Newborn Special Care Unit Research Articles

Referral Review of a SNCU in a District Hospital in Resource Limited Setting: A Retrospective Observational Study

Introduction: Special newborn care units (SNCUs) have been established in several district and subdivisional hospitals to meet the challenges of high neonatal mortality. With single digit target of infant mortality in 2030, we need to review the functioning of these SNCUs in order to strengthen them to reach the target. So this study was undertaken with primary objective to study mortality and referral pattern.
 Methods: This retrospective observational study was conducted in district hospital Udhampur by analysing case records from SNCU admissions over three years from 2017-2019
 Results: There were total of 341, 352 and 414 admissions in 2017, 2018 and 2019 respectively with a cumulative sex ratio of 702/405(male/female) over these 3 years. Referral rate was 31.31%, 31.31% and 30.19% for 2017, 2018 and 2019 respectively, whereas mortality rate was 2.05%, 1.93% and 2.41% for these 3 years respectively. Respiratory distress syndrome (RDS), sepsis and birth asphyxia were the major causes for referrals.
 Conclusion: With stagnant, non decreasing referral rates over 3 years, and ventilatory support as a major cause of referrals, a lot needs to be improved as far as respiratory support at SNCU level is concerned.

English

BACKGROUND Late preterm infants are less mature physiologically and have poor compensatory responses when compared to term infants. Recent studies have implied increased morbidities in late preterm infants and higher rate of hospital admission during neonatal period. Multiple maternal risk factors lead to the increasing incidence of late preterm births. We wanted to study the morbidity and mortality profile of late preterm infants compared to term infants. METHODS The study was conducted in the special newborn care unit (SCNU) of Silchar Medical College and Hospital. The study population comprised of 175 late preterm and 175 term babies admitted in SCNU. It was a cross sectional study. RESULTS In this study 175 late preterm neonates were compared with 175 term neonates. Late preterm babies were at increased risk of hypoglycemia (P value = 0.0130), neonatal jaundice (P = 0.021), culture positive sepsis (P = 0.001), respiratory distress (P = 0.000), hypocalcaemia (P = 0.030), difficulty in feeding (P = 0.000) and birth asphyxia (P = 0.013), longer hospital stay and mortality (P = 0.009) when compared to term babies. In babies of mothers with oligohydramnios and pregnancy induced hypertension, preterm babies had significant morbidity compared to term babies. CONCLUSIONS Late preterm babies have an increased risk of morbidity and mortality when compared to term neonates and need special care. Premature rupture of membranes, antepartum hemorrhage and pre-eclampsia are the main maternal complications leading to premature delivery of the baby. KEY WORDS Late Preterm, Preeclampsia, Oligohydramnios, Morbidity

Rationalising oxygen usage in a level II special newborn care unit in Madhya Pradesh, India

Non-judicious oxygen use in preterm infants is associated with increased risk of retinopathy of prematurity, bronchopulmonary dysplasia and longer hospital stay. Despite established guidelines on oxygen therapy, compliance with the...

Morbidity profile and outcome of neonates admitted in a secondary level SNCU in district Udhampur in Jammu and Kashmir

Background: Infant mortality is an important indicator of healthcare system of the country and neonatal mortality contributes a major proportion to infant mortality. So this study was undertaken to study the demographic and morbidity profile and outcome of neonatal care in our area.Methods: This study, a retrospective observational study was conducted in district hospital Udhampur which caters to a population of around 5.5 lakh. Case records of all SNCU (special newborn care unit) admissions between January 2018 to December 2018 were analysed in a pre-designed proforma which included identity, clinical and demographical variables, admitting complaints, diagnosis, treatment, hospital stay and outcome.Results: Of the total 364 neonates with an average birth weight of 2.67 kgs, 70.60% were of weight over 2.5 kgs. The most common diagnosis included sepsis (27.74%), neonatal hyperbilirubinemia (13.18%) and RDS (respiratory distress syndrome) (10.43%). Discharge rate was 60.71% with mortality of 3.26% and referral rate of 31.31%.Conclusions: Sepsis and RDS as the most common cause of morbidity in our setup indicate that improvement in community as well as hospital hygiene along with improved antenatal care and maternal health needs to be stressed upon to prevent them.

