Background: The current study is carried out with an aim to explore the spectrum of microorganism causing HAIs and to develop prevention bundle (algorithm) for neonatal healthcare-associated infections (HAIs) using the multimodal approach to overcome adaptation and training limitations. Methods and materials: A cross-sectional study was carried out for 19 months among 1233 neonate admitted for >48 hours at level III Neonatal Intensive Care Unit (NICU) identifying cases of HAIs (Using CDC & WHO criteria). The International expert proposal for interim definitions for acquired resistance was used for identifying Multi-drug resistance (MDR), extreme-drug resistance (XDR) and pan-drug resistance (PDR) strains. Root cause analysis using open-ended questionnaire, multiple observations, and failure mode effect analysis was done. Multiple in-depth interviews of the experts from neonatology and microbiology were carried out. System process mapping for various process & critical task involved in NICU against evidence was recorded to prevent HAIs, that brought the development of three major processes out of eighteen processes. The training videos were developed to prevent HAIs. Results: Among 1233 patients 118 neonates (9.6/100 admissions) acquired HAIs. The BacT/Alert culture showed 34% positivity for 474 blood/ fluid samples of these patients sent for investigation. Common pathogens isolated include Klebsiella pneumoniae (35%), coagulase-negative Staphylococcus aureus (CONS) (32%), Acinetobacter baumanii (12%), Enterobacter cloacae (8%), E. coli (8%) and others (5%). MDR, XDR, PDR microorganism identified were Klebsiella pneumoniae (66%, 19%, 4%), Acinetobacter baumanii (0%, 39%, 28%), E. coli (22%, 11%, 33%) and Enterobacter cloacae (46%, 18%, 9%). Common antibiotics used therapeutically for neonates acquiring HAIs were Amikacin, Piperacillin-Tazobactam, and Ampicillin among 95%, 78%, and 64% respectively. The frequent cause of HAIs were improper hand-washing, multiple procedures, improper device disinfection. Three process algorithm [(1) Nursing care process; (2) vascular access process; (3) cardiopulmonary resuscitation management process] identifying critical step preventing HAIs were developed. Conclusion: Presence of MDR, XDR and PDR demands the institution of antimicrobial stewardship. High vigilance on infection control measures, system process mapping of the individual healthcare setting and strict adherence to the algorithms is the need of an hour to prevent neonatal HAIs.
Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods: The ambient noise, in this study was the background sound existing in the environment of the acute NICU of a tertiary referral hospital in South India. The ambient noise levels were analyzed by an audiologist and acoustical engineer using a standardized and calibrated Sound Level Meter (SLM) i.e., the Hand Held Analyzer type 2250, Bruel and Kjaer, Denmark on a weighted frequency A and reported as dB (A). Results: The ambient noise levels were timed measurements yielded by the SLM in terms of LAeq, L10 as well as LAeqmax exceeded the standard levels (Leq< 45 dB, L10 ≤ 50 dB, and Lmax ≤ 65 dB).The LAeq ranged from 59.4 to 62.12 dB A. Ventilators with alarms caused the maximum amount of ambient noise yielding a LAF Sound Pressure Level (SPL) of 82.14 dB A. Conclusion: The study has found high levels of ambient noise in the acute NICU. Though there are several measures to reduce the ambient noise levels in the NICU, it is essential to raise awareness among health care personnel regarding the observed ambient noise levels and its effects on neonates admitted to the NICU
Abstract Objectives To assess the growth pattern of preterm, very low birth weight (VLBW) appropriate for gestational age (AGA) infants on three different feeding regimens. Methods This prospective open label three-arm parallel randomized controlled trial was conducted at neonatal intensive care unit, Kasturba Hospital, Manipal. One hundred twenty VLBW (weight between 1000–1500 g and gestational age 28–32 wk) preterm AGA infants admitted from April 2021 through September 2022 were included. Three feeding regimens were compared: Expressed breast milk (EBM); EBM supplemented with Human milk fortifier (HMF); EBM supplemented with Preterm formula feed (PTF). Primary outcome measure was assessing the growth parameters such as weight, length, head circumference on three different feeding regimens at birth 2, 3, 4, 5 and 6 wk/discharge. Secondary outcomes included incidence of co-morbidities and cost-effectiveness. Results Of 112 infants analyzed, Group 2 supplemented with HMF showed superior growth outcomes by 6th wk/discharge of intervention, with mean weight of 2053±251 g, mean length of 44.6±1.9 cm , and mean head circumference of 32.9±1.4 cm. However, infants in Group 3, supplemented with PTF, registered mean weight of 1968±203 g, mean length of 43.6±2.0 cm, and mean head circumference of 32.0±1.6 cm. Infants exclusively on EBM presented with mean weight of 1873±256 g, mean length of 43.0±2.0 cm and mean head circumference of 31.4±1.6 cm. Conclusions Addition of 1 g of HMF to 25 ml of EBM in neonates weighing 1000–1500 g showed better weight gain and head circumference at 6 wk/discharge, which was statistically significant. However, no significant differences in these parameters were observed at postnatal or 2, 3, 4, and 5 wk.
