SummaryBackgroundEvidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation.MethodsIn this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149.FindingsBetween March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: −1·6 (SD 1·2) in the 4 month group versus −1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI −0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group.InterpretationAlthough there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation.FundingIndian Council of Medical Research supported the study until Nov 14, 2015. Subsequently, Shuchita Gupta's salary was supported for 2 months by an institute fellowship from All India Institute Of Medical Sciences, and a grant by Wellcome Trust thereafter.

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Background: Antibiotic resistance (ABR) has now become a global health problem. It has significantly increased the mortality and morbidity related to infectious diseases as well as the economic burden due to these infections. There is global consensus on development of new strategies for prevention of antibiotic abuse and hence decreasing the prevalence of ABR. Medical students should be given more education during their undergraduate training regarding antibiotic resistance and appropriate prescribing. Therefore, this study was planned to assess Knowledge, attitude and practice (KAP) about antibiotics usage among medical undergraduates.Methods: An observational cross-sectional study was done among 2nd year undergraduate medical students of NC Medical College and Hospital, Israna, Panipat. Data was collected through specifically developed structured questionnaire from 130 students. The data was entered in MS excel 2010 and statistical analysis was done using MS excel 2010 and IBM Statistical package for social sciences (SPSS) version 20.0.0.Results: 93.07% (n=121) of the students were aware that antibiotic resistance has become an important and serious global public health issue. The attitude of the students about antibiotic use and resistance was found to be casual and negligent. 21.53% (n=28) of study participants believed that they should take antibiotics when they have cold to prevent from getting a serious illness. 38.46% (n=50) of students considered taking antibiotics whenever they had fever.Conclusions: This study provides useful information about the knowledge, attitudes and the practices of 2nd year undergraduate medical students about antibiotic resistance and usage.

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