Problem Description

Sepsis is a leading cause of neonatal death worldwide, and it disproportionately affects neonatal mortality rates (NMR) in low-and-middle income countries (LMICs). The team has determined that in low-resource communities, the failure to rapidly and accurately identify sepsis following births leads to delays in treatment, increasing morbidity and mortality.  Among the 6 million children who die every year, approximately 2.8 million are neonates (less than 28 days old). Sepsis alone currently causes 15% of these neonatal deaths.[1] In high-mortality settings (NMR >45), almost 50% of deaths are due to severe infection, tetanus, and diarrhea.[2] In LMICs where 99% of all neonatal deaths occur, home delivery and subsequent home-based neonatal care are both associated with poor neonatal health outcomes, particularly in areas related to infections. Despite efforts to move deliveries from homes to facilities, more than 70% of the women in the poorest two wealth quintiles still deliver at home in developing countries within Sub-Saharan Africa (SSA), South Asia and Southeast Asia. Specifically, in SSA, studies have shown that 56% of the home births in the poorest quintile are unattended.[3] Three quarters of all neonatal deaths occur within the first week of life, often at home, and more than 50% of deaths for home-delivered neonates are caused by sepsis and severe infections.[4] This indicates that there is a lack of a method to provide timely, home-based diagnosis of neonatal sepsis in LMICs. Furthermore, the standard of community-based neonatal care in most LMICs does not adequately address sepsis-related mortality, as the postpartum checkups performed by community health workers (CHWs) are relatively infrequent.[5] To emphasize the magnitude of the problem, the team has identified several stakeholders who may benefit from a potential solution. Firstly, improved survival of neonates reduces psychological and emotional suffering of their parents. The neonates themselves will benefit from better medical attention and increased chance of survival. CHWs also have a stake in the health of their neonatal patients, in terms of the success of their career, and the trust they earn from the community. Finally, federal health care systems, which have strong incentive to improve quality of healthcare in underserved regions, will benefit from improving neonatal survival rates.

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.

Reinhart, K., Bauer, M., Riedemann, N., & Hartog, C. (2012). New Approaches to Sepsis: Molecular Diagnostics and Biomarkers. Clinical Microbiology Reviews, 609-634.