Neonatal Infectious Diseases in Developing Countries
The opening presentation was given by Barbara Stoll, Chair, Department of Pediatrics at Emory University, Atlanta, U.S.A.
Dr. Stoll introduced the topic by citing Millenium Development Goal #4 “Reduce child mortality”. She focused on the importance of neonatal mortality (Figure 1.1). She also outlined the causes of neonatal mortality and its high incidence in the first few days of life (Figure 1.2).
Specific examples of the types of diseases experienced in a developing country are shown in Figure 1.3. This chart emphasizes the importance of infectious diseases as a major cause of neonatal disease and deaths.
Unfortunately, in many developing countries, laboratory facilities are not available for the diagnosis of infections in the newborn. Reliance must be on clinical diagnosis. Figure 1.4 lists criteria for clinical diagnosis of sepsis as defined in publications by the World Health Association and the Integrated Management of Childhood Illness.
The pathogens responsible for neonatal sepsis vary by virtue of geographic region, age of the child, and in-hospital/home setting. Therefore, microbiologic surveillance is essential. This matter was discussed further in the workshop proceedings.
Dr. Stoll reviewed various specific forms of infection which affect neonates in developing countries. These included tuberculosis - most commonly acquired post-natally from infected mothers.
Neonatal tetanus, a preventable disease, is still prevalent in many developing countries (Figure1.5).
Malaria does affect newborns, particularly if the mother has placental malaria (Figure 1.6).
HIV was briefly discussed with emphasis on two points. Antiretroviral therapy of infected mothers significantly reduces the incidence of maternal-to-infant transmission (Figure 1.7). Secondly, HIV can be transmitted through breast milk however studies are necessary to determine the relative value of cessation of breast feeding with its inherent risks to the health of the child.