the infection, but physical symptoms such as fever, respiratory distress, grunting, or hypothermia may only occur after a few days from the initial onset.[9] The rapid progression of sepsis from systemic inflammatory response to septic shock and multiple organ failure can occur in a matter of hours, making early detection of neonatal sepsis vital in ensuring neonates receive medical treatment. The neonate’s immature immune system further exacerbates the progression of this condition. Though not all septic cases lead to death, delayed medical treatment may cause morbidities such as neurodevelopmental impairment, hearing loss, and cognitive delays.[10] In early postpartum home visits conducted by CHWs, neonates are assessed for signs of serious illnesses, while their families are also provided appropriate referrals and counselling on neonatal care and when to seek medical treatment.[11] The World Health Organization (WHO) has published a set of Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines that many CHWs are trained to adopt as they conduct their home visits.[12] The WHO and United Nations Children’s Fund (UNICEF) recommend early postnatal visits be conducted by CHWs on days 1, 3, and 7 after birth.[13] However, many areas in Asia and SSA face shortages in health workers;[14] given the challenges of providing care in these rural settings, many CHWs are unable to conduct frequent visits.[15] The team deduced that the lack of neonatal care within communities is the primary explanation for many cases of neonatal sepsis being unreported until it is too late for treatment. Furthermore, despite WHO standards of CHW postpartum visitations, the steep progression rate of sepsis means that home visits alone are inadequate for early detection of sepsis. Symptoms of sepsis are broad and unspecific. As a result, diagnosis of neonatal sepsis is not practiced in community-level settings. In tertiary medical facilities, the current gold standard for diagnosis of sepsis is a blood culture test, which can take up to 48 hours. Critical vital signs such as heart rate, respiratory rate, mean systolic blood pressure, and temperature are often used as pre-indicators for neonatal sepsis.[16,17] More recently, studies have shown heart rate variability and transient heart rate decelerations to be potentially effective indicators.[18]

1. United Nations. Department of Economic and Social Affairs. (2015). The Millennium Development Goals Report 2015. United Nations Publications.

2. Lawn, J. E., Cousens, S., & Zupan, J. 4 million neonatal deaths: When? Where? Why? The Lancet, 365(9462), 891-900. doi:http://dx.doi.org/10.1016/S0140-6736(05)71048-5

3. Montagu, D., Yamey, G., Visconti, A., Harding, A., & Yoong, J. (2011). Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data. PLoS ONE.

4. Bang, A. T., Bang, R. A., Baitule, S. B., Reddy, M. H., & Deshmukh, M. D. (1999). Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. The Lancet, 354(9194), 1955-1961. doi:http://dx.doi.org/10.1016/S0140-6736(99)03046-9

5. Interview with Dr. Eric McCollum

6. Anderson-Berry, A. (2014, February 11). Neonatal Sepsis. Retrieved October 3, 2015.

7. Hornik, C. P., Fort, P., Clark, R. H., Watt, K., Benjamin, D. K., Smith, P. B., ... & Cohen-Wolkowiez, M. (2012). Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early human development, 88, S69-S74. Pg 32.

8. Interview with Dr. Acharya and Neha Goel.

9. Gerdes, J. S. (2004). Diagnosis and management of bacterial infections in the neonate. Pediatric Clinics of North America, 51(4), 939.

10. Simonsen, K. A., Anderson-Berry, A. L., Delair, S. F., & Davies, H. D. (2014). Early-onset neonatal sepsis. Clinical microbiology reviews, 27(1), 21-47.

11. Ganatra, H. A., Stoll, B. J., & Zaidi, A. K. (2010). International perspective on early-onset neonatal sepsis. Clinics in Perinatology, 37(2), 501.

12. WHO Department of Child and Adolescent Health and Development (CAH), MOHFW (2003). Student's handbook for Integrated management of neonatal and childhood illness.

13. Newborns: Reducing mortality. WHO (2012, May 1). Retrieved September 12, 2015, from http://www.who.int/mediacentre/factsheets/fs333/en/

14. Lassi, Z. S., Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reproductive health, 11(Suppl 2), S2.

15. Doskoch, P. (2009). Early Postpartum Visits from Community Health Workers Reduce Neonatal Mortality in Bangladesh. International Perspectives on Sexual and Reproductive Health, 35(4), 208.

16. Yapicioglu, H., Ozlü, F., & Sertdemir, Y. (2014). Are vital signs indicative for bacteremia in newborns? The Journal of Maternal-Fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 1.

17. Griffin, M. P., Lake, D. E., & Moorman, J. R. (2005). Heart rate characteristics and laboratory tests in neonatal sepsis. Pediatrics, 115(4), 937-941.

18. HeRO monitoring to reduce mortality in NICU patients. Fairchild KD, Aschner JL. P Research and Reports in Neonatology 2012.

19. Ertuğrul, S., Annagur, A., Kurban, S., Altunhan, H., & Ors, R. (2013). Comparison of urinary neutrophil gelatinase-associated lipocalin, C-reactive protein and procalcitonin in the diagnosis of late onset sepsis in preterm newborns. The Journal of Maternal-Fetal & Neonatal Medicine, 26(4), 430-433.

20. Counting health workers: Definitions, data, methods and global results. (2007). Retrieved October 1, 2015, from http://www.who.int/hrh/documents/counting_health_workers.pdf

21. Interview with Neha

22. Henry, K. E., Hager, D. N., Pronovost, P. J., & Saria, S. (2015). A targeted real-time early warning score (TREWScore) for septic shock. Science Translational Medicine, 7(299), 299ra122-299ra122. doi:10.1126/scitranslmed.aab3719

23. Henry, K., Hager, D., Pronovost, P., & Saria, S. (2015). A targeted real-time early warning score (TREWScore) for septic shock. Science Translational Medicine.