Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

Li Danny Liang; Naima Kotadia; Lacey English; Niranjan Kissoon; J Mark Ansermino; Jerome Kabakyenga; Pascal M Lavoie; Matthew O Wiens

doi:10.3389/fped.2018.00277

Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

Front Pediatr. 2018 Oct 4:6:277. doi: 10.3389/fped.2018.00277. eCollection 2018.

Authors

Li Danny Liang¹, Naima Kotadia², Lacey English³, Niranjan Kissoon^{4

5}, J Mark Ansermino^{5

6

7}, Jerome Kabakyenga^{8

9}, Pascal M Lavoie¹⁰, Matthew O Wiens^{5

6

9}

Affiliations

¹ Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³ School of Medicine, University of North Carolina, Chapel Hill, NC, United States.
⁴ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
⁵ Center for International Child Health, British Columbia Children's Hospital, Vancouver, BC, Canada.
⁶ Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁷ Department of Anesthesia, British Columbia Children's Hospital and University of British Columbia, Vancouver, BC, Canada.
⁸ Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
⁹ Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
¹⁰ Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.

Abstract

Background: Neonates and infants comprise the majority of the 6 million annual deaths under 5 years of age around the world. Most of these deaths occur in low/middle income countries (LMICs) and are preventable. However, the clinical identification of neonates and infants at imminent risk of death is challenging in developing countries. Objective: To systematically review the literature on clinical risk factors for mortality in infants under 12 months of age hospitalized for sepsis or serious infections in LMICs. Methods: MEDLINE and EMBASE were systematically searched using MeSH terms through April 2017. Abstracts were independently screened by two reviewers. Subsequently, full-text articles were selected by two independent reviewers based on PICOS criteria for inclusion in the final analysis. Study data were qualitatively synthesized without quantitative pooling of data due to heterogeneity in study populations and methodology. Results: A total of 1,139 abstracts were screened, and 169 full-text articles were selected for text review. Of these, 45 articles were included in the analysis, with 21 articles featuring neonatal populations (under 28 days of age) exclusively. Most studies were from Sub-Saharan Africa and South Asia. Risk factors for mortality varied significantly according to study populations. For neonatal deaths, prematurity, low birth-weight and young age at presentation were most frequently associated with mortality. For infant deaths, malnutrition, lack of breastfeeding and low oxygen saturation were associated with mortality in the highest number of studies. Conclusions: Risk factors for mortality differ between the neonatal and young infant age groups and were also dependant on the study population. These data can serve as a starting point for the development of individualized predictive models for in-hospital and post-discharge mortality and for the development of interventions to improve outcomes among these high-risk groups.

Keywords: developing countries; hospital mortality; infant mortality; infectious disease; neonatal mortality; risk prediction; sepsis; systematic review.