Community based healthcare workers need a method to detect early signs of neonatal sepsis following a delivery in low resource settings to help neonates’ family members and healthcare workers seek timely interventions, thus reducing sepsis-related neonatal mortality.  

The team acknowledges that neonatal mortality is a global issue, and has decided to focus specifically on early detection of neonatal sepsis in the community. This decision is supported by literature and interviews with sponsors, which identified a lack of a method to detect sepsis after home births in LMICs as a major gap that needs to be addressed. Targeting this issue would lower rates of neonatal deaths within communities with high NMRs, and would be a major step towards achieving the Millennium Development Goal of reducing child mortality.[1] In determining the scope of the project, the team has the option to focus its efforts on diagnosing EOS or LOS. EOS has a shorter window of opportunity before manifestation of physical symptoms, by which time it may be too late to transport the neonate to the hospital in order to administer proper treatment. This evidence suggests that addressing LOS is potentially the best course of action as it would have a greater impact, allowing families to take their neonates to the hospital in a timely manner.  Neonatal healthcare is intrinsically linked to maternal care and familial support. The project’s end user target population hence encompasses both neonates’ families and CHWs. The desired outcome is to develop a method for early detection of sepsis so as to help CHWs identify when it is necessary to take neonates to healthcare facilities before the neonate’s condition becomes critical. The team envisions that through this project, the timeliness of treatment for neonatal sepsis within local communities can be improved, hence drastically reducing the number of preventable deaths.

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.