Pre-Emptive Screening Strategies to Identify Postnatal CMV Diseases on the Neonatal Unit.

Cytomegalovirus (CMV) is the most common congenital infection.1 Congenital CMV (cCMV) is diagnosed if the virus is isolated in the first 3 weeks of life. It is challenging to differentiate between congenital and postnatal infection (pCMV) if the virus is detected after this time point. Retrospective diagnosis of cCMV requires the identification of the virus on the dried blood spot, a method which has been shown to be insensitive.2 Additionally, there are no internationally accepted definitions for symptomatic pCMV

Safety of meningococcal group B vaccination in hospitalised premature infants.

OBJECTIVES: To assess the risk of significant adverse events in premature infants receiving the novel 4-component group B meningococcal vaccine (4CMenB) with their routine immunisations at 2 months of age. PARTICIPANTS, DESIGN AND SETTING: In December 2015, Public Health England requested neonatal units across England to voluntarily participate in a national audit; 19 units agreed to participate. Anonymised questionnaires were completed for infants receiving 4CMenB alongside their routine immunisations. For comparison, a historical cohort of premature infants receiving their primary immunisations without 4CMenB or paracetamol prophylaxis was used. MAIN OUTCOME MEASURES: Paracetamol use; temperature, cardiovascular, respiratory and neurological status before and after vaccination; and management and investigations postvaccination, including serum C reactive protein levels, infection screens and antibiotic use. RESULTS: Complete questionnaires were returned for 133 premature infants (38°C) after vaccination compared with 20% (5/25) of those receiving 4CMenB without paracetamol (P=0.06) and none of those in the historical cohort. There were no significant differences between cohorts in the proportion of infants with apnoea, bradycardia, desaturation and receiving respiratory support after vaccination. CONCLUSIONS: 4CMenB does not increase the risk of serious adverse events in hospitalised premature infants. This audit supports the current national recommendations to offer 4CMenB with other routine vaccinations and prophylactic paracetamol to premature infants at their chronological age

Exploring separated children's experience of migration in Nepal

Most Nepalese children live in rural areas where poverty, employment and education act as key drivers in their decision to migrate to urban centres. This paper reports on a study which researched the experiences of separated children who migrated, as reported through interviews with 20 practitioners working in NGOs in Kathmandu. It describes children's motivations, migratory journeys and situations, when ‘promises of work’ often failed to materialise. Having seen more children migrating to Kathmandu and recently fearful that the impact of the COVID-19 pandemic may lead to further increase, practitioners identify the need for an urgent, coherent and multi-faceted response

Experiences of separated children in Nepal

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Seepage Losses for the Rio Grande Project (Franklin Canal Case Study)

The El Paso Del Norte Region, composed of the cities of El Paso, Texas; Las Cruces, New Mexico in the United States; and Ciudad Juarez, Chihuahua, in Mexico, is facing a severe drought and, as a result, a significant reduction in surface water allotments is forecasted for the upcoming irrigation season. Water conservation strategies have become even more urgent. Preliminary studies have shown that there was a great potential for improvement of water delivery efficiency (water savings or reduction in water diversions for a given level of surface water diversion) through lining of canals within this region. Through canal lining, water losses in the conveyance system due to seepage losses will be minimized, thereby maximizing delivery for the available diversion amount. Since canal lining is a project that requires a significant investment of money, water losses need to be determined prior to the execution of the project. This paper presents a study of seepage losses in Elephant Butte Irrigation District (EBID) and the El Paso Count Water Improvement District No. 1 (EPCWID). This study was conducted by TA&MU and NMSU scientists and engineers in collaboration with El Paso County Water Improvement District No. 1 in Texas, and with The Elephant Butte Irrigation District, in New Mexico. Authors first selected several canal sections with large seepage losses based on the Districts' operation experience and previous studies. Three ponding tests were conducted in Franklin Canal, El Paso, Texas. The canals were blocked into several sections by earth dams, and water was fed into the blocked sections. Canal banks were allowed to saturate for over 48 hours before the measurement of water level started. The water level was measured with a pre-installed staff gage. Water level measurements were taken for 2 or 3 days. The water levels in the ponding sites dropped at a rate ranging from 0.11 ft/day to 0.35 ft/day, which includes an evaporation rate of 0.006 ft/day on average. Based on geometry of the canal and water level changes, seepage rates were estimated. The results indicated that the seepage rate for the Franklin Canal ranged from 0.85 to 3.03 gal/sq. ft/day (0.11385 to 0.40261 cubic feet per day per square feet of the wetted area). The results also indicated that seepage rates changed from one location to another, and the seepage rate tended to reduce with drop of water levels in the canal. Authors concluded that there would be a great potential for improvement of delivery efficiency by lining canals. Preliminary results from inflow-outflow tests in EBID’s main canals indicate losses of 3 to 7 cfs per mile. Work is continuing to provide replication, greater detail, and to measure additional canals

Vestibular and balance dysfunction in children with congenital CMV: a systematic review.

OBJECTIVE: This systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities. DESIGN: MEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. PATIENTS: Children with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture). INTERVENTION: Studies of vestibular function and/or balance assessments. MAIN OUTCOME MEASURES: Vestibular function and balance. RESULTS: 1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%-60%), than asymptomatic cCMV (0%-12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months. CONCLUSIONS: Vestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case-controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions. PROSPERO REGISTRATION: CRD42019131656

Therapeutic drug monitoring of ganciclovir for postnatal cytomegalovirus infection in an extremely low birth weight infant: a case report

Background: Ganciclovir is a therapeutic choice for extremely premature infants with severe postnatal cytomegalovirus disease, but little is known about its optimal dose size and dosing interval for them. Case presentation: We treated an extremely premature female infant with postnatal cytomegalovirus infection with intravenous administration of ganciclovir since 49 days of life (postmenstrual age of 31 weeks). After ganciclovir treatment was initiated at a dose of 5 mg/kg every 12 h, cytomegalovirus loads in the peripheral blood were markedly decreased. However, since plasma ganciclovir trough level was too high, the interval was extended to every 24 h. Subsequently, the trough level and the estimated 12-h area under the concentration-time curve (AUC0-12) were decreased from 3.5 mg/L to 0.3 mg/L and 53.9 mg ・ h/L to 19.2 mg ・ h/L, respectively, resulting in an exacerbation of viremia and clinical condition. Adjustment of dosing interval from 24 h to 12 h led to a peak level of 4.2 mg/L, trough level of 1.1 mg/L, and AUC0-12 of 31.8 mg ・ h/L, resulting in a marked suppression of viral load. Conclusions: Monitoring the therapeutic drug levels and cytomegalovirus loads is useful in obtaining a proper treatment effect and preventing overdosage during ganciclovir therapy in premature infants with postnatal cytomegalovirus infection

Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines

Background Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. Methods & findings Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month–12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1–3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region. Conclusions Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research