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Goyal M, Mascarenhas D, Rr P, Nanavati R. Long-Term Growth and Neurodevelopmental Outcomes of Neonates Infected with SARS-CoV-2 during the COVID-19 Pandemic at 18-24 Months Corrected Age: A Prospective Observational Study. Neonatology 2024:1-10. [PMID: 38583433 DOI: 10.1159/000537803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/07/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION During the early coronavirus disease (COVID-19) pandemic in 2020, researchers cautioned about the potential neuroinvasive capability of the virus and long-term neurological consequences. Although a few preliminary studies have found delayed communication, fine motor, and problem-solving skills in infants after COVID-19 infection, there continues to be a paucity of data on long-term development of neonates diagnosed with COVID-19. METHODS We conducted a prospective study of 20 neonates who acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the first wave of the pandemic (April-July 2020). At 18-24 months corrected age, we assessed neurodevelopment by Bayley Scales of Infant and Toddler Development, the third edition (BSID-III), along with growth, hearing, and vision evaluation. RESULTS The mean corrected age at assessment was 21 months 11 days ± 1 month 28 days. We found developmental delay in nearly half of the children with scores below one standard deviation in either of the BSID-III domains. Mild delay in either motor, cognitive, or language domains was found in 9 (45%) children and moderate delay in 2 (10%). Expressive language, fine motor, and receptive language were predominantly affected. None of the children had hearing impairment, blindness, or significant growth faltering including clinically severe microcephaly. The mean composite cognitive, language, and motor scores were significantly lower in those with neurodevelopmental delay (p value - 0.02, 0.000, and 0.03, respectively) without any differences in their disease characteristics. CONCLUSION Neonates infected with SARS-CoV-2 have an increased risk of developmental delays in expressive language, fine motor, and receptive language skills at 18-24 months of age. The severity of delays is predominantly mild.
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Affiliation(s)
- Medha Goyal
- Division of Neonatology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Dwayne Mascarenhas
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prashanth Rr
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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Vaddi VK, Mascarenhas D, Kirthana SB, Mundhra N, Nanavati R. A Quality Improvement Initiative to Increase the Milk Donation to the Human Milk Bank Post-Coronavirus Disease-19 Pandemic. Breastfeed Med 2023; 18:864-869. [PMID: 37733277 DOI: 10.1089/bfm.2023.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background and Objective: Donor human milk (DHM) from the human milk bank (HMB) is the next best alterative in circumstances when mother's own milk is not available. There was a steep decline in the volume of DHM collected during the coronavirus disease-19 (COVID-19) pandemic due to various factors, while DHM demand increased. Hence, a quality improvement (QI) study was conducted to increase the volume of milk donation to HMB from postpandemic baseline of 300-400 to 1,000 mL/day over 8 weeks. Materials and Methods: Fish bone analysis was used to identify the potential barriers, and four Plan-Do-Study-Act (PDSA) cycles were conducted from January 2021 to March 2021 to address the key barriers. In the first PDSA cycle, training of health care providers was done. Sessions for educating mothers in the second PDSA cycle and individualized one-to-one counseling of mothers by a mother support group were done in the third PDSA cycle. The availability of breast pump was increased in the fourth PDSA cycle. Sustainability of the interventions was studied for 6 months and data were analyzed. Results: The average DHM collected per day at the end of each PDSA cycle was 900, 1,500, 1,000, and 1,100 mL. Although the sustenance phase was affected by the second COVID-19 wave, prompt identification of the issues and timely interventions prevented the donated volume from dropping to preintervention levels. Conclusion: QI initiatives customized for local settings can result in significant improvement in voluntary milk donation in HMB, which can result in more availability of DHM to premature babies.
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Affiliation(s)
- Vamsi Krishna Vaddi
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Dwayne Mascarenhas
- Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | - S B Kirthana
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nitu Mundhra
- Department of Neonatology, Wockhardt Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Goyal M, Mascarenhas D, Nanavati R. Risk Calculator for Bronchopulmonary Dysplasia in Preterm Neonates: A Prospective Observational Study. Indian J Pediatr 2023:10.1007/s12098-023-04857-6. [PMID: 37789210 DOI: 10.1007/s12098-023-04857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To determine the incidence, risk factors, and accuracy of a previously published risk estimator in predicting Bronchopulmonary dysplasia (BPD) in a very preterm cohort from India. METHODS A single-center prospective observational study was conducted in preterm neonates born at 23-30 wk of gestation with a birth weight of 501-1249 g. The incidence and risk factors of BPD were evaluated, and the accuracy of BPD prediction at six pre-specified time points using the National Institute of Child Health and Human Development (NICHD) BPD risk estimator was assessed by comparing the estimated risk with the observed rates. RESULTS A total of 310 neonates with mean gestation age of 28.7±1.5 wk and birth weight of 1023.6±171.4 g were enrolled in the study. The study cohort had 49.7% males and 32.3% neonates requiring resuscitation. Any BPD was observed in 54 (17.4%) neonates with severity being mild, moderate, and severe in 29 (53.7%), 17 (31.5%), and 8 (14.8%) neonates respectively. Hundred (32.3%) neonates died before discharge from the hospital. Sepsis, patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage, and blood transfusion were significant risk factors for the development of BPD. The calculator was accurate for the prediction of death or moderate-severe BPD on days 1 and 3 with the area under the curve of 0.82 and 0.77 respectively. CONCLUSIONS The NICHD BPD estimator helped to accurately predict moderate-severe BPD early in Indian preterm infants.
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Affiliation(s)
- Medha Goyal
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - Dwayne Mascarenhas
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012, India.
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012, India
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Aguilar GR, Swetschinski LR, Weaver ND, Ikuta KS, Mestrovic T, Gray AP, Chung E, Wool EE, Han C, Hayoon AG, Araki DT, Abdollahi A, Abu-Zaid A, Adnan M, Agarwal R, Dehkordi JA, Aravkin AY, Areda D, Azzam AY, Berezin EN, Bhagavathula AS, Bhutta ZA, Bhuyan SS, Browne AJ, Castañeda-Orjuela CA, Chandrasekar EK, Ching PR, Dai X, Darmstadt GL, De la Hoz FP, Diao N, Diaz D, Mombaque dos Santos W, Eyre D, Garcia C, Haines-Woodhouse G, Hassen MB, Henry NJ, Hopkins S, Hossain MM, Iregbu KC, Iwu CC, Jacobs JA, Janko MM, Jones R, Karaye IM, Khalil IA, Khan IA, Khan T, Khubchandani J, Khusuwan S, Kisa A, Koyaweda GW, Krapp F, Kumaran EA, Kyu HH, Lim SS, Liu X, Luby S, Maharaj SB, Maronga C, Martorell M, May J, McManigal B, Mokdad AH, Moore CE, Mostafavi E, Murillo-Zamora E, Mussi-Pinhata MM, Nanavati R, Nassereldine H, Natto ZS, Qamar FN, Nuñez-Samudio V, Ochoa TJ, Ojo-Akosile TR, Olagunju AT, Olivas-Martinez A, Ortiz-Brizuela E, Ounchanum P, Paredes JL, Patthipati VS, Pawar S, Pereira M, Pollard A, Ponce-De-Leon A, Sady Prates EJ, Qattea I, Reyes LF, Roilides E, Rosenthal VD, Rudd KE, Sangchan W, Seekaew S, Seylani A, Shababi N, Sham S, Sifuentes-Osornio J, Singh H, Stergachis A, Tasak N, Tat NY, Thaiprakong A, Valdez PR, Yada DY, Yunusa I, Zastrozhin MS, Hay SI, Dolecek C, Sartorius B, Murray CJ, Naghavi M. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am 2023; 25:100561. [PMID: 37727594 PMCID: PMC10505822 DOI: 10.1016/j.lana.2023.100561] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 09/21/2023]
Abstract
Background Antimicrobial resistance (AMR) is an urgent global health challenge and a critical threat to modern health care. Quantifying its burden in the WHO Region of the Americas has been elusive-despite the region's long history of resistance surveillance. This study provides comprehensive estimates of AMR burden in the Americas to assess this growing health threat. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO Region of the Americas in 2019. We obtained data from mortality registries, surveillance systems, hospital systems, systematic literature reviews, and other sources, and applied predictive statistical modelling to produce estimates of AMR burden for all countries in the Americas. Five broad components were the backbone of our approach: the number of deaths where infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of pathogens resistant to an antibiotic class, and the excess risk of mortality (or duration of an infection) associated with this resistance. We then used these components to estimate the disease burden by applying two counterfactual scenarios: deaths attributable to AMR (compared to an alternative scenario where resistant infections are replaced with susceptible ones), and deaths associated with AMR (compared to an alternative scenario where resistant infections would not occur at all). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Findings We estimated 569,000 deaths (95% UI 406,000-771,000) associated with bacterial AMR and 141,000 deaths (99,900-196,000) attributable to bacterial AMR among the 35 countries in the WHO Region of the Americas in 2019. Lower respiratory and thorax infections, as a syndrome, were responsible for the largest fatal burden of AMR in the region, with 189,000 deaths (149,000-241,000) associated with resistance, followed by bloodstream infections (169,000 deaths [94,200-278,000]) and peritoneal/intra-abdominal infections (118,000 deaths [78,600-168,000]). The six leading pathogens (by order of number of deaths associated with resistance) were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Together, these pathogens were responsible for 452,000 deaths (326,000-608,000) associated with AMR. Methicillin-resistant S. aureus predominated as the leading pathogen-drug combination in 34 countries for deaths attributable to AMR, while aminopenicillin-resistant E. coli was the leading pathogen-drug combination in 15 countries for deaths associated with AMR. Interpretation Given the burden across different countries, infectious syndromes, and pathogen-drug combinations, AMR represents a substantial health threat in the Americas. Countries with low access to antibiotics and basic health-care services often face the largest age-standardised mortality rates associated with and attributable to AMR in the region, implicating specific policy interventions. Evidence from this study can guide mitigation efforts that are tailored to the needs of each country in the region while informing decisions regarding funding and resource allocation. Multisectoral and joint cooperative efforts among countries will be a key to success in tackling AMR in the Americas. