scholarly journals Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle

2018 ◽  
Vol 69 (8) ◽  
pp. 1360-1367 ◽  
Author(s):  
Lawrence Mwananyanda ◽  
Cassandra Pierre ◽  
James Mwansa ◽  
Carter Cowden ◽  
A Russell Localio ◽  
...  
Keyword(s):  
Birth Weight ◽  
Total Mortality ◽  
Bloodstream Infections ◽  
Baseline Period ◽  
Outcome Data ◽  
Incidence Density ◽  
Infection Prevention And Control ◽  
Suspected Sepsis ◽  
Low Resource Settings ◽  
Low Resource

Abstract Background Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. Methods We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. Results Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549 [74.5%]), predominantly Klebsiella pneumoniae (289/409 [70.1%]). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birth weight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period. Conclusions A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. Clinical Trials Registration NCT02386592.

Simplified Age-Weight Mortality Risk Classification for Very Low Birth Weight Infants in Low-Resource Settings

2008 ◽  
Vol 153 (4) ◽  
pp. 519-524.e3 ◽  
Author(s):  
Rebecca E. Rosenberg ◽  
Saifuddin Ahmed ◽  
Samir K. Saha ◽  
A.S.M. Nawshad U. Ahmed ◽  
M.A.K. Azad Chowdhury ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Mortality Risk ◽  
Very Low Birth Weight ◽  
Risk Classification ◽  
Low Birth Weight Infants ◽  
Low Resource Settings ◽  
Low Resource

scholarly journals Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes in Low-Resource Settings

2019 ◽  
Vol 10 (5) ◽  
pp. 765-777 ◽  
Author(s):  
Andrea M Weckman ◽  
Chloe R McDonald ◽  
Jo-Anna B Baxter ◽  
Wafaie W Fawzi ◽  
Andrea L Conroy ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Birth Weight ◽  
Preterm Birth ◽  
Birth Outcomes ◽  
Fetal Growth ◽  
Adverse Birth Outcomes ◽  
Low Resource Settings ◽  
Low Resource ◽  
Arginine Supplementation ◽  
In Pregnancy

ABSTRACT The available data support the hypothesis that L-arginine or L-citrulline supplementation would be suitable for implementation in resource-constrained settings and will enhance placental vascular development and improve birth outcomes. In resource-constrained settings, the rates of adverse birth outcomes, including fetal growth restriction, preterm birth, and low birth weight, are disproportionately high. Complications resulting from preterm birth are now the leading cause of mortality in children <5 y of age worldwide. Despite the global health burden of adverse birth outcomes, few effective interventions are currently available and new strategies are urgently needed, especially for low-resource settings. L-arginine is a nutritionally essential amino acid in pregnancy and an immediate precursor of nitric oxide. During pregnancy, placental and embryonic growth increases the demand for L-arginine, which can exceed endogenous synthesis of L-arginine from L-citrulline, necessitating increased dietary intake. In many low-resource settings, dietary intake of L-arginine in pregnancy is inadequate owing to widespread protein malnutrition and depletion of endogenous L-arginine due to maternal infections, in particular malaria. Here we examine the role of the L-arginine–nitric oxide biosynthetic pathway in pregnancy including placental vascular development and fetal growth. We review the evidence for the relations between altered L-arginine bioavailability and pregnancy outcomes, and strategies for arginine supplementation in pregnancy. Existing studies of L-arginine supplementation in pregnancy in high-resource settings have shown improved maternal and fetal hemodynamics, prevention of pre-eclampsia, and improved birth outcomes including higher birth weight and longer gestation. Arginine supplementation studies now need to be extended to pregnant women in low-resource settings, especially those at risk of malaria.

scholarly journals Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sara Tomczyk ◽  
Julie Storr ◽  
Claire Kilpatrick ◽  
Benedetta Allegranzi
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Technical Assistance ◽  
High Impact ◽  
Infection Prevention And Control ◽  
Low Resource Settings ◽  
Low Resource ◽  
Implementation Themes ◽  
And Control

Abstract Background The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings. Methods Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively. Results Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and “data for action”; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and “data for action”; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy. Conclusions These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.

scholarly journals External validation of ELASTIC NET regression models including newborn metabolomic markers for postnatal gestational age estimation in East and South-East Asian infants

2020 ◽  
Vol 4 ◽  
pp. 164
Author(s):  
Steven Hawken ◽  
Malia S. Q. Murphy ◽  
Robin Ducharme ◽  
A. Brianne Bota ◽  
Lindsay A. Wilson ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
External Validation ◽  
Model Development ◽  
Population Level ◽  
The Philippines ◽  
Baseline Model ◽  
Low Resource Settings ◽  
Screening Programs ◽  
Low Resource

