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Infection Control Practices Reduce Nosocomial Infections and Mortality in Preterm Infants in Bangladesh


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The skin is a potential source for invasive infections in neonates from developing countries such as Bangladesh, where the level of environmental contamination is exceedingly high. A randomized controlled trial was conducted from 1998 to 2003 in the Special Care Nursery of a tertiary hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing the skin barrier of preterm neonates less than 33 weeks of gestational age. In the initial months of the study, the infection and mortality rates were noted to be unacceptably high. Therefore, an infection control program was introduced early in the trial to reduce the rate of nosocomial infections. After a comprehensive review of neonatal care practices and equipment to identify sources of nosocomial infections, a simple but comprehensive infection control program was introduced that emphasized education of staff and caregivers about measures to decrease risk of contamination, particularly hand-washing, proper disposal of infectious waste, and strict asepsis during procedures, as well as prudent use of antibiotics. Infection control efforts resulted in declines in episodes of suspected sepsis (47%), cases of culture-proven (61%) sepsis, patients with a clinical diagnosis of sepsis (79%), and deaths with clinical (82%) or culture-proven sepsis (50%). The infection control program was shown to be a simple, low-cost, low-technology intervention to reduce substantially the incidence of septicemia and mortality in the nursery.
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Original Article
Infection Control Practices Reduce Nosocomial Infections and
Mortality in Preterm Infants in Bangladesh
Gary L. Darmstadt, MD, MS
A.S.M. Nawshad Uddin Ahmed, MBBS, FRCP
Samir K. Saha, PhD
MAK Azad Chowdhury, MBBS, FRCP
Muhammad Asif Alam, MBBS, MS
Mahamuda Khatun, MBBS
Robert E. Black, MD, MPH
Mathuram Santosham, MD, MPH
The skin is a potential source for invasive infections in neonates from
developing countries such as Bangladesh, where the level of
environmental contamination is exceedingly high. A randomized
controlled trial was conducted from 1998 to 2003 in the Special Care
Nursery of a tertiary hospital in Bangladesh to test the effectiveness of
topical emollient therapy in enhancing the skin barrier of preterm
neonates less than 33 weeks of gestational age. In the initial months of
the study, the infection and mortality rates were noted to be unacceptably
high. Therefore, an infection control program was introduced early in the
trial to reduce the rate of nosocomial infections.
After a comprehensive review of neonatal care practices and equipment to
identify sources of nosocomial infections, a simple but comprehensive
infection control program was introduced that emphasized education of
staff and caregivers about measures to decrease risk of contamination,
particularly hand-washing, proper disposal of infectious waste, and strict
asepsis during procedures, as well as prudent use of antibiotics.
Infection control efforts resulted in declines in episodes of suspected sepsis
(47%), cases of culture-proven (61%) sepsis, patients with a clinical
diagnosis of sepsis (79%), and deaths with clinical (82%) or culture-
proven sepsis (50%).
The infection control program was shown to be a simple, low-cost, low-
technology intervention to reduce substantially the incidence of
septicemia and mortality in the nursery.
Journal of Perinatology (2005) 25, 331335. doi:10.1038/
Published online 17 February 2005
Nosocomial infections are a principal cause of morbidity and
mortality among hospitalized neonates in developing countries.
The incidence of sepsis in premature infants in developing
countries is particularly high, estimated at 30 to 60%,
mortality is 40 to 70%.
Limited information is available,
however, from many developing countries on the impact of
strategies to prevent and control these infections.
Model infection control programs to detect and prevent
nosocomial infections and minimize the emergence and spread of
antibiotic-resistant strains within hospital nurseries have been
established in developed countries, and some countries in Latin
America have adapted these programs based on local needs and
Many aspects of these programs, however, are not
readily applicable to health-care settings with more limited
resources, such as many health facilities in south Asia and sub-
Saharan Africa, where the majority of global neonatal deaths
occur. Infection control programs should incorporate two broad
strategies fundamental to the control of nosocomial infections:
reducing bacterial transmission within the nursery through
infection control interventions, and reducing selective pressure for
the emergence of antibiotic resistance through promotion of
rational use of antibiotics and control of their misuse. Although
resource limitations will restrict the scope of infection control
programs in many settings, the ability to use antibiotics rationally
and to implement simple infection control procedures, such as
hand-washing, are not beyond the reach of health-care facilities
with even very limited resources.
In the course of implementing an intervention trial at Dhaka
Shishu Hospital, Bangladesh, to assess the impact of topical
Address correspondence and reprint requests to Gary L. Darmstadt, MD, Department of
International Health E8153, Bloomberg School of Public Health, Johns Hopkins University, 615
North Wolfe Street, Baltimore, MD 21205, USA.
Presented in part at 10th Asian Conference on Diarrhoeal Diseases and Nutrition, Dhaka,
Bangladesh, 2004; and Third National Annual Conference and Scientific Session, Bangladesh
Neonatal Forum, Dhaka, Bangladesh, 2002.
Department of International Health (G.L.D., R.E.B., M.S.), Bloomberg School of Public Health,
Johns Hopkins University, Baltimore, MD, USA; Saving Newborn Lives Initiative (G.L.D.), Save the
Children USA, Washington, DC, USA; Department of Neonatology (A.S.M.N.U.A.; M.A.K.A.C.),
Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology
(M.A.A., M.K., S.K.S.), Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
Journal of Perinatology 2005; 25:331335
2005 Nature Publishing Group All rights reserved. 0743-8346/05 $30 331
emollient therapy to enhance skin barrier function on the
incidence of infections in preterm infants, the results of which will
be reported elsewhere,
we found alarmingly high rates of
nosocomial infections and mortality. This led to the development
and evaluation of the impact of a low-cost infection control
program, including antibiotic use guidelines and emphasis on
hygiene, on the incidence of nosocomial infections and neonatal
mortality rates among preterm infants in the Special Care Nursery.
Study Setting and Patient Population
A randomized, controlled intervention trial was initiated in
December 1998 at Dhaka Shishu Hospital, Bangladesh, aimed to
reduce infections in preterm infants less than 33 weeks gestational
age through topical therapy with skin-barrier-enhancing
Dhaka Shishu Hospital is the largest tertiary-level
pediatric hospital in Bangladesh, with 345 beds, including 16 cribs
and eight isolettes in the Special Care Nursery. Patients come to
Shishu Hospital from all over Bangladesh, although the principal
catchment area includes a population of approximately 16 million
from Dhaka and adjoining districts.