Feasibility of establishing an infant hearing screening program and measuring hearing loss among infants at a regional referral hospital in south western Uganda.

Despite the high burden of hearing loss (HL) globaly, most countries in resource limited settings lack infant hearing screening programs(IHS) for early HL detection. We examined the feasibility of establishing an IHS program in this setting, and in this pilot program measured the prevalence of infant hearing loss (IHL) and described the characteristics of the infants with HL. We assessed feasibility of establishing an IHS program at a regional referral hospital in south-western Uganda. We recruited infants aged 1 day to 3 months and performed a three-staged screening. At stage 1, we used Transient Evoked Oto-acoustic Emissions (TEOAEs), at stage 2 we repeated TEOAEs for infants who failed TEOAEs at stage 1 and at stage 3, we conducted Automated brainstem responses(ABRs) for those who failed stage 2. IHL was present if they failed an ABR at 35dBHL. We screened 401 infants, mean age was 7.2 days (SD = 7.1). 74.6% (299 of 401) passed stage 1, the rest (25.4% or 102 of 401) were referred for stage 2. Of those referred (n = 102), only 34.3% (35 of 102) returned for stage 2 screening. About 14.3% (5/35) failed the repeat TEOAEs in at least one ear. At stage 3, 80% (4 of 5) failed the ABR screening in at least one ear, while 25% (n = 1) failed the test bilaterally. Among the 334 infants that completed the staged screening, the prevalence of IHL was 4/334 or 12 per 1000. Risk factors to IHL were Newborn Special Care Unit (NSCU) admission, gentamycin or oxygen therapy and prematurity. IHS program establishment in a resource limited setting is feasible. Preliminary data indicate a high prevalence of IHL. Targeted screening of infants at high risk may be a more realistic and sustainable initial step towards establishing IHS program s in a developing country like Uganda.

Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI)

To develop a composite index that serves as a proxy marker of quality of clinical service and pilot test its use in 11 special neonatal care units (SNCUs) across two states in India. Secondary data from SNCU webportal. Special new-born care units in Rajasthan and Orissa. We developed a composite SNCU Quality of care Index (SQCI) based on seven indices from SNCU online database. These included rational admission index, index for rational use of antibiotics, inborn birth asphyxia index, index for mortality in normal weight babies, low birth weight admission index, low birth weight survival index, and optimal bed utilization index. Based on the SQCI score, the performance of SNCUs was labelled as good (SQCI 0.71- 1.0), satisfactory (SQCI 0.4- 0.7) or unsatisfactory (SQCI <0.4). The mean difference in SQCI between Jan-Mar 2016 and 2017 was 0.20 (95% CI 0.13- 0.28; P<0.001). Similar results were obtained for rational admission index, rational use of antibiotics, mortality in normal weight babies, low birth weight survival and optimal bed utilization. A significant improvement in the overall composite score was noted in Odisha (Mean difference 0.22, 95% CI 0.11-0.33, P=0.003) and Rajasthan (Mean difference 0.17, 95% CI 0.05- 0.3, P=0.002). QI approach using SQCI tool is a useful and replicable intervention. Preliminary results show that it does lead to strengthening of implementation of the programs at SNCUs based on the comprehensive scores generated as part of routine system.

