Despite substantial global decline in childhood mortality rates, equivalent progress in neonatal mortality
reduction has not been achieved. Severe bacterial infection affects 6.9 million neonates and causes an
estimated 750 000 deaths in low-middle income countries (LMIC) annually, substantially exceeding other
infectious disease-related deaths. New approaches to sepsis prevention for hospitalized and preterm
newborns in LMIC are urgently needed as antimicrobial resistance threatens the few remaining therapeutic
options. The paucity of data on neonatal sepsis epidemiology is an additional obstacle to development of
infection prevention interventions for low-resource settings.
Care bundles are evidence-based strategies targeting healthcare-associated infections; bundles are widely-
adopted and effective in high-income countries, especially in adult intensive care populations. A care
bundled approach for neonatal sepsis prevention in LMIC has great potential; it is likely to be cost-effective,
culturally-acceptable, empowering for mothers and potentially applicable in both hospital and community-
based settings. Possible bundle elements could include emollient application, chlorhexidine gluconate body
washing, promotion of a clean newborn environment, safe intravenous access and improved hand hygiene
among neonatal caregivers.
Our research programme entails an initial surveillance phase to better characterize the epidemiology of
bacterial sepsis in hospitalized South African neonates. A series of observational studies will establish the
dynamics and determinants of neonatal bacterial colonization and infection. The acceptability, feasibility and
compliance indicators for at least five potential elements of a ‘neonatal sepsis prevention care bundle' will be
determined. A final phase will measure the feasibility and acceptability of the bundle in two observational
hospital cohorts of 50 infants each. The overall impact of this research will include an advanced
understanding of the epidemiology of hospital-onset sepsis in South African neonates and development of a
‘neonatal sepsis prevention care bundle’ for low-resource settings.