Neonatal Mortality in a Tertiary Care Private Set Up in Saudi Arabia

To ascertain Neonatal Mortality Rate (NMR), Early NMR (ENMR), Late NMR (LNMR), Corrected NMR (cNMR), and causes of neonatal mortality in a major tertiary care private maternity and Neonatal Intensive Care Unit (NICU) set up in Saudi Arabia. This was a retrospective analysis of hospital data. We ascertained 1-year data (from January 1, 2017 to December 31, 2017) from the electronic patient medical records database as well as the annual reports of four tertiary care labor and delivery rooms and NICU’s of Sulaiman Al Habib Medical Group (HMG). We obtained the total number of deliveries and neonatal outcomes and calculated overall NMR, ENMR, and LNMR rates per 1000 live births and stratified them by Sociodemographic Index (SDI). We analyzed the data using Microsoft Excel. The electronic patient records included data on 14,339 deliveries and 14,543 births (including twins and multiple births). We observed a total of 51 neonatal deaths (30: early, 21: late) resulting in NMR of 3.5/1000, ENMR of 2.06/1000, and LNMR of 1.44/1000. The deaths due to futility were 24 (47%), giving a cNMR of 1.8/1000. We found complications of extreme prematurity and congenital anomalies incompatible with life as the two major causes of death in our dataset. There was no death due to perinatal asphyxia. The NMR and cNMR were comparable to the most recent global, regional, and national data. The cNMR of a select population with high SDI served by a major private tertiary care set up was lower than the NMR of the global high SDI group. The high incidence of major and futile congenital anomalies warrants further study

Quality assessment of clinical practice guidelines for neonatal sepsis using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: A systematic review of neonatal guidelines

Background and objective: Neonatal sepsis (NS) continues to be a critical healthcare priority for the coming decades worldwide. The aim of this study was to critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal sepsis and to summarize and compare their recommendations. Methods: This study involves a systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases and professional societies. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. We summarized the recommendations in a comparison practical table. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Its protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42021258732). Results: Our search retrieved 4,432 citations; of which five CPGs were eligible and appraised: American Academy of Pediatrics (AAP 2018) (35 and 34 weeks); Canadian Pediatric Society (CPS 2017); National Institute for Health and Care Excellence (NICE 2021); and Queensland Maternity and Neonatal Services (QH 2020). Among these, the overall assessment of two evidence-based CPGs scored > 70% (NICE and QH), which was consistent with their higher scores in the six domains of the AGREE II instrument. In domain 3 (rigor of development), NICE and QH scored 99 and 60%, respectively. In domain 5 (applicability), they scored 96 and 74%, respectively, and in domain 6 (editorial independence), they scored 90 and 71%, respectively. Conclusion: The methodological quality of the NICE CPG was superior followed by the QH CPG with relevant recommendations for use in practice. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021258732, PROSPERO (CRD42021258732). Copyright © 2022 Amer, Shaiba, Hadid, Anabrees, Almehery, AAssiri, Alnemri, Darwish, Baqawi, Aboshaiqah, Hneiny, Almaghrabi, El-Malky and Al-Dajani

Probiotics Reduce the Risk of Necrotizing Enterocolitis in Preterm Infants: A Meta-Analysis

&lt;i&gt;Background:&lt;/i&gt; Necrotizing enterocolitis (NEC) is the most common serious acquired disease of the gastrointestinal tract in preterm infants. Probiotic bacteria are live microbial supplements that colonize the gastrointestinal tract and potentially provide benefit to the host. &lt;i&gt;Objective:&lt;/i&gt; To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC and other morbidities in preterm infants. &lt;i&gt;Methods:&lt;/i&gt; A meta-analysis was performed in accordance with the Cochrane Neonatal Review Group methods. Preterm infants &lt;37 weeks’ gestational age and/or &lt;2,500 g birth weight were included. Literature searches were made of MEDLINE, EMBASE, Cochrane Library Controlled Trials Register (CENTRAL), and abstracts of annual meetings of the Society for Pediatric Research and the European Society of Pediatric Research. &lt;i&gt;Results:&lt;/i&gt; Nine eligible trials randomizing 1,425 infants were included. Included trials were highly variable with regard to enrollment criteria, baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis, enteral probiotics supplementation significantly reduced the incidence of severe NEC [typical RR 0.32 (95% CI 0.17, 0.60)] and mortality [typical RR 0.43 (95% CI 0.25, 0.75)]. There was no evidence of significant reduction of nosocomial sepsis [typical RR 0.93 (95% CI 0.73, 1.19)] or days on total parenteral nutrition [weighted mean difference –1.9 (95% CI –4.6, 0.77)]. The statistical test of heterogeneity for NEC, mortality and sepsis was insignificant. Data regarding extremely low birth weight infants (ELBW) could not be extrapolated. The included trials reported no systemic infection with the probiotics supplemental organism. &lt;i&gt;Conclusion:&lt;/i&gt; Enteral supplementation of probiotics reduces the risk of severe NEC and mortality in preterm infants. A large randomized controlled trial is required to investigate the benefit and safety profile of probiotics supplementation in ELBW infants.</jats:p