Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Association Between Intermittent Hypoxemia and Severe Bronchopulmonary Dysplasia in Preterm Infants

RATIONALE Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent hypoxemia may play a role in this relationship. OBJECTIVE To determine the association between prolonged episodes of intermittent hypoxemia and severe bronchopulmonary dysplasia. METHODS Post-hoc analysis of extremely preterm infants in the Canadian Oxygen Trial who survived to 36 weeks postmenstrual age. Oxygen saturations <80% for ≥1 minute and the proportion of time per day with hypoxemia were quantified using continuous pulse oximetry data that had been sampled every 10 seconds from within 24 hours of birth until 36 weeks postmenstrual age. The study outcome was severe bronchopulmonary dysplasia as defined in the 2001 National Institutes of Health Workshop Summary. RESULTS Of 1018 infants, 332 (32.6%) developed severe bronchopulmonary dysplasia. The median number of hypoxemic episodes ranged from 0.8/day (IRQ 0.2-1.1) to 60.2/day (IQR 51.4-70.3) among the least and most affected 10% of infants. Compared to the lowest decile of exposure to hypoxemic episodes, the adjusted relative risk of severe bronchopulmonary dysplasia increased progressively from 1.72 (95% CI 1.55-1.90) at the second decile to 20.40 (95% CI 12.88-32.32) at the 10th decile. Similar risk gradients were observed for time in hypoxemia. Significant differences in the rates of hypoxemia between infants with and without severe bronchopulmonary dysplasia emerged within the first week after birth. CONCLUSIONS Prolonged intermittent hypoxemia beginning in the first week after birth was associated with an increased risk of developing severe bronchopulmonary dysplasia among extremely preterm infants

Hyperglycaemia in preterm neonates: What to know, what to do

a b s t r a c t a r t i c l e i n f o Available online xxxx Neonatal hyperglycaemia is a frequent complication in VLBW infants during the first week of life. The more common causes include high glucose intake, stress situations such as sepsis, NEC, and surgical treatments, as well as the administration of vasoactive drugs and methylxanthines. The appropriate definition is unclear. Hyperglycaemia has been associated with increased mortality and major morbidities. There have been insufficient randomized clinical trials to help in clarifying which infants should be treated, and there are insufficient data on the pharmacokinetics of insulin in these vulnerable patients