Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010

Abstract

Background: Survivors of neonatal infections are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified and yet important for program priority setting. Systematic reviews and meta-analyses were undertaken and applied in a three-step compartmental model to estimate NDI cases after severe neonatal bacterial infection in South Asia, sub-Saharan Africa, and Latin America in neonates of >32 wk gestation (or >1,500 g).

Methods: We estimated cases of sepsis, meningitis, pneumonia, or no severe bacterial infection from among estimated cases of possible severe bacterial infection ((pSBI) step 1). We applied respective case fatality risks ((CFRs) step 2) and the NDI risk among survivors (step 3). For neonatal tetanus, incidence estimates were based on the estimated deaths, CFRs, and risk of subsequent NDI.

Results: For 2010, we estimated 1.7 million (uncertainty range: 1.1-2.4 million) cases of neonatal sepsis, 200,000 (21,000-350,000) cases of meningitis, 510,000 cases (150,000-930,000) of pneumonia, and 79,000 cases (70,000-930,000) of tetanus in neonates >32 wk gestation (or >1,500 g). Among the survivors, we estimated moderate to severe NDI after neonatal meningitis in 23% (95% confidence interval: 19-26%) of survivors, 18,000 (2,700-35,000) cases, and after neonatal tetanus in 16% (6-27%), 4,700 cases (1,700-8,900).

Conclusion: Data are lacking for impairment after neonatal sepsis and pneumonia, especially among those of >32 wk gestation. Improved recognition and treatment of pSBI will reduce neonatal mortality. Lack of follow-up data for survivors of severe bacterial infections, particularly sepsis, was striking. Given the high incidence of sepsis, even minor NDI would be of major public health importance. Prevention of neonatal infection, improved case management, and support for children with NDI are all important strategies, currently receiving limited policy attention.

Figure 1

Disease schema for severe bacterial infection in neonates.

Figure 2

Parameters required and three-step modeling process for the estimation of the burden of neonatal infection. HIC, high-income country; pSBI, possible severe bacterial infection.

Figure 3

Estimated cases, with uncertainty of neonatal sepsis, meningitis, pneumonia, and tetanus in South Asia, sub-Saharan Africa, and Latin America, respectively.

Figure 4

Meta-analysis of eight studies (N = 451) reporting the incidence of any moderate/severe impairment (motor, cognitive, hearing, or vision) outcomes after neonatal meningitis. CI, confidence interval; ES, estimate.

Figure 5

Meta-analysis of four studies (N = 89) reporting the incidence of any moderate/severe impairment (motor, cognitive, hearing, or vision) outcomes after neonatal tetanus. CI, confidence interval; ES, estimate.

Figure 6

Regional burden of neonates with meningitis showing mortality, impairment, and the proportion with impairment-free survival. Note that impairment outcomes following neonatal sepsis could not be estimated due to lack of data. Outcomes following neonatal tetanus are shown in Table 2.

Figure 7

Summary of outcomes in terms of deaths and disability for neonates with sepsis, meningitis, or pneumonia born in South Asia, sub-Saharan Africa, and Latin America in 2010. ^aUncertainties not included in estimates of death, which should be interpreted with caution, and include adjustment for care-seeking behavior, as discussed in the text.