Neonatal Infections: A Global Perspective

Among the greatest challenges in global public health are to eliminate the gaps between high- and low-income countries in health care resources, provide access to preventive and curative services, and improve health outcomes. Although the child and infant mortality burden has declined substantially in recent decades, neonatal mortality, especially deaths in the first week of life, has changed relatively little. Worldwide, an estimated 2.9 million neonatal deaths occur annually, accounting for 44% of deaths in children younger than 5 years. The vast majority (99%) of these deaths occur in low- and middle-income countries (LMICs), in the context of poverty, high-risk maternal and newborn care practices, poor care seeking and access to quality care, and poorly functioning health systems. Causes of neonatal mortality, especially in low-income countries, are difficult to ascertain, partly because many of these deaths occur at home, unattended by medical personnel, in settings without vital registration systems, and partly because critically ill neonates often present with nondiagnostic signs and symptoms of disease. In this chapter, we review the global burden of infectious diseases in the newborn, direct and indirect causes of neonatal mortality attributed to infection, specific infections of relevance in LMICs, and strategies to reduce both the incidence of neonatal infection and morbidity and mortality in infants who do become infected.