Family-centered care to complement care of sick newborns: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate.

Design

Randomized controlled trial

Setting

Tertiary referral nursery (October 2010 to March 2012).

Participants

295 neonates randomized at the time of hospitalization in neonatal intensive care unit.

Intervention

Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors.

Outcome measure

Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate.

Results

Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)].

Conclusions

There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.

     

Quality Improvement Approaches Associated with Quality of Childbirth Care Practices in Six Indian States

Objective

To compare the impact of quality improvement (QI) approaches and other health system factors (level of health facility, cadre of staff conducting the delivery, years of experience of staff conducting the delivery, and time of day) on the quality of six elements of delivery and postpartum/postnatal care.

Design

Cross-sectional study using external observers.

Setting

12 public health facilities in 6 states in India during November 2014.

Participants/patients

461 deliveries in above facilities.

Intervention

Facilities were chosen based on having received one day of QI training and at least six monthly QI coaching visits.

Main Outcome Measure(s)

(i) Administration of oxytocin within one minute following delivery, (ii) immediate drying and wrapping of the newborn, (iii) use of sterile cord clamps, (iv) breastfeeding within one hour of birth, (v) mothers’ condition assessed between 0 and 30 minute after delivery, and (vi) vitamin K given to infants within 6 hour of birth.

Results

On multivariate analysis, facilities using QI approaches with deliberate aims to address the processes of interest were more likely to dry and wrap infants (OR 2.6, 95% CI: 2.1, 6.6), initiate early breastfeeding (OR 3.6, 95% CI: 2.1, 6.2) and conduct post-partum vitals monitoring (OR 2.7, 95% CI: 1.7, 4.2). The other health system factors had mixed effects.

Conclusions

Facilities using QI approaches to ensure all women and babies receive specific elements of care provide that element of care to a greater proportion than facilities not using QI approaches for that element of care.

     

Ankyloglossia in infancy: An Indian experience

Objective

To study the prevalence, clinical presentation and management of infants with ankyloglossia.

Methods

A retrospective file review of infants less than 6 months of age with a diagnosis of ankyloglossia.

Results

Of the 25786 babies born during the assessment period (2007-2015), 134 (0.52%) had ankyloglossia. Sixty-four (47.7%) infants who presented with breastfeeding difficulties were diagnosed significantly earlier than the asymptomatic group (P<0.05). Of the symptomatic group, 85.9% underwent frenotomy with satisfactory results. Seventy asymptomatic infants were managed conservatively with counselling.

Conclusions

Frenotomy seems to be a safe and effective procedure in infants with symptomatic ankyloglossia.

     

Clinical and molecular characterization of children with neonatal diabetes mellitus at a tertiary care center in northern India

Objective

To study the genetic mutations and clinical profile in children with neonatal diabetes mellitus

Methods

Genetic evaluation, clinical management and follow-up of infants with neonatal diabetes

Results

Eleven infants were studied of which eight had permanent neonatal diabetes. Median age at presentation was 8 weeks and mean (SD) birth weight was 2.4 (0.5) kg. Pathogenic genetic mutations were identified in 7 (63.6%) children; 3 infants with mutations in KCNJ11 gene and 1 in ABCC8 were switched to oral sulfonylureas; 2 infants had mutations in INS and 1 in ZFP57.

Conclusion

Neonatal diabetes mellitus is a heterogeneous disorder. Identification of genetic cause guides clinical management.

     

Neurodevelopmental evaluation of very low birth weight infants with transient hypothyroxinemia at corrected age of 18–24 months

Objective

To perform neurodevelopmental evaluation at 18 to 24 months’ corrected age in very low birth infants (VLBW) with transient hypothyroxinemia.

Design

Cohort study.

Setting

Maternity teaching hospital.

Patients

Premature infants who were previously evaluated for thyroid hormone values in the first weeks of life were included.

Intervention

Data of these infants who weighed ≤1500 g and ≤32 weeks of gestation were retrieved for the current study. Available subjects (n=56) were evaluated for neurodevelopmental status at 18 to 24 months of corrected age. Bayley Scales of Infant Development -Second Edition (BSID-II) was performed to define Mental developmental index (MDI) and Psychomotor developmental index (PDI).

Results

The mean MDI and PDI scores were similar between the infants with and without transient hypothyroxinemia of prematurity (THOP) [79.9 ± 14.9 vs 70 ± 20.7, respectively (P=0.54); and 92.2 ± 16.4 vs 85.6 ± 18.9, respectively (P=0.68)]. After adjustment for gestational age and multiple prenatal, perinatal, and early and late neonatal variables, THOP was not associated with an increased risk of disabling cerebral palsy, or a reduction of MDI and PDI scores.

