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Tran HT, Luu HM, Le TD, Pham NTQ, Sobel HL, Murray JCS. Factors associated with high exclusive breastfeeding rates among preterm infants under 34 weeks of gestation in Da Nang, Vietnam: A retrospective cohort study. J Glob Health 2023; 13:04121. [PMID: 37934970 PMCID: PMC10630854 DOI: 10.7189/jogh.13.04121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Preterm infants have higher mortality than full-term infants. While breastfeeding dramatically reduces preterm death, it is limited by biological and practice barriers, particularly for babies born before 34 weeks gestational age. Da Nang Hospital for Women and Children developed a quality improvement approach to improve breastfeeding of preterm infants by strengthening feeding support, non-separation, and kangaroo mother care (KMC). Methods To determine breastfeeding outcomes following discharge and explore factors associated with improved feeding, mothers of infants under 34 weeks gestational age born October 2021 to March 2022 and discharged alive were interviewed at six months and their medical records were reviewed. Results Out of 104 preterm infants included, all were exclusively breastfed at discharge and one month, 86.5% at three months, and 63.5% at six months; 47.1% received immediate skin-to-skin contact, 31.7% immediate and continuous KMC, and the remaining 68.3% continuous KMC beginning at a median of three days. Exclusive breastfeeding at six months was associated with the mother antenatally seeking breastfeeding information (odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-173.6), avoiding bottle-feeding at home (OR = 7.7; 95% CI = 1.7-33.7) and reduced with each day delay between birth and full breastfeeding (OR = 0.8; 95% CI = 0.6-0.9). Conclusions Hospital environments that limit mother-baby separations and feeding delays, including rooming-in of mothers and infants, KMC, and breastfeeding support from birth, enabled 100% of preterm infants born before 34 weeks gestational age to breastfeed exclusively with continued rates higher than previously reported. Addressing antenatal and post-natal factors limiting practice can further improve longer-term breastfeeding outcomes. The approach can be adapted to achieve high exclusive breastfeeding rates, regardless of gestational age.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Hanh My Luu
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Thao Dieu Le
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Nga Thi Quynh Pham
- World Health Organization Representative Office in Viet Nam, Ha Noi, Vietnam
| | - Howard L Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - JCS Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
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2
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Toan ND, Darton TC, Huong NHT, Nhat LTH, Nguyen TNT, Tuyen HT, Thinh LQ, Mau NK, Tam PTT, Phuong CN, Nhan LNT, Minh NNQ, Xuan NM, Thuong TC, Hung NT, Boinett C, Reece S, Karkey A, Day JN, Baker S. Clinical and laboratory factors associated with neonatal sepsis mortality at a major Vietnamese children's hospital. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000875. [PMID: 36962870 PMCID: PMC10021837 DOI: 10.1371/journal.pgph.0000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 07/13/2022] [Indexed: 06/18/2023]
Abstract
Sepsis is a major cause of neonatal mortality and children born in low- and middle-income countries (LMICs) are at greater risk of severe neonatal infections than those in higher-income countries. Despite this disparity, there are limited contemporaneous data linking the clinical features of neonatal sepsis with outcome in LMICs. Here, we aimed to identify factors associated with mortality from neonatal sepsis in Vietnam. We conducted a prospective, observational study to describe the clinical features, laboratory characteristics, and mortality rate of neonatal sepsis at a major children's hospital in Ho Chi Minh City. All in-patient neonates clinically diagnosed with probable or culture-confirmed sepsis meeting inclusion criteria from January 2017 to June 2018 were enrolled. We performed univariable analysis and logistic regression to identify factors independently associated with mortality. 524 neonates were recruited. Most cases were defined as late-onset neonatal sepsis and were hospital-acquired (91.4% and 73.3%, respectively). The median (IQR) duration of hospital stay was 23 (13-41) days, 344/524 (65.6%) had a positive blood culture (of which 393 non-contaminant organisms were isolated), and 69/524 (13.2%) patients died. Coagulase-negative staphylococci (232/405; 57.3%), Klebsiella spp. (28/405; 6.9%), and Escherichia coli (27/405; 6.7%) were the most isolated organisms. Sclerema (OR = 11.4), leukopenia <4,000/mm3 (OR = 7.8), thrombocytopenia <100,000/mm3 (OR = 3.7), base excess < -20 mEq/L (OR = 3.6), serum lactate >4 mmol/L (OR = 3.4), extremely low birth weight (OR = 3.2), and hyperglycaemia >180 mg/dL (OR = 2.6) were all significantly (p<0.05) associated with mortality. The identified risk factors can be adopted as prognostic factors for the diagnosis and treatment of neonatal sepsis and enable early risk stratification and interventions appropriate to reduce neonatal sepsis in LMIC settings.
