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Lloyd LG, van Weissenbruch MM, Dramowski A, Gleeson B, Ferreyra C, Bekker A. Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case-control study. BMJ Paediatr Open 2023; 7:e002056. [PMID: 37550083 PMCID: PMC10407408 DOI: 10.1136/bmjpo-2023-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/08/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of neonatal infection is essential to prevent serious complications and to avoid unnecessary use of antibiotics. The prevalence of healthcare-associated infections (HAIs) among very low birthweight (VLBW; <1500 g) infants is 20%; and the mortality in low-resource settings can be as high as 70%. This study aimed to develop an Infection Prediction Score to diagnose bacterial HAIs. METHODS A retrospective cohort of VLBW infants investigated for HAI was randomised into two unmatched cohorts. The first cohort was used for development of the score, and the second cohort was used for the internal validation thereof. Potential predictors included risk factors, clinical features, interventions, and laboratory data. The model was developed based on logistic regression analysis. RESULTS The study population of 655 VLBW infants with 1116 episodes of clinically suspected HAIs was used to develop the model. The model had five significant variables: capillary refill time >3 s, lethargy, abdominal distention, presence of a central venous catheter in the previous 48 hours and a C reactive protein ≥10 mg/L. The area below the receiver operating characteristic curve was 0.868. A score of ≥2 had a sensitivity of 54.2% and a specificity of 96.4%. CONCLUSION A novel Infection Prediction Score for HAIs among VLBW infants may be an important tool for healthcare providers working in low-resource settings but external validation needs to be performed before widespread use can be recommended.
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Affiliation(s)
- Lizel G Lloyd
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mirjam Maria van Weissenbruch
- Division IC Neonatology (NICU), Department of Pediatrics, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Angela Dramowski
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | - Adrie Bekker
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Healthcare-associated Infections in Very Low Birth-weight Infants in a South African Neonatal Unit: Disease Burden, Associated Factors and Short-term Outcomes. Pediatr Infect Dis J 2022; 41:911-916. [PMID: 35980840 PMCID: PMC9555825 DOI: 10.1097/inf.0000000000003666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection is a leading cause of death among very low birth-weight (VLBW) infants in resource-limited settings. METHODS We performed a retrospective review of healthcare-associated infection (HAI) episodes among VLBW infants from January 1, 2016, to December 31, 2017. The epidemiology, causative organisms and short-term outcomes were analyzed. Logistic regression was used to investigate for factors associated with development of HAI. RESULTS During the study period, 715 VLBW infants with suspected HAI were investigated, including 162/715 (22.7%) proven and 158/715 (22.1%) presumed HAI. Of the proven infections, 99/162 (61.1%) contained at least one Gram-negative organism per blood culture; 84/162 (51.9%) single Gram-negative organisms and 15/162 (9.3%) polymicrobial growth. Independent factors associated with development of any HAI included low gestational age, small for gestational age, indwelling central venous catheter and invasive ventilation. Compared with infants in whom HAI had been excluded, infants with HAI were more likely to be diagnosed with necrotizing enterocolitis (5.6% vs. 23.1%; P < 0.001) and bronchopulmonary dysplasia (1.0% vs. 4.4%; P = 0.007). Infants with any HAI also had a longer hospital stay [44 (25-65) vs. 38 (26-53) days; P < 0.001] and increased mortality [90/320 (28.1%) vs. 21/395 (5.3%); P < 0.001] compared with infants who did not develop HAI episodes. CONCLUSIONS Proven and presumed HAI are a major contributor to neonatal morbidity and mortality; further research is urgently needed to better understand potential targets for prevention and treatment of HAI in resource-limited neonatal units.
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John HB, Oommen SP, Swathi TO, Kumar M, Stoen R, Adde L. Preterm General Movements in Prediction of Neurodevelopmental Disability and Cerebral Palsy at Two Years: A Prospective Cohort Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment. Adv Neonatal Care 2022; 22:E58-E76. [PMID: 33993154 DOI: 10.1097/anc.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. PURPOSE To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. METHODS A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. RESULTS Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. IMPLICATIONS FOR PRACTICE There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. IMPLICATIONS FOR RESEARCH Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.
