BACKGROUND
Neonatal Sepsis
The first 28 days of life represents the most vulnerable period for mortality for young children. The highest risk for mortality occurs during the early neonatal period (the first 7 days), with deaths from day 7 through day 27 categorized as late neonatal deaths. Globally, the primary causes of neonatal mortality include premature birth, birth complications (e.g., asphyxia), infections, and birth defects. While the overall mortality rate for children under five has seen a significant decline since the 1990s, the reduction in neonatal mortality has progressed more slowly compared to mortality among children aged 1-59 months.
A major, and often preventable, cause of neonatal death is neonatal sepsis. Neonatal sepsis is a severe systemic infection that contributes to over 550,000 neonatal deaths annually. Together with other severe infections such as meningitis and pneumonia, neonatal sepsis accounts for over 550,000 neonatal deaths each year. Because neonates have immature immune systems, sepsis can progress rapidly from infection to organ failure, making early detection and intervention vital for reducing neonatal mortality globally.
NEONATAL SEPSIS
Quick Facts
0 +m Global Cases Annually
Globally, sepsis affects an estimated 3 million newborns every year, contributing to over 550,000 preventable deaths.
0 in 5 Mortality Rate
The condition is fatal in nearly 20% of cases, making it one of the leading causes of neonatal mortality worldwide.
0 % of Cases have Antibiotic Resistance
Approximately 40% of bacterial infections causing neonatal sepsis are now resistant to standard first-line antibiotics.
Related CHAMPS Sites
Recent Data
| Etiologic agent |
Overall | Presumed hospital-acquired infection |
Presumed community-acquired infection |
||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total | IND | VEND | END | LND | Total | IND | VEND | END | LND | Total | IND | VEND | END | LND | |
| N=1,147 | N=188 | N=274 | N=295 | N=390 | N=537 | N=0 | N=23 | N=249 | N=265 | N=586 | N=188 | N=251 | N=44 | N=103 | |
| n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
| Gram-negative bacteria (n = 850) | |||||||||||||||
| Klebsiella pneumoniae | 478(41.7) | 58(30.9) | 112(40.9) | 142(48.1) | 166(42.6) | 260(48.4) | - | 6(26.1) | 129(51.8) | 125(47.2) | 206(35.2) | 58(30.9) | 106(42.2) | 12(27.3) | 30(29.1) |
| Acinetobacter baumannii | 295(25.7) | 8(4.3) | 51(18.6) | 105(35.6) | 131(33.6) | 244(45.4) | - | 17(73.9) | 105(42.2) | 122(46) | 48(8.2) | 8(4.3) | 34(13.5) | 0(0.0) | 6(5.8) |
| Escherichia coli | 119(10.4) | 30(16) | 32(11.7) | 17(5.8) | 40(10.3) | 35(6.5) | - | 3(13) | 14(5.6) | 18(6.8) | 81(13.8) | 30(16) | 29(11.6) | 3(6.8) | 19(18.4) |
| Pseudomonas aeruginosa | 61(5.3) | 3(1.6) | 18(6.6) | 16(5.4) | 24(6.2) | 31(5.8) | - | 0(0.0) | 15(6) | 16(6) | 26(4.4) | 3(1.6) | 18(7.2) | 1(2.2) | 4(3.9) |
| Enterobacter cloacae | 24(2.1) | 2(1.1) | 13(4.7) | 6(2) | 3(0.8) | 7(1.3) | - | 1(4.3) | 5(2) | 1(0.4) | 16(2.7) | 2(1.1) | 12(4.8) | 1(2.2) | 1(1) |
