Management of malaria in newborns: a systematic review

Abstract Background Malaria in neonates (age ≤ 28 days) remains under-recognized and poorly characterized, without specific management guidelines. We conducted a systematic review to collate available evidence on antimalarial treatment in this age group. Methods We searched PubMed and Web of Science for studies reporting confirmed Plasmodium spp. infection and antimalarial treatment in neonates. Any type of study with original data, including case reports, was included if published in English, German or French. Demographic, clinical and antimalarial treatment data were extracted and summarized descriptively. Results Out of 4028 reports identified, 26 publications (22 case reports, three case series, one cross-sectional study) reporting on antimalarial treatment in 40 neonates with confirmed malaria were included. The majority (75%) of publications originated from malaria-endemic regions with 19 cases reported from African countries. Median age at symptom onset and diagnosis was 16 and 19 days, respectively. Plasmodium falciparum and P. vivax accounted for 45% and 43% of cases, one case had a P. falciparum and P. vivax co-infection, and in four cases species of Plasmodium was not reported. All but one neonate were reported with symptomatic malaria, with fever, jaundice, and anaemia as predominating symptoms; 70% were initially misdiagnosed with sepsis. Treatment regimens varied substantially. Of neonates with P. falciparum malaria, only 28% received artemisinin-based therapy and most (56%) were treated with oral amodiaquine or chloroquine monotherapy. P. vivax malaria was mostly treated with oral chloroquine (64%). Oral drug administration practice was rarely reported but included drug administration as syrup or crushed tablets and use of an orogastric tube. All patients survived, with reported parasitaemia clearance in 2–7 days. Conclusion The literature on newborn malaria management remains notably sparse. Reported management practices are highly inconsistent with regimens deviating from current treatment recommendations. Prospective interventional studies on the management of malaria in newborns, including evaluation of oral drug administration practices and pharmacokinetics are urgently needed to inform evidence-based age-specific guidelines. Clinical trial Not applicable.