A study on traditional practice of squeezing of breasts in newborn care among mothers in a tertiary care centre in Malda, West Bengal, India

Background: Newborn care is culturally and traditionally sensitive in every society. India is a vast country with different communities having their own traditional practices of newborn care. Squeezing of breasts in newborn period is one such unique traditional practice prevalent among population of rural background of West Bengal. This study was conducted to explore the traditional practice of squeezing of neonatal breasts and to highlight its related morbidities following the procedure among newborns.Methods: This was a descriptive, cross-sectional study conducted at triage of Special Newborn Care Unit (SNCU) of Malda Medical College and Hospital among 352 mothers who presented to us with their sick newborns following squeezing of neonatal breasts. After obtaining proper informed consent, mothers were interviewed. The data were collected using pre-designed questionnaires. Statistical analyses of the data were done using SPSS version 21.Results: In the present study, majority (33.52%) of mothers were 18-21 years old and 92.90% were Muslims. Squeezing of neonatal breasts was usually done on 10th day of life (40.34%) and on 4th day of life (27.27%). Local application following squeezing was done with hot turmeric paste (31.25%) and mustard oil (27.56%). Majority of newborns presented with features of mastitis (39.49%), 15.91% with breast abscess and 35.51% with sepsis.Conclusions: This study highlights the harmful aspects of traditional practice of breasts-squeezing among newborns prevalent in rural Bengal. This practice must be condemned by everyone through an integrated approach of proper health education and counseling of mothers and family members.

Decreasing antibiotic over-use by implementation of an antibiotic stewardship programme in preterm neonates in resource limited settings – a quality improvement initiative

ABSTRACT Background Antibiotics play a critical role in neonatal sepsis but excessive use is associated with adverse outcomes and the current prescribing rates of antibiotics are unacceptably high. Aim To reduce antibiotic over-use in preterm neonates by implementing an antibiotic stewardship programme using a quality improvement (QI) initiative. Methods This study was conducted at a neonatal intensive care unit in a resource-limited setting. The reasons for antibiotic over-use were analysed and an antibiotic stewardship programme was implemented by using a QI initiative. The duration of the QI was a 1-month baseline phase followed by 3 months of implementation which was undertaken in the form of Plan-Do-Study-Act (P-D-S-A) cycles. The sustainment phase was observed for 2 months. All neonates admitted to the preterm unit were included. The outcome measure was the antibiotic usage expressed as days of therapy (DOT)/1000 patient days. Results In the baseline phase, DOT/1000 patient days was 1464 which fell to 706, 511, and 442 DOT/1000 patient days, respectively, over 3 months, resulting in a 65% reduction in antibiotic usage. This was achieved by a combination of efforts directed towards defining the conditions for no antibiotics, revising existing antibiotic policy, stopping orders at 48 hours, de-escalation to the narrowest spectrum antibiotic, stopping prophylactic antifungal agents and limited use of broad-spectrum antibiotics. The results were achieved without an increase in culture-positive sepsis or mortality. Conclusions Implementation of a tailored antibiotic stewardship programme through a QI initiative was effective and safe in reducing antibiotic use in preterm neonates in a resource-limited setting. Abbreviations AIIMS, All India Institute of Medical Sciences; DOT, days of therapy; HIC, high-income countries; ICMR, Indian Council of Medical Research; LMIC, low- to middle-income countries; LOS, late-onset sepsis; NICU, neonatal intensive care unit; NNF, National Neonatology Forum; P-D-S-A, plan-do-study-act; QI, quality improvement; SNCU, Special newborn care unit.

ROP screening and treatment in four district-level special newborn care units in India: a cross-sectional study of screening and treatment rates

ObjectiveBlindness from retinopathy of prematurity (ROP) in middle-income countries is generally due to absence of screening or inadequate screening. The objective of this study was to assess uptake of services...

Addressing Quality of Care in Pediatric Units using a Digital Tool: Implementation Experience from 18 SNCU of India.