Gestational age of neonates admitted to the Hospital was
determined by maternal dates and Ballard and Dubowitz
the average of the three values was used. Infants were
enrolled in the study if their average gestational age was less than
33 weeks, their chronological age was less than 72 hours, and
parental informed consent was obtained. Exclusion criteria
included: (1) admission for a major surgical procedure attended by
a high rate of infectious complications; (2) clinically evident skin
infection (confirmed by surface culture); (3) generalized skin
disease likely to produce a defect in epidermal barrier function; (4)
a structural defect of the skin involving greater than 5% body
surface area (e.g., congenital blistering disorder); (5) a major
congenital anomaly likely to predispose to infection; or (6) known
During the initial phase of the trial, nosocomial infection and
mortality rates were found to be unacceptably high at 35 and 61%,
respectively, and the study Data Safety and Monitoring Board
encouraged the investigators to assess and address the situation.
Previously, epidemic outbreaks of nosocomial infections had
occurred in the Special Care Nursery due to Flavobacterium
meningosepticum, Salmonella typhi Group B, and Klebsiella
Infection Control Program
Given the high rate of nosocomial infections and mortality among
preterm neonates in the Special Care Nursery, an infection control
program was introduced in January 1999. In the first phase, a
review of neonatal care practices and equipment in the Nursery was
undertaken to identify potential sources of nosocomial infections,
including the staff, particularly their hands, and equipment used
in patient care, including incubators, nasal prongs, and suction
devices. Antibiotic use and intravenous catheter care were also
reviewed. Based on the findings of the review, educational sessions
were held with the nurses in the Nursery, who, in turn, held daily
sessions with patient family members (generally the mother, or, if
the mother was unavailable, another female relative) who resided
in the unit and assisted in caring for their own hospitalized
newborn. Emphasis was placed initially on personal hygiene of the
nurses and caregivers, particularly hand-washing, nail care, and
bathing. Emphasis was also placed on minimum handling of very
preterm infants, newborn bathing techniques to minimize risk for
hypothermia, and promotion of breastfeeding. Nurses were also
taught clean umbilical cord care and regular shifting of infant
posture and mild physiotherapy. Ward physicians were given
refresher training on early recognition and culturing of infants
with suspected sepsis, and appropriate antibiotic therapy.
In 2000, the Hospital formed an Infection Control Committee
comprising the Hospital Director, Epidemiologist, Head of
Microbiology, Nursing Supervisor, and a Staff Nurse. Further
measures the Committee took to prevent nosocomial infections
1. Hand-washing: A freestanding wash basin containing Savlon
antiseptic was set at an accessible place near the sink in the
ward to further encourage hand-washing by doctors and nurses.
A poster was placed at the basin as a reminder of the ideal way
to wash hands.
2. Waste disposal: Colored buckets were placed in the ward; blue
buckets for normal waste and red for potentially infectious or
dangerous waste such as syringes, needles, broken tubes, etc.
3. Introduction of disposable needles: Private-paying patients
(20% of admissions) were asked to provide disposable syringes
and needles; for non-paying patients, disposable needles were
donated by the hospital, used and discarded, although in some
cases, due to lack of resources, syringes were used more than
once (after cleaning and boiling).
4. Visitation: Restrictions were placed on the number of visitors in
the wards, and visitors were required to wash their hands before
going to a patient’s bedside.
5. Cohorting: Surgical postoperative patients with wound infec-
tions were isolated from other patients.
6. Care of intravenous and urinary catheters: The staff was
trained in standard guidelines for use of these devices and an
infection control nurse was appointed to monitor their use.
7. Training and supervision: Weekly classes on infection control
procedures on the wards were conducted by the Nursing
Supervisor with nurses and caregivers. The head of the Infection
Control Committee also conducted classes on a regular basis
with the nurses, with special reference to specimen collection,
aseptic measures, and basics of microbiology related to
Darmstadt et al. Infection Control Reduces Neonatal Mortality
332 Journal of Perinatology 2005; 25:331335
nosocomial infections. Practices were reinforced through daily
supervision by the Nursing Supervisor.
In a third stage of the infection control program begun in 2001, a
new Nursing Supervisor with interest and training in infection
control began to assemble groups of three to four mothers and other
caregivers on the ward to reinforce health and infection control
messages. A log book of these sessions was maintained, including
documentation of the issues discussed. Emphasis was further placed
on increasing awareness of the importance of infection control and
personal hygiene. Nurses inspected the mother’s hygiene, including
the ngernails, each day. Caregivers were given a clean gown each
day to wear at the bedside when handling the baby, and were given a
box in which to keep dirty items.
Hand-washing was highlighted as the most important measure
to prevent nosocomial infections. Caregivers and staff were
instructed to wash hands at the sink with soap and water, followed
by hexisol (2.5% v/v chlorhexidine gluconate solution in 70% w/w
isopropyl alcohol) before handling the babies. A towel at the sink
for use by caregivers was changed each day; prior to the
intervention, this was not regularly monitored. Study nurses and
physicians began to use disposable tissues, rather than the towel, to
dry their hands.
Additional actions taken as part of the third stage of the infection
control program included: (1) a separate suction device was
designated for each baby and placed at the bedside; (2) incubators
were cleaned with soap and water and Savlon, and dried in-between
patients and at least once per week if the baby was in the incubator
for a prolonged period; (3) emphasis was placed on keeping the
floors clean; (4) new bed mattresses were purchased without crevices
in which ‘‘dirt’’ could accumulate, and were cleaned with Savlon
every day; (5) nurse workload was restructured so that one nurse
would feed all the babies and a different nurse would change and
clean the beds, rather than sharing duties; (6) further instruction
and supervision was provided to ensure that invasive procedures
(e.g., venipuncture, catheter placement, lumbar puncture) were
performed using strict asepsis, including use of iodine and alcohol
(not just alcohol as practiced previously); and (7) babies with
clinically suspected or bacteriological-proven septicemia were
cohorted, if possible. Finally, judicious antibiotic use was reviewed,
including initial empiric use of ampicillin and gentamicin as first-
line treatment for suspected sepsis, prompt discontinuation of
antibiotics if cultures were negative and the baby was well clinically,
and appropriate and prompt adjustment of the antibiotic regimen
according to the sensitivity pattern of the isolate.
