Vaccination, early diagnosis, improved sanitation, access to clean water, proper hand hygiene, kangaroo mother care and early breastfeeding can reduce likelihood of infection and need for antimicrobials
The majority of neonatal infections are caused by bacteria, and these include pneumonia, sepsis, and meningitis_ The silent pandemic of antimicrobial resistace (AMR) can pose a serious challenge when a child or a newborn contracts a drug-resistant infection. A drug-resistant infection occurs when the microbes that cause it, develop the ability to resist the drugs intended to kill them, causing antimicrobials to fail to cure the infection.
Exposure to the hospital environment and also to caregivers in hospital settings, who attend different neonates at the same time, can further make neonates or children prone to the risk of infection.
According to the World Health Organization (WHO), 75 per cent of neonatal deaths occur during the first week of life, and in 2019, approximately a million newborns died within the first 24 hours due to infections, preterm birth, childbirth-related complications, and birth defects.
The majority of neonatal infections are caused by bacteria, and these include pneumonia, sepsis, and meningitis. Low- and middle-income countries (LMIC) appear to be especially vulnerable, with an estimated 6.9 million cases of potentially serious bacterial infection in young infants aged 0 to 59 days occurring each year.
In a recent October 2022 research published in the Indian Journal of Paediatrics, findings from an 18-month Neonatal Intensive Care Unit dataset from JIPMER, Pondicherry revealed that multidrug-resistant pathogens caused 55 per cent of neonatal bloodstream infections.
In neonates, multidrug-resistant infections have a 41 per cent mortality rate. Alarming multidrug resistance was also found in 76 per cent of all Elizabethkingia anophelis isolates, 79 per cent of Acinetobacter spp, 62 per cent of all Klebsiella spp, and 52 per cent of all E. coli isolates.
The above findings were discussed by one of the authors, Nishad Plakkal in a webinar organised by the Global Antibiotic Research & Development Partnership (GARDP) November 22.
The webinar addressed the issue of antibiotic resistance in the context of neonatal sepsis, the leading killer of babies. Recognising the need to put children first for better outcome on drug-resistant infections, experts at the webinar emphasised the importance of developing novel antibiotics.
“AMR is really an indicator of health disparity in the world today. If we want to improve health equity, we need to start with children,” Subasree Srinivasan, medical director, GARDP, said.
In the absence of new antibiotics and their production taking time, the solution lies in adoption of preventive measures so that the infection can be avoided in the first place.
This includes, for children and infants, approaches like vaccination, early diagnosis, improved sanitation, access to clean water and proper hand hygiene. For newborns, interventions like kangaroo mother care and early initiation of breastfeeding can reduce the likelihood of infection and the need for antimicrobials.
Another webinar hosted by the Pediatric Infectious Diseases Society discussed the key role that vaccination and early disease diagnosis can play in the prevention of antibiotic-resistant infections in children.
Vaccination, without a doubt, reduces the incidence of disease and secondary infections by instilling immunity against the disease. Similarly, proper diagnostics can help in the selection of the most appropriate drug.
The webinar included experts from Harvard Medical School and World Health Organization. Mateusz Hasso-Agopsowicz from WHO also emphasised prevention, highlighting that only a few players are in the process of clinical development of vaccines targeting critical WHO priority pathogens, and that until these vaccines are available, only prevention can help combat AMR.
Dhanya Dharampalan, a paediatrician working at Apollo Hospitals in India who was also in the webinar panel, said: “Hand hygiene is critical for infection control. The majority of paediatric infections are spread through contact with toys, bed railings, and equipment, or through droplets.”
She added: “Children who have contagious respiratory infections like flu can be either cohorted in wards or cared for in separate rooms; vaccination of healthcare workers also needs to be encouraged.”
The webinars were organised as part of the World Antimicrobial Awareness Week 2022 with a global theme of Preventing antimicrobial resistance together.
The prevention agenda provides a low-cost and simple way to contain AMR, across all sectors, especially for LMICs that are resource-constrained and cannot afford the high cost of cleaning up after polluting.
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