February 24, 2011 Concept Note: The Neonatal Septisome Steven J. Schiff and Benjamin C. Warr Penn State and Harvard University New Perspective to an Old Problem We have uncovered a world-wide burden from the sequelae of neonatal infections which has not been recognized by the global health community. The reasons are complex, and revolve around the recent introduction of technical pediatric neurosurgery in developing countries, along with the stigmata and shortened life spans of severely damaged children. One of us (BCW) has accumulated the world's largest experience in the treatment of children with hydrocephalus in the developing world, and the other (SJS) is leading efforts to define and model the microbiome that underlies this situation. Our attention to these brain damaged infants has refocused our attention on the relatively stagnant state of our approach to neonatal infections in the developing world. With several clinical trials underway in Uganda, and a strong network of colleagues throughout East Africa, we are in a unique position to leverage our experience and network of colleagues to have a transformational impact on this situation. Economic Burden of Disease The World Health Organization estimates that 1.6 million neonates die world- wide of infection each year, and almost half of these cases of neonatal sepsis (NS) occur in sub-Saharan Africa (SSA). There are about 100,000 postinfectious hydrocephalus (PIH) cases per year in SSA, generated from a pool of 1,000,000- 2,000,000 million cases of NS. As developing countries acquire the technical capability of pediatric neurosurgery, large numbers of children previously left untreated swamp new facilities. The most common condition overwhelming the most established centers, in Uganda and Kenya, is PIH. This experience is similar to those of colleagues we have trained to treat hydrocephalus in Vietnam, Nepal, Zambia, Nigeria, Ghana, Ethiopia, and Tanzania. The brains of children wi