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Sepsis in Neonates and Children

Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2018.00277

Predictors of Mortality in Neonates and Infants Hospitalized with Sepsis or Serious Infections in Developing Countries: A Systematic Review

 Li Liang1,  Naima Kotadia2,  L Lacey English3, Niranjan Kissoon2, Jerome Kabakyenga4, 5,  J Mark Ansermino2, 6,  Pascal M. Lavoie2 and  Matthew O. Wiens2, 4, 6*
  • 1Faculty of Medicine, University of Toronto, Canada
  • 2Faculty of Medicine, University of British Columbia, Canada
  • 3School of Medicine, University of North Carolina at Chapel Hill, United States
  • 4Mbarara University of Science and Technology, Uganda
  • 5Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology (MUST), Uganda
  • 6Centre for International Child Health, British Columbia Children's Hospital, Canada

Background: Neonates and infants comprise the majority of the 6 million annual deaths under 5 years of age around the world. Most of these deaths occur in low/middle income countries (LMICs) and are preventable. However, the clinical identification of neonates and infants at imminent risk of death is challenging in developing countries.

Objective: To systematically review the literature on clinical risk factors for mortality in infants under 12 months of age hospitalized for sepsis or serious infections in LMICs.

Methods: MEDLINE and EMBASE were systematically searched using MeSH terms through April 2017. Abstracts were independently screened by two reviewers. Subsequently, full-text articles were selected by two independent reviewers based on PICOS criteria for inclusion in the final analysis. Study data were qualitatively synthesized without quantitative pooling of data due to heterogeneity in study populations and methodology.

Results: A total of 1139 abstracts were screened, and 169 full-text articles were selected for text review. Of these, 45 articles were included in the analysis, with 21 articles featuring neonatal populations (under 28 days of age) exclusively. Most studies were from Sub-Saharan Africa and South Asia. Risk factors for mortality varied significantly according to study populations. For neonatal deaths, prematurity, low birth-weight and young age at presentation were most frequently associated with mortality. For infant deaths, malnutrition, lack of breastfeeding and low oxygen saturation were associated with mortality in the highest number of studies.

Conclusions: Risk factors for mortality differ between the neonatal and young infant age groups and were also dependent on the study population. These data can serve as a starting point for the development of individualized predictive models for in-hospital and post-discharge mortality and for the development of interventions to improve outcomes among these high-risk groups.

Keywords: Pediatrics, risk prediction, neonatal mortality, Infant Mortality, Systematic review, Developing Countries, Infectious Disease, Sepsis, Hospital Mortality

Received: 31 Mar 2018; Accepted: 12 Sep 2018.

Edited by:

Valeriane Leroy, Institut National de la Santé et de la Recherche Médicale (INSERM), France

Reviewed by:

Lucy Thairu, Stanford University, United States
Giuseppe Liotta, Università degli Studi di Roma Tor Vergata, Italy  

Copyright: © 2018 Liang, Kotadia, English, Kissoon, Kabakyenga, Ansermino, Lavoie and Wiens. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Matthew O. Wiens, Mbarara University of Science and Technology, Mbarara, Uganda,