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Affiliation(s)
- Nguyen Duc Toan
- Clinical Departments, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Paediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thomas C. Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Nguyen Hoang Thien Huong
- Clinical Departments, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Department of Paediatrics, Vietnam National University School of Medicine, Ho Chi Minh City, Vietnam
| | - Le Thanh Hoang Nhat
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - To Nguyen Thi Nguyen
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Quoc Thinh
- Clinical Departments, Children’s Hospital 1, Ho Chi Minh City, Vietnam
| | - Nguyen Kien Mau
- Clinical Departments, Children’s Hospital 1, Ho Chi Minh City, Vietnam
| | - Pham Thi Thanh Tam
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Cam Ngoc Phuong
- Hanh Phuc International Hospital, Binh Duong Province, Vietnam
| | - Le Nguyen Thanh Nhan
- Clinical Departments, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Ngo Minh Xuan
- Department of Paediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tang Chi Thuong
- Department of Paediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Department of Health, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Hung
- Clinical Departments, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Department of Paediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Department of Paediatrics, Vietnam National University School of Medicine, Ho Chi Minh City, Vietnam
| | | | - Stephen Reece
- Kymab, Babraham Research Campus, Cambridge, United Kingdom
| | - Abhilasha Karkey
- Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Jeremy N. Day
- Hospital for Tropical Diseases, Wellcome Trust Africa and Asia Programmes, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephen Baker
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
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3
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Tran HT, Le TD, Skinner A, Narchi H. Very preterm infants admitted to a tertiary neonatal unit in central Vietnam showed poor postnatal growth. Acta Paediatr 2022; 111:307-313. [PMID: 34536961 DOI: 10.1111/apa.16116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
AIM We aimed to evaluate the postnatal growth of very preterm infants. METHODS This was a cross-sectional observational study of neonates born before 32 weeks of gestation and admitted to the neonatal unit at Da Nang Hospital for Women and Children, Vietnam, between 1 February 2020 and 30 September 2020. Morbidities, therapies, nutrition modalities and growth status were recorded from admission to discharge. RESULTS The 78 infants (51% female) were born at a median of 29 weeks and mean birth weight of 1247 grams. The mean weight gain velocity from regaining their birth weight until discharge was 12.7 ± 4.9 g/kg/d. At discharge, the Z-scores for weight, length, both weight and length and weight for length were lower than at birth in 94%, 67%, 64% and 95% of infants and the Delta Z-scores were less than -1 in 73%, 44%, 39% and 82%. Late-onset sepsis (LOS) and bronchopulmonary dysplasia (BPD) were significantly associated with growth failure, with adjusted odds ratios of 3.6 and 20.1, respectively. CONCLUSION The high rate of poor growth among the very preterm infants in our study indicates the need to reduce LOS and BPD and ensure the availability of human milk fortifier, vitamin and mineral supplements.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal UnitDa Nang Hospital for Women and Children Da Nang Vietnam
- Department of Paediatrics School of Medicine and Pharmacy Da Nang University Da Nang Vietnam
| | - Thao Dieu Le
- Neonatal UnitDa Nang Hospital for Women and Children Da Nang Vietnam
- Department of Paediatrics School of Medicine and Pharmacy Da Nang University Da Nang Vietnam
| | - Alyson Skinner
- Department of Paediatrics Manor HospitalWalsall Healthcare NHS Trust Walsall UK
- Department of Paediatrics College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
| | - Hassib Narchi
- Department of Paediatrics College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
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4
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Tran HT, Murray JCS, Sobel HL, Mannava P, Huynh LT, Nguyen PTT, Giang HTN, Le TTM, Hoang TA, Nguyen VD, Li Z, Pham NTQ. Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study. BMJ Open Qual 2021; 10:bmjoq-2020-001089. [PMID: 34301731 PMCID: PMC8728344 DOI: 10.1136/bmjoq-2020-001089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 06/20/2021] [Indexed: 11/27/2022] Open
Abstract
Background To improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction. Methods Maternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics. Findings A total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59). Conclusion The EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam .,School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - John Charles Scott Murray
- Reproductive, Maternal, Newborn, Child and Adolescent Health, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Howard Lawrence Sobel
- Reproductive, Maternal, Newborn, Child and Adolescent Health, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Priya Mannava