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Russell NJ, Stöhr W, Plakkal N, Cook A, Berkley JA, Adhisivam B, Agarwal R, Ahmed NU, Balasegaram M, Ballot D, Bekker A, Berezin EN, Bilardi D, Boonkasidecha S, Carvalheiro CG, Chami N, Chaurasia S, Chiurchiu S, Colas VRF, Cousens S, Cressey TR, de Assis ACD, Dien TM, Ding Y, Dung NT, Dong H, Dramowski A, DS M, Dudeja A, Feng J, Glupczynski Y, Goel S, Goossens H, Hao DTH, Khan MI, Huertas TM, Islam MS, Jarovsky D, Khavessian N, Khorana M, Kontou A, Kostyanev T, Laoyookhon P, Lochindarat S, Larsson M, Luca MD, Malhotra-Kumar S, Mondal N, Mundhra N, Musoke P, Mussi-Pinhata MM, Nanavati R, Nakwa F, Nangia S, Nankunda J, Nardone A, Nyaoke B, Obiero CW, Owor M, Ping W, Preedisripipat K, Qazi S, Qi L, Ramdin T, Riddell A, Romani L, Roysuwan P, Saggers R, Roilides E, Saha SK, Sarafidis K, Tusubira V, Thomas R, Velaphi S, Vilken T, Wang X, Wang Y, Yang Y, Zunjie L, Ellis S, Bielicki JA, Walker AS, Heath PT, Sharland M. Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS). PLoS Med 2023; 20:e1004179. [PMID: 37289666 PMCID: PMC10249878 DOI: 10.1371/journal.pmed.1004179] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/19/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. METHODS AND FINDINGS Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa). Prospective daily observational data was collected on clinical signs, supportive care, antibiotic treatment, microbiology, and 28-day mortality. Two prediction models were developed for (1) 28-day mortality from baseline variables (baseline NeoSep Severity Score); and (2) daily risk of death on IV antibiotics from daily updated assessments (NeoSep Recovery Score). Multivariable Cox regression models included a randomly selected 85% of infants, with 15% for validation. A total of 3,204 infants were enrolled, with median birth weight of 2,500 g (IQR 1,400 to 3,000) and postnatal age of 5 days (IQR 1 to 15). 206 different empiric antibiotic combinations were started in 3,141 infants, which were structured into 5 groups based on the World Health Organization (WHO) AWaRe classification. Approximately 25.9% (n = 814) of infants started WHO first line regimens (Group 1-Access) and 13.8% (n = 432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2-"Low" Watch). The largest group (34.0%, n = 1,068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3-"Medium" Watch), 18.0% (n = 566) started a carbapenem (Group 4-"High" Watch), and 1.8% (n = 57) a Reserve antibiotic (Group 5, largely colistin-based), and 728/2,880 (25.3%) of initial regimens in Groups 1 to 4 were escalated, mainly to carbapenems, usually for clinical deterioration (n = 480; 65.9%). A total of 564/3,195 infants (17.7%) were blood culture pathogen positive, of whom 62.9% (n = 355) had a gram-negative organism, predominantly Klebsiella pneumoniae (n = 132) or Acinetobacter spp. (n = 72). Both were commonly resistant to WHO-recommended regimens and to carbapenems in 43 (32.6%) and 50 (71.4%) of cases, respectively. MRSA accounted for 33 (61.1%) of 54 Staphylococcus aureus isolates. Overall, 350/3,204 infants died (11.3%; 95% CI 10.2% to 12.5%), 17.7% if blood cultures were positive for pathogens (95% CI 14.7% to 21.1%, n = 99/564). A baseline NeoSep Severity Score had a C-index of 0.76 (0.69 to 0.82) in the validation sample, with mortality of 1.6% (3/189; 95% CI: 0.5% to 4.6%), 11.0% (27/245; 7.7% to 15.6%), and 27.3% (12/44; 16.3% to 41.8%) in low (score 0 to 4), medium (5 to 8), and high (9 to 16) risk groups, respectively, with similar performance across subgroups. A related NeoSep Recovery Score had an area under the receiver operating curve for predicting death the next day between 0.8 and 0.9 over the first week. There was significant variation in outcomes between sites and external validation would strengthen score applicability. CONCLUSION Antibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis. TRIAL REGISTRATION ClinicalTrials.gov, (NCT03721302).
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Affiliation(s)
- Neal J. Russell
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Wolfgang Stöhr
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Aislinn Cook
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - James A. Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Bethou Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Ramesh Agarwal
- Newborn Division and WHO-CC, All India Institute of Medical Sciences, New Delhi, India
| | - Nawshad Uddin Ahmed
- Child Health Research Foundation (CHRF), Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Manica Balasegaram
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Daynia Ballot
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | | | | | - Cristina G. Carvalheiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Neema Chami
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suman Chaurasia
- All India Institute of Medical Sciences, Department of Paediatrics, New Delhi, India
| | - Sara Chiurchiu
- Academic Hospital Paediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Simon Cousens
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tim R. Cressey
- PHPT/IRD-MIVEGEC, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Tran Minh Dien
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Yijun Ding
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Nguyen Trong Dung
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Han Dong
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Madhusudhan DS
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ajay Dudeja
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
| | - Jinxing Feng
- Department of Neonatology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Youri Glupczynski
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Srishti Goel
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Doan Thi Huong Hao
- Vietnam National Children’s Hospital, Hanoi, Vietnam and Surgical Intensive Care Unit, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Mahmudul Islam Khan
- Child Health Research Foundation (CHRF), Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Tatiana Munera Huertas
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | | | - Daniel Jarovsky
- Pediatric Infectious Diseases Unit, Santa Casa de São Paulo, São Paulo, Brazil
| | - Nathalie Khavessian
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Meera Khorana
- Neonatal Unit, Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Angeliki Kontou
- Neonatology Dept, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Tomislav Kostyanev
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | | | | | - Mattias Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maia De Luca
- Academic Hospital Paediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Nitu Mundhra
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Philippa Musoke
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University and MUJHU Care, Kampala, Uganda
| | - Marisa M. Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ruchi Nanavati
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Firdose Nakwa
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
| | - Jolly Nankunda
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Borna Nyaoke
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Christina W. Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Department of Global Health, Amsterdam, the Netherlands
| | - Maxensia Owor
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Wang Ping
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | | | - Shamim Qazi
- World Health Organization, Maternal, Newborn, Child and Adolescent Health Department, Geneva, Switzerland
| | - Lifeng Qi
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Tanusha Ramdin
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Amy Riddell
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Lorenza Romani
- Academic Hospital Paediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Praewpan Roysuwan
- PHPT/IRD-MIVEGEC, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Robin Saggers
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Dept Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Samir K. Saha
- Child Health Research Foundation (CHRF), Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Kosmas Sarafidis
- Neonatology Dept, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Valerie Tusubira
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University and MUJHU Care, Kampala, Uganda
| | - Reenu Thomas
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tuba Vilken
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Xiaojiao Wang
- Department of Neonatology, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
| | - Yajuan Wang
- Department of Neonatology, Children’s Hospital, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing, China
| | - Yonghong Yang
- Department of Neonatology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Liu Zunjie
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Sally Ellis
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - Julia A. Bielicki
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - A. Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Paul T. Heath
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Mike Sharland
- Center for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
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Joshi AS, Adhikarla C, Goyal M, Haribalakrishna A(A, Kulkarni DV, Nanavati R. A case report on umbilical artery catheter embolization in a neonate, and its surgical management. Indian J Thorac Cardiovasc Surg 2023; 39:305-308. [PMID: 37124598 PMCID: PMC10140212 DOI: 10.1007/s12055-023-01480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Umbilical arterial and venous catheters are used widely in management of critically ill neonates. Being delicate, they can get inadvertently damaged by needles, scissors, or tight purse-string sutures during insertion and removal. Umbilical artery catheter embolization is a rare and dreaded complication, with less than 15 cases reported to date. We describe a term neonate, in whom a 3.5-Fr umbilical artery catheter, accidentally broken and dislodged, was surgically retrieved through right common iliac arteriotomy, safely and completely. Direct surgical retrieval of umbilical catheters while avoiding attempts at local exploration maybe considered a first line in management, particularly if endovascular facilities are unavailable or inaccessible.
