Infections are responsible for about one fifth of the world’s annual 2.7 million neonatal deaths. In South Asia and sub-Saharan Africa about one quarter of all neonatal deaths are due to infections. Many sick infants only have non-specific signs, and thus are not recognized to have infection. Even when the signs are detected, hospitalization and life-saving treatment may not be accessible, acceptable or affordable to families in settings with high newborn mortality. Key studies in South Asia and in Africa indicate that up to two thirds or more of families do not accept referral for hospitalization of a young infant with signs of infection.