Paediatrics and International Child Health最新文献

{"title":"Peritoneal dialysis in children with sepsis-associated AKI (SA-AKI): an experience in a low- to middle-income country.","authors":"Apurva Tomar,&nbsp;Virendra Kumar,&nbsp;Abhijeet Saha","doi":"10.1080/20469047.2021.1874201","DOIUrl":"https://doi.org/10.1080/20469047.2021.1874201","url":null,"abstract":"<p><p><b>Background</b>: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.<b>Aim</b>: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.<b>Methods</b>: Early PD (<i>n</i> = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group (<i>n</i> = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.<b>Results</b>: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up (<i>p</i> < 0.001). The duration of PD was less if it was commenced early (<i>p</i> < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group (<i>p</i> < 0.001).<b>Conclusions</b>: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis.<b>Abbreviations</b> : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"137-144"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1874201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38826874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of adverse birth outcomes among HIV-infected and HIV-uninfected women delivering in high and low risk settings in the era of universal ART in Malawi: a registry study.","authors":"Rachel Chamanga,&nbsp;Chaplain Katumbi,&nbsp;Luis Gadama,&nbsp;Rachel Kawalazira,&nbsp;Dingase Dula,&nbsp;Bonus Makanani,&nbsp;Sufia Dadabhai,&nbsp;Taha E Taha","doi":"10.1080/20469047.2021.1874200","DOIUrl":"https://doi.org/10.1080/20469047.2021.1874200","url":null,"abstract":"<p><p><b>Background</b>: Recent studies show that ART is associated with an adverse birth outcome in HIV-infected women.<b>Aim</b>: To compare rates of low birthweight (LBW) and preterm birth (PTB) between HIV-infected women receiving lifelong ART and HIV-uninfected women giving birth in low- and high-risk settings in Malawi.<b>Methods</b>: This observational, registry study was conducted from January 2016 to August 2017 in one large, tertiary referral hospital and four primary healthcare (PHC) facilities in Blantyre, Malawi. Women who delivered singleton live births or stillbirths of ≥20 weeks gestation were included in the analysis. Descriptive and stratified analyses were conducted using χ² tests and multivariable logistic models to control for maternal age, gravidity and health facility.<b>Results</b>: A total of 14,233 births were included in the analysis (7715 from the tertiary hospital and 6518 from PHC facilities). In the univariable analysis, there were no differences in rates of LBW (6.7% <i>vs</i> 6.4%) and PTB (42.5% <i>vs</i> 42.0%) between HIV-infected and -uninfected women delivering in PHC facilities. However, differences in LBW were significantly higher in HIV-infected women in multivariable analysis (LBW aOR 1.40, 95% CI 1.01-1.95). Rates of LBW and PTB were significantly higher in HIV-infected women than in uninfected women delivering at the tertiary hospital (LBW 17.6% <i>vs</i> 13.2%, aOR 1.53, 95% CI 1.27-1.85; PTB 28.2% <i>vs</i> 24.9%, aOR 1.37, 95% CI 1.17-1.60)<b>Conclusion</b>: Rates of adverse birth outcomes are significantly higher in HIV-infected women than in HIV-uninfected women, and this is more apparent in high-risk hospital settings than in low-risk PHC settings.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"112-122"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1874200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38815818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight.","authors":"Sarah Unsworth,&nbsp;Hellen C Barsosio,&nbsp;Florence Achieng,&nbsp;Daniel Juma,&nbsp;Linda Tindi,&nbsp;Fred Omiti,&nbsp;Simon Kariuki,&nbsp;Helen M Nabwera","doi":"10.1080/20469047.2021.1881269","DOIUrl":"https://doi.org/10.1080/20469047.2021.1881269","url":null,"abstract":"<p><strong>Background: </strong>Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes.</p><p><strong>Aim: </strong>To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya.</p><p><strong>Methods: </strong>This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data.</p><p><strong>Results: </strong>At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers.