Neonatal Infection

Abstract

Neonatal infection remains a leading worldwide cause of mortality and morbidity despite significant focus on reducing rates, improving accuracy and speed of diagnosis, and refining treatment regimens and adjuncts. We summarise current key challenges to neonatologists of accurately defining burdens resulting from infections and their specific nature, reducing preventable vertical transmission, including ‘missed opportunities’ for reducing syphilis, CMV and blood borne viruses. Ongoing diagnostic challenges and the potential benefits and shortfalls of molecular technologies and biomarkers in clinical practice are reviewed. Adjuncts to decision making using national or local guidance and risk calculators, as well as treatment adjuncts are explored. The importance to individuals remains the threat to life and developmental outcome, but globally antimicrobial stewardship and reducing antimicrobial resistance and preventable infections remain key goals for the neonatal and obstetric community. Reducing antibiotic exposure and duration are key, remain poorly researched, and are challenges for future trials. On the horizon, refined data capture and better data sharing could enhance and share learning and offer universal promise to reduce global neonatal infections and their impact. Faster, more accurate diagnostic and monitoring strategies, utilising refined molecular technologies could reduce unnecessary treatment, and better biomarkers emerging from better mechanistic understanding may add to this. Studies are required to determine optimal duration of antibiotics where infection is proved, and better non-antimicrobial treatment adjuncts urgently needed. More widespread consideration of cheap, and potentially universally available strategies such as microbiomic manipulation (e.g. probiotics) may further help reduce the impact of neonatal infection worldwide.