- Reproductive, Maternal, Newborn, Child and Adolescent Health, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Le Thi Huynh
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam.,School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Phuong Thi Thu Nguyen
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam.,School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Hoang Thi Nam Giang
- School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Tuyen Thi Mong Le
- General Obstetrics and Gynaecology, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Tuan Anh Hoang
- Maternal and Child Health Department, Ministry of Health of Vietnam, Ha Noi, Vietnam
| | - Vinh Duc Nguyen
- Maternal and Child Health Department, Ministry of Health of Vietnam, Ha Noi, Vietnam
| | - Zhao Li
- Reproductive, Maternal, Newborn, Child and Adolescent Health, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Nga Thi Quynh Pham
- Universal Health Coverage team, World Health Organization Representative Office in Vietnam, Ha Noi, Vietnam
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5
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Trends and Dynamics in the First Four Years of Operation of the First Human Milk Bank in Vietnam. Nutrients 2021; 13:nu13041107. [PMID: 33800596 PMCID: PMC8067108 DOI: 10.3390/nu13041107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Since 1979, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight (LBW) and preterm newborns as the ‘first alternative’ when mothers are unable to provide their own milk. However, they have not issued any guidelines for the safe establishment and operation of an HMB. This gap contributes to the demand for gathering experiences from HMB networks, especially those from lower-middle income countries. To fill this knowledge gap, this study examines the characteristics of donors, donation, pasteurization, and recipients during the first four years of operation in the first HMB in Vietnam. Methods: Data about the donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB from 1 February 2017 to 31 January 2021. Results: In the first four years of operation there were 433 donors who donated 7642 L of milk (66% from the community) with an increased trend in the amount of donated milk, donation duration, and average amount of milk donated by a donor. Approximately 98% of the donated milk was pasteurized, and 82% passed both pre- and post-pasteurization tests. Although the pass rate tended to increase with time, a few dips occurred. Of 16,235 newborns who received pasteurized donor milk, two thirds were in the postnatal wards. The main reason for the prescription of pasteurized donor milk was insufficient mothers’ own milk in the first few days after birth. There was a decreased trend in the amount and duration of using pasteurized donor milk in both postnatal wards and the neonatal unit. Conclusions: The HMB has operated efficiently in the previous four years, even during the COVID-19 pandemic, to serve vulnerable newborns. Ongoing evidence-based adjustments helped to improve the operation to recruit suitable donors, to increase the access to and quality of raw donor milk, to improve the pasteurization process, and to meet the need of more newborns.
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6
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Mansen K, Nguyen TT, Nguyen NQ, Do CT, Tran HT, Nguyen NT, Mathisen R, Nguyen VD, Ngo YTK, Israel-Ballard K. Strengthening Newborn Nutrition Through Establishment of the First Human Milk Bank in Vietnam. J Hum Lact 2021; 37:76-86. [PMID: 32833551 PMCID: PMC7907997 DOI: 10.1177/0890334420948448] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tuan T Nguyen
- 1311 Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | | | - Chung T Do
- Alive & Thrive Southeast Asia, FHI 360, Danang, Vietnam
| | - Hoang T Tran
- Danang Hospital for Women and Children, Danang, Vietnam
| | | | - Roger Mathisen
- 1311 Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | - Vinh D Nguyen
- Maternal and Child Health Department, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Yen T K Ngo
- Danang Department of Health, Danang, Vietnam
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7
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Tran HT, Nguyen PTK, Huynh LT, Le CHM, Giang HTN, Nguyen PTT, Murray J. Appropriate care for neonates born to mothers with COVID-19 disease. Acta Paediatr 2020; 109:1713-1716. [PMID: 32544288 PMCID: PMC7323199 DOI: 10.1111/apa.15413] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
The global COVID‐19 pandemic has been associated with high rates of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission, morbidity and mortality in the general population. Evidence‐based guidance on caring for babies born to mothers with COVID‐19 is needed. There is currently insufficient evidence to suggest vertical transmission between mothers and their newborn infants. However, transmission can happen after birth from mothers or other carers. Based on the currently available data, prolonged skin‐to‐skin contact and early and exclusive breastfeeding remain the best strategies to reduce the risks of morbidity and mortality for both the mother with COVID‐19 and her baby.