</p><p><strong>Conclusion: </strong>Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"145-153"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1881269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25417118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric scurvy: frequently misdiagnosed.","authors":"Husna Musa,&nbsp;Imma Isniza Ismail,&nbsp;Nurul Hazwani Abdul Rashid","doi":"10.1080/20469047.2020.1816285","DOIUrl":"https://doi.org/10.1080/20469047.2020.1816285","url":null,"abstract":"<p><p>Paediatric scurvy is uncommon in the modern age but cases have been reported in children with neurodevelopmental issues and restricted dietary habits. The broad clinical picture is frequently overlooked as primarily other systemic diseases are considered first leading to extensive investigations and delay in diagnosis. A 4-year-old boy with autism and bilateral lower limb pain and refusal to walk is reported. His restricted diet and radiographic findings were highly suggestive of scurvy which was confirmed by the extremely low levels of ascorbic acid. Treatment with ascorbic acid replenishment and maintenance resulted in remarkable improvement. This case highlights the importance of a high index of suspicion in at-risk children so as to avoid unnecessary invasive investigations and procedures.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"158-161"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1816285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38483413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region.","authors":"Elizabeth M Keating, Msandeni Chiume, Elizabeth Fitzgerald, Yamikani Mgusha, Tisungane Mvalo, Nora Fino, Heather L Crouse, Michelle Eckerle, Kathleen Gorman, Emily J Ciccone, Gladstone Airewele, Jeff A Robison","doi":"10.1080/20469047.2021.1881270","DOIUrl":"10.1080/20469047.2021.1881270","url":null,"abstract":"<p><strong>Background: </strong>In children in sub-Saharan Africa, severe anaemia (SA) is an important cause of mortality, and malaria is a primary cause. The World Health Organization (WHO) recommends blood transfusion for all children with haemoglobin (Hb) <4 g/dL and for those with Hb 4-6 g/dL with signs of instability. In sub-Saharan Africa, evidence of the effect on mortality of transfusion in children with SA with and without malaria is mixed.</p><p><strong>Aim: </strong>To determine in children with and without malaria whether receipt of transfusion was associated with lower mortality at WHO transfusion thresholds.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 1761 children with SA (Hb ≤6 g/dL) admitted to Kamuzu Central Hospital in Malawi. In those whose Hb was 4-6 g/dL, mortality was compared by transfusion, stratified by haemoglobin, malaria status and signs of instability.</p><p><strong>Results: </strong>Children with profound anaemia (Hb <4 g/dL) and malaria were the only subgroup who had a significant decrease in the odds of in-hospital death if they received a transfusion (OR 0.43, <i>p</i> = 0.01). Although children with Hb 4-6 g/dL and at least one sign of instability had higher mortality than children with none, there was no difference in the odds of mortality between those who received a transfusion and those who did not (OR 1.16, <i>p</i> = 0.62).</p><p><strong>Conclusions: </strong>This study suggests that transfusion of children with profound anaemia and malaria may confer increased in-hospital survival. An understanding of the factors associated with mortality from SA will allow for interventions to prioritise the provision of limited blood.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"129-136"},"PeriodicalIF":1.4,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523581/pdf/nihms-1667283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38895635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between cardiorespiratory fitness and cardiometabolic risk factors in Brazilian children and adolescents: the mediating role of obesity parameters.","authors":"Caroline Brand,&nbsp;Cézane Priscila Reuter,&nbsp;Anelise Reis Gaya,&nbsp;Jorge Mota,&nbsp;Michael Duncan,&nbsp;Leticia Borfe,&nbsp;Jane Dagmar Pollo Renner","doi":"10.1080/20469047.2020.1838758","DOIUrl":"https://doi.org/10.1080/20469047.2020.1838758","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of clarity as to which obesity parameters may be more important in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk factors (CMRF).</p><p><strong>Aim: </strong>To verify the mediating role of different obesity parameters on the association between CRF and CMRF in normal weight and overweight/obese children and adolescents.</p><p><strong>Methods: </strong>This cross-sectional study comprised 999 children and adolescents (534 boys) aged 7-14 years from the south of Brazil. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and percentage of body fat were assessed. Participants were classified as normal weight, overweight and obese according to BMI. CRF was evaluated by the 6-minute run/walk test. . A continuous CMRF score was calculated by summing the Z-scores of the following variables: systolic and diastolic blood pressure, glucose, total cholesterol, high-density lipoprotein cholesterol and triglycerides. Data analysis was performed using partial correlation and linear regression models.