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Affiliation(s)
- Abhishek Shrinivas Joshi
- P.K. Sen Department of Cardiovascular and Thoracic Surgery, Seth G.S. Medical College and K.E.M. Hospital, Room 305, CVTS Office, Ground Floor, CVTC Building, KEM Hospital, Parel, Mumbai-12, India
| | - Chandana Adhikarla
- P.K. Sen Department of Cardiovascular and Thoracic Surgery, Seth G.S. Medical College and K.E.M. Hospital, Room 305, CVTS Office, Ground Floor, CVTC Building, KEM Hospital, Parel, Mumbai-12, India
| | - Medha Goyal
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
| | | | - Dwarkanath Vivekanand Kulkarni
- P.K. Sen Department of Cardiovascular and Thoracic Surgery, Seth G.S. Medical College and K.E.M. Hospital, Room 305, CVTS Office, Ground Floor, CVTC Building, KEM Hospital, Parel, Mumbai-12, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
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Ahir-Bist S, Chavan V, Padmaja Samant M, Nanavati R, Mehta P, Mania-Pramanik J. Human leukocyte antigens class I and class II alleles associated with vertical human immunodeficiency virus transmission - an exploratory study from Mumbai, India. Indian J Dermatol Venereol Leprol 2023; 89:159. [PMID: 36331825 DOI: 10.25259/ijdvl_654_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/01/2022] [Indexed: 01/30/2023]
Abstract
Background Human leukocyte antigens (HLA) an important host genetic factor is responsible for influencing human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) transmission and disease progression. Contributions of HLA I and II alleles have not been reported in the Indian population with respect to vertical HIV transmission. Aim In the current study we determined the frequencies of HLA class I and class II alleles in a cohort of children exposed to HIV through their mothers. Method In this exploratory study children perinatally exposed to HIV-1 who fit the study criteria and had completed 18 month follow-up were typed for HLA class I and class II alleles using polymerase chain reaction combined with sequence-specific oligonucleotides probes (PCR-SSOP) and sequence-specific primer (SSP) method. HLA typing was done in 30 positive and 60 HIV negative children along with confounding factors such as treatment regimens, viral load and CD4 count of the mother, feeding option, etc. SPSS software was used for statistical analysis and online docking tools for in-silico analysis. Results HLA-B*40 (p = 0.018) was significantly higher in negative children and was associated with protection, whereas HLA-A*01 (p = 0.05), HLA-B*37 (p = 0.032) and HLA-DRB1*09 (p = 0.017) were associated with transmission. Known protective allele HLA-B*27 was only present in negative children. Many specific haplotypes were exclusively present in the negative children or the positive ones. In-silico analysis was performed to predict the ability of HLA-B*40 to bind to antigenic peptides obtained from HIV-1 sequences in our study group. Limitations Small sample size is a concerning limitation of the study. Nonetheless this is a comprehensive study on HLA alleles in HIV exposed Indian children Conclusion Our study highlights the contribution of HLA class I and II alleles in the Indian children and further adds to understanding the immunogenetic mechanisms. These can be developed as markers for prediction of infection transmission. The observations also contribute to the database of genetic makeup of our population and can help in designing vaccine strategies.
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Affiliation(s)
- Swati Ahir-Bist
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Vijay Chavan
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Mavani Padmaja Samant
- Department of Obstetrics and Gynaecology, Seth G. S. Medical College and K. E. M Hospital, Parel, Mumbai, Maharashtra, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G. S. Medical College and K. E. M Hospital, Parel, Mumbai, Maharashtra, India
| | - Preeti Mehta
- Department of Microbiology, Seth G. S. Medical College and K. E. M Hospital, Parel, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Mascarenhas D, Goyal M, Nanavati R, Kirthana SB, Subhadarsini S. Short-term outcome and complications of therapeutic hypothermia in neonates with moderate-to-severe hypoxic ischaemic encephalopathy: a single-centre retrospective observational study in a hospital in Mumbai, India. Paediatr Int Child Health 2022; 42:117-126. [PMID: 36755411 DOI: 10.1080/20469047.2023.2171762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Although shown to reduce death or disability in moderate-to-severe hypoxic ischaemic encephalopathy (HIE), therapeutic hypothermia (TH) has recently been associated with an increase in adverse events in low- and middle-income countries (LMIC). AIM To determine the clinical characteristics, complications and short-term outcome in neonates receiving TH in King Edward Memorial Hospital, Mumbai, India. METHODS A retrospective single-centre study of neonates with moderate-to-severe HIE who received TH from 1 January 2018 to 31 December 2021 was undertaken. TH was provided as per the unit's protocol using either a servo-controlled device or a phase-changing material (PCM). RESULTS One hundred and fifty-five neonates were included with 94.2% intramural births. Mean gestation and birthweight were 38.6 (1.5) weeks and 2776.7 (431) g, respectively. HIE staging was moderate in 87.1% and severe in 12.9%, with a mean cord pH of 6.93 (0.14) and seizures in 38.7%. Adverse events included shock (50.3%), clinically significant bleeding (16%), acute kidney injury (6.7%), culture-positive sepsis (11.6%), persistent pulmonary hypertension (9%), bradycardia (9%), food intolerance (14.9%) and premature termination (7.1%). A servo-controlled device (15.5%) or PCM (84.5%) was used, with comparable adverse events. 84.5% of the neonates were discharged, 7.1% discharged against medical advice and 8.4% died. Detailed neurological assessment at discharge/discharge against medical advice suggested neurological impairment in 128 (87.1%) neonates. CONCLUSION Adverse events during TH range from asymptomatic laboratory abnormalities to life-threatening complications, which are manageable in well equipped units. Neurological impairment at discharge in neonates who received cooling mandates strict neurological follow-up.Abbreviations: aEEG: amplitude-integrated EEG; AKI: acute kidney injury; BW: birthweight; EEG: electro-encephalogram; GA: gestational age; HELIX: hypothermia for encephalopathy in low- and middle-income countries; HIE: hypoxic ischaemic encephalopathy; IVH: intraventricular haemorrhage; LMIC: low- and middle-income countries; NICHD: National Institute of Child Health and Human Development; NICU: neonatal intensive care unit; PPHN: persistent pulmonary hypertension of newborn; PCM: phase-changing material; SGA: small-for-gestational age; TH: therapeutic hypothermia.
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Affiliation(s)
- Dwayne Mascarenhas
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Medha Goyal
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
| | - S B Kirthana
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Santoshi Subhadarsini
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
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Singh S, Ananthan A, Nanavati R. Post-INSURE Administration of Heated Humidified High-Flow Therapy Versus Nasal Continuous Positive Airway Pressure in Preterm Infants More Than 28 Weeks Gestation with Respiratory Distress Syndrome: A Randomized Non-Inferiority Trial. J Trop Pediatr 2022; 68:6649677. [PMID: 35877150 DOI: 10.1093/tropej/fmac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In preterm infants with respiratory distress syndrome (RDS), non-invasive ventilation (NIV) is usually provided using nasal continuous positive airway pressure (NCPAP) or non-invasive mechanical ventilation after surfactant administration by INtubation-SURfactant-Extubation (INSURE) method. Heated humidified high-flow nasal cannula (HHHFNC) is a mode of NIV with advantages of ease of application, less grades of nasal injury and easy handling. This study was done to compare the effectiveness of HHHFNC therapy administration as post-INSURE respiratory support in preterm infants as compared to NCPAP. The primary outcome was to compare the rate of treatment failure within 7 days of randomization to HHHFNC or NCPAP as a post-INSURE ventilatory modality. It was a pilot trial wherein all preterm infants more than 1 kg and more than 28 weeks gestational age with RDS who required surfactant were randomized to receive NCPAP or HHHFNC. Infants with an urgent need for intubation and mechanical ventilation were considered to have treatment failure. Thirty babies were enrolled-15 in each group. Baseline demographic characteristics were comparable. There was no significant difference in the primary outcome of early failure rate, i.e. mechanical ventilation rate within 7 days of starting treatment. There were no significant differences in other outcomes except nasal injury which was significantly lesser in the HHHFNC group. In conclusion, HHHFNC appears to be non-inferior to NCPAP when used in preterm infants more than 28 weeks gestation with RDS as a post-INSURE ventilatory modality.
