Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of idiopathic nephrotic syndrome (INS) in children. Evidence on the optimal duration of antibiotics in this population is limited. We investigated whether 5-day antibiotic therapy is non-inferior to 7-day therapy for SBP in children with INS. In this single-center, open-label, randomized controlled non-inferiority trial, 50 children aged 1-14 years with INS and SBP were allocated 1:1 to intravenous ceftriaxone for 5 days (Group A, n = 25) or 7 days (Group B, n = 25). The primary outcome was composite clinical response (resolution of fever, abdominal pain, and tenderness) at the end of treatment, analyzed by intention-to-treat. The pre-specified non-inferiority margin was -15%. Secondary outcomes included bacteriological cure, cytological response, and the need for additional antibiotics. Fifty children [median age 50 (30.8-92) months] were randomized. Composite clinical response was achieved in 25/25 (100%) in Group A versus 22/25 (88%) in Group B (risk difference 12%, 95% CI -3.5% to 30.0%; P = 0.23); the lower CI bound exceeded the -15% non-inferiority margin, establishing non-inferiority. Bacteriological cure was achieved in 96% of both groups. Cytological response (64% vs 72%; P = 0.54) was inconclusive for non-inferiority. Additional or modified antibiotic therapy was required in 16% versus 20% (P = 1.00). Median hospitalization was comparable (10 vs 11 days; P > 0.05). No ceftriaxone-related adverse events were recorded. Five-day intravenous ceftriaxone is non-inferior to 7-day therapy for SBP in children with INS, with respect to composite clinical response; the secondary outcome of cytological response was inconclusive for non-inferiority.
Critically ill children face high risks of mortality and healthcare-associated infections. Probiotics may improve outcomes by modulating gut microbiota and enhancing immune function. To evaluate the efficacy and safety of probiotics in critically ill children in pediatric intensive care units (PICUs). We systematically reviewed randomized controlled trials (RCTs) from PubMed, EMBASE, SCOPUS, and Web of Science until 10 June 2024. The primary outcome was all-cause mortality; secondary outcomes were ventilator-associated pneumonia (VAP), length of hospital stay (LOS), and duration of mechanical ventilation (MV). Risk ratios (RR) and mean differences (MD) were pooled using random-effects models (DerSimonian-Laird), with Hartung-Knapp adjustment as a sensitivity analysis. Evidence certainty was assessed using GRADE. Eight RCTs involving 744 children were included. Probiotics did not significantly reduce all-cause mortality (RR 0.85, 95% CI 0.66-1.11; P = .24; I² = 0%; low certainty); estimates were similar under Hartung-Knapp adjustment (RR 0.85, 0.69-1.06; P = .14) and in a sensitivity analysis restricted to low-risk-of-bias trials (RR 0.89, 0.60-1.34; P = .58). Probiotics significantly reduced VAP (RR 0.47, 95% CI 0.35-0.64; P < .0001; I² = 0%; high certainty), halving pneumonia risk (absolute risk reduction 21.9%; number needed to treat approximately 5). Reductions in LOS (MD -2.57 days, 95% CI -7.26 to 2.11; P = .20) and MV (MD -1.61 days, -4.43 to 1.20; P = .17) were nonsignificant (low certainty). No serious probiotic-associated adverse events occurred. High-certainty evidence indicates probiotics reduce VAP in critically ill children; the mortality effect was inconclusive. Probiotics may be considered an adjunctive strategy for VAP prevention in the PICU, pending larger multicenter trials. PROSPERO REGISTRY NUMBER:CRD42024546238.
