Current Issue : January - March Volume : 2015 Issue Number : 1 Articles : 7 Articles
Background: Antimicrobial use is very common in hospitalized children. An assessment of clinician�s prevailing\nknowledge and clinical approach to prescribing antimicrobials is helpful in order to develop the best strategies for\nsuccessful stewardship programs. The objectives of the study were to determine fundamental knowledge of\nprinciples, approach to antimicrobial use through the clinical vignettes and to identify perceived challenges in\ndecreasing antimicrobial use.\nMethods: A questionnaire was developed by subject matter experts and pretested to ensure validity. Using a\ncross-sectional prospective design, the questionnaire was completed anonymously by staff and trainee physicians\nat a single tertiary care pediatric hospital between late November 2011 and February 2012.\nResults: Of 159 eligible physicians, 86 (54.1%) responded, of which 77 (46 staff and 31 trainees) reported regularly\nprescribing antimicrobials. The majority of physicians had modest knowledge of factors that would increase risk of\nresistance however, less than 20% had correct knowledge of local resistance patterns for common bacteria. Almost\nhalf of physicians correctly answered the clinical vignettes. Over half of trainees and one third of staff relied most\non online manuals for information regarding antimicrobials to assist prescription decision-making. Overall, physicians\nperceived that discontinuing empiric antimicrobials was the most difficult to achieve to decrease antibiotic use.\nConclusions: Our results highlight several challenges that pediatric practioners face with respect to knowledge and\napproach to antimicrobial prescribing. Pediatric stewardship programs could in this setting focus on discontinuing\nantimicrobials appropriately and promoting local antibiograms in the proper clinical setting to decrease overall use\nof antimicrobials....
Background: Bacterial meningitis is more common in the neonatal period than any other time in life; however, it is\nstill a challenge for the evidence based diagnosis. Strategy for identification of neonatal bacterial meningitis\npathogens is presented by evaluating three different available methods to establish evidence-based diagnosis for\nneonatal bacterial meningitis.\nMethods: The cerebrospinal fluid samples from 56 neonates diagnosed as bacterial meningitis in 2009 in Beijing\nChildren�s Hospital were analyzed in the study. Two PCR based molecular assays, real-time fluorescence quantitative\nPCR (RT-PCR) and multiplex PCR based-reverse line blot hybridization (mPCR/RLB), were used to assess 7 common\nneonatal meningitis bacterial pathongens, including Escherichia coli, Staphylococcus aureus, Listerisa monocytogenes,\nNeisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus agalactiae. The findings\nin examinations of two assays were compared with the results obtained bacterial culture tests.\nResults: Bacterial meningitis was identified in five cases (9%) by CSF cultures, 25 (45%) by RT-PCR and 16 (29%) by\nmPCR/RLB. One strain of S. epidermidis and one of E. faecalis were identified using mPCR/RLB but not by RT-PCR. In\ncontrast, cultures identified one strain of S. pneumoniae which was missed by both PCR assays. Overall, the bacterial\npathogens in 28 cases were identified with these three methods. Both RT-PCR and mPCR/RLB assays were more\nsensitive than bacterial culture, (p < 0.05).\nConclusion: Our study confirmed that both RT-PCR and mPCR/RLB assays have better sensitivity than bacterial\nculture. They are capable of detecting the pathogens in CSF samples with negative culture results...