</p><p><strong>Results: </strong>BMI, WC, WHtR and percentage of body fat mediated the relationship between CRF and CMRF in overweight/obese boys and girls but not those of normal weight. Additionally, the percentage of the influence of each obesity parameter was 20% for BMI and WC, 16% for percentage of body fat and 18% for WHtR in girls. For boys, the mediation effect was 25% for BMI, 26% for WC, 28% for percentage of body fat and 25% for WHtR.</p><p><strong>Conclusion: </strong>Adiposity plays a central role in CMRF; therefore, maintaining an adequate weight status should be an important objective of health-promoting programmes in early age.</p><p><p><b>Abbreviations</b>: CMRF, cardiometabolic risk factors; CRF, cardiorespiratory fitness; BMI. body mass index; HDL-c, high-density lipoprotein cholesterol, PROCESS PROESP-Br, Projeto Esporte Brasil; SPSS, Package for Social Sciences; TC, total cholesterol; TG, triglycerides; WC, waist circumference; WHtR, waist-to-height ratio; %BF, percentage of body fat.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"93-102"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1838758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38537160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report.","authors":"Özge Kaba,&nbsp;Manolya Kara,&nbsp;Zuhal Bayramoğlu,&nbsp;Emine Çalışkan,&nbsp;Bilal Çetin,&nbsp;Elnur Karimov,&nbsp;Ünsal Özkuvancı,&nbsp;Yasemin Özlük,&nbsp;Selda Hançerli Torun,&nbsp;Zeynep Nagehan Yürük Yıldırım,&nbsp;Hasan Orhan Ziylan,&nbsp;Ayper Somer","doi":"10.1080/20469047.2020.1822633","DOIUrl":"https://doi.org/10.1080/20469047.2020.1822633","url":null,"abstract":"<p><p>A 15-year-old girl was followed up for 2 years in a district hospital for management of vesicoureteral reflux and, subsequently, hydronephrosis of both kidneys and required bilateral ureteroneocystostomy. Despite surgery, there was continuous progression of the left hydronephrosis. Referral to a tertiary hospital because of continued sterile pyuria prompted investigation for tuberculosis (TB): she was diagnosed with bilateral pulmonary TB and urine culture confirmed <i>Mycobacterium tuberculosis</i>. Despite tuberculous chemotherapy and dexamethasone, she required a left nephrectomy. Histology demonstrated necrotising granulomatous pyelonephritis. She remains well with normal function of the right kidney. Despite the rarity, chronic urinary tract disorders should always prompt investigation for tuberculosis.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"154-157"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1822633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38432451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and laboratory features associated with mortality in children with severe malnutrition in Papua New Guinea.","authors":"Ian Kintwa,&nbsp;Paulus Ripa,&nbsp;Jonah Kurubi,&nbsp;Magdalynn Kaupa,&nbsp;Trevor Duke","doi":"10.1080/20469047.2021.1901435","DOIUrl":"https://doi.org/10.1080/20469047.2021.1901435","url":null,"abstract":"<p><p><b>Background:</b> The World Health Organization has a clinical and syndromic approach to the management of severe acute malnutrition which recognises that laboratory investigations are often not possible where children with severe malnutrition present. In low- and middle-income countries including Papua New Guinea, rates of death from severe malnutrition in many hospitals remain 10% or more.<b>Aim:</b> To evaluate the clinical predictors of death and the association between disturbances of electrolytes and haematological investigations in children with severe malnutrition and the risk of mortality.<b>Methods:</b> The clinical and laboratory predictors of death in a prospective cohort of 150 children with severe malnutrition admitted to a provincial hospital in Papua New Guinea were analysed. The clinical signs and electrolytes, complete blood count and liver function tests at presentation and on Days 3 and 5 were recorded.<b>Results:</b> The strongest independent predictors of mortality at assessment on admission were a low child Glasgow coma scale (≤12), hypoxaemia (SpO₂ <90%), prolonged capillary refill (>3 seconds) and dysnatraemia (<130 or >150 mmol/L). The area under the receiver operating characteristics curve for these four variables was 0.93.<b>Conclusions:</b> That three of these four criteria correspond closely to the WHO Emergency Clinical Signs reinforces the value of a system of triage and risk assessment in children with severe malnutrition. If a child has emergency signs they should be managed in an area on the ward where close monitoring and supportive care can be provided, the WHO guidelines for severe malnutrition followed, and other specific care provided. Measurements of serum sodium, particularly in children with diarrhoea and dehydration, is also important in risk assessment and management.