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Affiliation(s)
- Srijan Singh
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
| | - Anitha Ananthan
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
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Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, Han C, Bisignano C, Rao P, Wool E, Johnson SC, Browne AJ, Chipeta MG, Fell F, Hackett S, Haines-Woodhouse G, Kashef Hamadani BH, Kumaran EAP, McManigal B, Achalapong S, Agarwal R, Akech S, Albertson S, Amuasi J, Andrews J, Aravkin A, Ashley E, Babin FX, Bailey F, Baker S, Basnyat B, Bekker A, Bender R, Berkley JA, Bethou A, Bielicki J, Boonkasidecha S, Bukosia J, Carvalheiro C, Castañeda-Orjuela C, Chansamouth V, Chaurasia S, Chiurchiù S, Chowdhury F, Clotaire Donatien R, Cook AJ, Cooper B, Cressey TR, Criollo-Mora E, Cunningham M, Darboe S, Day NPJ, De Luca M, Dokova K, Dramowski A, Dunachie SJ, Duong Bich T, Eckmanns T, Eibach D, Emami A, Feasey N, Fisher-Pearson N, Forrest K, Garcia C, Garrett D, Gastmeier P, Giref AZ, Greer RC, Gupta V, Haller S, Haselbeck A, Hay SI, Holm M, Hopkins S, Hsia Y, Iregbu KC, Jacobs J, Jarovsky D, Javanmardi F, Jenney AWJ, Khorana M, Khusuwan S, Kissoon N, Kobeissi E, Kostyanev T, Krapp F, Krumkamp R, Kumar A, Kyu HH, Lim C, Lim K, Limmathurotsakul D, Loftus MJ, Lunn M, Ma J, Manoharan A, Marks F, May J, Mayxay M, Mturi N, Munera-Huertas T, Musicha P, Musila LA, Mussi-Pinhata MM, Naidu RN, Nakamura T, Nanavati R, Nangia S, Newton P, Ngoun C, Novotney A, Nwakanma D, Obiero CW, Ochoa TJ, Olivas-Martinez A, Olliaro P, Ooko E, Ortiz-Brizuela E, Ounchanum P, Pak GD, Paredes JL, Peleg AY, Perrone C, Phe T, Phommasone K, Plakkal N, Ponce-de-Leon A, Raad M, Ramdin T, Rattanavong S, Riddell A, Roberts T, Robotham JV, Roca A, Rosenthal VD, Rudd KE, Russell N, Sader HS, Saengchan W, Schnall J, Scott JAG, Seekaew S, Sharland M, Shivamallappa M, Sifuentes-Osornio J, Simpson AJ, Steenkeste N, Stewardson AJ, Stoeva T, Tasak N, Thaiprakong A, Thwaites G, Tigoi C, Turner C, Turner P, van Doorn HR, Velaphi S, Vongpradith A, Vongsouvath M, Vu H, Walsh T, Walson JL, Waner S, Wangrangsimakul T, Wannapinij P, Wozniak T, Young Sharma TEMW, Yu KC, Zheng P, Sartorius B, Lopez AD, Stergachis A, Moore C, Dolecek C, Naghavi M. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399:629-655. [PMID: 35065702 PMCID: PMC8841637 DOI: 10.1016/s0140-6736(21)02724-0] [Citation(s) in RCA: 3952] [Impact Index Per Article: 1976.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen-drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. METHODS We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. FINDINGS On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62-6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911-1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9-35·3), and lowest in Australasia, at 6·5 deaths (4·3-9·4) per 100 000. Lower respiratory infections accounted for more than 1·5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000-1 270 000) deaths attributable to AMR and 3·57 million (2·62-4·78) deaths associated with AMR in 2019. One pathogen-drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000-100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. INTERPRETATION To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Abstract
BACKGROUND Neonatal palliative care (NPC) aims to prevent and relieve the suffering of neonates who are not going to recover. Although an integral part of neonatal care, it remains in nascent stages in many parts of the world. AIM To describe neonatologists' level of knowledge and understanding of NPC, and to describe current practices and barriers to its delivery. METHODS The study, a cross-sectional web-based national survey, was undertaken between 2019 and 2020. A structured form of 22 questions about NPC was completed by neonatologists across level III neonatal intensive care units in India. RESULTS Of the 145 questionnaires sent out, 65 responses were returned (44.8%). The participating units were in both public (38.5%) and private/corporate hospitals (61.5%). The concept of NPC was known to 90.8%, and 93.8% could identify conditions necessitating palliation. However, 81.5% of units lacked a palliative team, and few had teams of only neonatologists and neonatal nurses. Only 10.8% of the units had a structured policy, but none addressed all aspects of neonatal palliation. The creation of memories by parents spending time with their neonate (38.9%), photography (75.9%), footprints (13%) or collecting memorabilia was allowed at many centres. Frequently encountered barriers included inadequate knowledge (16.9%), poor infrastructure (21.5%), inadequate human resources (24.6%) and a lack of structured guidelines and legal support (15.4%). CONCLUSION This is the first study to highlight a large gap in neonatal end-of-life care in India and it reflects an urgent need to facilitate its incorporation into routine care. ABBREVIATIONS NICU: neonatal intensive care unit; NPC: neonatal palliative care.
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Affiliation(s)
- Dwayne Mascarenhas
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Medha Goyal
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India
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R Chavan V, Ahir S, Kerkar S, Ansari Z, Samant-Mavani P, Nanavati R, Mehta P, Mania-Pramanik J. Th1 cytokine gene polymorphism and the corresponding plasma cytokine levels: A comparative study in HIV-1 positive and exposed uninfected infants. J Med Virol 2021; 94:625-633. [PMID: 34698402 DOI: 10.1002/jmv.27408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/20/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022]
Abstract
The pro-inflammatory (Th1) cytokines namely interleukin (IL)-2, IL-6, IL-12, interferon (IFN)-γ, tumor necrosis factor-α (TNF-α) are vital in the clearance of HIV infection. This prospective cohort study aimed to evaluate the polymorphisms of Th1 cytokine genes and their corresponding plasma cytokine levels in HIV-1 positive and exposed uninfected (EU) infants born to HIV-1 positive mothers. CD4 count, viral load of HIV-1 positive mothers was done using commercially available reagents. Cytokine genotyping analysis and levels were done in 20 HIV-1 positive and 54 EU infants. The polymorphisms of Th1 cytokines were done using the PCR-SSP method. Plasma cytokine levels were estimated using Bio-Plex-Pro cytokine assay (BIO-RAD; USA). Results revealed treatment status of the mothers and viral load were the two confounding factors having a significant effect on HIV status of the infant. TNF-α GG genotype is significantly higher in EU infants as compared with HIV-1 positive infants. GG genotype was associated with high TNF- α levels in HIV-1 positive infants but the difference was not statistically significant. HIV-1 positive infants with -IFN-γ (+874) TT genotype was significantly associated with high IFN-γ levels. To the best of our knowledge, this is the first study reporting the role of Th1 cytokine gene polymorphisms and their corresponding plasma cytokine levels in HIV-1 positive and EU infants from India.
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Affiliation(s)
- Vijay R Chavan
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Swati Ahir
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Shilpa Kerkar
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Zakia Ansari
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Padmaja Samant-Mavani
- Departments of Obstetrics and Gynaecology, Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Ruchi Nanavati
- Departments of Obstetrics and Neonatology, Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Preeti Mehta
- Departments of Obstetrics and Microbiology, Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Ananthan A, Nanavati R. Implementation of Directly Observed Procedural Skills in Resident Doctors in Neonatology-An Observational Study. Indian J Pediatr 2021; 88:946. [PMID: 34263431 DOI: 10.1007/s12098-021-03837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Anitha Ananthan
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, 400012, India.
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, 400012, India
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Muzumdar D, Hawaldar A, Bhambhere S, Singh M, Lunawat A, Nanavati R. Open Neural Tube Defects in COVID-19 Pandemic: An Analysis of 26 Neonatal Patients in a Tertiary Care Center. J Pediatr Neurosci 2021; 16:5-10. [PMID: 34316301 PMCID: PMC8276957 DOI: 10.4103/jpn.jpn_126_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) pandemic has severely affected and disrupted medical practice all over the world since December 2019 till date. This has affected the pediatric surgical practice in general and neurosurgical practice in particular. An analysis of 26 neonatal patients with open neural tube defects who underwent surgery in the neurosurgery department at the King Edward VII Memorial Hospital (KEM), Mumbai during the period of March 2020 till December 2020 is presented. The cumulative experience and challenges encountered in the comprehensive management of these cohort of patients in the difficult period of the pandemic is discussed in accordance with relevant literature on the subject.
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Affiliation(s)
- Dattatraya Muzumdar
- Department of Neurosurgery, Seth GS Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Akshay Hawaldar
- Department of Neurosurgery, Seth GS Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sagar Bhambhere
- Department of Neurosurgery, Seth GS Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Malwinder Singh
- Department of Neurosurgery, Seth GS Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Aditya Lunawat
- Department of Neurosurgery, Seth GS Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Mascarenhas D, Goyal M, Mundhra N, Haribalakrishna A, Nanavati R, Nataraj G. COVID-19 Infection in Newborn Infants. Indian J Pediatr 2021; 88:394. [PMID: 33244731 PMCID: PMC7691071 DOI: 10.1007/s12098-020-03578-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Dwayne Mascarenhas
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400 012, India.
| | - Medha Goyal
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400 012, India
| | - Nitu Mundhra
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400 012, India
| | - Anitha Haribalakrishna
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400 012, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400 012, India
| | - Gita Nataraj
- Department of Microbiology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Abstract
Purpose: Exclusive breastfeeding is an integral component of Kangaroo Mother Care (KMC). However, the practice of breastfeeding in KMC position is often suboptimal. Hence, a Quality Improvement (QI) initiative study was conducted to improve breastfeeding rates while providing KMC. Materials and Methods: Fish bone analysis was used to identify the potential barriers, which were targeted to bring improvement through Plan-Do-Study-Action (PDSA) cycles. Eligible mother-infant (≥34 weeks) dyad who were admitted in Neonatal intensive care unit during the study period were enrolled in the study (n = 45). QI was implemented through two PDSA cycles. In the first PDSA cycle, training and sensitization of health care providers was done. In the second PDSA cycle, mothers were educated and trained for breastfeeding in the KMC position. Data were collected using bed side nursing charts and interviewing the mothers. Data were analyzed using run charts and SPSS software. A p-value of <0.05 was considered to be significant. Results: Percentage of mothers practicing breastfeeding in KMC position increased to 50% after first PDSA cycle and to 100% after the second PDSA cycle from the baseline of <10%. Average duration of KMC increased significantly from baseline 6.09 to 10.9 hours (p = 0.003) in first cycle and 15.6 hours in second cycle (p < 0.001). Conclusion: QI measures increased the rates of breastfeeding in KMC position. The total duration of KMC per day was also significantly increased.