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Affiliation(s)
- Hoang Thi Tran
- Da Nang Hospital for Women and Children Da Nang Vietnam
- The Faculty of Medicine and Pharmacy The University of Da Nang Da Nang Vietnam
| | | | - Le Thi Huynh
- Da Nang Hospital for Women and Children Da Nang Vietnam
| | | | - Hoang Thi Nam Giang
- The Faculty of Medicine and Pharmacy The University of Da Nang Da Nang Vietnam
| | | | - John Murray
- Consultant medical epidemiologist Iowa City IA USA
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8
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Giang HTN, Bechtold-Dalla Pozza S, Ulrich S, Linh LK, Tran HT. Prevalence and Pattern of Congenital Anomalies in a Tertiary Hospital in Central Vietnam. J Trop Pediatr 2020; 66:187-193. [PMID: 31377805 DOI: 10.1093/tropej/fmz050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Burden and pattern of congenital anomalies are insufficiently reported in Vietnam. This study aims to determine the prevalence and pattern of congenital anomalies in neonates in a tertiary hospital in central Vietnam. METHODS A prospective cross-sectional study recruited all newborns with congenital anomalies in Da Nang Hospital for Women and Children-where nearly 60% neonates in the city are delivered. RESULTS Over a 1-year period, 551 out of 14 335 registered live births were found to have congenital anomalies, equivalent to an overall prevalence of 384.4 per 10 000 live births. Congenital heart defects were the most common type (52.3%) with the prevalence of 200.9 per 10 000 live births, followed by anomalies of musculoskeletal system, digestive system. CONCLUSIONS This study revealed a high prevalence of congenital anomalies with the most common type being congenital heart defects in central Vietnam compared to both higher income countries and resource-limited settings.
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Affiliation(s)
- Hoang Thi Nam Giang
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany.,The Faculty of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Susanne Bechtold-Dalla Pozza
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany.,Pediatric Endocrinology and Diabetology, University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Sarah Ulrich
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany.,Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Le Khac Linh
- Residency Training Program, VinUniversity Project, 458 Minh Khai Street, Hai Ba Trung District, Ha Noi, 100 000, Vietnam
| | - Hoang Thi Tran
- The Faculty of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam.,Da Nang Hospital for Women and Children, Da Nang, Vietnam.,Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
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9
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Labuda SM, Te V, Var C, Iv Ek N, Seang S, Bazzano AN, Oberhelman RA. Neonatal Sepsis Epidemiology in a Rural Province in Southeastern Cambodia, 2015-2017. Am J Trop Med Hyg 2020; 100:1566-1568. [PMID: 30994093 DOI: 10.4269/ajtmh.18-0739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Neonatal sepsis is the second most prevalent cause of neonatal deaths in low- and middle-income countries, and many countries lack epidemiologic data on the local causes of neonatal sepsis. During April 2015-November 2016, we prospectively collected 128 blood cultures from neonates admitted with clinical sepsis to the provincial hospital in Takeo, Cambodia, to describe the local epidemiology. Two percent (n = 3) of positive blood cultures identified were Gram-negative bacilli (GNB) and were presumed pathogens, whereas 10% (n = 13) of positive blood cultures identified were likely contaminants, consistent with findings in other published studies. No group B Streptococcus was identified in any positive cultures. The presence of GNB as the primary pathogens could help influence local treatment guidelines.