| Ureaplasma spp. | 23(2) | 4(2.1) | 13(4.7) | 2(0.7) | 4(1) | 4(0.7) | - | 0(0.0) | 2(0.8) | 2(0.8) | 19(3.2) | 4(2.1) | 13(5.2) | 0(0.0) | 2(1.9) |
| Escherichia coli/Shigella spp. | 19(1.7) | 2(1.1) | 8(2.9) | 2(0.7) | 7(1.8) | 7(1.3) | - | 0(0.0) | 2(0.8) | 5(1.9) | 12(2) | 2(1.1) | 8(3.2) | 0(0.0) | 2(1.9) |
| Pantoea spp. | 15(1.3) | 5(2.7) | 5(1.8) | 5(1.7) | 0(0.0) | 5(0.9) | - | 0(0.0) | 5(2) | 0(0.0) | 10(1.7) | 5(2.7) | 5(2) | 0(0.0) | 0(0.0) |
| Serratia marcescens | 15(1.3) | 2(1.1) | 3(1.1) | 3(1) | 7(1.8) | 10(1.9) | - | 0(0.0) | 3(1.2) | 7(2.6) | 5(0.9) | 2(1.1) | 3(1.2) | 0(0.0) | 0(0.0) |
| Haemophilus influenzae | 13(1.1) | 1(0.5) | 1(0.4) | 1(0.3) | 10(2.6) | 2(0.4) | - | 0(0.0) | 1(0.4) | 1(0.4) | 10(1.7) | 1(0.5) | 1(0.4) | 0(0.0) | 8(7.8) |
| Salmonella spp. | 13(1.1) | 0(0.0) | 5(1.8) | 4(1.4) | 4(1) | 7(1.3) | - | 0(0.0) | 4(1.6) | 3(1.1) | 6(1) | 0(0.0) | 5(2) | 0(0.0) | 1(1) |
| Treponema pallidum | 11(1) | 5(2.7) | 4(1.5) | 2(0.7) | 0(0.0) | 3(0.6) | - | 1(4.3) | 2(0.8) | 0(0.0) | 8(1.4) | 5(2.7) | 3(1.2) | 0(0.0) | 0(0.0) |
| Gram-positive bacteria (n = 251) | |||||||||||||||
| Group B Streptococcus | 65(5.7) | 32(17) | 7(2.6) | 11(3.7) | 15(3.8) | 17(3.2) | - | 1(4.3) | 9(3.6) | 7(2.6) | 46(7.8) | 32(17) | 6(2.4) | 2(4.5) | 6(5.8) |
| Staphylococcus aureus | 43(3.7) | 0(0.0) | 10(3.6) | 7(2.4) | 26(6.7) | 19(3.5) | - | 2(8.7) | 4(1.6) | 13(4.9) | 21(3.6) | 0(0.0) | 8(3.2) | 2(4.5) | 11(10.7) |
| Enterococcus faecalis | 36(3.1) | 7(3.7) | 9(3.3) | 8(2.7) | 12(3.1) | 21(3.9) | - | 1(4.3) | 8(3.2) | 12(4.5) | 15(2.6) | 7(3.7) | 8(3.2) | 0(0.0) | 0(0.0) |
| Enterococcus faecium | 34(3) | 1(0.5) | 4(1.5) | 6(2) | 23(5.9) | 26(4.8) | - | 0(0.0) | 5(2) | 21(7.9) | 8(1.4) | 1(0.5) | 4(1.6) | 1(2.2) | 2(1.9) |
| Streptococcus pneumoniae | 32(2.8) | 8(4.3) | 4(1.5) | 9(3.1) | 11(2.8) | 8(1.5) | - | 0(0.0) | 6(2.4) | 2(0.8) | 23(3.9) | 8(4.3) | 4(1.6) | 3(6.8) | 8(7.8) |
| Streptococcus spp. | 28(2.4) | 10(5.3) | 3(1.1) | 6(2) | 9(2.3) | 10(1.9) | - | 1(4.3) | 4(1.6) | 5(1.9) | 18(3.1) | 10(5.3) | 2(0.8) | 2(4.5) | 4(3.9) |
| Fungi (n = 60) | |||||||||||||||
| Candida albicans | 24(2.1) | 1(0.5) | 2(0.7) | 4(1.4) | 17(4.4) | 18(3.4) | - | 0(0.0) | 4(1.6) | 14(5.3) | 6(1) | 1(0.5) | 2(0.8) | 0(0.0) | 3(2.9) |
| Candida spp. | 10(0.9) | 2(1.1) | 0(0.0) | 1(0.3) | 7(1.8) | 7(1.3) | - | 0(0.0) | 1(0.4) | 6(2.3) | 3(0.5) | 2(1.1) | 0(0.0) | 0(0.0) | 0(0.0) |
| Virus (n = 48) | |||||||||||||||
| Cytomegalovirus | 17(1.5) | 3(1.6) | 6(2.2) | 3(1) | 5(1.3) | 8(1.5) | - | 1(4.3) | 3(1.2) | 4(1.5) | 9(1.5) | 3(1.6) | 5(2) | 0(0.0) | 1(1) |
| Respiratory syncytial virus | 10(0.9) | 0(0.0) | 0(0.0) | 0(0.0) | 10(2.6) | 5(0.9) | - | 0(0.0) | 0(0.0) | 5(1.9) | 4(0.7) | 0(0.0) | 0(0.0) | 0(0.0) | 4(3.9) |
Infectious syndromes in the causal chain of neonatal deaths
Of all neonatal deaths, infectious syndromes contributed to just under half: 40% (590/1,458). Among deaths with an infectious syndrome (n=590), sepsis was most common (85%, 504/590), followed by pneumonia (43%, 254/590), meningitis (24%, 143/590), and other infections (6%, 33/590).