Conclusions

THOP may not be an important cause of problems in neurologic and mental development detected at the age of 18 to 24 months’ corrected age.

     

Nasal Continuous Positive Airway Pressure in Bronchiolitis: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objective

To evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis.

Design

Randomized controlled trial.

Setting

Tertiary-care hospital in New Delhi, India.

Participants

72 infants (age < 1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP.

Intervention

The outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis.

Main outcome measures

Change in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score.

Results

14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate[8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively.

Conclusion

nCPAP helped reduce respiratory distress significantly compared to standard care.

     

Assisted Physical Exercise for Improving Bone Strength in Preterm Infants Less than 35 Weeks Gestation: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objective

To compare the efficacy of daily assisted physical exercise (starting from one week of postnatal age) on bone strength at 40 weeks of post menstrual age to no intervention in infants born between 27 and 34 weeks of gestation.

Design

Open-label randomized controlled trial.

Setting

Tertiary-care teaching hospital in northern India from 16 May, 2013 to 21 November, 2013.

Participants

50 preterm neonates randomized to Exercise group (n=26) or Control group (n=24).

Intervention

Neonates in Exercise group underwent one session of physical exercise daily from one week of age, which included range-of-motion exercises with gentle compression, flexion and extension of all the extremities with movements at each joint done five times, for a total of 10-15 min. Infants in Control group underwent routine care and were not subjected to any massage or exercise.

Outcome measures

Primary: Bone speed of sound of left tibia measured by quantitative ultrasound at 40 weeks post menstrual age. Secondary: Anthropometry (weight length and head circumference) and biochemical parameters (calcium, phosphorus, alkaline phosphatase) at 40 weeks post menstrual age.

Results

The tibial bone speed of sound was comparable between the two groups [2858 (142) m/s vs. 2791 (122) m/s; mean difference 67.6 m/s; 95% CI -11 to 146 m/s; P=0.38]. There was no difference in anthropometry or biochemical parameters.

Conclusion

Daily assisted physical exercise does not affect the bone strength, anthropometry or biochemical parameters in preterm (27 to 34 weeks) infants.

     

Effect of Gastric Lavage on Meconium Aspiration Syndrome and Feed Intolerance in Vigorous Infants Born with Meconium Stained Amniotic Fluid — A Randomized Control Trial

Objective

To compare the incidence of meconium aspiration syndrome and feed intolerance in infants born through meconium stained amniotic fluid with or without gastric lavage performed at birth.

Setting

Neonatal unit of a teaching hospital in New Delhi, India.

Design

Parallel group unmasked randomized controlled trial.

Participants

700 vigorous infants of gestational age ≥34 weeks from through meconium stained amniotic fluid.

Intervention

Gastric lavage in the labor room with normal saline at 10 mL per kg body weight (n=350) or no gastric lavage (n=350). Meconiumcrit was measured and expressed as ≤30% and >30%.

Outcome Measures

Meconium aspiration syndrome, feed intolerance and procedure-related complications during 72 h of observation.

Results

5 (1.4%) infants in lavage group and 8 (2.2%) in no lavage group developed meconium aspiration syndrome (RR 0.63, 95% CI 0.21, 1.89). Feed intolerance was observed in 37 (10.5%) and 53 infants (15.1%) in lavage and no lavage groups, respectively (RR 0.70, 95% CI 0.47, 1.03). None of the infants in either group developed apnea, bradycardia or cyanosis during the procedure.

Conclusion

Gastric lavage performed in the labor room does not seem to reduce either meconium aspiration syndrome or feed intolerance in vigorous infants born through meconium stained amniotic fluid.

     

Simultaneous two-site blood culture for diagnosis of neonatal sepsis

Objective

To evaluate efficacy of two blood cultures taken simultaneously from two different sites as compared to standard practice of single blood culture in diagnosis of neonatal sepsis.

Study Design

Prospective cohort study.

Setting

A tertiary-care center at a public hospital.

Participants

475 neonates admitted to intensive care unit with suspected sepsis, from August 2014-July 2015.

Intervention

Two blood cultures drawn from two different peripheral veins in patients with suspected neonatal sepsis.

Main outcome measures

Increase in culture-positivity rate with use of two blood cultures.

