TY - JOUR
T1 - Infectious aetiologies of neonatal illness in south Asia classified using WHO definitions
T2 - a primary analysis of the ANISA study
AU - Arvay, Melissa L.
AU - Shang, Nong
AU - Qazi, Shamim A.
AU - Darmstadt, Gary L.
AU - Islam, Mohammad Shahidul
AU - Roth, Daniel E.
AU - Liu, Anran
AU - Connor, Nicholas E.
AU - Hossain, Belal
AU - Sadeq-ur Rahman, Qazi
AU - El Arifeen, Shams
AU - Mullany, Luke C.
AU - Zaidi, Anita K.M.
AU - Bhutta, Zulfiqar A.
AU - Soofi, Sajid B.
AU - Shafiq, Yasir
AU - Baqui, Abdullah H.
AU - Mitra, Dipak K.
AU - Panigrahi, Pinaki
AU - Panigrahi, Kalpana
AU - Bose, Anuradha
AU - Isaac, Rita
AU - Westreich, Daniel
AU - Meshnick, Steven R.
AU - Saha, Samir K.
AU - Schrag, Stephanie J.
N1 - Funding Information:
We thank the members of the ANISA technical advisory group: Mathuram Santosham (chair), Cynthia G Whitney, Derrick W Crook, Larry J Anderson, Patricia L Hibberd, Stephen P Luby, Shamim A Qazi, Shams El Arifeen, Abdullah H Baqui, Anita K M Zaidi, Zulfiqar A Bhutta, Pinaki Panigrahi, Anuradha Bose, and Samir K Saha. AKMZ now works at the Gates Foundation; her ANISA work at the Aga Khan University was completed before she joined the Gates Foundation. All phases of this study were supported by a grant (OPPGH5307) from the Gates Foundation to the Child Health Research Foundation, Dhaka, Bangladesh. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Funding Information:
We thank the members of the ANISA technical advisory group: Mathuram Santosham (chair), Cynthia G Whitney, Derrick W Crook, Larry J Anderson, Patricia L Hibberd, Stephen P Luby, Shamim A Qazi, Shams El Arifeen, Abdullah H Baqui, Anita K M Zaidi, Zulfiqar A Bhutta, Pinaki Panigrahi, Anuradha Bose, and Samir K Saha. AKMZ now works at the Gates Foundation; her ANISA work at the Aga Khan University was completed before she joined the Gates Foundation. All phases of this study were supported by a grant (OPPGH5307) from the Gates Foundation to the Child Health Research Foundation, Dhaka, Bangladesh. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2022/9
Y1 - 2022/9
N2 - Background: Globally, neonatal mortality accounts for almost half of all deaths in children younger than 5 years. Aetiological agents of neonatal infection are difficult to identify because the clinical signs are non-specific. Using data from the Aetiology of Neonatal Infections in south Asia (ANISA) cohort, we aimed to describe the spectrum of infectious aetiologies of acute neonatal illness categorised post-hoc using the 2015 WHO case definitions of critical illness, clinical severe infection, and fast breathing only. Methods: Eligible infants were aged 0–59 days with possible serious bacterial infection and healthy infants enrolled in the ANISA study in Bangladesh, India, and Pakistan. We applied a partial latent class Bayesian model to estimate the prevalence of 27 pathogens detectable on PCR, pathogens detected by blood culture only, and illness not attributed to any infectious aetiology. Infants with at least one clinical specimen available were included in the analysis. We assessed the prevalence of these aetiologies according to WHO's case definitions of critically ill, clinical severe infection, and infants with late onset, isolated fast breathing. For the clinical severe definition, we compared the prevalence of signs by bacterial versus viral aetiology. Findings: There were 934 infants (992 episodes) in the critically ill category, 3769 (4000 episodes) in the clinical severe infection category, and 738 (771 episodes) in the late-onset isolated fast breathing category. We estimated the proportion of illness attributable to bacterial infection was 32·7% in infants in the critically ill group, 15·6% in the clinical severe infection group, and 8·8% among infants with late-onset isolated fast breathing group. An infectious aetiology was not identified in 58–82% of infants in these categories. Among 4000 episodes of clinical severe infection, those with bacterial versus viral attribution had higher proportions of hypothermia, movement only when stimulated, convulsions, and poor feeding. Interpretation: Our modelled results generally support the revised WHO case definitions, although a revision of the most severe case definition could be considered. Clinical criteria do not clearly differentiate between young infants with and without infectious aetiologies. Our results highlight the need for improved point-of-care diagnostics, and further study into neonatal deaths and episodes with no identified aetiology, to ensure antibiotic stewardship and targeted interventions. Funding: The Bill and Melinda Gates Foundation.
AB - Background: Globally, neonatal mortality accounts for almost half of all deaths in children younger than 5 years. Aetiological agents of neonatal infection are difficult to identify because the clinical signs are non-specific. Using data from the Aetiology of Neonatal Infections in south Asia (ANISA) cohort, we aimed to describe the spectrum of infectious aetiologies of acute neonatal illness categorised post-hoc using the 2015 WHO case definitions of critical illness, clinical severe infection, and fast breathing only. Methods: Eligible infants were aged 0–59 days with possible serious bacterial infection and healthy infants enrolled in the ANISA study in Bangladesh, India, and Pakistan. We applied a partial latent class Bayesian model to estimate the prevalence of 27 pathogens detectable on PCR, pathogens detected by blood culture only, and illness not attributed to any infectious aetiology. Infants with at least one clinical specimen available were included in the analysis. We assessed the prevalence of these aetiologies according to WHO's case definitions of critically ill, clinical severe infection, and infants with late onset, isolated fast breathing. For the clinical severe definition, we compared the prevalence of signs by bacterial versus viral aetiology. Findings: There were 934 infants (992 episodes) in the critically ill category, 3769 (4000 episodes) in the clinical severe infection category, and 738 (771 episodes) in the late-onset isolated fast breathing category. We estimated the proportion of illness attributable to bacterial infection was 32·7% in infants in the critically ill group, 15·6% in the clinical severe infection group, and 8·8% among infants with late-onset isolated fast breathing group. An infectious aetiology was not identified in 58–82% of infants in these categories. Among 4000 episodes of clinical severe infection, those with bacterial versus viral attribution had higher proportions of hypothermia, movement only when stimulated, convulsions, and poor feeding. Interpretation: Our modelled results generally support the revised WHO case definitions, although a revision of the most severe case definition could be considered. Clinical criteria do not clearly differentiate between young infants with and without infectious aetiologies. Our results highlight the need for improved point-of-care diagnostics, and further study into neonatal deaths and episodes with no identified aetiology, to ensure antibiotic stewardship and targeted interventions. Funding: The Bill and Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85135713213&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(22)00244-3
DO - 10.1016/S2214-109X(22)00244-3
M3 - Article
C2 - 35961352
AN - SCOPUS:85135713213
SN - 2214-109X
VL - 10
SP - e1289-e1297
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 9
ER -