Meconium aspiration syndrome (MAS) is one of the common causes of respiratory distress among newborn. Severe MAS is associated with considerable morbidity and mortality, and there is sparse data on this entity from large studies from low- and middle-income countries. To determine the incidence of meconium aspiration syndrome (MAS) and severe MAS in a large perinatal centre over a 17-year period and to study the clinical course, complications, and outcomes of newborn with severe MAS. This was a retrospective study of babies admitted in the unit between 2006 and 2022. The list of babies with a diagnosis of MAS was extracted from the admission register and cross-checked with the ventilation database and discharge summaries. Relevant maternal, perinatal as well as postnatal courses, investigations, and outcomes were collected from the clinical workstation and the summaries. During the 17-year period, there were 206 377 deliveries in the hospital. There were 1294 babies admitted with MAS; 146 (11.3%) babies satisfied the criteria for severe MAS. With 73 of these newborn being inborn, incidence of severe MAS was 3.5/10 000 (95% CI 2.7-4.3/10 000) live births among inborn babies. High-frequency ventilation was required in 54 newborn (37%). The median duration of ventilation was 4 days (IQR 3-7 days). Sixteen babies had pulmonary air leak (11%) and persistent pulmonary hypertension (PPHN) was present in 63 babies (43%). The median length of hospital stay was 13 days (IQR 9-18). Of the 146 newborn with severe MAS, 118 survived (80.8%). Adverse outcome was associated with presence of PPHN [OR-5.24 (95% CI 1.7-15.9)] and pneumothorax [OR-17.3 (95% CI 3.5-85.2)]. Sixty-nine (53.9%) of the survivors had long-term follow-up. Adverse neurodevelopmental outcomes were present in 7.8% of neonates, which included developmental delay, microcephaly, cerebral palsy, seizure disorder, autistic traits, and hearing loss. A small proportion (11.3%) of babies with MAS had severe MAS. Nearly one-fifth of babies with severe MAS had adverse short-term outcome. The presence of PPHN and air leaks were significantly associated with adverse outcomes.
Over the past three decades, the recognition and management of dengue fever (DF) and severe dengue (SD) in children have undergone significant transformation. In the 1990s, limited understanding of dengue pathophysiology led to delayed recognition, with aggressive fluid resuscitation, invasive ventilation, and frequent blood product use, often resulting in adverse outcomes. The 1997 World Health Organisation (WHO) Guidelines introduced a structured classification and emphasized cautious fluid management, improving survival. Advances in diagnostics, particularly non-structural (NS) protein antigen testing, enabled earlier detection in the 2000s. The revised WHO 2009 classification and recognition of Expanded Dengue Syndrome (EDS) in 2012 broadened the understanding of severe organ involvement beyond plasma leakage. In the 2020s, improved intensive care unit (ICU) technologies enabled advanced organ support, and the coronavirus disease of 2019 (COVID-19) pandemic highlighted potential viral interactions. Ongoing controversy remains regarding the role of immunomodulation for dengue-associated hyperinflammation. Continued clinical research is essential to refine management strategies and optimize outcomes in severe dengue.
Unplanned extubation (UE) is a common and largely preventable safety event in neonatal intensive care units, with agitation, hand-to-endotracheal tube (ETT) interaction, and subsequent staff intervention frequently preceding events. This study aimed to evaluate the short-term efficacy of the Sunflower Technique (SFT), a non-pharmacological developmental containment intervention, in reducing agitation, behaviors related to self-extubation, and the need for staff intervention in invasively ventilated neonates. In this pilot randomized cross-over trial, intubated neonates of any gestational age underwent two 1-h observation periods on the same day, receiving SFT and conventional care (CC) in randomized order (30 min each during both 1 h periods). Primary outcomes included near-miss self-extubation events (grabbing the ETT), possible self-extubation events (touching the tube), agitation assessed using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and COMFORTneo scales. Secondary outcome included frequency of staff intervention. All observation periods were video-recorded for assessment. Fifty-seven neonates contributed 114 observation periods for each group. Compared with CC, SFT was associated with significantly fewer near-miss and possible self-extubation events (P < .001 for both). Agitation scores were significantly lower during SFT periods on both N-PASS and COMFORTneo scales (P < .001). No UE events occurred during either period. No interventions needed by staff were comparable during SFT and CC periods (72.8% vs. 61.4%, P = .059). The SFT was associated with reduced agitation, fewer behaviors related to self-extubation, and a comparable need for staff intervention in invasively ventilated neonates.