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"123-128"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1901435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25542771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantile nephrotic syndrome secondary to cytomegalovirus infection in a 7-month-old girl: resolution with ganciclovir.","authors":"Jasleen Kaur,&nbsp;Bobbity Deepthi,&nbsp;Rachita Singh Dhull,&nbsp;M D Faruq,&nbsp;Abhijeet Saha","doi":"10.1080/20469047.2020.1823176","DOIUrl":"https://doi.org/10.1080/20469047.2020.1823176","url":null,"abstract":"<p><p>Infantile nephrotic syndrome is a rare disorder which is frequently caused by genetic defects. A 7-month-old girl presented with fever, loose stools and anasarca and was diagnosed with nephrotic syndrome. Work-up for a genetic cause was negative. Cytomegalovirus polymerase chain reaction (CMV PCR) was positive and the infant was treated with ganciclovir for 6 weeks, followed by valganciclovir for 10 weeks. All symptoms resolved within 2 weeks of commencing treatment and she attained complete remission within 4 weeks. CMV PCR was negative within 4 weeks of antiviral therapy. At 18 months follow-up she remained well. Appropriate treatment of infantile nephrotic syndrome secondary to CMV should result in recovery.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"162-165"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1823176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38431956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing antibiotic over-use by implementation of an antibiotic stewardship programme in preterm neonates in resource limited settings - a quality improvement initiative.","authors":"Anitha Kommalur,&nbsp;Vidyalakshmi Baddadka,&nbsp;Sahana Devadas,&nbsp;Mallesh Kariyappa,&nbsp;B Dakshayani,&nbsp;Shilpa Krishnapura Lakshminarayana,&nbsp;Suman P N Rao,&nbsp;Praveen Venkatagiri,&nbsp;Gayathri Devi Chinnappa,&nbsp;Sushma Veranna Sajjan","doi":"10.1080/20469047.2021.1886545","DOIUrl":"https://doi.org/10.1080/20469047.2021.1886545","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics play a critical role in neonatal sepsis but excessive use is associated with adverse outcomes and the current prescribing rates of antibiotics are unacceptably high.</p><p><strong>Aim: </strong>To reduce antibiotic over-use in preterm neonates by implementing an antibiotic stewardship programme using a quality improvement (QI) initiative.</p><p><strong>Methods: </strong>This study was conducted at a neonatal intensive care unit in a resource-limited setting. The reasons for antibiotic over-use were analysed and an antibiotic stewardship programme was implemented by using a QI initiative. The duration of the QI was a 1-month baseline phase followed by 3 months of implementation which was undertaken in the form of Plan-Do-Study-Act (P-D-S-A) cycles. The sustainment phase was observed for 2 months. All neonates admitted to the preterm unit were included. The outcome measure was the antibiotic usage expressed as days of therapy (DOT)/1000 patient days.</p><p><strong>Results: </strong>In the baseline phase, DOT/1000 patient days was 1464 which fell to 706, 511, and 442 DOT/1000 patient days, respectively, over 3 months, resulting in a 65% reduction in antibiotic usage. This was achieved by a combination of efforts directed towards defining the conditions for no antibiotics, revising existing antibiotic policy, stopping orders at 48 hours, de-escalation to the narrowest spectrum antibiotic, stopping prophylactic antifungal agents and limited use of broad-spectrum antibiotics. The results were achieved without an increase in culture-positive sepsis or mortality.</p><p><strong>Conclusions: </strong>Implementation of a tailored antibiotic stewardship programme through a QI initiative was effective and safe in reducing antibiotic use in preterm neonates in a resource-limited setting.</p><p><strong>Abbreviations: </strong>AIIMS, All India Institute of Medical Sciences; DOT, days of therapy; HIC, high-income countries; ICMR, Indian Council of Medical Research; LMIC, low- to middle-income countries; LOS, late-onset sepsis; NICU, neonatal intensive care unit; NNF, National Neonatology Forum; P-D-S-A, plan-do-study-act; QI, quality improvement; SNCU, Special newborn care unit.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"103-111"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1886545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25492585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}