Background. Conclusion. Infections are among the leading causes of death for infants less than 4 months old (neonates) (3-4). A lower proportion of bacteriologically confirmed EONS was observed during this research, despite a significant prevalence of clinically diagnosed EONS. Each year, four million newborns die. most of them occur in developing countries, with the majority occurring within the beginning of the first week of life [4-64-7. The application of molecular diagnostics as well as non-specific indicators of infection have to be investigated in poor resource settings to help improve diagnostics of EONS and justify the use of antibiotics. Neonatal sepsis may be diagnosed via a clinical exam and/or a positive microbiology in normally non-sterile samples (blood cerebrospinal liquid (CSF) as well as urine taken in a safe method).

Background. A diagnosis of neonatal septicemia that is based solely on microbiological results is not a good way to determine the actual extent of neonatal sepsis7. Infections are the most common cause of death among infants younger than 4 weeks of age (neonates) (1-3).

However, information on the incidence of pathogens specific to a particular disease can only be obtained from studies based on microbiological diagnostics. Each year, an estimated four million newborns die. the majority of deaths occur in the developing world , with most occurring in the first week of their lives [4-66 ]. There are a variety of reasons why confirmation of microbiology might not be feasible particularly in developing countries. Neonatal sepsis is often diagnosed through a clinical examination and/or positive microbiology results from normal sterilized site samples (blood cerebrospinal fluid (CSF) and urine collected in a clean way). There are a few limitations in laboratories, the difficulty of collecting enough blood from a newborn and the inhibition of bacterial growth in culture with antibiotics administered during labor [88.

The diagnosis of neonatal sepsis solely based on microbiological evidence can underestimate the real severity of the condition [77. A recent review of pathogens responsible for infection among infants in the developing world found that for infants who were less than 7 days old (early term neonatal sepsis (EONS)) Gram positive organisms dominated in an ratio of 2:1 with Escherichia Coli being the most often isolated pathogen. But, the information about the prevalence of a specific pathogen is only derived from studies that are based on microbiological diagnoses. The authors suggested the reason why Gram negative pathogens were predominant in EONS was due to them being in the environment as a result of unsanitary birth practices [99.

There are many reasons why microbiological verification is not possible especially in developing countries. Historically, the infection associated with GBS is reported to be very rare in developing countries [11. This includes the lack of lab facilities, difficulties in getting enough blood from an infant and the suppression of bacterial growth in culture through the use of antibiotics during labour [88. There are a variety of reasons, including lesser maternal carriers and less highly virulent forms of GBS and also research design [1010. A recent study of pathogens that cause infections in infants across the developing world revealed that in infants younger than 7 days old (early neonatal sepsis at the onset (EONS)) Gram-negative organisms were the most prevalent, with the ratio of 2:1, with Escherichia-coli being the most frequently isolated pathogen. EONS GBS disease is often seen very early in life, with 90 percent in cases of sepsis being diagnosed within 12 hours of birth [11-1211-12. The researchers suggested that the reason Gram negative organisms dominated EONS is due to the fact that they were exposed to the environment through unsanitary birth practices [99.

Therefore, cheap studies that study EONS in babies born in the community that are admitted to hospitals will be biased as babies with EONS GBS have a greater probability that they will die in their home environment or when they go to the hospital. In the past, infection with GBS has been found to be very uncommon in the developing world [11. In addition, a recent systematic review showed that studies that report there is a need for intrapartum antibiotics (IAP) have been reported are associated with lower incidences of EO GBS diseases [13]. The reasons for this are lower maternal burden of less harmful strains of GBS as well as study design [1010. In recent years, African studies have shown higher rates of early-onset neonatal GBS infection [14-18and 18-18.

The EONS GBS illness is seen at an early age, with 90 percent instances of sepsis appearing within 12 hours after birth [11,1212]. A review article by Seale and co. states that these higher incidents result from more sensitive designs for studies that concentrate on infants who are born in hospitals who suffer from early onset sepsis. Thus, research studies that examine EONS in infants born in the community who are admitted to hospitals could be biased since infants suffering from EONS GBS are at a higher chance to die at home, or while traveling to the hospital.