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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Global Management of Serious Bacterial Infections in Young Infants Aged 0 to 59 Days: An Overview of Systematic
Karen M Edmond1, Georgia R Whisson2, Derek C Swe2
1World Health Organization, Geneva, Switzerland.
Insights
Few studies address serious bacterial infections (SBI) in infants. More high-quality research is needed on antibiotic regimens for newborns, particularly in low- and middle-income countries (LMICs).
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Evidence Synthesis
Background:
- Serious bacterial infections (SBI) pose a significant threat to infants aged 0-59 days.
- World Health Organization (WHO) guidelines require up-to-date evidence for managing SBI in newborns.
- Existing systematic reviews may not fully address current diagnostic and management practices in low- and middle-income countries (LMICs).
Purpose of the Study:
- To identify and evaluate systematic reviews on the diagnosis and management of SBI in infants (0-59 days) published within the last five years.
- To assess if these reviews cover the population, intervention, comparator, and outcomes (PICOs) relevant to current WHO recommendations in LMICs.
- To inform the development of evidence-based WHO guidelines for neonatal SBI management.
Main Methods:
- Conducted an overview of systematic reviews using databases like MEDLINE, Embase, Cochrane Library, Epistemonikos, and PROSPERO.
- Included systematic reviews of randomized controlled trials or observational studies published between January 1, 2018, and November 3, 2023.
- Employed dual independent extraction of study characteristics, PICOs, and methodological quality.
Main Results:
- Nine systematic reviews met the inclusion criteria.
- Diagnostic accuracy for sepsis was examined in two reviews; pneumonia and meningitis were not covered.
- Antibiotic effectiveness was reviewed for sepsis (4 reviews) and pneumonia (1 review), but not meningitis. Antibiotic duration was addressed for sepsis and meningitis in one review each.
- Only 4 out of 9 systematic reviews were assessed as high-quality.
Conclusions:
- The current body of evidence on SBI diagnosis and management in newborns is limited, especially concerning antibiotic regimens used in LMICs.
- Many existing studies suffer from methodological weaknesses, raising concerns about the quality of evidence.
- There is a critical need for more high-quality research to inform effective management strategies for neonatal SBI, particularly in resource-limited settings.
Background:
To inform World Health Organization guidelines for the management of serious bacterial infection (SBI) (suspected or confirmed sepsis, pneumonia, or meningitis) in infants aged 0-59 days.
Objective:
To conduct an "overview of systematic reviews" to: (1) understand which systematic reviews have examined diagnosis and management of SBI in infants aged 0-59 days in the last 5 years; and (2) assess if the reviews examined PICOs (population, intervention, comparator, outcomes) and regimens currently being recommended in low and middle income countries (LMICs) by the World Health Organization.
Data Sources:
MEDLINE; Embase; Cochrane Library; Epistemonikos; PROSPERO.
Study Selection:
Systematic reviews of randomized controlled trials or observational studies of infants aged 0-59 days examining diagnostic accuracy and antibiotic regimens for SBI from January 1, 2018 to November 3, 2023.
Data Extraction:
Dual independent extraction of study characteristics, PICOs, and methodological quality.
Results:
Nine systematic reviews met our criteria. Two reviews examined diagnostic accuracy for sepsis, and no reviews examined pneumonia or meningitis. Five reviews examined antibiotic effectiveness (sepsis [n = 4]; pneumonia [n = 1]), and no reviews examined meningitis. One review examined antibiotic duration for sepsis and one for meningitis, and no reviews for pneumonia. Only 4 of the 9 systematic reviews met criteria for high-quality.
Limitations:
Our review was limited to the last 5 years to inform current guideline updates.
Conclusions:
Few studies have examined antibiotic regimens currently being used in LMICs and quality is of concern in many studies. More high-quality data are needed to inform management of SBI in newborns, especially in LMICs.
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