Prolonged empirical antibiotic exposure in neonates is associated with adverse outcomes and antimicrobial resistance. Serial C-reactive protein (CRP) and procalcitonin (PCT) measurements may support earlier discontinuation, but neonatal protocols remain heterogeneous. To map evidence on CRP- and/or PCT-guided antibiotic-duration strategies in neonatal sepsis and summarize their effects on antibiotic exposure and safety. Following Joanna Briggs Institute guidance and PRISMA-ScR, PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library were searched from inception to December 2023. Peer-reviewed English-language studies of neonates aged 0-28 days with suspected, probable or culture-proven early- or late-onset sepsis were included when serial CRP and/or PCT formed part of an explicit antibiotic-stopping strategy. Two reviewers independently screened records and charted study characteristics, protocols and outcomes. Fifteen studies involving 4755 neonates were included: five randomized trials, six cohort studies, two prospective observational studies and two systematic reviews with meta-analyses. Seven studies evaluated CRP-guided discontinuation, six evaluated PCT-guided strategies and four used combined approaches. Biomarker-guided care reduced mean antibiotic duration from 7.3 to 4.5 days, a mean reduction of 2.8 days (38.6%). Reductions were directionally consistent and appeared greater in early-onset than late-onset sepsis. Thirteen studies reported treatment failure and 14 reported mortality; neither outcome showed an apparent increase with biomarker-guided discontinuation. Antimicrobial-resistance, ecological and cost outcomes were infrequently reported. CRP- and/or PCT-guided stopping strategies may reduce antibiotic exposure in neonatal sepsis without an apparent increase in treatment failure or mortality. Standardized protocols and further implementation, cost-effectiveness and resistance-focused research are needed, particularly in resource-limited settings and extremely preterm infants.
Neonates admitted to intensive care are exposed to frequent radiation due to various reasons. Radiation hazard is an overlooked entity among neonates. Hence, this quality improvement (QI) project was conducted to address the issue. We aimed to reduce the average number of X-rays per neonate in our tertiary neonatal intensive care unit (NICU) from a baseline mean of 1.98 to ≤1.5 within 6 months (March to August 2024) through implementation of the as low as reasonably achievable principle and increased use of point-of-care ultrasound as an alternative to radiography. A dedicated QI team comprising neonatology consultants, residents, nursing staff, and radiography technicians was constituted. In the baseline phase, data on the total number of X-rays performed per patient were analysed over 6 months (August 2023 to January 2024). Contributing factors to increased radiation exposure were identified using a fishbone analysis. Subsequently, a series of stepwise plan-do-study-act cycles was implemented to reduce radiation exposure among neonates. During the baseline period, a total of 204 X-rays were performed on 103 neonates admitted to our NICU, with a mean (±SD) of 1.98 ± 2.16 X-rays per patient. Following the intervention phase (March 2024 through August 2024), a total of 179 X-rays were recorded among 125 neonates, with a reduced mean (±SD) of 1.43 ± 2.72 X-rays per patient. The effective implementation of targeted QI strategies was associated with a reduction in radiation exposure among neonates admitted to the NICU.