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Hoyt-Austin AE, Kair LR, Larson IA, Stehel EK. Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022. Breastfeed Med 2022; 17:197-206. [PMID: 35302875 PMCID: PMC9206473 DOI: 10.1089/bfm.2022.29203.aeh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
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Affiliation(s)
- Adrienne E Hoyt-Austin
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Laura R Kair
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Ilse A Larson
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth K Stehel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Lloyd LG, Dramowski A, Bekker A, Malou N, Ferreyra C, Van Weissenbruch MM. Performance Comparison of Infection Prediction Scores in a South African Neonatal Unit: A Retrospective Case-Control Study. Front Pediatr 2022; 10:830510. [PMID: 35359896 PMCID: PMC8963199 DOI: 10.3389/fped.2022.830510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Infection prediction scores are useful ancillary tests in determining the likelihood of neonatal hospital-acquired infection (HAI), particularly in very low birth weight (VLBW; <1,500 g) infants who are most vulnerable to HAI and have high antibiotic utilization rates. None of the existing infection prediction scores were developed for or evaluated in South African VLBW neonates. METHODS We identified existing infection prediction scores through literature searches and assessed each score for suitability and feasibility of use in resource-limited settings. Performance of suitable scores were compared using a retrospective dataset of VLBW infants (2016-2017) from a tertiary hospital neonatal unit in Cape Town, South Africa. Sensitivity, specificity, predictive values, and likelihood ratios were calculated for each score. RESULTS Eleven infection prediction scores were identified, but only five were suitable for use in resource-limited settings (NOSEP1, Singh, Rosenberg, and Bekhof scores). The five selected scores were evaluated using data from 841 episodes of HAI in 659 VLBW infants. The sensitivity for the scores ranged between 3% (NOSEP1 ≥14; proven and presumed infection), to a maximum of 74% (Singh score ≥1; proven infection). The specificity of these scores ranged from 31% (Singh score ≥1; proven and presumed infection) to 100% (NOSEP1 ≥11 and ≥14, NOSEP-NEW-1 ≥11; proven and presumed infection). CONCLUSION Existing infection prediction scores did not achieve comparable predictive performance in South African VLBW infants and should therefore only be used as an adjunct to clinical judgment in antimicrobial decision making. Future studies should develop infection prediction scores that have high diagnostic accuracy and are feasible to implement in resource-limited neonatal units.
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Affiliation(s)
- Lizel Georgi Lloyd
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nada Malou
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Ikeda S, Shibanuma A, Silwal R, Jimba M. Factors associated with the length of stay at health facilities after childbirth among mothers and newborns in Dhading, Nepal: a cross-sectional study. BMJ Open 2021; 11:e042058. [PMID: 33947724 PMCID: PMC8098919 DOI: 10.1136/bmjopen-2020-042058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To measure the length of stay at a health facility after childbirth, identify factors associated with the length of stay and measure the gap between the timings of the last check-up and discharge. DESIGN A cross-sectional study. SETTING Five public health facilities in Dhading, Nepal. PARTICIPANTS 351 randomly selected mothers who gave birth at selected health facilities within 1 year of data collection between 10 and 31 August 2018. OUTCOME MEASURE Length of stay (hours) at a health facility after childbirth. Adequate length was defined as 24 hours or longer based on the WHO guidelines. RESULTS Among 350 mothers (99.7%) out of 351 recruited, 61.7% were discharged within 24 hours after childbirth. Factors associated with shorter length of stay were as follows: travel time less than 30 min to a health facility (incidence rate ratio (IRR)=0.69, 95% CI 0.61 to 0.78); delivery attended by auxiliary staff (IRR=0.86, 95% CI 0.75 to 0.98); and delivery in a primary healthcare centre (IRR=0.67, 95% CI 0.58 to 0.79). Factors associated with longer length of stay were as follows: aged 22 years or above at the first pregnancy (IRR=1.25, 95% CI 1.13 to 1.40); having maternal complications (IRR=2.41, 95% CI 2.16 to 2.70); accompanied by her own family (IRR=1.17, 95% CI 1.03 to 1.34), accompanied by her husband (IRR=1.16, 95% CI 1.04 to 1.29); and delivered at a facility with a physical space where mother and newborn could stay overnight (IRR=1.20, 95% CI 1.07 to 1.34). Among mothers without complications, 32% received the last check-up 3 hours or less before discharge. CONCLUSIONS Multiple factors, such as mothers' conditions, health facility characteristics and external support, were associated with the length of stay after childbirth. However, even if mothers stayed long, they might have not necessarily received timely and proper assessment before discharge.
