23,840 research outputs found

    Persisting non-albicans candidemia in low birth weight neonates in a tertiary care hospital, Jammu and Kashmir

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    Background: Neonatal candidemia is among the leading causes of mortality in neonatal intensive care units of the developing countries like India. This work aimed at determining the prevalence of candidemia, spectrum of disease, risk factors and the antifungal susceptibility in low birth weight neonates in neonatal intensive care unit (NICU)’s at a tertiary care level. Methods: This was a prospective cross-sectional study of blood culture positive candidemia cases in neonates admitted to the neonatal intensive care unit of tertiary care hospital, SMHS, Jammu and Kashmir, India, between July 2021 to December 2022. All neonates with a clinical suspicion of candidemia with a positive blood culture (BacT alert) were identified. Patient demographics, clinical details, neonatal risk factors, and laboratory data and antifungal susceptibilities (using VITEK 2 compact system) were recorded and analyzed. Results: A total of 680 neonatal blood culture samples were collected from NICU’s, out of which 88 (12.94%) developed candidemia. Low birth weight (33.33%), indwelling catheters (31.52%), prematurity (31.31%) and prolonged use of antibiotics were important risk factors. The commonest clinical manifestation was feed intolerance 66.1% and respiratory distress 62.2%. Non-albicans candida was seen in majority cases 86.36% with Candida krusei 77.27%. All the Candida spp. showed 100% sensitivity to voriconazole and caspofugin followed by amphotericin B, fluconazole and micafugin. Conclusions: In this study, we focussed on determining the prevalence of candidemia in low birth weight neonates. The persistently emerging non-albicans Candida particularly Candida krusei has emerged as a big concern and needs attention for its prevention and treatment to minimize the morbidity and mortality rate

    Origins of neonatal intensive care in the UK

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    Chaired by Professor Robert Boyd, this seminar reviewed the development and changes in care of the newborn in the UK over the past 50 years. Advances in techniques were described, such as mechanical ventilation, total parenteral nutrition and continuous monitoring of vital signs, to care for ill or vulnerable newborn infants. Diagnostic techniques that were developed and introduced in the 1970s and early 1980s were discussed, such as ultrasound imaging, magnetic resonance spectroscopy and imaging and near infrared spectroscopy, for the non-invasive investigation of the brain, as well as the setting up of neonatal intensive care units. Witnesses include: Professor Eva Alberman, Dr Herbert Barrie, Professor Richard Cooke, Dr Beryl Corner, Dr Pamela Davies, Professor John Davis, Professor David Delpy, Professor Victor and Dr Lilly Dubowitz, the late Professor Harold Gamsu, Professor David Harvey, Professor Colin Normand, Professor Tom Oppé, Professor Osmund Reynolds, Dr Jean Smellie, Professor Maureen Young and nurses, including Miss Anthea Blake, Miss Caroline Dux and Miss Mae Nugent. Introduction by Professor Peter Dunn, viii, 84pp, 1 chart, glossary, subject and name index

    PCR for the detection of pathogens in neonatal early onset sepsis.

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    BACKGROUND: A large proportion of neonates are treated for presumed bacterial sepsis with broad spectrum antibiotics even though their blood cultures subsequently show no growth. This study aimed to investigate PCR-based methods to identify pathogens not detected by conventional culture. METHODS: Whole blood samples of 208 neonates with suspected early onset sepsis were tested using a panel of multiplexed bacterial PCRs targeting Streptococcus pneumoniae, Streptococcus agalactiae (GBS), Staphylococcus aureus, Streptococcus pyogenes (GAS), Enterobacteriaceae, Enterococcus faecalis, Enterococcus faecium, Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium, a 16S rRNA gene broad-range PCR and a multiplexed PCR for Candida spp. RESULTS: Two-hundred and eight samples were processed. In five of those samples, organisms were detected by conventional culture; all of those were also identified by PCR. PCR detected bacteria in 91 (45%) of the 203 samples that did not show bacterial growth in culture. S. aureus, Enterobacteriaceae and S. pneumoniae were the most frequently detected pathogens. A higher bacterial load detected by PCR was correlated positively with the number of clinical signs at presentation. CONCLUSION: Real-time PCR has the potential to be a valuable additional tool for the diagnosis of neonatal sepsis