Results

475 babies with suspected sepsis were enrolled. 185 patients had only first culture positive (38.9%). When we added second culture positivity, yield increased to 221 (46.5%). Adding on second culture increased the culture yield by 36 (7.6%; 95% CI 2.41 to 12.79; P=0.018). The most common organisms isolated were E. coli, S. aureus and Candida spp. Major morbidities and mortality were more common in blood culture positive patients Contamination was ruled out in 25 babies who grew Coagulase negative Staphylococcus (CONS) (n=10) and Candida spp. (n=15) in either of the two cultures.

Conclusion

Two blood cultures taken simultaneously from two different sites improve rate of pathogen detection as compared to routine practice of single blood culture.

     

Parental behaviors and sleep/wake patterns of infants and toddlers in Hong Kong,China

Background

To describe the sleep patterns of children below 36 months in Hong Kong, and evaluate the associations between parental behaviors and childhood sleep/wake patterns.

Methods

Parents of 1049 infants and toddlers completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.

Results

Total sleep duration (P<0.001), frequency (P<0.001) and duration (P<0.001) of nocturnal awakenings decreased with age, whereas the longest sleep duration (P<0.001) and nocturnal sleep duration (P<0.001) increased with age. Children who room- or bed-shared with parents had later bedtimes (P<0.001), but similar sleep duration compared with those who had a separate sleep location. Falling asleep independently was associated with longer nocturnal sleep duration (P<0.001) and less sleep awakenings (P<0.001). Full-time employment of parents was associated with shorter total sleep duration of children (P<0.001). Although breastfeeding was associated with more nocturnal awakenings (P<0.001), no association was detected between breastfeeding and shorter sleep duration in children.

Conclusions

As infants and toddlers develop, their sleep consolidates. Falling asleep independently was associated with longer nocturnal sleep duration and fewer sleep awakenings, whereas sleep location was not. This is an important finding, especially for families with limited living space where parent/child room- or bed-sharing cannot be avoided.

     

Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization

Objectives

To develop and assess Pediatric Appropriateness Evaluation Protocol for India (PAEP-India) for inter-rater reliability and appropriateness of hospitalization.

Design

Cross-sectional study.

Setting

The available PAEP tools were reviewed and adapted for Indian context by ten experienced pediatricians following semi-Delphi process. Two PAEP-India tools; newborn (≤28 days) and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness of admission and inter-rater reliability between assessors.

Participants

Two sets of case records were used: (i) 274 cases from five medical colleges in Delhi-NCR [≤28 days (n=51); >28 days to 18 years (n=223)]; (ii) 622 infants who were hospitalized in 146 health facilities and were part of a cohort (n= 30688) from two southern Indian states.

Interventions

Each case-record was evaluated by two pediatricians in a blinded manner using the appropriate PAEPIndia tools, and ‘admission criteria’ were categorized as appropriate, inappropriate or indeterminate.

Main outcome measures

The proportion of appropriate hospitalizations and inter-rater reliability between assessors (using kappa statistic) were estimated for the cases.

Results

97.8% hospitalized cases from medical colleges were labelled as appropriate by both reviewers with inter-rater agreement of 98.9% (k=0.66). In the southerm Indian set of infants, both reviewers labelled 80.5% admissions as appropriate with inter-rater agreement of 96.1% (k= 0.89).

Conclusions

PAEP-India (newborn and child) tools are simple, objective and applicable in diverse settings and highly reliable. These tools can potentially be used for deciding admission appropriateness and hospital stay and may be evaluated later for usefulness for cost reimbursements for insurance proposes.

     

Prefeeding Oromotor Stimulation Program for Improving Oromotor Function in Preterm Infants — <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objective

To determine effect of Premature Infant Oral Motor Intervention program on oro-motor function and time to full independent wati spoon feeds in preterm infants.

Methods

30 preterm infants between 28–32 weeks of gestation on full gavage feeds of 150 mL/kg/day were randomized to receive either pre-feed oro-motor stimulation using Premature Infant Oral Motor Intervention (structured stimulation) or sham intervention (unstructured stimulation).

Results

Improvement in mean (SD) Neonatal Oro-Motor Assessment Scale (NOMAS) over 7 days from baseline was significantly higher in the study group infants as compared to control group (9.25 (1.73) vs 4.79 (1.52), P=0.001). Infants in the study group reached full independent wati spoon feeds significantly earlier than the infants in control group (4.0 (0.8) d; vs 6.64 (1.0) d; P=0.001). There was significant increase in weight gain after enrolment in infants in study group compared to those in control group.

Conclusions

Oral stimulation program improves the oro-motor skills and growth velocity in 28–32 week preterm infants. There is decreased transition time from gavage to full independent feeds by mouth.