Lack of quality care is associated with newborn mortality and stillbirth. India launched the Special newborn care unit (SNCU) Quality of Care Index (SQCI) for measuring quality indicators in SNCU. The USAID Vriddhi project provided support to the use of SQCI in 19 SNCU across aspirational districts of Jharkhand, Uttarakhand, Himachal Pradesh, Punjab and Haryana. The objective was to provide holistic support to quality care processes by generating analyzed quarterly reports for action with the goal toward sustainability by capacitating SNCU personnel and program officers to use SQCI, over a 1period from April 2019 to June 2020. The composite index has seven indicators and converts them into indices, each having a range from 0.1 to 1, to measure performance of SNCU.7 of the 18 SNCU improved their composite scores from the first to the last quarter. Rational use of antibiotics showed improvement in 12 SNCU. Survival in newborns >2500 g and <2500, low birth weight admission and optimal bed utilization had the most variations between and within facilities. Based on quarterly data analysis, all facilities introduced KMC, 10 facilities improved equipment and drug supply, 9 facilities launched in-house capacity building to improve asphyxia management. The SQCI implementation helped to show a process of using SQCI data for identifying bottlenecks and addressing quality concerns. The project has transitioned to complete responsibility of SQCI usage by the district and facility teams. Use of an existing mechanism of quality monitoring without any major external support makes the SQCI usable and doable.

Special Newborn Care Plus Project in India: Preliminary Findings from Community-Based Follow-up of Newborns Discharged from Facilities

An innovation of structured community based followup of SNCU discharged babies by ANM and ASHA was piloted under Norway India Partnership initiative. The current study describes the survival status and other outcomes among newborns discharged from SNCUs and followed at community level in first 42 days of life. It is a retrospective cohort study on newborns discharged from SNCUs from 13 districts across four states of India. Routine health systems data have been utilized to record key parameters like birth weight, sex, weights during follow-ups, any illnesses reported, status of feeding and survival status. These were compared between normal and low birth weight babies. Newborns discharged from special newborn care units (SNCUs) and followed up at community level at 24 hours, 7 days after first visit, and at 6 weeks of life. Follow up of 6319 newborns were conducted by the ANM (25.4%), ASHAs (4.7%) or both (69.8%); 97% of the babies were followed-up at all the visits. The median duration of follow- ups were 1 day post-discharge, 13th day and 45th days of life. Majority (97%) of them were breastfed, and were warm to touch at the time of the visit. More than 11% of the babies needed referral at every visit. Mortality rate in the cohort of babies discharged from SNCUs till 6 weeks of follow up was 1.5%. Among normal birth weight newborns, it was 0.4% while it was 2.02% among LBW babies. The proportion of girls among those who died increased from 20% in the first follow up to 38.1% at second follow up and 41% at 6 weeks. Babies with LBW were at higher risk of death as compared to babies with normal birth weight. Follow-up at critical timepoints can improve survival of small and sick newborns after discharge from SNCUs.

An Assessment of Implementation of Family Participatory Care in Special Newborn Care Units in Three States of India

To study special newborn care units (SNCUs) in terms of family participatory care (FPC) quality initiative as per Government of India guidelines in select public health facilities, and to document the perspectives of the doctors and mothers. Cross-sectional. SNCUs with functional FPC units in the states of Odisha, Madhya Pradesh and Rajasthan. 38 SNCUs; doctors and nurses in-charge of the unit; and two eligible mothers per unit, one inside the step-down unit and second outside the step-down unit whose newborns were admitted to special new-born care unit, having a stable baby weighing above 1500 g. The states implemented FPC as per Government of India guidelines using National Health Mission funds across special newborn care units. This assessment involved onsite observation and interviews of key providers. Proportion of facilities providing regular counselling sessions, enabling support to mothers, recording FPC information; perspectives of health providers on improvement of breastfeeding and kangaroo mother care; proportion of eligible mothers practicing FPC, exclusively breastfeeding, and providing kangaroo mother care services. Out of 38 SNCUs, we found that FPC sessions for mothers were happening in 36 (95%) facilities. SNCUs provided enabling support to mothers on FPC (74.2%), held regular sessions for the families (70.6%), nurses assisted mothers and family members for breastfeeding and kangaroo mother care (76.4%) and FPC information were recorded (70.6%). The assessment of facilities where FPC was implemented showed that SNCUs were equipped to implement FPC in public health settings.