Normothermia during the first hour of life predicts admission to neonatal intensive care unit (NICU) and improves the outcome for both sick and stable babies across all gestational ages. Immediate skin-to-skin contact (iSTS) offers a simple, effective approach to prevent hypothermia while enhancing feeding, survival, and bonding. The aim of this study is to implement a multidisciplinary quality improvement initiative addressing the barriers to optimal thermal care in the delivery room setting and establish sustainable protocols for preventing neonatal hypothermia across all gestational ages. The objective is to reduce the rate of hypothermia (temperature <36.5°C recorded just before transfer from the delivery room) from the existing 51.67% to <50% of the baseline data (<25.8%) in neonates over 12 weeks in the delivery room. This prospective Quality Improvement Study was undertaken to enhance newborn care in a tertiary-care hospital's delivery room from January 2024 to May 2024. A multidisciplinary team of Neonatologists/Pediatricians, Obstetricians, Anesthesiologists, OT staff, and Nurses identified problem areas using fishbone analysis. A situational analysis was conducted through process flow mapping, and three Plan-Do-Study-Act cycles were undertaken. In the first cycle, protocols were established through a multidisciplinary meeting involving consultants, pediatricians, anesthesiologists, and obstetricians. Resident doctors and nursing staff received educational sessions through manikin-based Objective Structured Clinical Examination drills. The second cycle focused on iSTS, maintaining optimal temperatures and ensuring equipment readiness in the operating room. During the third cycle, pre-operative counselling for mothers and sensitization of post-operative staff were implemented to further improve newborn care practices. Of the 148 neonates analysed (January 2024 to May 2024), hypothermia incidence (<36.5°C) decreased significantly from 51.67% to 13.16% (P < .001), representing a 74.5% relative improvement and an 85% reduction in odds (odds ratio = 0.15; 95% confidence interval: 0.08-0.28). Mean admission temperature increased from 36.2 ± 0.4°C to 36.8 ± 0.3°C (P < .001). Data collected on the incidence of hypothermia in cycles 1, 2, 3 showed hypothermia rates of 31.7%, 37.03%, and 22.58%, respectively, with cycle 2's increase attributed to heightened staff awareness and improved monitoring. STS ≥60 min increased from 25% to 85% (P < .001) and early breastfeeding from 30% to 78% (P < .001). The incidence of hypothermia was maintained at 13.16% through the 3-week sustainability phase, with no adverse events associated with the interventions. Implementation of simple evidence-based practices led to a significant decrease in hypothermia incidence in newborns after delivery. Immediate STS and using a head cap after birth are the two most important key interventions for preventing neonatal hypothermia in the delivery room.
Differentiating bacterial from viral infections in febrile young infants is challenging, particularly in dengue-hyperendemic regions. We developed and internally validated a clinical machine-learning model to enhance diagnostic accuracy in this risk population in Colombia. We retrospectively analyzed a pediatric infectious admission cohort (<18 years) at a reference hospital in southern Colombia from 2007 to 2019. 4671 admissions (2251 bacterial and 2420 viral) were included. Nine clinical and laboratory variables were used to train an eXtreme Gradient Boosting (XGBoost) classifier. We divided the data into development (70%) and test (30%) sets, with Youden's J statistics defining the optimal threshold. Penalized logistic regression (LR) and single-marker rules [leukocytosis, C-reactive protein (CRP)] served as comparators. The young-infant XGBoost achieved an area under the receiver-operating characteristic curve (AUC) of 0.896, outperforming LR (0.790) and single markers (0.746-0.706). Sensitivity was 93.5%, specificity 76.1%, positive predictive value 87.9%, and negative predictive value 86.4% in the temporal validation cohort. Discrimination was highest in children aged 6-10 years (AUC 0.967). CRP positivity, leukocytosis >16 × 10³ µl-1, and thrombocytopenia <150 × 10³ µl-1 were the most informative features. A nine-variable XGBoost model using routine clinical and hematologic variables accurately differentiated bacterial from viral infections in children from a low-resource dengue-endemic setting. Performance remained stable during temporal validation. Improved specificity with preserved sensitivity supports earlier targeted therapy and antibiotic stewardship. Multicenter studies and exploration of clinical challenges are the next steps for this kind of tool.