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Affiliation(s)
- Sarah M Labuda
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Vantha Te
- Takeo Provincial Hospital, Takeo, Cambodia
| | - Chivorn Var
- Reproductive Health Association of Cambodia, Phnom Penh, Cambodia
| | - Navapol Iv Ek
- Reproductive Health Association of Cambodia, Phnom Penh, Cambodia
| | | | | | - Richard A Oberhelman
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.,Tulane University School of Medicine, New Orleans, Louisiana
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10
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Doyle LW, Cheong JLY. Does bovine lactoferrin prevent late-onset neonatal sepsis? Lancet 2019; 393:382-384. [PMID: 30635140 DOI: 10.1016/s0140-6736(18)32390-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/21/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Jeanie L Y Cheong
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC 3052, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, VIC, Australia
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11
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Tran HT, Mannava P, Murray JC, Nguyen PTT, Tuyen LTM, Hoang Anh T, Pham TQN, Nguyen Duc V, Sobel HL. Early Essential Newborn Care Is Associated With Reduced Adverse Neonatal Outcomes in a Tertiary Hospital in Da Nang, Viet Nam: A Pre- Post- Intervention Study. EClinicalMedicine 2018; 6:51-58. [PMID: 31193626 PMCID: PMC6537584 DOI: 10.1016/j.eclinm.2018.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To accelerate reductions in neonatal mortality, Viet Nam rolled out early essential newborn care (EENC) using clinical coaching, quality improvement assessments in hospitals, and updated protocols. Da Nang Hospital for Women and Children, a tertiary referral hospital in central Viet Nam, compared outcomes pre- and post-EENC introduction. METHODS Records of live births and NICU admissions were reviewed pre- (November 2013-October 2014) and post- (November 2014-October 2015) EENC implementation. Delivery room practices, NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics. FINDINGS A total of 13,201 live births were delivered pre- and 14,180 live births post-EENC introduction. Post-EENC, delivery practice scores, rates of early and prolonged skin-to-skin contact and early breastfeeding rose significantly. There was a significant reduction in risk of NICU admissions (relative risk [RR] 0.68; 95% confidence interval [CI] 0.64-0.71; p < 0.0001), hypothermia on NICU admission (RR 0.72; 95% CI 0.65-0.81, p < 0.0001) and sepsis (RR 0.28; 95% CI 0.23-0.35, p < 0.0001). Exclusive breastfeeding rates in NICU increased from 49% to 88% (p < 0.0001) and of kangaroo mother care (KMC) from 52% to 67% (p < 0.0001). Reduced formula use resulted in decreased monthly costs. INTERPRETATION EENC introduction, including staff coaching, quality improvement assessments and changes in hospital protocols and environments, were associated with improved clinical practices, reduced NICU admissions, admissions with hypothermia and sepsis and increased rates of exclusive breastfeeding and KMC in the NICU. FUNDING Data collection was funded by the World Health Organization Western Pacific Regional Office and Newborns Vietnam. OUTSTANDING QUESTIONS •What is the impact of the package of early essential newborn care interventions on newborn mortality?•What are the total direct and indirect cost savings of early essential newborn care implementation?•What is the cost effectiveness of kangaroo mother care for preterm and low birth weight babies?•What strategies can help reduce unnecessary cesarean sections in hospitals?
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Affiliation(s)
- Hoang Thi Tran
- Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam
- Corresponding author at: Neonatal Unit, Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam.
| | - Priya Mannava
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
| | - John C.S. Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
| | | | - Le Thi Mong Tuyen
- Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam
| | - Tuan Hoang Anh
- Ministry of Health of Viet Nam, 138A Giang Vo Street, Ha Noi, Viet Nam
| | - Thi Quynh Nga Pham
- World Health Organization Representative Office in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam
| | - Vinh Nguyen Duc
- Ministry of Health of Viet Nam, 138A Giang Vo Street, Ha Noi, Viet Nam
| | - Howard L. Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
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12
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Laxminarayan R, Bhutta ZA. Antimicrobial resistance-a threat to neonate survival. LANCET GLOBAL HEALTH 2018; 4:e676-7. [PMID: 27633421 DOI: 10.1016/s2214-109x(16)30221-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton University, NJ, USA; Public Health Foundation of India, New Delhi, India.
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, The Aga Khan University South-Central Asia and East Africa, Karachi, Pakistan
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13
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Canh Chuong N, Minh Duc D, Anh ND, Thi Vui L, Pham Sy Cuong L, Thi Thuy Duong D, Thi Thu Ha B. Amniocentesis test uptake for congenital defects: Decision of pregnant women in Vietnam. Health Care Women Int 2018; 39:493-504. [PMID: 29319434 DOI: 10.1080/07399332.2018.1424168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our study aimed to identify the knowledge, attitude, and factors associated with uptake of amniocentesis test amongst pregnant women of advanced maternal age (35+ years old). A cross-sectional survey was performed on 481 participants in 2016. Women with higher educational attainment, higher income level, having a baby with congenital defects, and women with better knowledge and/or attitude about amniocentesis test were more likely to accept the test. Our study suggested the importance of counseling for women and more time should be given for them to absorb information before they make their decision to uptake the amniocentesis test.