Background: Postnatal gestational age (GA) algorithms derived from newborn metabolic profiles have emerged as a novel method of acquiring population-level preterm birth estimates in low resource settings. To date, model development and validation have been carried out in North American settings. Validation outside of these settings is warranted.   Methods: This was a retrospective database study using data from newborn screening programs in Canada, the Philippines and China. ELASTICNET machine learning models were developed to estimate GA in a cohort of infants from Canada using sex, birth weight and metabolomic markers from newborn heel prick blood samples. Final models were internally validated in an independent group of infants, and externally validated in cohorts of infants from the Philippines and China.  Results: Cohorts included 39,666 infants from Canada, 82,909 from the Philippines and 4,448 from China.  For the full model including sex, birth weight and metabolomic markers, GA estimates were within 5 days of ultrasound values in the Canadian internal validation (mean absolute error (MAE) 0.71, 95% CI: 0.71, 0.72), and within 6 days of ultrasound GA in both the Filipino (0.90 (0.90, 0.91)) and Chinese cohorts (0.89 (0.86, 0.92)). Despite the decreased accuracy in external settings, our models incorporating metabolomic markers performed better than the baseline model, which relied on sex and birth weight alone. In preterm and growth-restricted infants, the accuracy of metabolomic models was markedly higher than the baseline model. Conclusions: Accuracy of metabolic GA algorithms was attenuated when applied in external settings.  Models including metabolomic markers demonstrated higher accuracy than models using sex and birth weight alone. As innovators look to take this work to scale, further investigation of modeling and data normalization techniques will be needed to improve robustness and generalizability of metabolomic GA estimates in low resource settings, where this could have the most clinical utility.

scholarly journals Interventions to prevent neonatal healthcare-associated infections in low-resource settings: a systematic review

2020 ◽  
Author(s):  
Felicity C. Fitzgerald ◽  
Walter Zingg ◽  
Gwendoline Chimhini ◽  
Simbarashe Chimhuya ◽  
Stefanie Wittmann ◽  
...  
Keyword(s):  
Low Income ◽  
Bloodstream Infections ◽  
Final Analysis ◽  
Neonatal Infection ◽  
Evidence Base ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Research Centre ◽  
Infection Prevention And Control ◽  
Low Resource

AbstractBackgroundClinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control (IPC) interventions for neonates in low-and-middle-income countries (LMIC) are unknown.AimTo identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units.MethodsMedline, PUBMED, The Cochrane Database of Systematic Reviews, EMBASE, and PsychInfo (January 2003 – October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units.ResultsOur initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and ICROMS assessment criteria and were summarised in the final analysis. No studies were carried out in low-income countries, only one in sub-Saharan Africa and just two in multiple countries. Of the 18 single intervention studies, most targeted skin (n=4) and gastrointestinal mucosal integrity (n=5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-centre studies. Of the nine studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections.ConclusionThere is a limited evidence-base for the effectiveness of IPC interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multi-site studies with robust study designs are needed to inform IPC intervention strategies in low-resource neonatal units.Sources of SupportFF is supported by the Academy of Medical Sciences, the funders of the Starter Grant for Clinical Lecturers scheme and UCL Great Ormond Street NIHR Biomedical Research Centre. AD is supported by the Fogarty International Center of the National Institutes of Health, Emerging Global Leader Award Number K43-TW010682.

scholarly journals Infection Prevention and Control (IPC) Implementation in Low-Resource Settings: A Qualitative Analysis

2021 ◽  
Author(s):  
Sara Tomczyk ◽  
Julie Storr ◽  
Claire Kilpatrick ◽  
Benedetta Allegranzi
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Technical Assistance ◽  
High Impact ◽  
Infection Prevention And Control ◽  
Low Resource Settings ◽  
Low Resource ◽  
Implementation Themes ◽  
And Control

Abstract BackgroundThe coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings.MethodsSemi-structured interviews were conducted with IPC experts from low-resource settings, using a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and reviewed to ensure validity. Sub-themes appearing ≥3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively.ResultsInterviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes to achieve the WHO IPC core components included: 1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; 2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; 3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; 4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and “data for action”; 5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; 6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and “data for action”; 7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and 8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy.ConclusionsThese IPC implementation themes offer important qualitative evidence for IPC professionals to consider.

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