A call to bridge the diagnostic gap: diagnostic solutions for neonatal sepsis in low- and middle-income countries

#### SUMMARY BOX The first month of life is the most critical period for an infant’s survival, yet the most neglected for the provision of quality care. Each year, an estimated 2.3 million neonates die in their first month of life.1 Sepsis alone is responsible for 7.3% of all neonatal deaths worldwide, with a significant burden falling on low- and middle-income countries (LMICs).2 While there remains an ongoing debate regarding the definition of neonatal sepsis, it is broadly described as a suite of non-specific signs that may include fever or hypothermia, respiratory distress, cyanosis and apnoea, feeding difficulties, lethargy or irritability, hypotonia, seizures, bulging fontanelle, poor perfusion, bleeding problems, abdominal distention, hepatomegaly, unexplained jaundice or more importantly ‘just not looking right’.3 The absence of a conclusive, easily accessible and affordable diagnostic test for sepsis, as well as the multitude of potential pathogens, allows for ambiguity. This can result in underdiagnosis or overdiagnosis, both of which can have life-altering consequences for vulnerable neonates …