High rates of admission in lower middle-income countries’ neonatal units suggest an enhanced focus on infection prevention and control measures is required

The recent publication of key findings from a WHO/UNICEF report on care for sick and small newborns, Survive and Thrive: Transforming Care for Every Small and Sick Newborn ,1 recommends the expansion of NICU services globally for small/sick babies, but does not include the need to enhance infection prevention and control (IPC) in parallel with expansion of NICU services. There is evidence that incidence of healthcare-associated infections in NICUs in lower middle–income countries (LMICs) is higher than in high-income countries (HICs), and a high proportion of these neonatal infections are resistant to WHO-recommended ampicillin and gentamicin.2 3 Culture-positive neonatal infections in LMIC settings are predominantly caused by Gram-negative pathogens and Staphylococcus aureus whereas Group B streptococci and coagulase-negative staphylococci …