Nosocomial infection, or confirmed hospital-acquired sepsis, the
primary outcome measure, was defined as a noncontaminated
(e.g., Diphtheroids and Micrococcus spp. were excluded) positive
blood or cerebrospinal fluid (CSF) culture taken after 3 or more
days of hospitalization, where the culture did not grow the same
organism as the most recent previous culture in the same infant
(i.e., cultures that were positive on the basis of persistent infection
were excluded). If an infant had both a positive CSF and a positive
blood culture, or two positive blood cultures on the same day, only
one nosocomial infection on that day was counted.
Suspected sepsis was defined as any episode of illness for which
blood cultures were drawn. A patient was identified as having
clinical sepsis if, on the basis of clinical judgment, the attending
physician assigned sepsis as a final diagnosis at the end of
Data Analysis
All analyses were conducted using STATA 7.0 statistical software
(Stata Corporation, College Station, TX, USA).
Nosocomial Infections
Epidemics. In 1998, before our study was initiated, nosocomial
outbreaks of group B Salmonella accounted for 58 documented
Figure 1. Number of episodes of suspected sepsis and confirmed sepsis
among preterm neonates hospitalized at Dhaka Shishu Hospital,
Bangladesh, during institution of infection control measures during
different time periods: (A) Review for potential sources of infections;
educational sessions with families and staff, emphasizing hygiene,
essential newborn care practices, and antibiotic use; (B) Infection
Control Committee formed; consolidation of infection control measures,
training and supervision; (C) Infection Control Nursing Supervisor
hired; further emphasis on education regarding hygiene and antibiotic
Infection Control Reduces Neonatal Mortality Darmstadt et al.
Journal of Perinatology 2005; 25:331335 333
cases of nosocomial infection in the neonatal ward, whereas 12
such cases occurred in 1999, and there were no outbreaks of
Salmonella infection in 2000. Similarly, outbreaks with K.
pneumoniae accounted for 62 infections in 1999, 14 in 2000, and
none in 2001.
Sporadic infections. Significant declines from 1999 to 2001
were found in cases of suspected sepsis [i.e., total number of
cultures obtained (Figure 1) and number of cultures obtained per
patient (data not shown) for suspected sepsis] and culture-proven
sepsis [i.e., total number of positive cultures (Figure 1) and
proportion of cultures obtained per patient that were positive (data
not shown)]. Number of patients diagnosed with clinical sepsis
(Figure 2) was also reduced. Mortality declined over the study
period, with reduced numbers of patients who died with clinical
sepsis and confirmed sepsis (Figure 3).
This study has important implications for infection control and
antibiotic use policies in neonatal care units in developing
countries. Despite the proven benefit of infection control
practices in developed country nurseries, there is little
documentation of successful infection control efforts in the
developing world, where rates of nosocomial infections remain
unacceptably high and contribute to high mortality rates due to
sepsis in health facilities. The high mortality and infection rates
and alarmingly high rates of antibiotic resistance that we
encountered among the nosocomial isolates in the Special Care
Nursery at our study site
led us to institute low-technology,
low-cost infection control procedures, with encouraging results
that may be widely applicable to other developing country
neonatal care settings.
We demonstrated that a relatively simple infection control
program, aimed at fundamental sources of nosocomial infection
identified through a systematic review of the care practices and
equipment in the nursery, can have a marked impact on
nosocomial infection and mortality rates in hospitalized preterm
infants. Some of the key elements of the program appeared to be
designation of an infection control nurse on the ward and
formation of a hospital Infection Control Committee to oversee
training activities and stimulate ownership of the problem on the
part of the staff; systematic review and planning to redress principal
potential sources of environmental contamination in the nursery;
regular training and supervision of nurses and caregivers on
routine infection control practices, particularly hand-washing; and
focused attention on judicious use of antibiotics. Little to no cost
was required to implement the program except for materials such
as cleansers and time for the various educational activities with
staff and caregivers. The will and efforts of key individuals,
particularly the Nursing Supervisor, to improve infection control
practices was pivotal in achieving success. Other nurseries
throughout the developing world could readily implement such a
This study was supported by the Thrasher Research Fund, the Johns Hopkins
Family Health and Child Survival Cooperative Agreement with the United Sates
Agency for International Development, the Society for Pediatric Dermatology and
Save the Children USA through a grant from the Bill and Melinda Gates
Foundation. We thank the members of the Data Safety and Monitoring Board
(DSMB) for the parent intervention trial for their encouragement to pursue
infection control measures in the nursery. DSMB members included Kim
Mulholland, University of Melbourne, Barbara Stoll, Emory University, and
Figure 2. Number of preterm infants with clinical sepsis during
hospitalization at Dhaka Shishu Hospital, Bangladesh.
Figure 3. Number of patients who died with clinical sepsis and with
confirmed sepsis.
Darmstadt et al. Infection Control Reduces Neonatal Mortality
334 Journal of Perinatology 2005; 25:331335
William Blackwelder (retired), National Institutes of Health (USA). We thank
Rachel Haws for editorial assistance in preparation of the manuscript, and
Maksuda Islam for microbiological technical assistance.
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Infection Control Reduces Neonatal Mortality Darmstadt et al.
Journal of Perinatology 2005; 25:331335 335
... This environment posed a threat of infection particularly through contact with contaminated hands, objects or surfaces, to all individuals in the wards, including patients, family caregivers, visitors and hospital staff. Before these two exploratory studies in context of infection control practices a randomized control trial was conducted by Darmstadt et al. [11], from 1998 to 2003 in the Special Care Nursery in Dhaka Shishu hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing skin barrier of preterm neonates less than 33 weeks of gestational age. In the initial month of the study, the infection and mortality rates were noted to be unacceptably high. ...
... Supportive care components are described in the World Health Organisation (WHO) Standards for improving the quality of care for small and sick newborns in health facilities at different levels of health systems (Figure 1), and several indicators are assessed in this study, notably for safe oxygen therapy, phototherapy for jaundice (if needed), and management of hypoglycaemia. [19][20][21][22]. ...
