title: A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border.
abstract: BACKGROUND
  Each year an estimated four million neonates die, the majority in the first week of life. One of the major causes of death is sepsis. Proving the incidence and aetiology of neonatal sepsis is difficult, particularly in resource poor settings where the majority of the deaths occur.
  
  
  METHODS
  We conducted a three year observational study of clinically diagnosed early onset (<7 days of age) neonatal sepsis (EONS) in infants born to mothers following antenatal care at the Shoklo Malaria Research Unit clinic in Maela camp for displaced persons on the Thailand-Myanmar border. Episodes of EONS were identified using a clinical case definition. Conventional and molecular microbiological techniques were employed in order to determine underlying aetiology.
  
  
  RESULTS
  From April 2009 until April 2012, 187 infants had clinical signs of EONS, giving an incidence rate of 44.8 per 1000 live births (95% CI 38.7-51.5). One blood culture was positive for Escherichia coli, E. coli was detected in the cerebrospinal fluid specimen in this infant, and in an additional two infants, by PCR. Therefore, the incidence of bacteriologically proven EONS was 0.7 per 1000 live births (95% CI 0.1-2.1). No infants enrolled in study died as a direct result of EONS.
  
  
  CONCLUSIONS
  A low incidence of bacteriologically proven EONS was seen in this study, despite a high incidence of clinically diagnosed EONS. The use of molecular diagnostics and nonspecific markers of infection need to be studied in resource poor settings to improve the diagnosis of EONS and rationalise antibiotic use.
authors.affiliation: Shoklo Malaria Research Unit, Mae Sot 63110, Thailand. claudia@tropmedres.ac.
authors.forename: Claudia
authors.initials: C
authors.lastname: Turner
authors.forename: Paul
authors.initials: P
authors.lastname: Turner
authors.forename: Gabie
authors.initials: G
authors.lastname: Hoogenboom
authors.forename: Naw
authors.initials: N
authors.lastname: Aye Mya Thein
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
authors.forename: Kawalee
authors.initials: K
authors.lastname: Phakaudom
authors.forename: Aruni
authors.initials: A
authors.lastname: De Zoysa
authors.forename: Androulla
authors.initials: A
authors.lastname: Efstratiou
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
authors.forename: François
authors.initials: F
authors.lastname: Nosten
mesh_terms: D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008297:Male; D002052:Myanmar / Q000453:epidemiology; D012036:Refugees / Q000706:statistics & numerical data*; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013785:Thailand / Q000453:epidemiology