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Affiliation(s)
- Subaru Ikeda
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ram Silwal
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Green Tara Nepal, Kathmandu, Nepal
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Special Newborn Care Plus Project in India: Preliminary Findings from Community-Based Follow-up of Newborns Discharged from Facilities. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2195-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Anagnostou A, Schrod L, Jochim J, Enenkel J, Krill W, Schlößer RL. Morbidity in Newborns Readmitted Into a Hospital After Discharge From a Maternity Unit During the First 28 Days of Their Lives - Results From the Rhine-Main Area, Germany. Z Geburtshilfe Neonatol 2020; 225:161-166. [PMID: 32767292 DOI: 10.1055/a-1205-1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The neonatal period can be associated with a multitude of medical and social problems. Little is known about the reasons that lead to neonatal readmissions in a pediatric hospital and their individual outcomes. OBJECTIVE To record the diagnosis of neonatal admissions in a pediatric hospital after discharge from a maternity unit. Predictive parameters are to be identified and a possible trend over the years is to be examined. METHODS The medical history of newborns admitted to a pediatric hospital in the Rhine-Main area from 01/01/2004 to 31/12/2013 was retrospectively analyzed based on provided medical files. RESULTS The data of 2851 newborns was recorded. 72% of the patients were delivered by vaginal birth. During the period under examination, there was a certain fluctuation although no significant trend in the number of admissions per year (p=0.062). The most frequent primary diagnoses were jaundice (27%), newborn infection (12.4%), and feeding problems (12.3%). Exclusively breastfed newborns had fewer feeding problems than newborns with a mixed or purely formula diets (p < 0.001). CONCLUSIONS The results of this study showed that the hospital readmissions of newborns throughout the years did not increase. Unfortunately, owing to the retrospective character of the study, it is not possible to make a clear statement as to whether hospitalization can be prevented with more intensive preventative measures. A prospective study on this matter is being planned.
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Affiliation(s)
- Anastasia Anagnostou
- Department of Neonatology, University Hospital, Goethe University, Frankfurt am Main
| | - Lothar Schrod
- Department of Pediatrics, Hospital Frankfurt Höchst GmbH, Frankfurt am Main
| | - Judith Jochim
- Department of Pediatrics, Sana Klinikum Offenbach GmbH, Offenbach
| | - Jürgen Enenkel
- Department of Pediatrics, Sana Klinikum Offenbach GmbH, Offenbach
| | | | - Rolf Lambert Schlößer
- Department of Neonatology, University Hospital, Goethe University, Frankfurt am Main
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Alaali ZS, Longcore ND, Santos P, Glaze VH, Ahmad N. Methods of Tracking Newborns: New York State Zika Pregnancy and Infant Registry, 2015-2017. Am J Public Health 2019; 110:216-221. [PMID: 31855479 DOI: 10.2105/ajph.2019.305406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To describe methods employed to track infants enrolled in the New York State Zika Pregnancy and Infant Registry (NYSZPIR) and demonstrate the benefits of population databases to improve the process.Methods. We used patient medical records and provider outreach, New York State Immunization Information System (NYSIIS), and New York State Early Hearing Detection and Intervention Information System (NYEHDI-IS) to gather medical information. We used descriptive statistics to summarize variables and the McNemar test to determine statistical significance (P < .05).Results. We identified 109 live births from NYSZPIR mothers. Provider information was documented for 106 (97.2%) infants in NYSIIS compared with 72 (66.1%) through chart review. Collected results of newborn hearing screening increased from 82 (75.2%) to 106 (97.2%) using NYEHDI-IS. The amount of data obtained was significantly higher (P < .001) when including NYSIIS and NYEHDI-IS compared with using medical records alone.Conclusions. Public health surveillance systems can be used to track infants using data sources such as NYSIIS and NYEHDI-IS in addition to traditional methods. Using medical records alone is inadequate for locating and tracking infants and may result in high lost to follow-up rates.
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Affiliation(s)
- Zahra S Alaali
- All authors are with the Zika Pregnancy and Infant Registry, Division of Epidemiology, New York State Department of Health, Albany
| | - Nicole D Longcore
- All authors are with the Zika Pregnancy and Infant Registry, Division of Epidemiology, New York State Department of Health, Albany
| | - Pauline Santos
- All authors are with the Zika Pregnancy and Infant Registry, Division of Epidemiology, New York State Department of Health, Albany
| | - Viola H Glaze
- All authors are with the Zika Pregnancy and Infant Registry, Division of Epidemiology, New York State Department of Health, Albany
| | - Nina Ahmad
- All authors are with the Zika Pregnancy and Infant Registry, Division of Epidemiology, New York State Department of Health, Albany
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