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Affiliation(s)
- Nitu Mundhra
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Saumil Desai
- Department of Neonatology, King Edward Memorial Hospital, Subiaco, Western Australia
| | - Ruchi Nanavati
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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Nanavati R, Mascarenhas D, Goyal M, Haribalakrishna A, Nataraj G. A single-center observational study on clinical features and outcomes of 21 SARS-CoV-2-infected neonates from India. Eur J Pediatr 2021; 180:1895-1906. [PMID: 33544233 PMCID: PMC7862853 DOI: 10.1007/s00431-021-03967-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an ongoing pandemic with significant morbidity and mortality. Neonates represent a vulnerable population, in which we have limited knowledge of its natural history, optimal management, and outcomes. In this retrospective observational study from a low-middle-income setting, clinical characteristics and outcomes of neonatal SARS-CoV-2 infection were evaluated. We report an incidence of 10.6% of SARS-CoV-2 infection (21 neonates), among a group of 198 neonates with suspected infection. Most of the SARS-CoV-2-infected neonates were term (80.9%) and none required any resuscitation. The infection was detected by a positive nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2. Neonatal COVID-19 manifestations developed in one-third (33.3%) of the infected neonates. Most of them demonstrated the involvement of respiratory (33.3%) and gastrointestinal systems (4.8%). Laboratory parameters suggested multi-systemic involvement, with elevated creatine kinase (CK) (76.2%), creatine kinase-myocardial band (CK-MB) (76.2%), and lactate dehydrogenase (LDH) (71.4%) levels. Supportive treatment was given to infected neonates with intensive care required in six neonates (28.6%). This included four preterm and two term neonates, of which two received non-invasive and one received invasive ventilation with intra-tracheal surfactant instillation. IgM antibodies against COVID-19 were detected in one neonate. All neonates with COVID-19 improved and were successfully discharged.Conclusion: SARS-CoV-2 in neonates has a wide clinical spectrum. Further studies are needed which are adequately powered to completely understand the course of this infection in neonates, its implications not only in the neonatal period but also on long-term follow-up. What is Known: • SARS-CoV-2 infection has a predilection for all age groups but with limited literature on clinical profile, outcomes, and long-term follow-up in neonates. What is New: • SARS-CoV-2 infection in neonates has a wide clinical spectrum and displays a significant overlap with common neonatal conditions. • Most neonates with COVID-19 improved with supportive care, though a subset required intensive care, emphasizing the need for cautious monitoring and management.
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Affiliation(s)
- Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400 012 India
| | - Dwayne Mascarenhas
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400 012 India
| | - Medha Goyal
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400 012 India
| | - Anitha Haribalakrishna
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400 012 India
| | - Gita Nataraj
- Department of Microbiology, Seth GS Medical College KEM Hospital, Mumbai, India
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18
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Kambli PM, Bargir UA, Yadav RM, Gupta MR, Dalvi AD, Hule G, Kelkar M, Sawant-Desai S, Setia P, Jodhawat N, Nambiar N, Dhawale A, Gaikwad P, Shinde S, Taur P, Gowri V, Pandrowala A, Gupta A, Joshi V, Sharma M, Arora K, Pilania RK, Chaudhary H, Agarwal A, Katiyar S, Bhattad S, Ramprakash S, Cp R, Jayaram A, Gornale V, Raj R, Uppuluri R, Sivasankaran M, Munirathnam D, Lashkari HP, Kalra M, Sachdeva A, Sharma A, Balaji S, Govindraj GM, Karande S, Nanavati R, Manglani M, Subramanyam G, Sampagar A, Ck I, Gutha P, Kanakia S, Mundada SP, Krishna V, Nampoothiri S, Nemani S, Rawat A, Desai M, Madkaikar M. Clinical and Genetic Spectrum of a Large Cohort of Patients With Leukocyte Adhesion Deficiency Type 1 and 3: A Multicentric Study From India. Front Immunol 2020; 11:612703. [PMID: 33391282 PMCID: PMC7772426 DOI: 10.3389/fimmu.2020.612703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
Leukocyte adhesion deficiency (LAD) syndrome is a group of inborn errors of immunity characterized by a defect in the cascade of the activation and adhesion leading to the failure of leukocyte to migrate to the site of tissue injury. Three different types of LAD have been described. The most common subtype is LAD type 1 (LAD1) caused due to defects in the ITGβ2 gene. LAD type 2 (LAD2) is caused by mutations in the SLC35C1 gene leading to a generalized loss of expression of fucosylated glycans on the cell surface and LAD type 3 (LAD3) is caused by mutations in the FERMT3 gene resulting in platelet function defects along with immunodeficiency. There is a paucity of data available from India on LAD syndromes. The present study is a retrospective analysis of patients with LAD collated from 28 different centers across India. For LAD1, the diagnosis was based on clinical features and flow cytometric expression of CD18 on peripheral blood leukocytes and molecular confirmation by Sanger sequencing. For patients with LAD3 diagnosis was largely based on clinical manifestations and identification of the pathogenic mutation in the FERMT3 gene by next-generation Sequencing. Of the total 132 cases diagnosed with LAD, 127 were LAD1 and 5 were LAD3. The majority of our patients (83%) had CD18 expression less than 2% on neutrophils (LAD1°) and presented within the first three months of life with omphalitis, skin and soft tissue infections, delayed umbilical cord detachment, otitis media, and sepsis. The patients with CD18 expression of more than 30% (LAD1+) presented later in life with skin ulcers being the commonest manifestation. Bleeding manifestations were common in patients with LAD3. Persistent neutrophilic leukocytosis was the characteristic finding in all patients. 35 novel mutations were detected in the ITGβ2 gene, and 4 novel mutations were detected in the FERMT3 gene. The study thus presents one of the largest cohorts of patients from India with LAD, focusing on clinical features, immunological characteristics, and molecular spectrum.
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Affiliation(s)
- Priyanka Madhav Kambli
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Umair Ahmed Bargir
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Reetika Malik Yadav
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Maya Ravishankar Gupta
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Aparna Dhondi Dalvi
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Gouri Hule
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Madhura Kelkar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Sneha Sawant-Desai
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Priyanka Setia
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Neha Jodhawat
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Nayana Nambiar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Amruta Dhawale
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Pallavi Gaikwad
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Shweta Shinde
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Prasad Taur
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Vijaya Gowri
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Ambreen Pandrowala
- Department of Bone Marrow Transplant, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vibhu Joshi
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhubala Sharma
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Arora
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himanshi Chaudhary
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Agarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute, Lucknow, India
| | - Shobita Katiyar
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute, Lucknow, India
| | - Sagar Bhattad
- Department of Pediatric Immunology and Rheumatology, Aster CMI Hospital, Bengaluru, India
| | - Stalin Ramprakash
- Pediatric Hemat-Oncology and Bone Marrow Transplant Unit, Aster CMI Hospital, Bengaluru, India
| | - Raghuram Cp
- Pediatric Hemat-Oncology and Bone Marrow Transplant Unit, Aster CMI Hospital, Bengaluru, India
| | - Ananthvikas Jayaram
- Department of Hematology and Pathology, Neuberg Anand Diagnostic and Research Centre, Bangalore, India
| | - Vinod Gornale
- Department of pediatric, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Teynampet, India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Teynampet, India
| | - Meena Sivasankaran
- Department of Pediatric, Hemato-oncology, Kanchi Kamakoti Childs Trust Hospital, Chennai, India
| | | | - Harsha Prasad Lashkari
- Department of Paediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Manas Kalra
- Department of Pediatric Hematology Oncology BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Anupam Sachdeva
- Department of Pediatric Hematology Oncology BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Avinash Sharma
- Dr. Rajendra Prasad Government Medical College, Tanda, India
| | - Sarath Balaji
- Department of Paediatrics, Institute of Child Health and Hospital for Children, Chennai, India
| | | | - Sunil Karande
- Department of Pediatrics, King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, King Edward Memorial Hospital, Mumbai, India
| | - Mamta Manglani
- Department of Pediatric, Oncology, Hematology & BMT, Comprehensive Thalassemia Care Center and Bone Marrow, Mumbai, India
| | | | - Abhilasha Sampagar
- Department of Pediatrics, KIES Dr. Prabhakar Kore Hospital & Medical Research, Belgaum, India
| | - Indumathi Ck
- Department of Pediatrics, St. John's Medical College, Bengaluru, India
| | - Parinitha Gutha
- Department of Paediatric Haematology and Oncology, Little Stars Children's Hospital, Hyderabad, India
| | - Swati Kanakia
- Department of Hematology-Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Vidya Krishna
- Department of Pediatrics, Sri Ramachandra Medical College, Chennai, India
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Science & Research Center, Cochin, India
| | - Sandeep Nemani
- Nihira Diagnostic Lab, Arihant Galaxy, Ganesh Naga, Sangli, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Desai
- Department of Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Manisha Madkaikar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
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19
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Sanghavi A, Desai S, Nanavati R, Prabhat D. Correlation of haematological parameters and C-reactive protein between cord blood and first post-natal blood sample in preterm neonates: A prospective observational study. J Paediatr Child Health 2020; 56:922-927. [PMID: 31943504 DOI: 10.1111/jpc.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 11/18/2019] [Accepted: 12/15/2019] [Indexed: 01/10/2023]
Abstract
AIM There is some recent evidence on the utility of the cord blood as a reliable source for admission complete blood count in preterm neonates. However, there is a need to validate other laboratory parameters from the cord blood such as C-reactive protein (CRP) to rule out neonatal sepsis. The present study was carried out to evaluate the correlation between haematological parameters and CRP obtained from the cord blood to the first post-natal blood sample, for it to be considered as a reliable alternative. METHODS A total of 89 paired cord blood and first post-natal blood samples were prospectively analysed to assess the haematological parameters (complete blood count) and CRP. Pearson's coefficient was calculated to assess the correlation between the cord blood and the first post-natal blood sample. RESULTS When Pearson's correlation coefficient was calculated for various haematological parameters, it showed good correlation coefficient of 0.84 for total leukocyte count, 0.84 for absolute neutrophil count count, 0.87 for immature to total neutrophil ratio and 0.95 for CRP. The correlation coefficient was 0.64 for haemoglobin and 0.36 for platelet count. CONCLUSION There is a strong correlation between the majority of haematological parameters and CRP obtained from the cord blood with the first post-natal blood sample in preterm neonates, except the platelet count. Hence, umbilical cord blood is a feasible and reliable alternative source for assessment of haematological parameters and CRP for the first post-natal blood sample, thereby avoiding a painful prick in these fragile preterm neonates.