     

Determinants of breastfeeding discontinuation in an Italian cohort of mother-infant dyads in the first six months of life: a randomized controlled trial

Background

Among breastfeeding determinants, the marketing of breast milk substitutes might contribute to suboptimal breastfeeding rates. The aim of this study was to investigate the effect of receiving information on breast milk substitutes on breastfeeding rates.

Methods

We conducted a randomized, single-blind, controlled trial from 2012 to 2014 in a northern Italian maternity ward. We enrolled 802 Caucasian mothers who gave birth to healthy, full-term singletons with a birth weight?>?2500 g and who were exclusively breastfeeding from delivery to discharge. Mothers who gave birth to infants with congenital diseases, chromosomal abnormalities, perinatal infections and/or cardio-respiratory instability and/or mothers being affected by endocrine and/or metabolic and/or gastrointestinal and/or renal diseases were excluded.Mothers were randomized to either receive (group A, n?=?405) or not (group B, n?=?397) written information on a breast milk substitute at discharge. Breastfeeding was promoted and supported in all mother-infant pairs equally. The mode of feeding for up to 6 months after delivery was determined by phone interview. To detect a 10% difference between groups in the discontinuation rate of exclusive breastfeeding at three months of age at 5% significance and 80% power, a total of 356 mother-infant pairs per group were needed.

Results

The exclusive breastfeeding prevalence was 91% and 92% at 7 days, 79% and 70% at 1 month, 75% and 66% at 2 months, 72% and 62% at 3 months, and 3% and 2% at 6 months in groups A and B, respectively. The relative risk (95% confidence interval) of exclusive breastfeeding (group A vs B) at 7 days and at 1, 2, 3 and 6 months was as follows: 0.99 (0.95–1.03), 1.12 (1.03–1.21), 1.13 (1.03–1.24), 1.15 (1.04–1.27), and 1.49 (0.62–3.61).Nutritional, lifestyle and lactational factors were the primary contributing determinants to early breastfeeding discontinuation.

Conclusions

The present findings indicate that receiving written information on breast milk substitutes at hospital discharge, provided that breastfeeding support and education are offered, does not negatively affect breastfeeding rates.

Trial registration

NCT03208114. Registered 5 July 2017.

     

Impact of a new aggressive nutrition policy incorporating early introduction of parenteral nutrition and mother’s own milk on growth of preterm infants

Background

Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country.

Methods

The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events.

Results

Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055).

Conclusion

Early aggressive parenteral nutrition and early provision of mother’s milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes

     

Probiotics for promoting feed tolerance in very low birth weight neonates — <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To measure the efficacy of a probiotic formulation on time to reach full enteral feeds in VLBW (very low birth weight) newborns.

Design

Blinded randomized control trial.

Setting

A tertiary care neonatal intensive care unit (NICU) in Southern India between August 2012 to November 2013.

Participants

104 newborns with a birth weight of 750–1499 g on enteral feeds.

Intervention

Probiotic group (n=52) received a multicomponent probiotic formulation of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii once a day at a dose of 1.25×10⁹ CFU from the time of initiation of enteral feeds till discharge and the control group (n=52) received only breast milk.

Outcome measure

Time to reach full enteral feeds (150 mL/kg/day).

Results

The mean (SD) time to reach full enteral feeding was 11.2 (8.3) days in probiotic vs. 12.7 (8.9) in no probiotic group; (P=0.4), and was not significantly different between the two study groups. There was a trend towards lower necrotizing enterocolitis in the probiotic group (4% vs. 12%).

Conclusion

Probiotic supplementation does not seem to result in significant improvement of feed tolerance in VLBW newborns.

     

Vitamin D Deficiency in Ambulant Children on Carbamazepine or Sodium Valproate Monotherapy

Objective

To assess the effect of monotherapy with Carbamazepine (CBZ) and Sodium valproate (VPA) on serum 25-OH vitamin D levels in children with epilepsy compared to controls.

Design

Cross-sectional study.

Setting

Outpatient department of a tertiary-care Pediatric Neurology centre, and a nearby day-care centre and school.

Study period

June 2012 to May 2013

Participants

Children with epilepsy aged 2 to 13 years on monotherapy with CBZ (n=28) or VPA (n=28) for at least 6 months; 109 age-matched controls from a nearby day-care centre and school.

Results

The median (IQR) values of 25 (OH) vitamin D was 18.0 ng/mL (13.7-27.3), 21.35 ng/mL (16.4 -25.2) and 30.5 ng/mL (19.1-43.7) in CBZ, VPA and control group, respectively (P=0.008). 60.7% of patients in CBZ group and 35.7 % in VPA group had low 25 (OH) D levels (<20 ng/mL) compared to 27.8% in controls (P=0.001).The serum alkaline phosphatase level was higher in children on carbamazepine therapy (P=0.001) than controls.