Full-text available
Background An estimated 7 million episodes of severe newborn infections occur annually worldwide, with half a million newborn deaths, most occurring in low- and middle-income countries. Whilst injectable antibiotics are necessary to treat the infection, supportive care is also crucial in ending preventable mortality and morbidity. This study uses multi-country data to assess gaps in coverage, quality, and documentation of supportive care, considering implications for measurement. Methods The EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Newborns with an admission diagnosis of clinically-defined infection (sepsis, meningitis, and/or pneumonia) were included. Researchers extracted data from inpatient case notes and interviews with women (usually the mothers) as the primary family caretakers after discharge. The interviews were conducted using a structured survey questionnaire. We used descriptive statistics to report coverage of newborn supportive care components such as oxygen use, phototherapy, and appropriate feeding, and we assessed the validity of measurement through survey-reports using a random-effects model to generate pooled estimates. In this study, key supportive care components were assessment and correction of hypoxaemia, hyperbilirubinemia, and hypoglycaemia. Results Among 1015 neonates who met the inclusion criteria, 89% had an admission clinical diagnosis of sepsis. Major gaps in documentation and care practices related to supportive care varied substantially across the participating hospitals. The pooled sensitivity was low for the survey-reported oxygen use (47%; 95% confidence interval (CI) = 30%-64%) and moderate for phototherapy (60%; 95% CI = 44%-75%). The pooled specificity was high for both the survey-reported oxygen use (85%; 95% CI = 80%-89%) and phototherapy (91%; 95% CI = 82%-97%). Conclusions The women’s reports during the exit survey consistently underestimated the coverage of supportive care components for managing infection. We have observed high variability in the inpatient documents across facilities. A standardised ward register for inpatient small and sick newborn care may capture selected supportive care data. However, tracking the detailed care will require standardised individual-level data sets linked to newborn case notes. We recommend investments in assessing the implementation aspects of a standardised inpatient register in resource-poor settings.
... The skin is the biggest organ in the human body, spanning the whole surface and being susceptible to a wide range of medical diseases and infections ranging from basic to complex symptoms. Among all other skin problems, eczema is one of the most common skin disorders that contribute to public health issues [1,2]. Though it has a low fatality rate, most instances of eczema have a chronic course with symptoms. ...
Full-text available
Background: Recently Eczema is one of the important causes of public health problem in diabetic patients. Objective: In this study our main goal is to evaluate the prevalence of eczema in outdoor diabetic patients. Method: This descriptive cross-sectional study was conducted among the diabetic patients in the department of Dermatology (Outpatient department) of Bangladesh. The population of the study was the diabetic patients of all ages of different occupations. Among all the patients with skin disease only the eczema infected patients were selected. A total of 100 diabetic patients infected with eczema were selected purposively. Results: During the study, most of the patients belongs to 41-50 years age group, 46% and 46% were male. Majority (45%) respondents had eczema in hand, 35% had it in legs and 15% in finger. Some other organs (5%) were also affected. Out of 100 respondents majority (55%) did not control diabetes, 10% controlled strictly and 35% just controlled it. It means that majority of eczema cases were in respondents with uncontrolled diabetes mellitus. Conclusion: Skin disorders like the type of eczema are very common, particularly in the case of type 2 diabetes patients. Further study is needed for better outcome.
... The World Health Organization (WHO) recommends inpatient management of infections among newborns with injectable antibiotics [13]. Early administration of appropriate injectable antibiotics with supportive care could avert hundreds of thousands of deaths a year [14][15][16]. However, substantial gaps exist between such recommendations and implementation [17][18][19], and there is a dearth of studies to inform measuring the coverage and quality of inpatient management of infections, particularly in LMIC contexts. ...
Full-text available
Background An estimated 30 million neonates require inpatient care annually, many with life-threatening infections. Appropriate antibiotic management is crucial, yet there is no routine measurement of coverage. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aimed to validate maternal and newborn indicators to inform measurement of coverage and quality of care. This paper reports validation of reported antibiotic coverage by exit survey of mothers for hospitalized newborns with clinically-defined infections, including sepsis, meningitis, and pneumonia. Methods EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017–July 2018). Neonates were included based on case definitions to focus on term/near-term, clinically-defined infection syndromes (sepsis, meningitis, and pneumonia), excluding major congenital abnormalities. Clinical management was abstracted from hospital inpatient case notes (verification) which was considered as the gold standard against which to validate accuracy of women’s report. Exit surveys were conducted using questions similar to The Demographic and Health Surveys (DHS) approach for coverage of childhood pneumonia treatment. We compared survey-report to case note verified, pooled across the five sites using random effects meta-analysis. Results A total of 1015 inpatient neonates admitted in the five hospitals met inclusion criteria with clinically-defined infection syndromes. According to case note verification, 96.7% received an injectable antibiotic, although only 14.5% of them received the recommended course of at least 7 days. Among women surveyed ( n = 910), 98.8% (95% CI: 97.8–99.5%) correctly reported their baby was admitted to a neonatal ward. Only 47.1% (30.1–64.5%) reported their baby’s diagnosis in terms of sepsis, meningitis, or pneumonia. Around three-quarters of women reported their baby received an injection whilst in hospital, but 12.3% reported the correct antibiotic name. Only 10.6% of the babies had a blood culture and less than 1% had a lumbar puncture. Conclusions Women’s report during exit survey consistently underestimated the denominator (reporting the baby had an infection), and even more so the numerator (reporting known injectable antibiotics). Admission to the neonatal ward was accurately reported and may have potential as a contact point indicator for use in household surveys, similar to institutional births. Strengthening capacity and use of laboratory diagnostics including blood culture are essential to promote appropriate use of antibiotics. To track quality of neonatal infection management, we recommend using inpatient records to measure specifics, requiring more research on standardised inpatient records.
... Neonatal mortality accounted for about 40% of the under 5 mortality in 2015 [2]. Most neonatal deaths can be prevented by administration of proven interventions for newborn survival [3][4][5][6]. These interventions require the presence of skilled health workers to recognize a newborn in need of additional care, conduct a timely assessment, and establish an appropriate management plan [7]. ...
