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Cited by 48Neonatal and Maternal InfectionsNeonatal skin health careInfection Control in Healthcare

The impact of interventions to prevent neonatal healthcare-associated infections in low- and middle-income countries: a systematic review

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Fitzgerald, Felicity C., Zingg, Walter, Chimhini, Gwendoline, Chimhuya, Simbarashe, Wittmann, Stefanie, Brotherton, Helen, Olaru, Ioana D., Neal, Samuel R. +7 more·2022·Pediatric Infectious Disease Journal
DOI 10.1097/inf.0000000000003320PMC PMC8815829

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Abstract

BACKGROUND: Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown. AIM: To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units. METHODS: Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units. RESULTS: Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections. CONCLUSIONS: There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units.

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  • Few studies have focused on management of infections and AMS in inpatient paediatric populations, particularly in LMICs.

    “To date, there have been few studies focusing on management of infections and AMS in inpatient paediatric populations, particularly in LMICs.15”

    From Rationalizing irrational prescribing—infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India (2024) · cites this paper as [15]

    The Discussion (page not provided) describes a paucity of published research on infection prevention and control in LMIC neonatal units. That supports a narrower claim about neonatal infection prevention, but not the broader claim about infection management and antimicrobial stewardship (AMS) across inpatient paediatric populations. (LLM, conf=0.88)

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Authors
Fitzgerald, F. C., Zingg, W., Chimhini, G., Chimhuya, S., Wittmann, S., Brotherton, H., Olaru, I. D., Neal, S. R., Russell, N., da Silva, A. R. A., Sharland, M., Seale, A. C., Cotton, M. F., Coffin, S., & Dramowski, A.
Affiliations
  • Biomedical Research and Training Institute (ZW)
  • University of Zurich (CH)
  • University of Zimbabwe (ZW)
  • London School of Hygiene & Tropical Medicine (GB)
  • University College London (GB)
  • St George's, University of London (GB)
  • Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Brazil
  • Stellenbosch University (ZA)
  • Children's Hospital of Philadelphia (US)
Corresponding author
  • Fitzgerald, Felicity C.
  • Neal, Samuel R.
  • Russell, Neal
  • Sharland, Mike
ORCID
Venue
Pediatric Infectious Disease Journal
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-02-08
Volume
41
Issue
3S
Pages
S26-S35
ISSN
0891-3668 (ISSN-L)
DOI
10.1097/inf.0000000000003320
PMC
PMC8815829
OpenAlex
W4210946202
Cited by
48
References
37
Citations by year
2026: 10 · 2025: 18 · 2024: 8 · 2023: 5 · 2022: 7
FWCI
1.89
Type
journal article
Language
en
Open access
Licence
Locations
  • The Pediatric Infectious Disease Journal (publishedVersion, cc-by-nc-nd)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc-nd)
Funders
  • National Institute for Health and Care Research (CL-2017-18-007)
  • Academy of Medical Sciences (SGL018\1064)
  • National Institutes of Health
  • Fogarty International Center (K43TW010682, TW010682)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Health Professions › Speech and Hearing › Neonatal skin health care
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Keywords
neonatal bloodstream infection, nosocomial infections, infection control, neonatal unit, low- and middle-income countries, bundle interventions, device-related infection, catheter-related infection, ventilator-associated infection, kangaroo mother care, lactoferrin, emollients, probiotics, glutamine
MeSH terms
Infant Health, Cross Infection, Developing Countries, Humans, Infant, Infant, Newborn, Infection Control, Sepsis, Evidence-Based Medicine, Patient Care Bundles

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