COVID-19 pandemic posed significant health challenges worldwide, with substantial impact on pediatric populations. In Brazil, hospitalizations and deaths among children and adolescents have continued throughout the pandemic despite beginning of vaccination. The objective of this study was to analyze sociodemographic background, presentation, and clinical outcomes among hospitalized Brazilian individuals under 20 years with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, analyzing risk factors for severity and death according to age group. Consisted of a population-based cross-sectional study using secondary data from children and adolescents (<20 years) hospitalized with COVID-19 in Brazil (March 2020-December 2023). Data from Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) included sociodemographic, clinical, and vaccination information. Cox proportional hazards models assessed intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and fatality by age group; 30-day survival was estimated using Kaplan-Meier analysis. A total of 123 382 hospitalizations were recorded; children under five accounted for 56.2% of cases and 43.3% of deaths. Hospitalized adolescents (11-19 years) showed the most severe outcomes, with relatively higher ICU admission (30.9%), IMV use (11.8%), and fatality (6.5%), in addition to lower overall survival (48.3%). Across all age groups, being hospitalized in the North or Northeast and IMV were associated with the highest risk of death. Overall, only 10.4% of the study population had received at least one vaccine dose. Adolescents experienced a higher relative frequency of severe clinical outcomes and lowest survival, although, in absolute numbers, more children under 5 years of age were hospitalized and died. These findings underscore the urgency of expanding pediatric vaccine coverage as a public health priority in Brazil.
Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral infection that may present mildly in children but can progress to severe clinical states due to secondary hemophagocytic lymphohistiocytosis (HLH). We retrospectively analyzed the clinical, laboratory, and treatment data of children aged 0-18 years with polymerase chain reaction (PCR)-confirmed CCHF who were hospitalized at Hacettepe University, a large referral center for CCHF, between January 2019 and July 2025. Serial laboratory values (Days 0, 3, 7, and 10) and therapeutic interventions were evaluated. Twenty-two children (median age 13 years, 72% male) were included. The most frequent symptoms were fever (100%), bradycardia (59%), and conjunctival hyperemia (41%). HLH was diagnosed in 18 patients (82%). Ribavirin (91%), intravenous immunoglobulin (IVIG) (86%), and corticosteroids (68%) were administered. Platelet counts began to recover by Day 7, whereas ferritin declined gradually and normalized later. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels showed a progressive decrease. No patient required intensive care, and none died. Secondary HLH was highly prevalent among pediatric CCHF cases, yet outcomes were favorable with early antiviral and immunomodulatory therapy. Platelet recovery and delayed ferritin normalization may serve as practical biomarkers of disease resolution. Prospective multicenter studies with cytokine and viral-load profiling are warranted.
Homocysteine, vitamin B12, and folic acid metabolism can be altered in idiopathic nephrotic syndrome (INS). Primary objective was to measure urinary homocysteine, serum vitamin B12, and folic acid levels in INS and controls. Secondary objectives were to compare the levels among different sub-groups of patients and also to find out correlations of homocysteine with biochemical parameters. Sixty children [16 with first-episode nephrotic syndrome (FENS), 15 with infrequent relapsing nephrotic syndrome (IRNS), 15 with frequent relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS), 14 with steroid-resistant nephrotic syndrome (SRNS)], 12 controls, and 19 patients in remission were enrolled. Urinary homocysteine, serum vitamin B12, and folic acid were measured in active and remission. Median urinary homocysteine/creatinine level was significantly raised in FENS as compared to controls, FRNS/SDNS, and SRNS (P < 0 .001), and normalized during remission. Mean serum vitamin B12 (P < 0.001) and median folic acid (P = 0.004) values were significantly lower in INS sub-groups than controls. During remission, both serum folic acid and vitamin B12 levels showed significant rise; the latter became greater than controls. Urinary homocysteine/creatinine correlated inversely with serum protein (r = -0.363, P < 0.001), albumin (r = -0.349, P < 0.01), and vitamin B12 (r = -0.227, P = 0.030), while showed positive correlations with serum cholesterol (r = 0.304, P = 0.003) and urine protein-creatinine ratio (r = 0.479, P < 0.001). Urinary homocysteine concentration was increased, and serum folic acid and B12 levels were decreased during active phase of the disease. Levels decreased during remission and became comparable with controls.