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Background: Neonatal mortality is high in developing countries. Lack of adequate training and insufficient management skills for sick newborn care contribute to these deaths. We developed a phone application dubbed Protecting Infants Remotely by Short Message Service (PRISMS). The PRISMS application uses routine clinical assessments with algorithms to provide newborn clinical management suggestions. We measured the feasibility, acceptability and efficacy of PRISMS by comparing its clinical case management suggestions with those of experienced pediatricians as the gold standard. Methods: Twelve different newborn case scenarios developed by pediatrics residents, based on real cases they had seen, were managed by pediatricians and PRISMS®. Each pediatrician was randomly assigned six of twelve cases. Pediatricians developed clinical case management plans for all assigned cases and then obtained PRISMS suggested clinical case managements. We calculated percent agreement and kappa (k) statistics to test the null hypothesis that pediatrician and PRISMS management plans were independent. Results: We found high level of agreement between pediatricians and PRISMS for components of newborn care including: 10% dextrose (Agreement = 73.8%), normal saline (Agreement = 73.8%), anticonvulsants (Agreement = 100%), blood transfusion (Agreement =81%), phototherapy (Agreement = 90.5%), and supplemental oxygen (agreement = 69.1%). However, we found poor agreement with potential investigations such as complete blood count, blood culture and lumbar puncture. PRISMS had a user satisfaction score of 3.8 out of 5 (range 1 = strongly disagree, 5 = strongly agree) and an average PRISMS user experience score of 4.1 out of 5 (range 1 = very bad, 5 = very good). Conclusion: Management plans for newborn care from PRISMS showed good agreement with management plans from experienced Pediatricians. We acknowledge that the level of agreement was low in some aspects of newborn care.
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Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. To assess the effectiveness of a multifaceted infection control and antibiotic stewardship programme on HAIs and antibiotic use. A retrospective study was conducted for a study period of 11months (June 2021-April 2022) in Vydehi Hospital, Bangalore. All patients admitted to the intensive care unit and wards were included in the study. Intervention period was 6 months (June 2021-Nov 2021) and post-intervention period was 5 months (Dec 2021- April 2022). Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of hand hygiene campaign, isolation of multidrug resistance organism’s patients, water and air quality analysis, training of health care workers in infection control practices, and antibiotic stewardship. Data was collected using an identical method in the intervention and post intervention periods. We observed a major reduction in HAIs, from 89% (198/222 patients) in the intervention period to 10.8% (24/222 patients) in the post intervention period (relative risk (RR) (95% CI) 0.48 (0.31 to 0.56). Antibiotic use in ICUs declined from 58% (780/1347) to 44% (442/995) (RR 0.44 (0.40 to 0.55). Overall, hand hygiene compliance among the health- care workers was maintained at 100% during both the periods. Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised patients in developing countries.