An assessment of admission and outcome trends among neonates admitted in special newborn care unit (SNCU) of Jalgaon, Maharashtra

Background: Children face the highest risk of dying in their first 28 days of life (neonatal period). Simple interventions have been tested and found to be effective in reducing the neonatal mortality. Facility Based Newborn Care (FBNC) has a significant potential for improving newborn survival. SNCU is a neonatal unit in the vicinity of labor room which is to provide special care (all care except assisted ventilation and major surgery) for sick newborns. Aims and objectives: To study the trend of neonatal admissions and their outcomes over a period of 7 years i.e. from the year (2013) of establishment to current year (2019) at SNCU in a district level hospital in Maharashtra. Materials and method: The present descriptive observational study with longitudinal design was conducted in the Government supported SNCU of District Hospital of Jalgaon District of Maharashtra which included all the neonates admitted in SNCUs from January 2013 to December 2019.The SNCU monthly report which is in a predefined format from Ministry of Health and Family Welfare, Government of India, which includes data on admission information, reasons of admission, course of admission, and mortality reasons (if any) with treatment outcomes was used for data collection. Result: It was seen that during the study period (i.e. from January 2013 to December 2019) total 16489 neonates were admitted to the SNCU. During the first year (2013) total 1182 neonates were admitted which went on increasing in subsequent years as 2494, 2916, 2944, 2525, 2078 and 2350 neonates were admitted in the year 2014,2015, 2016, 2017, 2018 and 2019. Yearwise data shows proportions of males and females were approximately similar with male preponderance in each year. Proportion of outborn neonates went on steadily increasing (26.90% in 2013 to 46.26% in 2019) and that of inborn neonates went on decreasing (73.10% in 2013 to 53.74% in 2019). Yearwise trend shows that more and more (54.65% in 2013 to 68.13% in 2019) LBWs were admitted as compared to NBWs neonates (45.35% in 2013 to 68.13% in 2019). Decreasing trend in the mortality was observed from 2013 to 2019 as neonatal mortality rate went on decreasing. It was recorded 18.75% in 2013, 12.43% in 2014, 11.48% in 2015, 12.59% in 2016, 10.54% in 2017, 4.75% in 2018, and 5.77% in 2019. Conclusion: Over a period of 7 years from 2013 to 2019 neonatal mortality went on decreasing including decrease in LBW. and preterm neonates.

An Assessment of 7 Years’ mortality pattern of Neonates Admitted in Special Newborn Care Unit (SNCU) of Jalgaon, Maharashtra

An Assessment of 7 Years’ mortality pattern of Neonates Admitted in Special Newborn Care Unit (SNCU) of Jalgaon, Maharashtra

An unusual case of multisystem inflammatory syndrome in children in newborn due to covid-19 – presenting with stage 11 b necrotizing enterocolitis

Neonatal enterocolitis is the most common gastrointestinal emergency reported in preterm babies. The most common infective organism involved in the pathogenesis includes bacteria such as Escherichia coli and Klebsiella. Until now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) as a causative agent of necrotizing enterocolitis (NEC) has not been reported. We report a unique case of multisystem inflammatory syndrome in children (MIS-C) and adolescents in newborn who presented with NEC. A 34-week-old male baby born to COVID-19-positive mother by normal vaginal delivery was admitted since birth in the special care newborn unit due to respiratory distress. Baby was COVID positive within 24 h of birth. He developed NEC at day 8 of life. He developed signs and symptoms of MIS-C. He responded to intravenous immunoglobulin and was discharged on day 16 of life. This is the first case report of MIS-C in newborn in India. Baby had NEC due to SARS-CoV2 which has not been reported until now. This case highlights the possibility of surge in newborn MIS-C postsecond wave of COVID-19 pandemic in India.

