Box 1 Operational definitions of neonatal infection-related terms
Neonatal sepsis | Systemic condition of infectious origin, associated with haemodynamic changes and other clinical manifestations, resulting in substantial morbidity and mortality in neonates (children aged less than 28 days) [20]. |
Diagnostic criteria of neonatal sepsis | According to Médecins Sans Frontières (MSF) neonatal guidelines used in Castor’s neonatal unit, sepsis is diagnosed if one or more of the following signs are present: Fever (> 38°), hypothermia (< 35,5°), poor sucking, haemodynamic instability, apnoea, respiratory distress, cyanosis, grunting, abdominal distension, coma, lethargy, irritability, bulging fontanelles, convulsions, recurrent hypoglycaemia, and purpura-like cutaneous rash. |
Clinical neonatal sepsis | Clinical manifestations consistent with infection in neonates with negative cultures of blood and other sterile fluids [33]. |
Serious bacterial infection | Classically includes bacteraemia, meningitis, urinary tract infection and occasionally pneumonia, enteritis, skin and soft tissue infections [34]. In this paper, “serious bacterial infection” includes bacteraemia, meningitis, pneumonia, and omphalitis. |
Neonatal infection | Clinical neonatal sepsis and/or serious bacterial infection. |
Suspected antibiotic-resistant neonatal infection | “Neonatal infection” in patients who received antibiotics (first- or second-line), (whichever diagnosis was recorded at discharge) and tested with blood culture because of treatment failure (poor clinical response after 48 h of antibiotic treatment). |
Onset of neonatal infection | Early: blood culture taken before 5 days of life (72 h of onset of symptoms + 48 h of treatment failure) Late: blood culture taken after 5 days of life (72 h of onset of symptoms + 48 h of treatment failure) |
Birth weight categories | Normal birth weight: > 2500 g Low birth weight (LBW): 1500–2499 g [35,36,37] |
Preterm birth categories | Preterm birth: <37th week of gestation [35, 38, 39]. Late preterm birth: 32nd-37th week of gestation [38, 39]. Very preterm birth: 28th-32nd week of gestation [38, 39]. Extremely preterm birth: < 28th week of gestation [35, 38, 39]. |
Diagnosis | As recorded by the clinician who filled the chart at discharge. |
Preterm-related condition | All “diagnoses” that are primarily related to preterm birth, including necrotizing enterocolitis and apnoea of prematurity syndrome. |
Fatal outcome/death | In-hospital death. |
ABR prevalence | The number of resistant bacteria isolated divided by the number of bacteria isolated and tested with the drug susceptibility test for a specific antibiotic. |
Presence of coagulase-negative Staphylococci (CoNS) in blood culture | Considered a contaminant or aetiological agent of neonatal infection according to the information recorded as the final diagnosis in the clinical file. |
African regions (central, eastern, western and southern) | As per the African Union definition and used by Okomo et al. [9]. |