Objectives Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers’ (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. Material and Methods A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. Results The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers ( P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers ( P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. Conclusion IPC practice especially among public HF workers was poor.
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2 ‫دﻛﺘﺮ‬ ‫زاﻫﺪﭘﺎﺷﺎ‬ ‫ﻳﺪاﻟﻪ‬ 3 ‫ﻣﺤﻤﺪزاده‬ ‫اﻳﺮج‬ ‫دﻛﺘﺮ‬ 4 1 ‫ارﺷﺪ‬ ‫ﻛﺎرﺷﻨﺎس‬ ‫ﭘﺮﺳﺘﺎري‬ ‫ﮔﺮوه‬ ، 3 ‫اﺳﺘﺎد‬ ‫ﮔﺮوه‬ ‫اﻃﻔﺎل‬ ، 4 ‫اﺳﺘﺎد‬ ‫ﻳﺎر‬ ‫اﻃﻔﺎل،‬ ‫ﮔﺮوه‬ ‫ﭘﺰﺷﻜﻲ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﺑﺎﺑﻞ‬ 2 ‫ﻣﺪرس‬ ‫ﺗﺮﺑﻴﺖ‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﺮﺳﺘﺎري،‬ ‫ﮔﺮوه‬ ‫اﺳﺘﺎدﻳﺎر‬ ‫ﺳﺎل‬ ‫ﻫﺮﻣﺰﮔﺎن‬ ‫ﭘﺰﺷﻜﻲ‬ ‫ﻣﺠﻠﻪ‬ ‫ﺳﻴﺰدﻫﻢ‬ ‫ﺷﻤﺎره‬ ‫دوم‬ ‫ﺗﺎﺑﺴﺘﺎن‬ 88 ‫ﺻﻔﺤﺎت‬ 122-115 ‫ﭼﻜ‬ ‫ﻴ‬ ‫ﺪه‬ ‫ﻣﻘﺪﻣﻪ‬ : ‫راه‬ ‫ﺑﺎ‬ ‫اﻣﺮوزه‬ ‫وزن‬ ‫ﻛﻢ‬ ‫و‬ ‫ﻧﺎرس‬ ‫ﻧﻮزادان‬ ‫ﻣﺎﻧﺪن‬ ‫زﻧﺪه‬ ‫ﻣﻴﺰان‬ ‫ﻛﺸﻮر،‬ ‫در‬ ‫ﻧﻮزادان‬ ‫وﻳﮋه‬ ‫ﻣﺮاﻗﺒﺖ‬ ‫ﺑﺨﺶ‬ ‫اﻧﺪازي‬ ‫اﻓﺰا‬ ‫اﺳﺖ‬ ‫ﻳﺎﻓﺘﻪ‬ ‫ﻳﺶ‬. ‫ﻣﻲ‬ ‫ﻫﻤﺮاه‬ ‫آﻧﻬﺎ‬ ‫ﺑﺮاي‬ ‫ﻣﺸﻜﻼﺗﻲ‬ ‫ﺑﺎ‬ ‫ﺑﻘﺎ‬ ‫اﻓﺰاﻳﺶ‬ ‫اﻳﻦ‬ ‫اﻣﺎ‬ ‫ﺑﺎﺷﺪ‬. ‫ﺗﺄﺛﻴﺮ‬ ‫ﺗﻌﻴﻴﻦ‬ ‫ﻫﺪف‬ ‫ﺑﺎ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫اﻳﻦ‬ ‫ﮔﺮدﻳﺪ‬ ‫اﻧﺠﺎم‬ ‫ﻣﻐﺰي‬ ‫و‬ ‫ﺷﻨﻮاﻳﻲ‬ ‫ﺑﻴﻨﺎﻳﻲ،‬ ‫ﻣﻌﺎﻳﻨﺎت‬ ‫ﭘﻴﮕﻴﺮي‬ ‫ﺑﺮ‬ ‫ﻧﺎرس‬ ‫ﻧﻮزادان‬ ‫ﻣﺎدران‬ ‫ﺑﻪ‬ ‫ﺗﺮﺧﻴﺺ‬ ‫از‬ ‫ﻗﺒﻞ‬ ‫آﻣﻮزش‬. ‫ر‬ ‫وش‬ ‫ﻛﺎر‬ : ‫ﺗﺠﺮﺑﻲ‬ ‫ﻧﻴﻤﻪ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫اﻳﻦ‬ ‫در‬ ، 55 ‫ﺑﺨ‬ ‫در‬ ‫ﺑﺴﺘﺮي‬ ‫وزن‬ ‫ﻛﻢ‬ ‫ﻧﻮزاد‬ ‫ﻧﻤﻮﻧﻪ‬ ‫روش‬ ‫ﺑﻪ‬ ‫آﻧﻬﺎ‬ ‫ﻣﺎدران‬ ‫و‬ ‫ﻧﻮزادان‬ ‫ﺶ‬ ‫ﮔﻴﺮي‬ ‫ﮔﺮﻓﺘﻨﺪ‬ ‫ﻗﺮار‬ ‫ﻛﻨﺘﺮل‬ ‫و‬ ‫آزﻣﻮن‬ ‫ﮔﺮوه‬ ‫دو‬ ‫در‬ ‫ﺗﺼﺎدﻓﻲ‬ ‫ﺗﺨﺼﻴﺺ‬ ‫روش‬ ‫ﺑﺎ‬ ‫و‬ ‫اﻧﺘﺨﺎب‬ ‫دﺳﺘﺮس‬ ‫در‬. ‫ﺟﻤﻊ‬ ‫اﺑﺰار‬ ‫داده‬ ‫آوري‬ ‫ﻫﺎ‬ ‫ﺑﻮد‬ ‫ﭘﺮﺳﺸﻨﺎﻣﻪ‬. ‫آﻣﻮزﺷﻲ‬ ‫ﺑﺮﻧﺎﻣﻪ‬) ‫ﭘﻴﮕﻴﺮ‬ ‫ﻣﺮاﻗﺒﺖ‬ (‫درﻳﺎﻓﺖ‬ ‫را‬ ‫ﺑﺨﺶ‬ ‫ﻣﻌﻤﻮل‬ ‫ﻣﺮاﻗﺒﺘﻬﺎي‬ ‫ﻛﻨﺘﺮل‬ ‫ﮔﺮوه‬ ‫و‬ ‫اﺟﺮا‬ ‫آزﻣﻮن‬ ‫ﮔﺮوه‬ ‫در‬ ‫ﻛﺮدﻧﺪ‬. ‫دو‬ ‫ﭘﻴﮕﻴﺮي‬ ‫و‬ ‫ارﺟﺎع‬ ‫اﻧﺪﻳﻜﺎﺳﻴﻮن،‬ ‫ﻣﻮارد‬ ‫و‬ ‫ﺷﺪﻧﺪ‬ ‫ﭘﻴﮕﻴﺮي‬ ‫ﺗﺮﺧﻴﺺ‬ ‫از‬ ‫ﭘﺲ‬ ‫ﻣﺎه‬ ‫ﺳﻪ‬ ‫ﺗﺎ‬ ‫ﺷﺪه‬ ‫ﺗﻌﻴﻴﻦ‬ ‫زﻣﺎﻧﻬﺎي‬ ‫در‬ ‫ﮔﺮوه‬ ‫ﻣﻐﺰي‬ ‫و‬ ‫ﺷﻨﻮاﻳﻲ‬ ‫ﺑﻴﻨﺎﻳﻲ،‬ ‫ﻣﺸﻜﻼت‬ ‫ﺷﺪ‬ ‫ﺛﺒﺖ‬. ‫ﺳﭙﺲ‬ ‫ﺟﻤﻊ‬ ‫ﮔﺮوه‬ ‫دو‬ ‫در‬ ‫ﺣﺎﺻﻠﻪ‬ ‫اﻃﻼﻋﺎت‬ ‫اﻓﺰار‬ ‫ﻧﺮم‬ ‫ﺑﺎ‬ ‫و‬ ‫آوري‬ SPSS ‫و‬ ‫ﻛﺎي‬ ‫ﻓﻴﺸﺮ،‬ ‫دﻗﻴﻖ‬ ‫آزﻣﻮن‬ ‫و‬ ‫ﮔﺮﻓﺖ‬ ‫ﻗﺮار‬ ‫ﺗﺤﻠﻴﻞ‬ ‫و‬ ‫ﺗﺠﺰﻳﻪ‬ ‫ﻣﻮرد‬ ‫اﺳﻜﻮﺋﺮ‬) 05 / 0 P< (‫ﻣﻌﻨﻲ‬ ‫ﺷﺪ‬ ‫ﺗﻠﻘﻲ‬ ‫دار‬. ‫ﻧﺘﺎﻳﺞ‬ : ‫ﻣﻲ‬ ‫ﻧﺸﺎن‬ ‫ﻧﺘﺎﻳﺞ‬ ‫د‬ ‫ﻛﻪ‬ ‫دﻫﺪ‬ ‫ﺑﻴﻨﺎﻳﻲ‬ ‫ﻣﻌﺎﻳﻨﺎت‬ ‫ر‬ ‫آزﻣﻮن‬ ‫ﮔﺮوه‬ ‫در‬ ‫ﺳﻨﺠﻲ،‬ 6 / 91 % ‫ﭘﻴﮕﻴﺮي‬ ‫ﻣﻴﺰان‬ ‫اﻳﻦ‬ ‫ﻛﻪ‬ ‫ﺣﺎﻟﻲ‬ ‫در‬ ‫ﻛﻨﺘﺮل‬ ‫ﮔﺮوه‬ 8 / 81 % ‫ﺑﻮد‬. ‫ﺷﻨﻮاﻳﻲ‬ ‫ﻣﻌﺎﻳﻨﺎت‬ ‫در‬ ‫آزﻣﻮن‬ ‫ﮔﺮوه‬ ‫در‬ ‫ﺳﻨﺠﻲ،‬ 50 % ‫ﻓﻘﻂ‬ ‫ﻛﻨﺘﺮل‬ ‫ﮔﺮوه‬ ‫در‬ ‫ﻣﻘﺎﺑﻞ،‬ ‫در‬ ‫ﺷﺪﻧﺪ،‬ ‫ﭘﻴﮕﻴﺮي‬ ‫اﻧﺪﻳﻜﺎﺳﻴﻮن‬ ‫ﻣﻮارد‬ ‫از‬ ‫در‬ 4 / 3 ‫ﻣﻮارد‬ ‫درﺻﺪ‬ ‫ﭘﻴﮕﻴﺮي‬ ‫اﻧﺪﻳﻜﺎﺳﻴﻮن‬ ‫ﺷﺪ‬ ‫اﻧﺠﺎم‬. . ‫آزﻣﻮن‬ ‫ﮔﺮوه‬ ‫در‬ ‫ﻣﻐﺰي،‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﻲ‬ ‫اﻧﺠﺎم‬ ‫در‬ ‫ﻣﻮارد‬ ‫ﻫﻤﻪ‬ ‫اﻧﺪﻳﻜﺎﺳﻴﻮن،‬ ‫ﺷﺪﻧﺪ‬ ‫ﭘﻴﮕﻴﺮي‬ ‫ﮔﺮوه‬ ‫در‬ ‫اﻣﺎ‬ ، ‫ﻛﻨﺘﺮل‬ ‫ﻓﻘﻂ‬ 3 / 33 ‫ﻣﻮارد‬ ‫از‬ ‫درﺻﺪ‬ ‫اﻧﺪﻳﻜﺎﺳﻴﻮن،‬ ‫ﺷﺪﻧﺪ‬ ‫ﭘﻴﮕﻴﺮي‬. ‫ﻣﻌﻨﻲ‬ ‫ﮔﺮوه‬ ‫دو‬ ‫ﺑﻴﻦ‬ ‫ﺗﻔﺎوت‬ ‫ﺑﻮد‬ ‫دار‬) 05 / 0 P< .