Maternal anaemia and its severity: an independent risk factor for preterm delivery and adverse neonatal outcome

Background: This study was done to evaluate the effect of maternal anaemia and its severity on gestational age and neonatal outcome.Methods: This was a retrospective study, conducted in Vardhman Mahavir medical college and Safdarjang hospital, New Delhi between April 2012 to March 2013. Cases were divided in three groups i.e. non anaemic, mild to moderately anaemic and severely anaemic (according to WHO classification). A total of 1050 woman (350 in each group) were recruited for study. The following outcome measures were used: preterm delivery (<37 weeks), birth weight, APGAR score, admission of baby in neonatal intensive care unit and early neonatal death. Data was analyzed by Chi-square test. A P value of or less than 0.05 was considered as significant.Results: The risk of preterm delivery, low birth weight, poor APGAR score and admission of baby in neonatal intensive care unit was more in anaemic group and it increased with severity of anaemia which was statistically significant. The increase in risk of early neonatal death was not significant in mild/moderate anaemic group (P value 0.326) while it was statistically significant in severely anaemic group (P value 0.004).Conclusions: Anaemia in pregnancy has a recognizable association with prematurity, low birth weight and poor neonatal outcome.

Clinico-epidemiological profile and predictors of in-hospital outcome of acute poisoning cases in children of Northern India

Background: Childhood poisoning is a common but preventable problem worldwide with incidence varying from 0.3% to 7.6%. Demography, socioeconomic status, education, local belief and customs, occupation, religious, and cultural influences determine the cause of poisoning. Aim: This study was conducted to understand the recent changes increasing urbanization and rapid socioeconomic development in India during the past decade and to find out the change in pediatric due to poisoning profile. Materials and Methods: This study was conducted in a pediatric ward of a tertiary care hospital in North India during the period of January 2016–December 2016. A total of 174 children admitted with acute poisoning in the hospital during the study tenure were enrolled for the study. Clinical and demographic data were recorded in a predesigned proforma and results were compared with the previous studies from the region. Results: Mean age at presentation was 3.7 years, wherein males outnumbered females. Accidental mode (97%) was the most common mode of poisoning while ingestion (99%) was the most common route of exposure. The common agents incriminated in decreasing order of frequency were corrosives (24.71%), pyrethroids (12.64%), and kerosene (9.77%). Majority of patients belongs to lower middle class (57%) and urban areas (61%). Most children present with mild symptoms, of them vomiting was the most common (65%) and 12.6% developed complications. Mean duration of hospital stay was 2.5±1.91 days with a mortality of 2.16%. Conclusion: There is changing pattern in acute poisoning in children with decline in incidence of kerosene and pesticide poisoning while increase in corrosives and parathyroid poisoning. Low Glasgow Coma Scale and time lapse between poisoning and presentation to the hospital can be a predictor of high mortality

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India

<div><p>Background</p><p>There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them.</p><p>Methods</p><p>In this prospective observational cohort study (2011–2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant.</p><p>Results</p><p>Of the total of 2588 neonates enrolled, culture positive sepsis and total sepsis–i.e. culture positive and/or culture negative sepsis–was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens–<i>Klebsiella pneumoniae</i> (n = 50, 12.5%) and <i>Acinetobacter baumannii</i> (n = 46, 11.5%)–showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks’ gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth.</p><p>Conclusions</p><p>In this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.</p></div

Profile of clinical isolates^*.

<p>Profile of clinical isolates^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180705#t004fn002" target="_blank">*</a>}.</p

Outcomes of enrolled neonates (n = 2588).

<p>Outcomes of enrolled neonates (n = 2588).</p

Demographic characteristics of enrolled infants.

<p>Demographic characteristics of enrolled infants.</p

Antimicrobial resistance (AMR) and case fatality rates among common pathogens by their AMR pattern.

<p>Antimicrobial resistance (AMR) and case fatality rates among common pathogens by their AMR pattern.</p

Definitions used in the study^*.

<p>Definitions used in the study^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180705#t001fn001" target="_blank">*</a>}.</p

Antimicrobial resistance of common Gram-negative isolates.

<p>Antimicrobial resistance of common Gram-negative isolates.</p