Background: Clinically suspected and laboratory-confirmed bloodstream infections are frequent
causes of morbidity and mortality during neonatal care. The most effective infection prevention
and control (IPC) interventions for neonates in low-and-middle-income countries (LMIC) are
unknown.
Aim: To identify effective interventions in the prevention of hospital-acquired bloodstream
infections in LMIC neonatal units.
Methods: Medline, PUBMED, The Cochrane Database of Systematic Reviews, EMBASE, and
PsychInfo (January 2003 – October 2020) were searched to identify studies reporting single or
bundled interventions for prevention of bloodstream infections in LMIC neonatal units.
Results: Our initial search identified 5206 articles; following application of filters, 27 publications
met the inclusion and ICROMS assessment criteria and were summarised in the final analysis. No
studies were carried out in low-income countries, only one in sub-Saharan Africa and just two in
multiple countries. Of the 18 single intervention studies, most targeted skin (n=4) and
gastrointestinal mucosal integrity (n=5). Whereas emollient therapy and lactoferrin achieved
significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no
benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in
individual single-centre studies. Of the nine studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and
ventilator-associated infections.
Conclusion: There is a limited evidence-base for the effectiveness of IPC interventions in LMIC
neonatal units; bundled interventions targeting device-associated infections were most effective.
More multi-site studies with robust study designs are needed to inform IPC intervention
strategies in low-resource neonatal units