Conclusion

This study identifies significant risk of vitamin D deficiency in ambulant children with epilepsy on monotherapy with CBZ or VPA.

     

Pune low birth weight study — Growth from birth to adulthood

Objective

To assess the growth, adiposity and blood pressure of non-handicapped low birthweight children at 18 years.

Design

Prospective cohort study.

Setting

Infants born between 1987-1989 with birthweight less than 2000g, discharged from a neonatal special care unit of a referral hospital and followed up till the age of 18 years.

Methods

The height, weight, and head circumference were measured. Measurements for adiposity, blood pressure, parental height and weight were recorded.

Results

The cohort of 161 low birth weight (LBW) infants was divided into three groups according to their gestation — preterm SGA (n=61), full term SGA (n=30) and preterm AGA (n=70). 71 full term AGA infants served as controls. Preterm SGA males had height of 164.5 cms (162–166.9, 95% CI) which was significantly less (mean deficit = 5.7 cms) than that of controls (P=0.02). However, PTSGA children were short inspite of normal midparental height. Preterm SGA and AGA children had smaller head circumference. There was no evidence of adiposity and no child had hypertension. Mid-parental height was an important determinant of height in LBW children. Both parentss’ weight and BMI were important determinants of weight and BMI, respectively in all LBW children.

Conclusion

Preterm SGA males were short, but there was no difference in the weight of the LBW group and controls. Preterms had smaller head circumference. There was no evidence of adiposity or hypertension.

     

Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

Objective

To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process.

Design

Quality improvement study.

Setting

Labor Room-Operation Theatre of a tertiary care hospital.

Participants

Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia.

Procedure

A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis. Various change ideas were tested through sequential Plan-Do- Study-Act (PDSA) cycles.

Outcome measure

Proportion of eligible babies breast fed within 1 hour of delivery.

Results

The rate of first-hour initiation of breastfeeding increased from 0% to 93% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources.

Conclusions

A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in cesarean deliveries.

     

Carbapenem-resistant <Emphasis Type="Italic">Enterobacteriaceae</Emphasis> in pediatric bloodstream infections in rural Southern India

Objective

To measure the frequency of antimicrobial resistance in pediatric blood culture isolates of Escherichia coli and Klebsiella spp. with focus on carbapenem resistance.

Methods

Over a period of three years, pediatric blood culture isolates were tested for antimicrobial susceptibility, including molecular investigations for carbapenem resistance.

Results

Amikacin, carbapenems, colistin and tigecycline had an antimicrobial efficacy of >70% (n=140). 7 of the 15 randomly selected isolates were positive for carbapenemase gene; among them, five were New Delhi Metallo β-lactamase (NDM).

Conclusion

There was a high prevalence of Klebsiella spp. in pediatric bacteremia and dissemination of NDMmediated carbapenem resistance in pediatric wards.

     

Comparative efficacy and safety of caffeine and aminophylline for apnea of prematurity in preterm (≤34 weeks) neonates: A randomized controlled trial

Objective

To compare the efficacy and safety of standard doses of Caffeine and Aminophylline for Apnea of prematurity.

Study design

Randomized controlled trial.

Setting

Tertiary-care referral centre and a teaching institution in Southern India. Trial was conducted from February 2012 to January 2015.

Participants

240 preterm (≤34 wk) neonates with apnea of prematurity.

Interventions

Neonates randomized into two groups: Caffeine group received loading dose of caffeine citrate (20 mg/kg) followed by 5 mg/kg/day maintenance dose every 24 hour. Aminophylline group received loading dose of Aminophylline–5 mg/kg and maintenance dose of 1.5 mg/kg 8-hourly.

Outcome measures

Difference in apneic spells, associated respiratory morbidity, and acute adverse events were assessed. Association of efficacy with therapeutic drug levels was also evaluated.

Results

Infants on aminophylline experienced less apnea spells in 4-7 days of therapy (P=0.03). Mean apnea rate and isolated desaturations were similar in 1-3, 4-7 and 8-14 days of therapy. No difference was noted in duration of Neonatal Intensive Care Unit stay and hospital stay. Mean heart rate was significantly high in Aminophylline group (P<0.001). Risk of developing tachycardia was less (RR 0.30; 95% CI range 0.15 to 0.60; P<0.001) in Caffeine- over Aminophylline-treated infants.

Conclusion

Aminophylline is as effective as caffeine for prevention of apneic spells in preterm neonates; however, dosage optimization needs to be done to reduce toxicity.