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Affiliation(s)
- Avi Sanghavi
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Saumil Desai
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Daksha Prabhat
- Pathology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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20
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Khandare J, Ds M, Ananthan A, Nanavati R. Is Routine Monitoring for Hypoglycemia Required in Intramural Asymptomatic Infant of Diabetic Mother? An Audit in a Tertiary Care Hospital. J Trop Pediatr 2020; 66:194-200. [PMID: 31340046 DOI: 10.1093/tropej/fmz051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS This retrospective audit aimed to analyze whether routine frequent monitoring for hypoglycemia is required in asymptomatic infant of diabetic mother born in tertiary care hospital. METHODS The study analyzed the blood sugar level of 196 infants of diabetic mothers. RESULTS The overall incidence of hypoglycemia from 196 study participants was 9.18% (N = 18). The incidence of hypoglycemia at 2 h of life was maximum (83.33%) and it was significant when compared to 3, 6, 9 and 12 h (p < 0.0001). Blood glucose levels were significantly more at 6 (p = 0.0002)), 9 (p = 0.0001) and 12 h (p = 0.0001) when compared to glucose level at 2 h except at 3 h of life (p = 0.062). Similarly blood glucose at 9 (p = 0.0001) and 12 h of life (p = 0.0002) were significantly more than at 3 h of life. Blood glucose at 9 h was significantly more than at 6 h of life (0.032) and at 12 hours of life (p = 0.0237) was significantly higher than at 6 h of life. CONCLUSION The frequent blood glucose monitoring for hypoglycemia in infant of diabetic mother as per American Academy of Pediatrics may be reduced as per the findings in our study. However, this needs to be confirmed by a properly designed observational study/adequately powered randomized controlled trial.
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Affiliation(s)
- Jayant Khandare
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Madhusudhan Ds
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Anitha Ananthan
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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21
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Abstract
OBJECTIVE The objective was to assess stress in fathers of preterm infants and use of "Kangaroo Father Care (KFC)" to mitigate it. STUDY DESIGN Stress levels of 30 fathers of preterm infants admitted in the NICU were assessed using the parental stressor scale: neonatal intensive care unit (PSS: NICU) before and after three sessions of KFC. The data was analysed using Wilcoxon signed rank sum test. RESULT There was a statistically significant reduction in stress levels after KFC (p = 0.006). Amongst all the four subscales, stress levels were found to be reduced in 'staff behaviour and communication' (p = 0.001) domain and 'baby looks and behaves' domain (p = 0.05). CONCLUSION Fathers of preterm infants admitted in the NICU experience a lot of stress, which can adversely affect their mental health. Kangaroo care is very effective in reducing this paternal stress levels.
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Affiliation(s)
- S Dongre
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - S Desai
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - R Nanavati
- Neonatology Department, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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Abstract
AIMS This prospective observational study compared placental lesions of stillbirth cases and live birth controls, and aimed to determine the cause of stillbirth. METHODS The study enrolled 85 stillbirths and 85 live births at the time of delivery. RESULTS There was significantly increased incidence of placental abruption (p = 0.005) and gestational diabetes (p = 0.032) in mothers with stillbirths. Histopathological examination of placenta was significantly abnormal in stillbirths compared with live births (p = 0.004). Delayed villous maturation was significantly more in stillbirths (38.82 vs. 16.47%; p = 0.002). Acute (30.59 vs. 16.47%; p = 0.04) and chronic diffuse villitis (16.47 vs. 4.7%; p = 0.02), chorionic plate acute vasculitis (28.235 vs. 14.11%; p = 0.04) were significantly more in stillbirths. Foetal vascular thrombi in the chorionic plate (30.58 vs. 14.12%; p = 0.02) and avascular villi (24.7 vs. 8.23%; p = 0.006) were significantly more in stillbirths. CONCLUSION These abnormal placental patterns could provide information about the etiopathogenisis in stillbirths of unknown aetiology.
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Affiliation(s)
- Anitha Ananthan
- Department of Neonatology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Pragati Sathe
- Department of Pathology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
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23
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Ahir-Bist S, Chavan V, Samant-Mavani P, Nanavati R, Mehta P, Mania-Pramanik J. Polymorphisms in TH1-TH2 cytokine and receptor genes associated with risk of vertical HIV transmission, in Mumbai, India. J Gene Med 2018; 20:e3047. [PMID: 30109734 DOI: 10.1002/jgm.3047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Vertical HIV transmission does not occur in all exposed infants. Many infants remain HIV uninfected even after exposure. This is partly attributed to the host genes involving cytokine production, which is rarely documented in vertical transmission. METHODS Here, an observational cohort study evaluated whether polymorphisms in cytokine, receptor and antagonist genes are associated with perinatal HIV transmission. Single nucleotide polymorphism (SNP) genotyping was performed via the polymerase chain reaction with sequence-specific primers method. Haplotype block structure was determined and statistical analysis was performed using appropriate software in each case. RESULTS Twenty-two SNPs were analysed in 30 seropositive and 61 seronegative children. Confounding factors such as mother's viral load, treatment regimen, breast feeding options, etc., were documented. Analysis revealed the association of two SNPs: IL1R1 (rs2234650) and TNFA (rs1800629) with vertical HIV transmission. CT genotype at IL1R1 was observed at a higher frequency in positive children (76.66% versus 42.62%, p = 0.002), whereas the CC genotype was significantly increased in exposed uninfected children (47.54% versus 16.66%, p = 0.004). Similarly, the GG genotype of TNFA was significantly higher in uninfected children compared to infected ones (76.66% versus 46.66%, p = 0.005), whereas the GA genotype frequency was higher among infected children (53.33% versus 21.66%, p = 0.003). The frequency of the 'G' allele of TNFA and 'C' allele of IL1R1 was significant (p = 0.018) in negative children. Haplotypes of SNPs belonging to IL1, TNFA and IL4 were also found to associate with transmission. CONCLUSIONS The present study confirms the association of SNPs IL1R1 (rs2234650) and TNFA (rs1800629) with the risk of vertical transmission. These SNPs can be exploited as possible predictive markers of HIV transmission.
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Affiliation(s)
- Swati Ahir-Bist
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), Mumbai, Maharashtra, India
| | - Vijay Chavan
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), Mumbai, Maharashtra, India
| | - Padmaja Samant-Mavani
- Department of Obstetrics and Gynecology, Seth G. S. Medical College & K.E.M Hospital, Mumbai, Maharashtra, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G. S. Medical College & K.E.M Hospital, Mumbai, Maharashtra, India
| | - Preeti Mehta
- Department of Microbiology, Seth G. S. Medical College & K.E.M Hospital, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), Mumbai, Maharashtra, India
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Martin SL, Desai S, Nanavati R, Colah RB, Ghosh K, Mukherjee MB. Innate immune gene polymorphisms and their association with neonatal sepsis. Infect Genet Evol 2018; 62:205-210. [PMID: 29715526 DOI: 10.1016/j.meegid.2018.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Snehal L Martin
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), KEM Hospital Campus, Parel, Mumbai, India
| | - Saumil Desai
- Department of Neonatology, KEM Hospital, Parel, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, KEM Hospital, Parel, Mumbai, India
| | - Roshan B Colah
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), KEM Hospital Campus, Parel, Mumbai, India
| | - Kanjaksha Ghosh
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), KEM Hospital Campus, Parel, Mumbai, India
| | - Malay B Mukherjee
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), KEM Hospital Campus, Parel, Mumbai, India.
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Martin SL, Desai S, Nanavati R, Colah RB, Ghosh K, Mukherjee MB. Red cell distribution width and its association with mortality in neonatal sepsis. J Matern Fetal Neonatal Med 2018; 32:1925-1930. [PMID: 29310472 DOI: 10.1080/14767058.2017.1421932] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Neonatal sepsis is a major cause of mortality in the developing countries. However, with current severity scores and laboratory parameters, predicting outcomes of neonatal sepsis is a serious challenge. Red cell distribution width (RDW) is a readily available pragmatic means to predict outcomes of various comorbidities in adults and children, without causing any additional blood loss. However, its utility in neonates remains unexplored. Hence, the objective of the present study was to evaluate the association of RDW with neonatal sepsis and its role as a predictive marker for mortality. METHODS This Prospective observational study was carried out in a Level IIIB NICU for a period of 3 years. It involved comparison of RDW values of septic neonates with those of controls (matched for gestational age and birth weight) with an equal allocation ratio. A total of 251 septic neonates along with 251 controls >28 weeks of gestational age were enrolled. The RDW was derived from complete blood count done within first 6 hours of life. After arranging the RDW (median; interquartile range (IQR)), the values were categorized as those above the 50th percentile i.e. ≥20% and those below the 50th percentile i.e. <20%. The cumulative survival rates of the above two groups were assessed using the Kaplan-Meier curve and the log rank test. RESULTS RDW levels were significantly higher among the neonatal sepsis cases (19.90%) as compared to the controls (18.90%) with a p value of < .001. RDW was significantly higher amongst the nonsurvivors than survivors (p < .003). Kaplan-Meier curve showed that septic neonates having RDW values ≥20% had significantly increased mortality (p < .02) with a hazard ratio of 0.5. CONCLUSIONS High RDW is associated with neonatal sepsis and is an independent outcome predictor for mortality associated with neonatal sepsis.