Assessment of Kangaroo Mother Care Services and identifying its Implementation Bottlenecks: Situational Analysis of Special New Born Care Units in Gujarat State of India

Introduction: Kangaroo Mother Care (KMC) and optimal feeding in Low Birth Weight (LBW) infants are evidence based cost effective interventions which if properly implemented across all facilities can help to save millions of newborn. The study, focussing on status of KMC services in Gujarat State, has not been conducted so far. Objectives: The intent of present study was to ascertain the infrastructure, facilities, policies and practices related to Kangaroo Mother Care at special newborn care units (SNCUs) of various regions of Gujarat and to suggest strategies for effective delivery of KMC services. Methods: A pre tested, semi structured and validated questionnaire including general information about SNCU, baseline data about KMC protocols and practices of each SNCU etc. was developed. The information was collected from all 40 Special Newborn Care Units (SNCUs) of Gujarat State of India.The data analysis was performed using EpiInfo 7 Statistical Software developed by Centres for Disease Control and Prevention (CDC), Atlanta. Simple frequency tables were used for analysis. Results: About 81% of the facilities reported that newborns with birth weight less than 2000 grams, either stable or with non-serious medical conditions were eligible for receiving KMC. None of the facilities were providing continuous KMC more than 12 hours. Thirty (81.08%) SNCUs had an earmarked space for performing KMC either in the form of separate ward or identified corner in the ward. Conclusion: The present study revealed inadequate Kangaroo Mother Care services in selected newborn care units of Gujarat State of India. The services, especially basic facilities like drinking water, food, toilet and hand washing was not available in some of the facility.

First comprehensive study on neonatal septicaemia at secondary-level public health-care facilities in Central India: An eye opener

Background: In India secondary-level public health-care facilities (HCF)-District Hospitals, are not equipped either with a microbiological laboratory or a robust Infection control program. The present study was initiated to investigate the epidemiology of neonatal septicaemia in SNCUs (Special new-born care units) situated at various District Hospitals of Chhattisgarh (a state in Central India) in terms of Blood Stream Infection (BSI) rates, pathogen profile and their antimicrobial sensitivity patterns. Methods & Materials: The study was conducted from October 2017 through June 2019 at the Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, a tertiary level healthcare teaching institute in collaboration with 23 SNCUs. Paired blood samples (0.5–1.0 ml) were collected in paediatric aerobic blood culture bottles (BacT/ALERT PF Plus, BioMerieux Inc. Durham, NC, USA) and transported to the laboratory, where culture and identification was performed by automated ID and AST system (Vitek 2 ID/AST system, BioMerieux Inc. Durham, USA) and by manual methods using standard laboratory protocol. Results: Paired blood cultures were received from 2843 neonates; out of which 1645 (58%) were sterile, 388 (13.6%) grew contaminants and 810 grew pathogens, indicating BSI rate of 28.4%. Gram negative bacilli were the most commonly encountered pathogens (382/810, 47.2%), with more than half being multi drug resistant (211/382, 55.2%). Klebsiella pneumoniae was the commonest isolate (n = 253). Amongst the gram- positive cocci (253/810, 31.2%) coagulase negative staphylococcus (CoNS) was commonest. Only 17 (6.7%) Methicillin Resistant Staphylococcus aureus and one Streptococcus agalactiae were isolated. Candida spp. accounted for 21.6% (175/810) pathogen, predominated by non-albicans candida (161/175). 18% of the Candida spp. were resistant to Fluconazole, while 1.2% were MDR. A fall in NMR (neonatal mortality rate) and antibiotic usage rate was observed in almost all the units after the microbiology laboratory support was initiated. Conclusion: The secondary-level public health-care facilities have a very high rate of laboratory proven neonatal septicemia with an alarmingly high AMR (Antimicrobial resistance) rate, both among bacterial and fungal isolates. This warrants urgent intervention for reducing neonatal septicaemia by microbiology laboratory support, optimising infection control practices and implementing AMSP (antimicrobial stewardship program).

