Lee Him Rachel, Rehman Sarah, Sihota Davneet, Yasin Rahima, Azhar Maha, Masroor Taleaa, Naseem Hamna Amir, Masood Laiba, Hanif Sawera, Harrison Leila, Vaivada Tyler, Sankar M Jeeva, Dramowski Angela, Coffin Susan E, Hamer Davidson H, Bhutta Zulfiqar A
Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.
Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Neonatology. 2025;122(Suppl 1):173-208. doi: 10.1159/000541871. Epub 2024 Nov 12.
We present a robust and up-to-date synthesis of evidence on the effectiveness of interventions to prevent and treat newborn infections in low- and middle-income countries (LMICs). Newborn infection prevention interventions included strategies to reduce antimicrobial resistance (AMR), prevention of healthcare-associated infections (HAIs), clean birth kits (CBKs), chlorhexidine cleansing, topical emollients, and probiotic and synbiotic supplementation. Interventions to treat suspected neonatal infections included prophylactic systemic antifungal agents and community-based antibiotic delivery for possible serious bacterial infections (PSBIs).
A descriptive review combining different methodological approaches was conducted. To provide the most suitable recommendations for real-world implementation, our analyses considered the impact of these interventions within three distinct health settings: facility, mixed, and community.
In facility settings, the strongest evidence supported the implementation of multimodal stewardship interventions for AMR reduction and device-associated infection prevention bundles for HAI prevention. Emollients in preterm newborns reduced the risk of invasive infection compared to routine skin care. Probiotics in preterm newborns reduced neonatal mortality, invasive infection, and necrotizing enterocolitis (NEC) risks compared to standard care or placebo. There was insufficient evidence for synbiotics and prophylactic systemic antifungals in LMICs. In mixed settings, CBKs reduced neonatal mortality risk compared to standard care. In community settings, chlorhexidine umbilical cord cleansing reduced omphalitis risk compared to dry cord care. For the treatment of PSBIs, purely domiciliary-based antibiotic delivery reduced the risk of all-cause neonatal mortality when compared to the standard hospital referral.
Strategies for preventing HAIs and reducing AMR in healthcare facilities should be multimodal, and strategy selection should consider the feasibility of integration within existing newborn care programs. Probiotics are effective for facility-based use in preterm newborns; however, the establishment of high-quality, cost-effective mass production of standardized formulations is needed. Chlorhexidine cord cleansing is effective in community settings to prevent omphalitis in contexts where unhygienic cord applications are prevalent. Community-based antibiotic delivery of simplified regimens for PSBIs is a safe alternative when hospital-based care in LMICs is not possible or is declined by parents. More randomized trial evidence is needed to establish the effectiveness of CBKs, emollients, synbiotics, and prophylactic systemic antifungals in LMICs.
We present a robust and up-to-date synthesis of evidence on the effectiveness of interventions to prevent and treat newborn infections in low- and middle-income countries (LMICs). Newborn infection prevention interventions included strategies to reduce antimicrobial resistance (AMR), prevention of healthcare-associated infections (HAIs), clean birth kits (CBKs), chlorhexidine cleansing, topical emollients, and probiotic and synbiotic supplementation. Interventions to treat suspected neonatal infections included prophylactic systemic antifungal agents and community-based antibiotic delivery for possible serious bacterial infections (PSBIs).
A descriptive review combining different methodological approaches was conducted. To provide the most suitable recommendations for real-world implementation, our analyses considered the impact of these interventions within three distinct health settings: facility, mixed, and community.
In facility settings, the strongest evidence supported the implementation of multimodal stewardship interventions for AMR reduction and device-associated infection prevention bundles for HAI prevention. Emollients in preterm newborns reduced the risk of invasive infection compared to routine skin care. Probiotics in preterm newborns reduced neonatal mortality, invasive infection, and necrotizing enterocolitis (NEC) risks compared to standard care or placebo. There was insufficient evidence for synbiotics and prophylactic systemic antifungals in LMICs. In mixed settings, CBKs reduced neonatal mortality risk compared to standard care. In community settings, chlorhexidine umbilical cord cleansing reduced omphalitis risk compared to dry cord care. For the treatment of PSBIs, purely domiciliary-based antibiotic delivery reduced the risk of all-cause neonatal mortality when compared to the standard hospital referral.
Strategies for preventing HAIs and reducing AMR in healthcare facilities should be multimodal, and strategy selection should consider the feasibility of integration within existing newborn care programs. Probiotics are effective for facility-based use in preterm newborns; however, the establishment of high-quality, cost-effective mass production of standardized formulations is needed. Chlorhexidine cord cleansing is effective in community settings to prevent omphalitis in contexts where unhygienic cord applications are prevalent. Community-based antibiotic delivery of simplified regimens for PSBIs is a safe alternative when hospital-based care in LMICs is not possible or is declined by parents. More randomized trial evidence is needed to establish the effectiveness of CBKs, emollients, synbiotics, and prophylactic systemic antifungals in LMICs.
