Early-Onset Neonatal Sepsis in Low-and Middle-Income Countries: Current Challenges and Future Opportunities

Kirsty Sands*, Owen B. Spiller, Kathryn Thomson, Edward A.R. Portal, Kenneth C. Iregbu, Timothy R. Walsh

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low-and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.

Original languageEnglish
Pages (from-to)933-946
Number of pages14
JournalInfection and Drug Resistance
Publication statusPublished - 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 Sands et al.


  • Antimicrobial resistance
  • Diagnosis
  • Early-onset neonatal sepsis
  • Low-and middle-income countries
  • Treatment


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