All neonatal deaths
590 / 1,458Breakdown among infectious deaths
Base = 590Reference
Mahtab, S., Madhi, S. A., Baillie, V. L., Els, T., Thwala, B. N., Onyango, D., Tippet-Barr, B. A., Akelo, V., Igunza, K. A., Omore, R., El Arifeen, S., Gurley, E. S., Alam, M., Chowdhury, A. I., Rahman, A., Bassat, Q., Mandomando, I., Ajanovic, S., Sitoe, A., … Whitney, C. G. (2023). Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016–December 2021. PLOS Global Public Health, 3(3), e0001612. https://doi.org/10.1371/journal.pgph.0001612
Group B Streptococcus is a hidden driver of stillbirths and newborn deaths. CHAMPS data reveals that Group B Streptococcus (GBS) is a significant, yet often overlooked, cause of mortality, responsible for 2.7% of all infant deaths and 2.3% of stillbirths across the studied regions. The pathogen is most lethal in the first 24 hours of life and disproportionately affects vulnerable, low-birth-weight infants. However, the burden of GBS varies drastically by location—ranging from just 0.3% of deaths in Sierra Leone to 7.2% in South Africa. This significant geographic variation suggests that policy makers should prioritize tailored, region-specific prevention strategies rather than a uniform approach, with a renewed focus on maternal interventions to prevent stillbirths.
Reference
Mahtab, S., Madhi, S. A., Baillie, V. L., Els, T., Thwala, B. N., Onyango, D., Tippet-Barr, B. A., Akelo, V., Igunza, K. A., Omore, R., El Arifeen, S., Gurley, E. S., Alam, M., Chowdhury, A. I., Rahman, A., Bassat, Q., Mandomando, I., Ajanovic, S., Sitoe, A., … Whitney, C. G. (2023). Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016–December 2021. PLOS Global Public Health, 3(3), e0001612. https://doi.org/10.1371/journal.pgph.0001612
Klebsiella pneumoniae as a major cause of child deaths, accounts for about 1 in 5 (21%) of all deaths within the CHAMPS Network. It is mostly a hospital problem, causing 22% of facility deaths versus 14% in the community, usually presenting as fatal sepsis or pneumonia. A serious concern is its high level of antibiotic resistance: 84% of cases in CHAMPS are resistant to ceftriaxone and 75% resist gentamicin, raising concerns about the efficacy of current standard treatments. This highlights the urgent need for new treatment approaches, better antimicrobial stewardship, and faster vaccine development against this resistant bacteria.
Reference
Verani, J. R., Blau, D. M., Gurley, E. S., Akelo, V., Assefa, N., Baillie, V., Bassat, Q., Berhane, M., Bunn, J., Cossa, A. C. A., El Arifeen, S., Gunturu, R., Hale, M., Igunza, A., Keita, A. M., Kenneh, S., Kotloff, K. L., Kowuor, D., Mabunda, R., … Breiman, R. F. (2024). Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and South Asia: A secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data. The Lancet Microbe, 5(2), e131–e141. https://doi.org/10.1016/S2666-5247(23)00290-2
Adherence to clinical care guidelines could be improved. Suboptimal clinical care is common in cases of neonatal sepsis resulting in mortality. Recommended diagnostics and therapeutics including blood cultures and timely antibiotics, are unfortunately uncommon in neonates who died from sepsis (Rahman A, et al. JAMA Network Open. 2025).
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