It’s time to meet the challenge of neonatal sepsis

This blog has been co-authored by Jasmin Major, Programme Manager, Challenge Works and Lisa Dawson, AMR Project Lead, LifeArc.

Globally, nearly half of deaths of children under the age of five are deaths of neonates (babies within 28 days of birth). Although there has been a significant decline in under-five mortality in the last 30 years, neonatal mortality rates remain startlingly high. 

In some hospitals in Nigeria, Pakistan and Mozambique, the mortality rate in the neonatal intensive care unit nears 40% – that’s two in every five newborns dying before they are four weeks old. The majority of these deaths are from sepsis, which claims the lives of an estimated 2.5 million neonates globally each year and is the biggest killer of newborns in low- and middle-income countries (LMICs). 

Clinicians faced with critically ill newborns should be able to identify at pace if the babies have sepsis – and if they do, how best to treat it. This means identifying which antibiotics may be effective to treat infection – information that is vital in ensuring sepsis is treated with the correct antibiotic, and only if it is needed.

Early identification and treatment of sepsis with the right drug saves lives, but the reality is that diagnosing sepsis based on symptoms alone is difficult and existing diagnostics are prohibitively expensive, with tests available to only a small percentage of hospitals in some LMICs. Even when diagnostics are available, these tests can take three or four days to give a result, while a very sick newborn may not be able to survive 24 hours.

As a result, newborns are given antibiotics to cover any infection they might already have, and to prevent them from contracting future infections, driving antimicrobial resistance (AMR) whilst also often failing to treat sepsis properly.

Innovation in diagnostics for newborn sepsis is critically needed to allow faster, more accurate diagnosis and reduce AMR.

In the BARNARDS study of more than 1,000 babies with sepsis, all had bacteria that were resistant to multiple classes of antibiotics, including the very ones used to treat neonatal sepsis.

Ampicillin, one of the first-line treatments for neonatal sepsis, was effective in fewer than 5% of cases and gentamicin, another go-to drug, worked in less than a third.

In June this year, Challenge Works crowned Sysmex Astrego the winners of the £8M Longitude Prize on Antimicrobial Resistance. The global challenge prize incentivised novel diagnostic tests that could identify whether an infection is bacterial, and if so, the right antibiotic to prescribe in a matter of minutes. 

The success of Sysmex Astrego and other inspirational entries within the Longitude Prize on AMR demonstrates the power of challenge-driven innovation to attract the best minds to create breakthrough solutions.  

It is this innovation method Challenge Works and LifeArc are harnessing in our new partnership to develop the Newborn Survival Prize, which will throw open the challenge of addressing neonatal sepsis to the best minds around the world. 

LifeArc is a medical research charity aiming to reduce morbidity and mortality from antimicrobial infections by driving better use of existing treatments and facilitating development of new targeted therapies for AMR. Their portfolio of initiatives to address unmet need in AMR includes PACE – a £30 million initiative providing funding, partnerships, and expertise to help antimicrobial drug development and diagnostics projects succeed, alongside ASPIRE – a project aimed at tackling AMR through better antibiotic stewardship in Zambia and Kenya in partnership with ReAct Africa.

Challenge Works and LifeArc are working together to develop a prize to incentivise the development and/or validation of affordable diagnostics to target neonatal sepsis in LMICs. Entrants to the prize would develop their tests in conjunction with target settings in LMICs, ensuring they are clinically relevant and fit for purpose in the places that need them the most. With the right test, clinicians in these settings would be equipped to dispense the right antibiotics to newborns at the right time – potentially saving hundreds of thousands of lives.

We are looking for input from neonatology experts, neonatal healthcare practitioners, technology developers, and families who have been affected by neonatal sepsis, in a range of settings in countries across South Asia, East Africa and Southern Africa to define the focus of the Newborn Survival Prize, which will then launch in 2025.

While our focus is on diagnostics for neonatal sepsis, through our research, we will also explore other innovation gaps where our challenge prize method could incentivise solutions to reduce neonatal mortality rates. This could include the lack of access to equipment in neonatal intensive care units, for example. 

If you think you could inform our research activities to develop the prize, please contact us at [email protected]