Abstract
Despite continued advances and developments in neonatal medicine, neonatal sepsis
is the third leading cause of neonatal mortality and a major public health problem,
especially in developing countries. Sepsis accounts for mortality for almost 50% of
global children under 5 years of age.
Over the past 50 years, there have been many advances in the diagnosis, prevention,
and treatment of neonatal infections. The diagnostic advances include better culture
techniques that permit more rapid confirmation of the diagnosis, advent of polymerase
chain reaction (PCR) to rapidly diagnose viral infections, use of biologic markers
indicating evidence of infection, and a better understanding of immunoglobulin markers
of infection. From a therapeutic stand point, there have been a variety of antibiotics,
antifungals, and antiviral agents, better approaches to prevent sepsis, specific immunotherapy,
for example, respiratory syncytial virus (RSV); bundled approach to prevention of
deep-line infection and better antibiotic stewardship, leading to earlier discontinuation
of antibiotic therapy.
Hand hygiene remains the benchmark and gold standard for late-onset sepsis prevention.
The challenge has been that each decade, newer resistant bacteria dominate as the
cause of sepsis and newer viruses emerge, for example, human immunodeficiency virus,
zika virus, and novel coronavirus disease 2019.
Future treatment options might include stem cell therapy, other antimicrobial protein
and peptides, and targeting of pattern recognition receptors in an effort to prevent
and/or treat sepsis in this vulnerable population. Also, the microbiome of premature
infants has a smaller proportion of beneficial bacteria and higher numbers of pathogenic
bacteria compared with term infants, likely owing to higher frequencies of cesarean
sections, antibiotic use, exposure to the hospital environment, and feeding nonhuman
milk products. Modifying the microbiome with more mother's milk and shorter duration
of antibiotics in noninfected babies should be a goal.
Key Points
Neonatal sepsis remains a leading cause of mortality.
Challenges include bacterial resistance and newer viruses.
Future treatments may include newer antibiotics/antivirals and stem cell therapy.
Keywords neonatal sepsis - neonatal medicine - neonatal infection
