Neonatal Sepsis in India: Epidemiology, Risk Factors and Preventive Strategies from a Public Health Perspective

Neonatal sepsis remains a leading cause of neonatal mortality in India, contributing to approximately 30%–40% of all neonatal deaths despite advances in neonatal care. This preventable condition disproportionately affects newborns in resource-limited settings where inadequate infection control, delayed care-seeking, suboptimal intrapartum practices and limited access to tertiary neonatal care converge to create a high disease burden. This narrative review examines the epidemiology of neonatal sepsis in India, analysing incidence rates, causative organisms, antimicrobial resistance patterns and regional variations. We synthesise evidence on risk factors operating at maternal, intrapartum, neonatal and healthcare system levels, including premature rupture of membranes, maternal infections, low birth weight, preterm delivery, unhygienic cord care practices, home deliveries and delayed referrals. The review explores the evolving microbiological landscape, with increasing predominance of Gram-negative organisms and alarming rates of multidrug-resistant pathogens, including extended-spectrum beta-lactamase producers and carbapenem-resistant organisms. We analyse the challenges of early diagnosis in resource-limited settings, examining the performance and limitations of clinical criteria, labouratory biomarkers and blood culture practices. Critical gaps in neonatal care delivery are identified, including inadequate infection prevention practices, suboptimal hand hygiene compliance, overcrowding in neonatal units, understaffing and limited availability of appropriate anti-microbials. The review presents evidence-based preventive strategies spanning the continuum from preconception through postnatal care, including antenatal infection screening and treatment, clean delivery practices, early breastfeeding initiation, rational antibiotic use and strengthening of infection control measures. We examine successful intervention models, including quality improvement initiatives, hand hygiene campaigns, kangaroo mother care programmes and community-based newborn care. Special emphasis is placed on anti-microbial stewardship as both a clinical and public health imperative to combat rising resistance.