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Affiliation(s)
- Snehal L Martin
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
| | - Saumil Desai
- b Department of Neonatology , KEM Hospital , Mumbai , India
| | - Ruchi Nanavati
- b Department of Neonatology , KEM Hospital , Mumbai , India
| | - Roshan B Colah
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
| | - Kanjaksha Ghosh
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
| | - Malay B Mukherjee
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
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Pendse A, Jasani B, Nanavati R, Kabra N. Comparison of transcutaneous bilirubin measurement with total serum bilirubin levels in preterm neonates receiving phototherapy. Indian Pediatr 2017; 54:641-643. [DOI: 10.1007/s13312-017-1126-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jasani B, Kannan S, Nanavati R, Gogtay NJ, Thatte U. An audit of colistin use in neonatal sepsis from a tertiary care centre of a resource-limited country. Indian J Med Res 2017; 144:433-439. [PMID: 28139542 PMCID: PMC5320849 DOI: 10.4103/0971-5916.198682] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background & objectives: Sepsis due to multidrug-resistant Gram-negative pathogens is a challenge for clinicians and microbiologists and has led to use of parenteral colistin. There is a paucity of data regarding safety and efficacy of intravenous colistin use in neonates. The objective of this retrospective analysis was to study the efficacy and safety of intravenous colistin in the treatment of neonatal sepsis. Methods: An audit of the data from neonates, admitted to a neonatal intensive care unit of a tertiary care hospital during January 2012 to December 2012, and who received intravenous colistin was carried out. Results: Sixty two neonates received intravenous colistin (52 preterm and 10 term) for the treatment of pneumonia, bloodstream infections and meningitis. The isolated pathogens in decreasing order of frequency were Acinetobacter baumannii, Klebsiella pneumonia and Pseudomonas aeruginosa. Of the total 62 neonates, 41 (66.12%) survived and 21 (33.87%) died. Significantly higher mortality was observed in neonates with lower body weights (P < 0.05). A significant association of mortality was found in those with sepsis due to Klebsiella species. Only one of seven with this infection survived as against 15 of the 23 who grew other organisms [P = 0.03; crude odds ratio = 11.25 (1.2, 110.5)]. None of the neonates developed neurotoxicity or nephrotoxicity. Interpretation & conclusions: This retrospective study in neonates with sepsis showed that intravenous colistin was safe and effective in the treatment of neonatal sepsis. Further, well–controlled, prospective clinical trials need to be done to corroborate these findings.
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Affiliation(s)
- Bonny Jasani
- Department of Neonatology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Sridharan Kannan
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Urmila Thatte
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
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Mehta Y, Shetye J, Nanavati R, Mehta A. Physiological effects of a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates. J Neonatal Perinatal Med 2016; 9:371-376. [PMID: 27834785 DOI: 10.3233/npm-16915140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the changes on various physiological cardio-respiratory parameters with a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates with respiratory distress syndrome. STUDY DESIGN This is a prospective observational study in a neonatal intensive care unit setting. Sixty preterm neonates with respiratory distress syndrome, thirty mechanically ventilated and thirty extubated preterm neonates requiring chest physiotherapy were enrolled in the study. Parameters like heart rate (HR), respiratory rate (RR), Silverman Anderson score (SA score in extubated), oxygen saturation (SpO2) and auscultation findings were noted just before, immediately after chest physiotherapy but before suctioning, immediately after suctioning and after 5 minutes of the session. RESULTS The mean age of neonates was 9.55±5.86 days and mean birth weight was 1550±511.5 g. As there was no significant difference in the change in parameters on intergroup comparison, further analysis was done considering two groups together (n = 60) except for SA score. As SA score was measured only in extubated neonates. HR did not change significantly during chest physiotherapy compared to the baseline but significantly decreased after 15 minutes (p = 0.01). RR and SA score significantly increased after suctioning (p = 0.014) but reduced after 15 minutes (p = <0.0001). SpO2 significantly reduced post-suctioning compared to the baseline and increased after positioning and 15 minutes of chest physiotherapy (p = <0.0001). Clinically, there was a reduction in HR, RR and SA score with an improvement in SpO2. This signifies that chest physiotherapy may help facilitate the overall well-being of a fragile preterm neonate. Lung auscultation finding suggests that after suctioning, there was a significant reduction in crepitation (p = 0.0000) but significant increase in crepitation after 15 minutes (p = <0.01), suggesting the importance of around-the-clock chest physiotherapy. CONCLUSION Chest physiotherapy is safe in preterm neonates. Suctioning causes significant cardio-respiratory parameter changes, but within normal physiological range. Thus, chest physiotherapy should be performed with continuous monitoring only when indicated and not as a routine procedure. More research is needed to study the long term effects of chest physical therapy.
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Affiliation(s)
- Y Mehta
- Department of Rehabilitation, Walnut Hill Medical Center, Dallas, TX, USA
| | - J Shetye
- Department of Physiotherapy, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - R Nanavati
- Department of Neonatology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - A Mehta
- Department of Physiotherapy, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
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Chavan VR, Ahir S, Ansari Z, Samant-Mawani P, Nanavati R, Mehta P, Mania-Pramanik J. Diversity in KIR gene repertoire in HIV-1 exposed infected and uninfected infants: A study from India. J Med Virol 2015; 88:417-25. [PMID: 26255774 DOI: 10.1002/jmv.24348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 12/19/2022]
Abstract
Natural killer (NK) cells have antiviral activity mediated through killer immunoglobulin receptors (KIRs). Studies have shown the importance of KIR receptors in HIV infection. However reports on association of KIR genes in HIV infection from Indian population are limited, not a single study is reported in HIV exposed uninfected (EU) and infected infants. This study compared the KIR gene repertoire of HIV-1 positive (n = 29) with EU (n = 76) infants to elucidate its association with transmission. KIR genotyping was analysed using the PCR-SSP method. Viral load of mothers, CD4 count of both mothers and infected infants were done using commercial kits. The data was analysed using SPSS software. Results revealed presence of significantly high frequencies of activating gene KIR 2DS5 (P = 0.040) and inhibitory gene KIR 2DL3 (P = 0.013) in EU infants as compared to HIV-1 positive infants, confirmed with multivariable linear regression modelling. Fifty-nine KIR genotypes were identified in these 105 infants. Nine genotypes were unique, reported for the first time. Twenty six genotypes were shared with the World populations. Twenty four genotypes were reported for the first time from India. Specific KIR genotype combinations (GIDs) were exclusively present either in HIV-1 positive (n = 19) or in EU infants (n = 30). The Linkage disequilibrium (LD) analysis shows a strong linkage between four pairs of genes in HIV-1 positive and three pairs of genes in EU infants. In conclusion, this study revealed that, besides maternal confounding factors such as ART and viral load, specific KIR genes are associated independently with perinatal HIV infection.
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Affiliation(s)
- Vijay R Chavan
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, Maharashtra, India
| | - Swati Ahir
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, Maharashtra, India
| | - Zakiya Ansari
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, Maharashtra, India
| | - Padmaja Samant-Mawani
- Department of Obstetrics and Gynaecology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Preeti Mehta
- Department of Microbiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, Maharashtra, India
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Jasani B, Nanavati R, Kabra N, Rajdeo S, Bhandari V. Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial. J Matern Fetal Neonatal Med 2015; 29:1546-51. [PMID: 26135774 DOI: 10.3109/14767058.2015.1059809] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether post-extubation respiratory support via nsNIPPV decreases the need for mechanical ventilation (MV) compared to nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS). METHODS In this randomized, controlled, open, prospective, single-center clinical trial, we randomly assigned preterm ventilated infants with RDS to either nsNIPPV or NCPAP after extubation. The primary outcome, extubation failure, was defined by pre-specified failure criteria in the 72 hours after extubation. RESULTS A total of 63 preterm ventilated infants were randomized to receive either nsNIPPV (n = 31) or NCPAP (n = 32). Extubation failure occurred in six (19.3%) of nsNIPPV group compared with nine (28.12%) of NCPAP group and was statistically not significant (p = 0.55). The duration of NIV was significantly lower in nsNIPPV group as compared to NCPAP group (40.4 ± 39.3 hours versus 111.8 ± 116.4 hours, p = 0.003). The duration of supplementary oxygen was significantly lower in nsNIPPV versus NCPAP group (84.9 ± 92.1 hours versus 190.1 ± 140.5 hours, p = 0.002). The rates of BPD in nsNIPPV group (2/29, 6.9%) were significantly lower than in NCPAP group (9/28, 32.14%) (p = 0.02). CONCLUSIONS Compared to NCPAP, nsNIPPV appears to be a feasible mode of extubation in preterm infants with significant beneficial effects of reduced duration of NIV support, supplementary oxygen and decreased rates of BPD.