(‫ﻧ‬ ‫ﺘﻴﺠﻪ‬ ‫ﮔﻴﺮي‬ : ‫ﻳﺎﻓﺘﻪ‬ ‫ﻧﺸ‬ ‫ﻣﺎ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫ﻫﺎي‬ ‫آزﻣﻮن‬ ‫ﮔﺮوه‬ ‫ﻣﺮاﺟﻌﺎت‬ ‫ﺑﻴﺸﺘﺮ‬ ‫اﻓﺰاﻳﺶ‬ ‫ﻣﻮﺟﺐ‬ ‫ﺗﺮﺧﻴﺺ‬ ‫از‬ ‫ﻗﺒﻞ‬ ‫آﻣﻮزش‬ ‫داد،‬ ‫ﺎن‬ ‫اﺳﺖ‬ ‫ﮔﺮدﻳﺪه‬ ‫واﻟﺪﻳﻦ‬ ‫ﺗﻮﺳﻂ‬ ‫ﻧﻮزادان‬ ‫ﭘﻴﮕﻴﺮي‬ ‫ﻛﻠﻴﻨﻴﻚ‬ ‫ﺑﻪ‬ ‫ﻛﻨﺘﺮل‬ ‫ﮔﺮوه‬ ‫ﺑﻪ‬ ‫ﻧﺴﺒﺖ‬. ‫ﻣﻲ‬ ‫ﭘﻴﺸﻨﻬﺎد‬ ‫ﻟﺬا‬ ‫از‬ ‫ﻗﺒﻞ‬ ‫آﻣﻮزش‬ ‫ﺑﺮﻧﺎﻣﻪ‬ ‫ﺷﻮد‬ ‫ﺑﺨﺶ‬ ‫در‬ ‫ﺗﺮﺧﻴﺺ‬ ‫ﮔﺮدد‬ ‫اﺟﺮا‬ ‫ﻧﻮزادان‬ ‫وﻳﮋه‬ ‫ﻣﺮاﻗﺒﺘﻬﺎي‬ ‫ﻫﺎي‬ .
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One hundred and fifty six babies with birth weight between 1500-2000 g and 103 full term-appropriate for gestational age (FT-AGA) babies delivered at University Hospital, District Hospital and village homes were included for a comparative study of mortality, morbidity and growth pattern. The low birth weight (LBW) babies from the three centres had similar birth weight and gestational age. Neonatal mortality rates for the LBW babies were similar at the three centres. The main cause of death were infections and aspiration with rates again being similar. Diarrhea and respiratory tract infections were common causes of morbidity. The mortality rates for the LBW babies were significantly higher as compared to FT-AGA babies irrespective of the place of delivery. The incidence of morbidities like diarrhea and respiratory infections were also higher in LBW babies. However, the differences were statistically significant mostly in the preterm group. The weight gain of all LBW babies was similar up to 3 months of age. The findings of an identical outcome for the LBW babies at village level to those managed at hospitals is an encouraging trend to increasing domiciliary care for LBW babies.
Bacterial penetration of a compromised epidermal barrier may be an important mode for acquisition of neonatal infections. We show concordance between isolates from the skin and blood of hospitalized neonates in Bangladesh. Additional support for transcutaneous entry of infections in neonates includes: 1) isolation of identical strains of coagulase-negative staphylococci from the skin and the blood of hospitalized neonates in developed countries, 2) in vitro studies demonstrating bacterial adherence to, entry into, and transcytosis through epidermal keratinocytes, 3) the presence of invasive opportunistic fungi beyond the stratum corneum in skin of preterm very low birth weight neonates with invasive disease, 4) altered risk of systemic infection in preterm infants treated topically with skin barrier enhancing formulations, and 5) reduced risk of septicemia following antiseptic cleansing of the birth canal. Greater understanding of mechanisms of entry of pathogens through the skin and of factors that promote epidermal barrier function may lead to novel strategies for preventing these infections.
