The World Health Organization has revised its recommendations and guidelines for diagnosing and treating conditions like sepsis, meningitis, and pneumonia in newborns, informed by the findings of a team led by a Brown physician-scientist. 

According to the WHO, serious bacterial infections are responsible for more than half a million of the estimated 3 million infant deaths each year. Anne CC Lee, MD, MPH, the Levinger Family Professor of Pediatrics, and her multinational team performed five systematic reviews of studies and clinical trials to assess how young infants are diagnosed and treated globally. 

“We found that the presence of one of seven infant clinical signs could identify most babies who needed to be further evaluated or treated for serious bacterial infections with antibiotics,” says Lee, who’s also the founding director of the Brown Global Alliance for Infant and Maternal Health Research. 

Four of the WHO recommendations are new while seven were updated as a result of the research. The organization’s Guidelines Development Group strongly OVERHEARD recommended the use of the Integrated Management of Childhood Illness (IMCI) algorithm in non-hospital settings to identify infants with possible serious bacterial infections who require further evaluation or treatment. It also made new recommendations for antibiotic regimens for suspected meningitis, pneumonia, and staphylococcal pneumonia. 

“In countries where I work, like Bangladesh or Ethiopia, community health workers or nurses are the frontline providers who assess and manage the majority of newborn babies,” Lee says. The WHO developed IMCI to improve case management of common childhood illnesses by training these providers to diagnose and treat infants using standard algorithms at the primary care level, she adds. Measuring signs like body temperature, breathing rate, and the quality of infant feeding can help identify infections early, and mean the difference between life and death. 

While physicians in hospitals can assess blood counts or analyze the presence of bacteria in an infant’s blood, many infants around the world can’t receive such laboratory testing. 

“For families living in rural, low-income communities, it is very important that these algorithms are accurate. We can’t afford to miss a baby with an infection and delay a potentially lifesaving treatment,” Lee says. “However, we also don’t want to over-refer infants who do not actually have an infection, because it requires resources, and we do not want to overload the health system.” 

While the new recommendations aren’t necessarily “major” changes, Lee says, her reviews identified key evidence gaps on first-line empiric antibiotic treatment and highlighted a lack of clinical trial data, as well as increasing antimicrobial resistance. Clinical trials of new antibiotics for babies were scarce due to limited funding or hesitancy to test therapies on this population. 

“Unfortunately, there are little new clinical trial data on the optimal antibiotic regimens in young infants and, in an era of antibiotic resistance, it’s challenging to make global recommendations when you have so few trials and evolving epidemiology and antibiotic resistance patterns in different world regions,” Lee says.