Neonatal Bloodstream Infections: A Narrative Review on Diagnostic and Therapeutic Challenges and Prospects in Developing Countries.

BACKGROUND: Bloodstream infections (BSIs) pose a significant global health challenge, particularly in developing countries. Neonates are highly vulnerable due to underdeveloped immune systems and immature physical barriers, a risk amplified by poor hygiene and limited healthcare access in low- and middle-income countries (LMICs), leading to an estimated incidence of 5.5 cases per 1000 live births. This review aims to provide insight into the diagnostic and therapeutic challenges of neonatal BSIs in developing countries and to identify prospects for improving their diagnosis and treatment. METHODS: This review employed a nonsystematic narrative approach. A comprehensive literature search was conducted using multiple electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and ScienceDirect. The search prioritized peer-reviewed articles, clinical trials, and systematic reviews published within the past decade (2015-2025). RESULTS: Diagnosis is severely hampered by nonspecific symptoms and limitations of conventional methods like blood culture, especially in resource-constrained settings lacking advanced molecular diagnostics. This often necessitates empirical antibiotic treatment, which intensifies antimicrobial resistance (AMR), complicates therapy, and leads to adverse outcomes. Promising solutions include rapid diagnostic technologies, artificial intelligence (AI), clinical decision support systems (CDSS), novel antimicrobial agents, alternative therapies like maternal immunization, and robust public health strategies, such as antimicrobial stewardship and stringent infection prevention. CONCLUSION: Addressing this complex issue requires concerted global efforts, substantial investment in local laboratory infrastructure, enhanced healthcare provider training, and the development of context-appropriate, affordable solutions to improve neonatal outcomes in LMICs.