Predictive Factors Affecting Newborn Survival Admitted in Special Newborn Care Units of Tertiary Care Hospitals

International Journal of Medicine and Public Health,2020,10,4,184-188.DOI:10.5530/ijmedph.2020.4.40Published:November 2020Type:Original ArticlePredictive Factors Affecting Newborn Survival Admitted in Special Newborn Care Units of Tertiary Care HospitalsShah Harsh, Nagar Shashwat, Thomas Ebbie, and Patel Jay Shah Harsh1, Nagar Shashwat2,*, Thomas Ebbie3, Patel Jay4 1Senior Consultant, NHM, Government of Gujarat, Gujarat, INDIA. 2Department of Community Medicine, PIMSR, Parul University, Vadodara, Gujarat, INDIA. 3Statistician Cum Tutor, NAMO MERI, Silvassa, INDIA. 4Consultant, Nutrition Consultant, NHM, Govt. of Gujarat, Gujarat, INDIA. Abstract:Context: Government efforts are being made for the reduction of child mortality through the facility and community-based strategies. Studies have indicated that several other factors also have an impact on child survival. This calls for researches to be directed efforts and understanding of the local causes and factors associated with it. Aim: To analyze the sociodemographic, programmatic and clinical profile of neonates’ admitted in SNCUs. Settings and Design: A cross sectional study amon 43 SNCUs during year 2017-18. Methods and Materials: The data was recorded from the pre-defined case record registers and analyzed using simple proportions. Statistical Analysis used: Chi-square test and multivariable logistic regression analysis were carried out for finding the association between survival rate of neonates and other variables. Results: Out of 48,775 neonates admitted at selected SNCUs across the State, 68.5% were successfully discharged, 6.7% referred to higher centers, 10% left against medical advice and 15.2% died during the study period. Survival Rate was observed to be significantly associated with the Place of Delivery, Mode of Transport, Type of Admission, Maturity of child admitted, weight of a child during admission and Indications of admission. Keywords:Child Survival, Gujarat state, NMR, Regression, SNCU, U5MRView:PDF (148.64 KB)

Antimicrobial Resistance Situation in SCANU of Faridpur Medical College Hospital, a Tertiary Level Hospital in Bangladesh

Considering the high risk of neonatal sepsis in low and middle-income countries, empirical antibiotic therapy is commonly employed in most cases to clinically suspected septic neonates without the aid of culture and antibiotic sensitivity report. Increasing antimicrobial resistance is posing a threat to these practices and urges the obligation for understanding the causative organisms and their changing resistance pattern at the local level. Aim of this study was to identify the pathogens responsible for neonatal sepsis and understand their current antimicrobial resistance pattern. This prospective study was undertaken in the Special Care Newborn Unit of the Faridpur Medical College Hospital from October 2017 to November 2018. Venous blood culture and antimicrobial susceptibility of 56 suspected neonatal sepsis cases were studied. Among the 56 clinically suspected cases 86% had culture positive isolates in the specimen. Predominant isolates were Klebsiella (42%) and coagulase-negative staphylococci (25%). Of all the identified bacteria, 88% were resistant to &gt;_ 3 classes of antibiotics. Eighty-five percent of Klebsiella isolates were found to be carbapenem-resistant along with 100% of E. coli isolates and 95% of Klebsiella isolates had possible extended spectrum b -lactamase production. Seventy-five percent of Acinetobacter isolates were multidrug-resistant and 100% of coagulase-negative staphylococci were methicillin resistant. The array of causative organisms and their increasing resistance to commonly practiced antibiotics are alarming. It is urgent to develop strategies focusing on all healthcare levels to cease the spread of antimicrobial resistance in an effort to reduce the burden of neonatal sepsis. Faridpur Med. Coll. J. Jan 2020;15(1): 28-33

Morbidity and mortality profile of neonates admitted in a special care newborn unit of a tertiary care teaching hospital of Assam, India

Morbidity and mortality profile of neonates admitted in a special care newborn unit of a tertiary care teaching hospital of Assam, India