Background: Pathogenesis of intraventricular hemorrhage (IVH) in premature infants is multifactorial. Little is\nknown about the impact of genetic variants in the vitamin K-dependent coagulation system on the development\nof IVH.\nMethods: Polymorphisms in the genes encoding vitamin K epoxide reductase complex 1 (VKORC1 -1639G>A) and\ncoagulation factor 7 (F7 -323Ins10) were examined prospectively in 90 preterm infants <32 weeks gestational age\nwith respect to coagulation profile and IVH risk.\nResults: F7-323Ins10 was associated with lower factor VII levels, but not with individual IVH risk. In VKORC1-wildtype\ninfants, logistic regression analysis revealed a higher IVH risk compared to carriers of the -1639A allele. Levels of\nthe vitamin K-dependent coagulation parameters assessed in the first hour after birth did not differ between\nVKORC1-wildtype infants and those carrying -1639A alleles.\nConclusions: Our data support the assumption that genetic variants in the vitamin K-dependent coagulation system\ninfluence the coagulation profile and the IVH risk in preterm infants. Further studies focussing on short-term changes\nin vitamin K-kinetics and the coagulation profile during the first days of life are required to further understand a\npossible link between development of IVH and genetic variants affecting the vitamin K-metabolism....
Background: Little evidence exists regarding the optimal concentration of oxygen to use in the treatment of term\nneonates with spontaneous pneumothorax (SP). The practice of using high oxygen concentrations to promote\nââ?¬Å?nitrogen washoutââ?¬Â still exists at many centers. The aim of this study was to identify the time to clinical resolution\nof SP in term neonates treated with high oxygen concentrations (HO: FiO2 ? 60%), moderate oxygen\nconcentrations (MO: FiO2 < 60%) or room air (RA: FiO2 = 21%).\nMethods: A population based cohort study that included all term neonates with radiologically confirmed\nspontaneous pneumothorax admitted to all neonatal intensive care units in Calgary, Alberta, Canada, within\n72 hours of birth between 2006 and 2010. Newborns with congenital and chromosomal anomalies, meconium\naspiration, respiratory distress syndrome, and transient tachypnea of newborn, pneumonia, tension pneumothorax\nrequiring thoracocentesis or chest tube drainage or mechanical ventilation before the diagnosis of pneumothorax\nwere excluded. The primary outcome was time to clinical resolution (hours) of SP. A Cox proportional hazards\nmodel was developed to assess differences in time to resolution of SP between treatment groups.\nResults: Neonates were classified into three groups based on the treatment received: HO (n = 27), MO (n = 35) and\nRA (n = 30). There was no significant difference in time to resolution of SP between the three groups, median\n(range 25th-75th percentile) for HO = 12 hr (8ââ?¬â??27), MO = 12 hr (5ââ?¬â??24) and RA = 11 hr (4ââ?¬â??24) (p = 0.50). A significant\ndifference in time to resolution of SP was also not observed after adjusting for inhaled oxygen concentration [MO\n(a HR = 1.13, 95% CI 0.54-2.37); RA (a HR = 1.19, 95% CI 0.69-2.05)], gender (a HR = 0.87, 95% CI 0.53-1.43) and ACoRN\nrespiratory score (a HR = 0.7, 95% CI 0.41-1.34).\nConclusions: Supplemental oxygen use or nitrogen washout was not associated with faster resolution of SP.\nInfants treated with room air remained stable and did not require supplemental oxygen at any point of their\nadmission....
Background: The effect of oral polio vaccine administered already at birth (OPV0) on child survival was not\nexamined before being recommended in 1985. Observational data suggested that OPV0 was harmful for boys, and\ntrials have shown that neonatal vitamin A supplementation (NVAS) at birth may be beneficial for boys. We set out\nto test this research question in a randomised trial.\nMethods: The trial was carried out at the Bandim Health Project, Guinea-Bissau. We planned to enrol 900 low-birth\nweight (LBW) boys in a randomised trial to investigate whether NVAS instead of OPV0 could lower infant mortality\nfor LBW boys. At birth, the children were randomised to OPV (usual treatment) or VAS (intervention treatment) and\nfollowed for 6 months for growth and 12 months for survival. Hazard Ratios (HR) for mortality were calculated using\nCox regression. We compared the individual anthropometry measurements to the 2006 WHO growth reference. We\ncompared differences in z-scores by linear regression. Relative risks (RR) of being stunted or underweight were\ncalculated in Poisson regression models with robust standard errors.\nResults: In the rainy season we detected a cluster of deaths in the VAS group and the trial was halted immediately\nwith 232 boys enrolled. The VAS group had significantly higher mortality than the OPV0 group in the rainy season\n(HR: 9.91 (1.23 ââ?¬â?? 80)). All deaths had had contact with the neonatal nursery; of seven VAS boys enrolled during one\nweek in September, six died within two months of age, whereas only one died among the six boys receiving OPV\n(p = 0.05). Growth (weight and arm-circumference) in the VAS group was significantly worse until age 3 months.\nConclusion: VAS at birth instead of OPV was not beneficial for the LBW boys in this study. With the premature\nclosure of the trial it was not possible to answer the research question. However, the results of this study call for\nextra caution when testing the effect of NVAS in the future...
