Newswise — Rates of neonatal infections in hospital born babies are up to 20 times higher in developing countries than in industrialised countries, reveals a review in this week's issue of The Lancet.

Neonatal deaths account for over one-third of the global burden of child mortality. Infections are the major cause of neonatal deaths in developing countries. (See The LancetNeonatal Survival Series, March 2005) Data suggest that unhygienic practices in labour and delivery, and in after-birth care, put babies in the developing world at great risk of infections and death soon after birth.

Anita Zaidi (Aga Khan University, Pakistan) and colleagues reviewed data from developing countries on rates of neonatal infections among hospital-born babies. They found that bacteria such as Klebsiella pneumoniaeand Staphylococcus aureus are the major causes of neonatal infections and deaths in hospital settings. Unhygienic conditions prevailing in hospitals of developing countries mean that babies born in such hospitals may be facing the same or even higher risk of infection as babies born at home by untrained attendants, state the authors. The main source of spread of infection for Staphylococcus aureusis the hands of health care providers. The authors also found that antimicrobial resistance in newborn nurseries in developing countries has reached alarming levels. They estimate that 70% of pathogens isolated from bloodstream infections in babies in hospital nurseries may not be treatable by the antibiotics ampicillin and gentamicin, which are currently recommended by the World Health Organisation for this purpose. The high proportion of the meticillinresistant Staphylococcus aureus(MRSA) strains in many areas, especially south Asia where 56% of all isolates were reported to be meticillin-resistant, is also of concern.

Dr Zaidi comments: "Infections in neonates in hospitals have another, unrecognised detrimental effect on neonatal survival. When hospitals are seen as institutions where children experience poor outcomes at great cost, people in communities in which they live are less likely to seek institutional care, even if advised." She adds: "Infection control in hospitals of developing countries must become part of the international agenda for health-systems improvement to achieve the Millennium Development Goals."