Can community health workers identify omphalitis? A validation study from Southern Province, Zambia

Neonatal pyogenic liver abscess following omphalitis: A case report

INTRODUCTION AND IMPORTANCE

Liver abscesses in neonates are rare. Omphalitis is a very rare cause. We report a case of a voluminous neonatal pyogenic liver abscess following omphalitis, successfully managed in our institution.

CASE PRESENTATION

A 21-day-old full-term female newborn was brought to our institution for progressive febrile swelling of the right hypochondrium. The parents reported umbilical suppuration. Clinical examination confirmed the presence of a mass extending from the epigastric region to the right hypochondrium in a febrile baby with no other abnormalities. Laboratory investigations revealed an elevated C-reactive protein level (64 mg/dl) and hyperleukocytosis (20,800/mm3) with neutrophil predominance and normochromic microcytic anemia (hemoglobin 8.2 g/dl). Her first abdominal ultrasound was interpreted as a cyst of the common bile duct. Triple antibiotic therapy with cephalosporin, ampicillin and gentamycin was started, but unsuccessful. Abdominal ultrasound was repeated, revealing a hepatic abscess in segment 8, with a volume of approximately 17 ml. Percutaneous echo-guided drainage was performed and antibiotic therapy was readjusted after identification of the germ (Staphylococcus aureus) with good outcome. The baby was discharged two weeks later. At one month follow-up, the baby was completely asymptomatic.

CLINICAL DISCUSSION AND CONCLUSION

As neonatal liver abscesses are unusual, they can lead to misdiagnosis. Omphalitis is a very rare cause. Treatment by percutaneous echo-guided drainage is simple and effective.

Effect of an integrated neonatal care kit on neonatal health outcomes: a cluster randomised controlled trial in rural Pakistan

Introduction

In 2016, 2.6 million children died during their first month of life. We assessed the effectiveness of an integrated neonatal care kit (iNCK) on neonatal survival and other health outcomes in rural Pakistan.

Methods

We conducted a community-based, cluster randomised, pragmatic, open-label, controlled intervention trial in Rahim Yar Khan, Punjab, Pakistan. Clusters, 150 villages and their lady health workers (LHWs), were randomly assigned to deliver the iNCK (intervention) or standard of care (control). In intervention clusters, LHWs delivered the iNCK and education on its use to pregnant women. The iNCK contained a clean birth kit, chlorhexidine, sunflower oil, a continuous temperature monitor (ThermoSpot), a heat reflective blanket and reusable heat pack. LHWs were also given a hand-held scale. The iNCK was implemented primarily by caregivers. The primary outcome was all-cause neonatal mortality. Outcomes are reported at the individual level, adjusted for cluster allocation. Enrolment took place between April 2014 and July 2015 and participant follow-up concluded in August 2015.

Results

5451 pregnant women (2663 and 2788 in intervention and control arms, respectively) and their 5286 liveborn newborns (2585 and 2701 in intervention and control arms, respectively) were enrolled. 147 newborn deaths were reported, 65 in the intervention arm (25.4 per 1000 live births) compared with 82 in the control arm (30.6 per 1000 live births). Neonatal mortality was not significantly different between treatment groups (risk ratio 0.83, 95% CI 0.58 – 1.18; p = 0.30).

Conclusion

Providing co-packaged interventions directly to women did not significantly reduce neonatal mortality. Further research is needed to improve compliance with intended iNCK use.