Background: Dietary behaviours and physical activity are modifiable risk factors to address increasing levels of\nobesity among children and adolescents, and consequently to reduce later cardiovascular and metabolic disease.\nThis paper explores perceptions, attitudes, barriers, and facilitators related to healthy eating and physical activity\namong adolescent girls in rural South Africa.\nMethods: A qualitative study was conducted in the rural Agincourt subdistrict, covered by a health and\nsociodemographic surveillance system, in Mpumalanga province, South Africa. Semistructured ââ?¬Å?duo-interviewsââ?¬Â were\ncarried out with 11 pairs of adolescent female friends aged 16 to 19 years. Thematic content analysis was used.\nResults: The majority of participants considered locally grown and traditional foods, especially fruits and vegetables, to\nbe healthy. Their consumption was limited by availability, and these foods were often sourced from family or\nneighbourhood gardens. Female caregivers and school meal programmes facilitated healthy eating practices. Most\nparticipants believed in the importance of breakfast, even though for the majority, limited food within the household\nwas a barrier to eating breakfast before going to school. The majority cited limited accessibility as a major barrier to\nhealthy eating, and noted the increasing intake of ââ?¬Å?convenient and less healthy foodsââ?¬Â. Girls were aware of the benefits\nof physical activity and engaged in various physical activities within the home, community, and schools, including\nhousehold chores, walking long distances to school, traditional dancing, and extramural activities such as netball and\nsoccer.\nConclusions: The findings show widespread knowledge about healthy eating and the benefits of consuming locally\ngrown and traditional food items in a population that is undergoing nutrition transition. Limited access and food\navailability are strong barriers to healthy eating practices. School meal programmes are an important facilitator of\nhealthy eating, and breakfast provision should be considered as an extension of the meal programme. Walking to\nschool, cultural dance, and extramural activities can be encouraged and thus are useful facilitators for increasing\nphysical activity among rural adolescent girls, where the prevalence of overweight and obesity is increasing....
Background: The speeding increase and the high prevalence of childhood obesity is a serious problem for Public\nHealth. Community Based Interventions has been developed to combat against the childhood obesity epidemic.\nHowever little is known on the efficacy of these programs. Therefore, there is an urgent need to determine the\neffect of community based intervention on changes in lifestyle and surrogate measures of adiposity.\nMethods/design: Parallel intervention study including two thousand 2249 children aged 8 to 10 years ( 4th and 5th\ngrade of elementary school) from 4 Spanish towns. The THAO-Child Health Program, a community based intervention,\nwere implemented in 2 towns. Body weight, height, and waist circumferences were measured. Children recorded their\ndietary intake on a computer-based 24h recall. All children also completed validated computer based questionnaires to\nestimate physical activity, diet quality, eating behaviors, and quality of life and sleep. Additionally, parental diet quality\nand physical activity were assessed by validated questionnaires.\nDiscussion: This study will provide insight in the efficacy of the THAO-Child Health Program to promote a healthy\nlifestyle. Additionally it will evaluate if lifestyle changes are accompanied by favorable weight management....
Loading....