Introduction: Neutrophil surface CD64 (Cluster of differentiation 64), the highaffinity Fc receptor, is quantitatively up-regulated during infection and sepsis. The diagnostic utility of NCD64 as a reliable marker of neonatal sepsis has not been explored so far. Hence this study has been conducted to compare NCD64 with other currently used infection markers including total leucocyte count, platelet count, absolute neutrophil count (ANC), band:neutrophil ratio and highly sensitive C reactive protein (hs-CRP). Methods: Consecutively born neonates between March 2014 to November 2014 were enrolled with documented sepsis (n = 81), clinical sepsis (n = 35), and no sepsis (n = 87). NCD64 was analyzed by flow cytometry. Results: Sepsis episodes had a higher median CD64 index of 10.35 (Range: 15.88, 6.87) as against 2.97 (Range: 5.53, 1.64) in the control group (p < 0.001). The percentage of NCD64 positive cells was also significantly higher in the sepsis group compared to the control group (63.90 ± 2.67 vs 15.07 ± 1.95; p = 0.001). In the ROC curve analysis NCD64, percentage of NCD64 positive cells had the highest AUC (AUC-0.914) using a cutoff of 28.01%, followed by CD64 mean fluorescence intensity (MFI) with an AUC of 0.850 using a cutoff of 5.54. NCD64 was significantly elevated in the groups with documented and clinical sepsis (p < 0.001). Conclusions: NCD64 is a highly sensitive marker for neonatal sepsis. Prospective studies incorporating NCD64 into a sepsis scoring system are warranted.
Stillbirths, the tragic loss of a baby before or during delivery, presents a profound global health concern. Investigating the diverse causes and risk factors is essential to develop targeted interventions, enhance perinatal care, and reduce the incidence of this devastating outcome. The aim of this study was to identify the causes and possible risk factors of stillbirths in India.
ABSTRACT Background Preterm birth is a highly stressful experience for both parents and infants. Parental participation in care enhances developmental outcomes, fosters parent–infant interactions and builds parental confidence. However, low parental adherence has always been a challenge in the successful implementation of intervention programs both in the NICU and at home. It is imperative to understand parents' perspectives and view the challenges that they experience through their lens while providing early intervention to their infants born preterm. This study is aimed at identifying new parents' challenges when implementing early intervention programs for their infants during the transition from hospital to home. Methods Ten parents of preterm infants trained to administer early intervention programs in the NICU and at home were recruited during their infants' 3‐month follow‐up. Semistructured in‐depth interviews were conducted until data saturation. The audio recordings of the interviews were transcribed and translated into English. Thematic analysis, using ATLAS.ti Version 8.0 software, identified overarching challenges through deductive and inductive coding. Results Data analysis identified five recurring themes: (1) navigating early days of parenthood, (2) nurturing resilience in infant care, (3) supporting infants through informed caregiving, (4) maximizing efficiency in infant care through time mastery and (5) balancing equity and flexibility in caregiving. Parents expressed fear of handling their infants born preterm because of their low birth weight and small size. Time constraints, changing sleep patterns and daily routines make it difficult for mothers to adhere to exercise programs. Parents also face challenges when infants exhibit stressful behaviour. Furthermore, gender differences were observed, with fathers often not continuing the program at home. Conclusions The study highlights parents' main challenges when providing early intervention for infants born preterm at home. It emphasizes issues related to maternal roles, family support and difficulties in infant handling, exercise and time management. Trial Registration ClinicalTrials.gov identifier: CTRI/2020/09/027994.
Data from hospital record of 96 neonates hospitalized with sepsis were analyzed using SPSS 11.5version to identify sepsis- its signs and symptomswith which they were admitted, bacterial isolates and antibiotic susceptibility patterns among neonates admitted during 2007-2009. The
retrospective data revealed that majority of the neonates 61 (63.5 %) were males. Of the 96 neonates 52 (54.2%) were preterm, and 44 (45.8%) were referred from various institutes after initial trial of management for the same. Majority66 (68.8%) had respiratory distress. Lethargy
was noted in 56 (58.3%), fever among 10 (10.4%) and jaundice was reported among 6(6.2%). Blood culture and sensitivity revealed that pseudomonas infection claimed to have triggered early signs and symptomsof sepsisamong II (11.46%)neonatesand Staphylococcusaureus was
responsiblefor triggering late signs and symptomsof sepsisamong 1.1() 1.46%)neonates.
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