我们对低收入和中等收入国家（LMICs）预防和治疗新生儿感染的干预措施的有效性进行了全面且最新的证据综合分析。新生儿感染预防干预措施包括减少抗菌药物耐药性（AMR）的策略、预防医疗保健相关感染（HAIs）、清洁分娩包（CBKs）、洗必泰清洗、局部润肤剂以及益生菌和合生元补充剂。治疗疑似新生儿感染的干预措施包括预防性全身用抗真菌药物以及针对可能的严重细菌感染（PSBIs）的社区抗生素给药。
进行了一项结合不同方法学途径的描述性综述。为了为实际应用提供最合适的建议，我们的分析考虑了这些干预措施在三种不同卫生环境中的影响：医疗机构、混合环境和社区。
在医疗机构环境中，最有力的证据支持实施多模式管理干预措施以降低AMR，并实施与设备相关的感染预防措施组合以预防HAIs。与常规皮肤护理相比，早产儿使用润肤剂可降低侵袭性感染的风险。与标准护理或安慰剂相比，早产儿使用益生菌可降低新生儿死亡率、侵袭性感染和坏死性小肠结肠炎（NEC）的风险。在LMICs中，关于合生元和预防性全身用抗真菌药物的证据不足。在混合环境中，与标准护理相比，CBKs可降低新生儿死亡风险。在社区环境中，与脐带干燥护理相比，洗必泰脐带清洗可降低脐炎风险。对于PSBIs的治疗，与标准医院转诊相比，单纯基于家庭的抗生素给药可降低全因新生儿死亡风险。
医疗机构预防HAIs和降低AMR的策略应是多模式的，策略选择应考虑与现有新生儿护理计划整合的可行性。益生菌在医疗机构用于早产儿是有效的；然而，需要建立高质量、具有成本效益的标准化制剂大规模生产。在脐带处理不卫生情况普遍的社区环境中，洗必泰脐带清洗对预防脐炎有效。当LMICs无法提供或家长拒绝基于医院的护理时，针对PSBIs的简化方案的社区抗生素给药是一种安全的替代方法。需要更多随机试验证据来确定CBKs、润肤剂、合生元和预防性全身用抗真菌药物在LMICs中的有效性。
我们对低收入和中等收入国家（LMICs）预防和治疗新生儿感染的干预措施的有效性进行了全面且最新的证据综合分析。新生儿感染预防干预措施包括减少抗菌药物耐药性（AMR）的策略、预防医疗保健相关感染（HAIs）、清洁分娩包（CBKs）、洗必泰清洗、局部润肤剂以及益生菌和合生元补充剂。治疗疑似新生儿感染的干预措施包括预防性全身用抗真菌药物以及针对可能的严重细菌感染（PSBIs）的社区抗生素给药。
进行了一项结合不同方法学途径的描述性综述。为了为实际应用提供最合适的建议，我们的分析考虑了这些干预措施在三种不同卫生环境中的影响：医疗机构、混合环境和社区。
在医疗机构环境中，最有力的证据支持实施多模式管理干预措施以降低AMR，并实施与设备相关的感染预防措施组合以预防HAIs。与常规皮肤护理相比，早产儿使用润肤剂可降低侵袭性感染的风险。与标准护理或安慰剂相比，早产儿使用益生菌可降低新生儿死亡率、侵袭性感染和坏死性小肠结肠炎（NEC）的风险。在LMICs中，关于合生元和预防性全身用抗真菌药物的证据不足。在混合环境中，与标准护理相比，CBKs可降低新生儿死亡风险。在社区环境中，与脐带干燥护理相比，洗必泰脐带清洗可降低脐炎风险。对于PSBIs的治疗，与标准医院转诊相比，单纯基于家庭的抗生素给药可降低全因新生儿死亡风险。
医疗机构预防HAIs和降低AMR的策略应是多模式的，策略选择应考虑与现有新生儿护理计划整合的可行性。益生菌在医疗机构用于早产儿是有效的；然而，需要建立高质量、具有成本效益的标准化制剂大规模生产。在脐带处理不卫生情况普遍的社区环境中，洗必泰脐带清洗对预防脐炎有效。当LMICs无法提供或家长拒绝基于医院的护理时，针对PSBIs的简化方案的社区抗生素给药是一种安全的替代方法。需要更多随机试验证据来确定CBKs、润肤剂、合生元和预防性全身用抗真菌药物在LMICs中的有效性。