    Prenatal Corticosteroids for Reducing Morbidity and mortality after Preterm Birth

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    Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam. First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2005.©The Trustee of the Wellcome Trust, London, 2005.All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam.Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam.Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam.Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam.Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam.Annotated and edited transcript of a Witness Seminar held on 15 June 2004. Introduction by Barbara Stocking, Oxfam.In 1959 the New Zealand obstetrician Graham (Mont) Liggins began investigating mechanisms that triggered premature labour. Supported by the Wellcome Trust, he examined the effects of hormones on labour in sheep, and demonstrated coincidentally that in utero corticosteroids accelerated fetal lung maturation. A randomized controlled trial (RCT) of prenatal corticosteroids in humans by Liggins and pediatrician Ross Howie, showed a reduction of respiratory distress syndrome in preterm babies. This Witness Seminar, chaired by the late Dr Edmund Hey, discussed the influence of Liggins' and Howie's 1972 paper announcing these results, and subsequent work by Avery and Kotas on induction of pulmonary surfactant in lambs. Other subjects included Crowley's 1981 systematic review of four RCTs; the low uptake of corticosteroids in practice until the Royal College of Obstetricians and Gynaecologists issued usage guidelines in 1992; trials to determine optimum drug, dose and number of courses; potential adverse effects; and cost-benefit analysis. Participants included the late Dr Mel Avery, Sir Iain Chalmers, Dr Patricia Crowley, the late Professor Harold Gamsu, Professor Jane Harding, Professor Richard Lilford, Professor Miranda Mugford, Professor Ann Oakley, Professor Dafydd Walters and Mr John Williams. Appendices from Liggins and Howie; Liggins' Wellcome Trust grant; and the protocol of the 1975 UK trial of betamethasone, complete the volume. Reynolds L A, Tansey E M. (eds) (2005) Prenatal corticosteroids for reducing morbidity and mortality after preterm birth, Wellcome Witnesses to Twentieth Century Medicine, volume 25. London: The Wellcome Trust Centre for the History of Medicine at UCL.The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183

    Parents' experiences of sharing neonatal information and decisions: Consent, cost and risk

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    This paper is about the care of babies with confirmed or potential neurological problems in neonatal intensive care units. Drawing on recent ethnographic research, the paper considers parents' experiences of sharing information and decisions with neonatal staff, and approaches that support or restrict parents' involvement. There are growing medico-legal pressures on practitioners to inform parents and involve them in their babies' care. Data are drawn from observations in four neonatal units in southern England, and interviews with the parents of 80 babies and with 40 senior staff. The paper compares standards set by recent guidance, with parents' views about their share in decision-making, their first meetings with their babies, 'minor' decision-making, the different neonatal units, being a helpless observer and missed opportunities. Parents' standards for informed decisions are summarised, with their reported views about two-way decision-making, and their practical need to know. Whereas doctors emphasise distancing aspects of the consent process, parents tend to value 'drawing together' aspects

    Ten steps or climbing a mountain: A study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding

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    Background: The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. Methods: The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. Results: Three main themes were identified: ‘Belief and Commitment’; ‘Interpreting BFHI’ and ‘Climbing a Mountain’. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. Conclusion: Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation

    Tetanus : forgiven, not forgotten

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    Tetanus is an illness that is still prevalent although the incidence has markedly decreased largely due to immunisation programmes. The latest four cases managed at St. Luke's hospital over 2001-2002 are presented. All of these patients survived. We give an overview of the illness and discuss the cases and management. The potential benefit of using dual antibiotic therapy is questioned.peer-reviewe
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