Neonatal jaundice (NJ) is a common condition that may progress to serious complications such as kernicterus. Probiotics can also be used for treatment of jaundice by their effect on intestinal motility and microbial flora of the intestine. We aimed to evaluate the effect of probiotic supplementation as an adjuvant therapy in pathological neonatal unconjugated hyperbilirubinemia. A randomized, parallel-group comparative study was conducted on 44 neonates with confirmed pathological unconjugated hyperbilirubinemia admitted to the Neonatal Intensive Care Unit at Tanta University Hospital (Egypt) between May 2024 and April 2025. Participants were randomized (1:1) into two groups: phototherapy alone (control group n = 22) and phototherapy plus oral Bacillus clausii probiotic (probiotic group n = 22). Demographic data and bilirubin fractions were recorded. The primary outcome was the change in bilirubin levels; secondary outcomes included inflammatory biomarkers. Baseline characteristics were comparable between groups. Both groups exhibited significant declines in total serum bilirubin and indirect bilirubin, but only the probiotic group showed a significant reduction in direct bilirubin. By the end of treatment, the probiotic group showed a significantly greater reduction in lipopolysaccharide and tumor necrosis factor-α levels compared with the control group. Hospital stay was significantly shorter with probiotic therapy (3.8 ± 1.18 vs 6.3 ± 2.14 days; P < .001). Bacillus clausii supplementation alongside phototherapy significantly enhanced bilirubin reduction, decreased inflammatory markers, and shortened hospitalization, supporting its role as a beneficial adjunct therapy in neonatal hyperbilirubinemia.
To evaluate the association of superior mesenteric artery (SMA) Doppler parameters after the first feed with feed intolerance and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) neonates. This prospective cohort study was conducted in a tertiary neonatal intensive care unit from July 2024 to January 2025. VLBW neonates underwent SMA Doppler assessment before and 60 min after the first feed using standardized protocols. The primary outcome was time to full enteral feeds; secondary outcomes included feed intolerance, NEC, and sepsis. Fifty neonates were included. Post-feed resistive index (RI) decreased significantly (0.76-0.68; P = .01). On adjusted analysis, SMA Doppler parameters were not independently associated with time to full feeds, while respiratory distress syndrome (RDS) and hemodynamically significant patent ductus arteriosus (hsPDA) were significantly associated. Median time to full feeds was 9 days on Kaplan-Meier analysis. Neonates with feed intolerance had lower post-feed pulsatility index (PI) and RI, and a greater fall in RI. ROC analysis showed modest discrimination (AUC 0.69, 95% CI 0.53-0.84). Doppler differences in neonates with NEC were not statistically significant; an exploratory model showed modest discrimination (AUC 0.72, 95% CI 0.50-0.87). SMA Doppler parameters show possible association with feed intolerance and NEC but have limited predictive value as standalone markers. Feeding progression appeared to be more strongly influenced by systemic illnesses such as RDS, hsPDA, and by clinical management factors including feed withholding and individualized advancement decisions.
Early differentiation of acute pyelonephritis (APN) from lower urinary tract infection (LUTI) and identification of children at risk for renal scarring remain clinical challenges. We aimed to evaluate the diagnostic and prognostic performance of complete blood count (CBC)-derived inflammatory markers, particularly systemic immune-inflammation index (SII) and immature granulocyte percentage (IG%). In this retrospective single-center study (January 2013-December 2023), 265 children with confirmed urinary tract infections (UTIs) were classified as APN (n = 132) or LUTI (n = 133). Patients with prior antibiotic use or conditions affecting inflammatory markers were excluded. CBC-derived indices and IG% were analyzed. Renal ultrasonography was performed in all patients, and Technetium-99m dimercaptosuccinic acid scintigraphy was used during follow-up to assess renal scarring. Diagnostic performance was evaluated using receiver operating characteristic analysis, and independent predictors were assessed with multivariable logistic regression. C-reactive protein (CRP), neutrophil count, SII, IG%, and neutrophil-to-lymphocyte ratio (NLR) were significantly higher in APN compared to those in LUTI (all p < .001). Renal scarring was detected in 48 of 115 (41.7%) APN patients. Patients with renal scarring had higher CRP, SII, IG%, neutrophil count, and NLR, and lower lymphocyte levels. SII showed the highest discriminative performance [area under the curve (AUC) = 0.941, 95% confidence interval: 0.902-0.980) with a cut-off of 750 × 10³/µL (sensitivity 91%, specificity 86%). IG% (AUC = 0.895) and CRP (AUC = 0.891) also performed well. SII [odds ratio (OR) = 2.87] and IG% (OR = 1.42) remained independent predictors. SII and IG% are inexpensive, readily available biomarkers that may improve early risk stratification for renal scarring in children with UTI. Given that these parameters are derived from routine CBC tests at no additional cost, they may offer a practical and scalable approach to risk assessment in low- and middle-income settings where access to advanced imaging is limited.