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Affiliation(s)
- Bonny Jasani
- a Department of Neonatology , Seth G S Medical College and KEM Hospital , Mumbai , India and
| | - Ruchi Nanavati
- a Department of Neonatology , Seth G S Medical College and KEM Hospital , Mumbai , India and
| | - Nandkishor Kabra
- a Department of Neonatology , Seth G S Medical College and KEM Hospital , Mumbai , India and
| | - Shankar Rajdeo
- a Department of Neonatology , Seth G S Medical College and KEM Hospital , Mumbai , India and
| | - Vineet Bhandari
- b Department of Pediatrics , Yale University School of Medicine , New Haven , CT , USA
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Jasani B, Kabra N, Nanavati R. Does intubation, surfactant, and extubation play a role in late preterm neonates with respiratory distress syndrome: an observational cohort study. J Clin Neonatol 2015. [DOI: 10.4103/2249-4847.151159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahir S, Mania-Pramanik J, Chavan V, Kerkar S, Samant-Mavani P, Nanavati R, Mehta P. Genetic variation in the promoter region of pro-inflammatory cytokine TNF-α in perinatal HIV transmission from Mumbai, India. Cytokine 2014; 72:25-30. [PMID: 25544182 DOI: 10.1016/j.cyto.2014.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022]
Abstract
Various host factors such as cytokines and HLA, regulate the immune system and influence HIV transmission to infants exposed to HIV-1 through their mothers. Tumor Necrosis Factor Alpha (TNF-α) is a strong pro-inflammatory mediator and thought to influence vulnerability to HIV infection (and/or) transmission. Polymorphisms in regulatory regions are known to govern the production of this cytokine. However, the association of these variations in perinatal HIV transmission is yet to be established. Present study aimed to evaluate if polymorphisms in promoter region of TNF-α gene is associated with perinatal HIV transmission. With informed consent from parents, infants' blood was collected for HIV screening and SNPs analysis at 2 loci: TNF (rs1800629) and TNF (rs361525) using PCR-SSP method. HIV positive (n = 27) and negative (n = 54) children at the end of 18th month follow up were considered for this study. GG genotype, responsible for low expression of TNF (rs1800629) was significantly (p = 0.005) higher in uninfected children, while higher GA genotype frequency was observed in infected children. The 'G' allele frequency was significantly higher in negative children (p = 0.016). We conclude that genotypic variants of TNF (rs1800629) are a likely contributor to perinatal HIV transmission. This provides new insights in markers of differential susceptibility to perinatal HIV transmission.
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Affiliation(s)
- Swati Ahir
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), J.M. Street, Parel, Mumbai 400 012, Maharashtra, India.
| | - Vijay Chavan
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Shilpa Kerkar
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Padmaja Samant-Mavani
- Department of Obstetrics and Gynaecology, Seth G.S. Medical College & K.E.M. Hospital, J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G.S. Medical College & K.E.M. Hospital, J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Preeti Mehta
- Department of Microbiology, Seth G.S. Medical College & K.E.M. Hospital, J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
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Abstract
Leukocyte adhesion deficiency type I is an extremely serious and rare form of congenital immunodeficiency with recurrent episodes of infection since neonatal period. It is usually diagnosed in childhood, but if diagnosed early in neonatal period then definitive treatment can be instituted early with promising results. High index of suspicion is necessary to diagnose this condition in neonates. Neonate may present with serious bacterial infections with a leukemoid reaction.
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Affiliation(s)
- Bonny B Jasani
- Department of Neonatology, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Ruchi Nanavati
- Department of Neonatology, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Nandkishor Kabra
- Department of Neonatology, KEM Hospital, Parel, Mumbai, Maharashtra, India
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Jasani B, Nanavati R. Neonatal aortic thrombosis as a result of congenital homocystinuria. Indian Pediatr 2013; 50:1054-1056. [PMID: 24382903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Arterial thrombosis, that too in aorta is rare in neonates. CASE CHARACTERISTICS A 4-day-old presented with non-recordable BP in lower limbs. Doppler ultrasonography of abdomen revealed aortic thrombus. OBSERVATION Serum homocysteine level was elevated (25.5 umol/L). OUTCOME Thrombus resolved with subcutaneous LMW heparin therapy for 2 weeks. MESSAGE Congenital classic homocystinuria can rarely cause aortic thrombosis in neonatal period.
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Affiliation(s)
- Bonny Jasani
- Department of Neonatology, KEM Hospital, Parel, Mumbai, India. Correspondence to: Dr Bonny Jasani, Department of Neonatology, 10th Floor, New M.S. Building, KEM Hospital, Parel, Mumbai 400 012, India.
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Ahir SP, Chavan V, Kerkar S, Samant-Mavani P, Nanavati R, Mehta P, Mania-Pramanik J. Antiretroviral treatment, viral load of mothers & perinatal HIV transmission in Mumbai, India. Indian J Med Res 2013; 138:201-8. [PMID: 24056596 PMCID: PMC3788205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND & OBJECTIVES Mother-to-child transmission (MTCT) is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART) or prophylactic treatment (PT) to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. METHODS A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. RESULTS Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/μl) was high compared to the women on ART (289 cells/ μl). At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. INTERPRETATION & CONCLUSIONS Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit mother to child HIV transmission.
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Affiliation(s)
- Swati P. Ahir
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - V. Chavan
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - S. Kerkar
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - P. Samant-Mavani
- Department of Obstetrics & Gynaecology, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - R. Nanavati
- Department of Neonatology, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - P.R. Mehta
- Department of Microbiology, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - J. Mania-Pramanik
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India,Reprint requests: Dr Jayanti Mania-Pramanik, National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai 400 012, India e-mail:
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Ahir S, Chaudhari D, Chavan V, Samant-Mavani P, Nanavati R, Mehta P, Mania-Pramanik J. Polymorphisms in IL-1 gene cluster and its association with the risk of perinatal HIV transmission, in an Indian cohort. Immunol Lett 2013; 153:1-8. [PMID: 23769826 DOI: 10.1016/j.imlet.2013.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/03/2013] [Accepted: 05/20/2013] [Indexed: 12/14/2022]
Abstract
Host genetic diversity plays a very important role in protecting infants exposed to HIV-1 through their mothers. IL-1 family genes are key mediators of inflammatory responses and no studies are available on its association with perinatal HIV transmission. We aimed to evaluate if single nucleotide polymorphisms in IL-1 family genes are associated with perinatal HIV transmission. Infants of HIV positive women were genotyped for five polymorphic loci in IL1 gene cluster namely; IL1R1 (rs2234650), IL1A (rs1800587), IL1B (rs16944), IL1B (rs1143634), and IL1RN (rs315952) using polymerase chain reaction with sequence specific primers (PCR-SSP) method. Haplotype block structure was determined using Haploview and statistical analysis was done using PyPop. In this cohort based observational study significantly increased frequency of CT genotype in IL1R1 (rs2234650) was observed in positive vs. negative children (76.4% vs. 42.2%, p = 0.023), while CC genotype was significantly (p = 0.022) high in exposed uninfected children compared to infected ones (51.1% vs. 17.6%). These significances, however, did not stand the Bonferroni corrections. Haplotypic analysis demonstrated that the TCCCT haplotype was significantly associated (p = 0.002) with HIV transmission and remained significant even after Bonferroni correction. The children who had the protective CC genotype at IL1R1 (rs2234650) and were still positive had the TTC haplotype for IL1A (rs1800587):IL1B (rs1143634):IL1R1 (rs2234650). In contrast, 16 out of 19 (84.2%) children who had the CT genotype and were still negative had the protective CTC haplotype for IL1A (rs1800587):IL1B (rs16944):IL1B (rs1143634). IL1R1 (rs2234650) polymorphisms CT/CC along the specific haplotypes of the IL-1 gene family can be exploited as possible markers for prediction of perinatal HIV transmission.
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Affiliation(s)
- Swati Ahir
- Department of Infectious Diseases Biology, National Institute for Research in Reproductive Health (DHR/ICMR), J. M. Street, Parel, Mumbai 400 012, Maharashtra, India
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Pandya YS, Shetye J, Nanavati R, Mehta A. Resolution of lung collapse in a preterm neonate following chest physiotherapy. Indian J Pediatr 2011; 78:1148-50. [PMID: 21390521 DOI: 10.1007/s12098-011-0397-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
Preterm neonates are prone to lung collapse because of many reasons. Chest physiotherapy can be used successfully in such cases with lung collapse in order to facilitate removal of secretions and re-expansion of the lung. With the help of a chest radiograph, improvement can be noted as in this case.
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Suman RPN, Udani R, Nanavati R. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Indian Pediatr 2008; 45:17-23. [PMID: 18250500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To compare the effect of Kangaroo mother care (KMC) and conventional methods of care (CMC) on growth in LBW babies (> 2000 g). STUDY DESIGN Randomized controlled trial. SETTING Level III NICU of a teaching institution in western India. SUBJECTS 206 neonates with birth weight < 2000 g. INTERVENTION The subjects were randomized into two groups: the intervention group (KMC-103) received Kangaroo mother care. The control group (CMC: 103) received conventional care. OUTCOME MEASURES Growth, as measured by average daily weight gain and by other anthropometrical parameters at 40 weeks postmenstrual age in preterm babies and at 2500 g in term SGA infants was assessed. RESULTS The KMC babies had better average weight gain per day (KMC: 23.99 g vs CMC: 15.58 g, P< 0.0001). The weekly increments in head circumference (KMC: 0.75 cm vs CMC: 0.49 cm, P = 0.02) and length (KMC: 0.99 cm vs CMC: 0.7 cm, P = 0.008) were higher in the KMC group. A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and sepsis. There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs 76%). KMC was acceptable to most mothers and families at home. CONCLUSION Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home.
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Affiliation(s)
- Rao P N Suman
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India.
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