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Affiliation(s)
- Nguyen Canh Chuong
- a Center for Prenatal Diagnosis and Testing, Hanoi Obstetrics & Gynecology Hospital , Ba Dinh District, Hanoi , Vietnam
| | - Duong Minh Duc
- b Department of Reproductive Health , Hanoi University of Public Health , Bac Tu Liem District, Hanoi , Vietnam.,c International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Nguyen Duy Anh
- d Department of Assisted Reproductive Techniques , Hanoi Obstetrics & Gynecology Hospital , Ba Dinh District, Hanoi , Vietnam
| | - Le Thi Vui
- b Department of Reproductive Health , Hanoi University of Public Health , Bac Tu Liem District, Hanoi , Vietnam
| | - Le Pham Sy Cuong
- a Center for Prenatal Diagnosis and Testing, Hanoi Obstetrics & Gynecology Hospital , Ba Dinh District, Hanoi , Vietnam
| | - Doan Thi Thuy Duong
- b Department of Reproductive Health , Hanoi University of Public Health , Bac Tu Liem District, Hanoi , Vietnam
| | - Bui Thi Thu Ha
- b Department of Reproductive Health , Hanoi University of Public Health , Bac Tu Liem District, Hanoi , Vietnam
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14
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Neonatal mortality and morbidity in the post-implementation period of a neonatal teaching program in provincial hospitals in Laos. Public Health 2017; 154:123-129. [PMID: 29232564 DOI: 10.1016/j.puhe.2017.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/31/2017] [Accepted: 10/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Aim of this study was to analyze neonatal mortality and morbidity in the post-implementation period of a neonatal teaching program to examine a possible impact on neonatal outcomes. STUDY DESIGN This study is a retrospective data analysis of all neonatal patients treated in five provincial hospitals in Laos after implementation of a neonatal teaching program. METHODS A simulation-based teaching program aims to have positive impact on the theoretical and practical skill of hospital staff in the field of newborn care. A comparison between pre-implementation and post-implementation data of newborns admitted to provincial hospitals in Laos was used to quantify the effect of repetitive teaching on neonatal outcomes. RESULTS Neonatal mortality and morbidity as well as case fatality rates of infections and asphyxia decreased in the post-implementation period. In contrast, neonatal mortality rate as well as case fatality rate of prematurity increased. The total neonatal mortality rate increased in the post-implementation period. CONCLUSIONS The pre-implementation and post-implementation data enable longitudinal comparisons between hospitals and highlight the differences between hospitals concerning neonatal mortality and morbidity in provincial hospitals in Laos. These data can serve as a basis for an individual adaption of the teaching program to the unique requirements of each single hospital.
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15
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Gallagher K, Partridge C, Tran HT, Lubran S, Macrae D. Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study. BMC Pediatr 2017; 17:161. [PMID: 28697746 PMCID: PMC5505145 DOI: 10.1186/s12887-017-0909-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience. METHOD Semi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14. RESULTS Analysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience. CONCLUSIONS Qualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam.
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Affiliation(s)
- Katie Gallagher
- Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Colin Partridge
- Department of Pediatrics, University of California, San Francisco, USA
| | - Hoang T Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | | | - Duncan Macrae
- Pediatric Intensive Care, Royal Brompton and Harefield NHS Trust, London, UK
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16
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Nguyen N, Vandenbroucke L, Hernández A, Pham T, Beuchée A, Pladys P. Early-onset neonatal sepsis is associated with a high heart rate during automatically selected stationary periods. Acta Paediatr 2017; 106:749-754. [PMID: 28196284 DOI: 10.1111/apa.13782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/27/2016] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
Abstract
AIM This study examined the heart rate variability characteristics associated with early-onset neonatal sepsis in a prospective, observational controlled study. METHODS Eligible patients were full-term neonates hospitalised with clinical signs that suggested early-onset sepsis and a C-reactive protein of >10 mg/L. Sepsis was considered proven in cases of symptomatic septicaemia, meningitis, pneumonia or enterocolitis. Heart rate variability parameters (n = 16) were assessed from five-, 15- and 30-minute stationary sequences automatically selected from electrocardiographic recordings performed at admission and compared with a control group using the U-test with post hoc Benjamini-Yekutieli correction. Stationary sequences corresponded to the periods with the lowest changes of heart rate variability over time. RESULTS A total of 40 full-term infants were enrolled, including 14 with proven sepsis. The mean duration of the cardiac cycle length was lower in the proven sepsis group than in the control group (n = 11), without other significant changes in heart rate variability parameters. These durations, measured in five-minute stationary periods, were 406 (367-433) ms in proven sepsis group versus 507 (463-522) ms in the control group (p < 0.05). CONCLUSION Early-onset neonatal sepsis was associated with a high mean heart rate measured during automatically selected stationary periods.