Outcomes of periviable gestations in low- and middle-income countries (LMICs) depend on perinatal practices and tailored care strategies. The unit implemented a revised "Tiny Baby Protocol" (TBP) in 2023 for neonates born at periviable gestations (23-25 weeks). This prospective study compared survival and short-term outcomes in 23-25 weeks gestation neonates who received care by TBP (preferred proactive approach to perinatal care, elective intubation, respiratory care practices including volume guarantee and high frequency ventilation, inhaled nitric oxide, sedation, skin care practices, transpyloric feeding, rectal wash-outs, and targeted management of perfusion and patent ductus arteriosus) to those from a previous epoch who had received intensive care before TBP was implemented. Thirty-one periviable (23-25 weeks) neonates received care by TBP, of whom 58.1% survived, compared to 35.2% before TBP. Survivors (with TBP) required median (interquartile range) of 22 (14-32) days of ventilation, 9 (8-10) days of parenteral nutrition, and 104 (95-121) days of hospital stay, compared to 19 (13-42), 7 (6-12), and 95 (86-108) days of each respectively in the previous epoch. Changes in survival rates were observed after implementation of the TBP; from 0% to 60% at 23 weeks, 37.5% to 50% at 24 weeks, and 50% to 71.4% at 25 weeks. Implementation of a revised TBP policy for periviable neonates was associated with improved survival when compared to previous epoch of intensive care given in a neonatal intensive care unit in the South Kerala region in India. Wide-scale implementation of such protocols needs to be studied to examine if survival increases in other LMICs.
We aimed to evaluate the outcomes, antibiotic susceptibility of non-typhoidal Salmonella (NTS), and risk factors of invasive NTS (iNTS) infections in immunocompromised children. This is a retrospective observational study of immunocompromised children under 15 years of age with microbiologically proven NTS infections at Songklanagarind Hospital from January 2007 to December 2021. Among the 96 patients with NTS, 41 were diagnosed with hematologic malignancies, 26 with solid tumors, 6 with primary immunodeficiencies, and 23 with other immunodeficiencies, including nephrotic syndrome, autoimmune disorders treated with steroids, and aplastic anemia. NTS isolates collected during 2007-2012 and 2013-2021 demonstrated comparable susceptibility rates to ceftriaxone (100% and 93%, respectively), whereas susceptibility to ciprofloxacin decreased from 100% to 85.5%. Among the 96 patients, 21 (21.9%) had iNTS infections, including bacteremia (n = 19), urinary tract infections (UTIs; n = 2), and musculoskeletal infection (n = 1). One patient had concurrent UTI and osteomyelitis. The overall mortality rate among iNTS cases was 14.3%. In multivariable analysis, immunocompromised children with a sickly appearance, absence of gastrointestinal symptoms, and/or other immunodeficient conditions were at increased risk for iNTS infection, with predictive scores of 2.5, 2.7, and 2.8, respectively. A score ≥2.7 significantly predicted iNTS infection, with an area under the curve of 0.88. The sensitivity and specificity were 0.80 and 0.77, respectively. Nearly 22% of immunocompromised children had iNTS infection. Ceftriaxone remains an appropriate empirical treatment for suspected iNTS infection.
This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.