Nosocomial infections in developing countries represent a major public health problem that is not universally recognized. In Latin America rates for nosocomial infections range from 10 to 26% with a severe impact on morbidity and mortality and a consequent economic burden. The fundamental needs are: (1) to recognize the importance of this problem; (2) to modify the attitude of government authorities in the sense that hospital care could be improved; (3) to teach medical personnel the importance of infection control at the beginning of their training; and (4) to increase the awareness of the population of its right to better health care. From an international point of view we should establish the following guidelines: (1) the World Health Organisation should establish a worldwide programme on nosocomial infections; (2) medical and nursing schools should include regular courses on infection control; (3) international organizations should support training and research programmes in developing countries, focusing on the regional needs for infection control.
The case records of all neonates admitted to the neonatal unit at Aga Khan University Hospital (Karachi) in a 30 month period (Nov. 86-April 89) were analysed. Of 60 neonates with confirmed sepsis, 33 (55%) had non-nosocomial infection (NNC) whereas 27 (45%) had nosocomial sepsis (NC). The most common organisms causing early-onset NNC sepsis were Klebsiella species (53%) and Escherichia coli (10%), whereas the organisms causing late-onset NNC sepsis included Salmonella parathypi (21%), Group A Streptococcus (21%), Escherichia coli (14%) and Pseudomonas species (14%). Klebsiella was the most common organism causing NC sepsis, others being Staphylococcus aureus (15%) and Serratia species (15%). The mortality in NC sepsis, early-onset and late onset NNC sepsis was 44%, 26% and 43%, respectively. Risk factors associated with NNC sepsis included low birthweight, prematurity and prolonged and complicated deliveries. There was a high incidence of drug resistance to ampicillin and gentamicin among gram-negative organisms causing sepsis (mean 67%).
The Ballard Maturational Score was refined and expanded to achieve greater accuracy and to include extremely premature neonates. To test validity, accuracy, interrater reliability, and optimal postnatal age at examination, the resulting New Ballard Score (NBS) was assessed for 578 newly born infants and the results were analyzed. Gestational ages ranged from 20 to 44 weeks and postnatal ages at examination ranged from birth to 96 hours. In 530 infants, gestational age by last menstrual period was confirmed by agreement within 2 weeks with gestational age by prenatal ultrasonography (C-GLMP). For these infants, correlation between gestational age by NBS and C-GLMP was 0.97. Mean differences between gestational age by NBS and C-GLMP were 0.32 +/- 1.58 weeks and 0.15 +/- 1.46 weeks among the extremely premature infants (less than 26 weeks) and among the total population, respectively. Correlations between the individual criteria and C-GLMP ranged from 0.72 to 0.82. Interrater reliability of NBS, as determined by correlation between raters who rated the same subgroup of infants, ws 0.95. For infants less than 26 weeks of gestational age, the greatest validity (97% within 2 weeks of C-GLMP) was seen when the examination was performed before 12 hours of postnatal age. For infants at least 26 weeks of gestational age, percentages of agreement with C-GLMP remained constant, averaging 92% for all postnatal age categories up to 96 hours. The NBS is a valid and accurate gestational assessment tool for extremely premature infants and remains valid for the entire newborn infant population.
We conducted a 1-year longitudinal prospective study of infants born in a traditional rural indigenous community of Guatemala. Three hundred twenty-nine infants surviving birth and the first day of life were followed during the first 3 months of life. Surveillance included routine household and well baby clinic visits and clinic visits for minor illnesses. Detection of potentially lethal illnesses depended on orientation of families and midwives to important symptoms and to the need for immediate medical evaluation if such symptoms were identified. We identified 38 episodes of lethal and potentially lethal illness. Thirty-five (92%) of these episodes were infectious diseases, principally sepsis during the neonatal period and acute lower respiratory infection in Months 2 and 3. Of all study infants, low birth weight (less than 2500 g) infants comprised 14% and premature (less than 37 weeks gestation) infants comprised 1%. Premature infants had a relative risk of lethal and potentially lethal illnesses of 11.1 (95% confidence interval, 3.6 to 34.4) compared with normal term infants, and no premature infant survived the first 3 months of life despite medical intervention. Low birth weight infants had a relative risk of 3.2 (95% confidence interval, 1.5 to 6.6), but with medical intervention all but 2 survived. Despite their lower risk, because of their much greater number normal term infants experienced 60% of lethal and potentially lethal illnesses. Among all study infants medical intervention was associated with survival of 86% of lethal and potentially lethal infectious illnesses and with a rate of neonatal mortality among study children significantly lower than rates documented in previous years in the same community.
The neonatal mortality rate (per 1000 live births) dropped from 36.6 in 1985 to 23.9 in 1986. Neonatal sepsis ranked as number 2 as a cause of neonatal mortality in 1985, while it dropped to rank 4 (even lower than major malformations) in 1986. The decline in the sepsis-related neonatal mortality was due to reduced incidence of sepsis (38.2 and 18.8 per 1000 live births during 1985 and 1986 respectively) and improved survival (case fatality rates of 24.6% vs 17.7% in 1985 and 1986 respectively). The strategies which reduced the incidence of nosocomial infections included decongestion of use of the nursery, discontinuation of use of heparinised saline for flushing intravenous lines and routine use of intravenous cannulas instead of metallic scalp vein needles.
A scoring system for gestational age, based on 10 neurologic and 11 “external” criteria, has been applied to 167 newborn infants. The “external” score gave a better correlation with gestation than did the neurologic score, but the combined total score was better than either alone. The correlation coefficient for the total score against gestation was 0.93. The error of prediction of a single score was 1.02 weeks and of the average of two independent assessments was 0.7 weeks. The method gives consistent results within the first 5 days and is equally reliable in the first 24 hours of life. This scoring system is more objective and reproducible than trying to guess gestational age on the presence or absence of individual signs.
Fifty clinically suspected cases of neonatal septicemia were studied for evaluating the role of sepsis screen. Sensitivity and specificity of C-reactive protein test, micro-ESR, gastric aspirate cytology for polymorphs and toxic granules in neutrophils were studied singly and in combinations of two and three tests. Positive blood culture was obtained in only 20% cases, thereby underlying the need for a sepsis screen in the diagnosis of neonatal septicemia, especially in areas where adequate micro-biological facilities are lacking.