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Affiliation(s)
- Nga Nguyen
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Department of Pediatrics; Hanoi Medical University; Hanoi Vietnam
- Neonatal Department; National Hospital of Pediatrics; Hanoi Vietnam
| | - Laurent Vandenbroucke
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Obstetrics Department; CHU Rennes; Rennes France
| | - Alfredo Hernández
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Tu Pham
- Hanoi French Hospital; Hanoi Vietnam
| | - Alain Beuchée
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Division of Neonatology and CIC-1414; Department of Pediatrics; CHU Rennes; Rennes France
| | - Patrick Pladys
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Division of Neonatology and CIC-1414; Department of Pediatrics; CHU Rennes; Rennes France
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17
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Ha BTT, Huong NTT, Duong DTT. Prenatal diagnostic services in three regional centers in Vietnam. Int J Public Health 2016; 62:27-33. [PMID: 27628489 DOI: 10.1007/s00038-016-0897-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/16/2016] [Accepted: 09/03/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study aims to give information on the prenatal diagnostic (PND) services provided in three major regional PND centers in Vietnam. METHODS This cross-sectional study was conducted in early 2014. An inventory of services, human resources, facilities, and equipment and in-depth interviews were carried out. RESULTS Three regional PND centers were set up between 2007 and 2014, and technical guidelines on PND tests were released by the Ministry of Health in 2010. There were a variety of services among centers, and the number of services provided by the three PND centers was far below the target set by the Ministry of Health. There is still limited capacity of human resources, facilities, and equipment in PND centers. Different measures were implemented by hospitals to improve capacity, including counseling. CONCLUSIONS Despite a late start, with government support, PND services in Vietnam have developed quickly. However, to reach the objectives of 15 % of women receiving PND services by 2015 and 50 % by 2020, several actions should be taken to expand the service coverage and capacity of centers.
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18
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Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam. J Perinatol 2015; 35:846-51. [PMID: 26156065 DOI: 10.1038/jp.2015.78] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/16/2015] [Accepted: 05/29/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the prevalence, causes and outcome of sepsis in hospitalized neonates in the largest neonatal unit in central Vietnam. STUDY DESIGN A 1-year prospective cohort study of newborns admitted to the neonatal unit in Da Nang. A sepsis work-up including blood culture was undertaken before commencing antibiotics for neonates with suspected sepsis. RESULT Of 2555 neonatal admissions, 616 neonates had 729 episodes of suspected invasive sepsis. A pathogen was isolated from blood in 115 (16%) episodes in 106 neonates. The prevalence of early-onset sepsis (EOS) was 8 (95% confidence interval (CI): 4 to 11) per 1000 admissions, and of late-onset sepsis (LOS) was 34 (95% CI: 27 to 41) per 1000 admissions. Of 86 neonates with LOS, 69 (80%) also fulfilled the criteria for nosocomial sepsis. The commonest bacterial causes of EOS were coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus, and of LOS were Acinetobacter, CoNS and Klebsiella pneumoniae. Fungal sepsis occurred in 35 neonates of which most were nosocomial sepsis. In vitro resistance to multiple antibiotics was common among Gram-negative bacteria. Antibiotics were prescribed and given to 68% of all admissions, and 14% of all admissions received four or more different antibiotics. The case fatality rate for confirmed sepsis was 46%. CONCLUSION Late-onset, nosocomial sepsis was common and associated with a high mortality in hospitalized newborns in the largest neonatal unit in central Vietnam. These findings highlighted the need for improved infection control measures and antibiotic stewardship, which have since been implemented.
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Affiliation(s)
- H T Tran
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam.,Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - L W Doyle
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - K J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - N M Dang
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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