Background and objective Bacterial infectioins in particular meningitis, pneumonia and septicemia are still some of the most causes of mortalities in children. The aim of present study was to identify the most common bacterial agents causing infectionis in children under 14 and detection of antibiotic resistance paterns. Material and methods During two years,1897 samples were obtained from the patients suspected bacterial infectioins. They were investigated for bacterial cultures, age, sex and antibiogram patterns. The species were identified by biochemical and serological methods.Results Of 1897 samples, 563 (29.6%) had positve bacterial culture. Of these 74.7% were gram negative and 25.3% gram positive. The most common species were Escherichia coli (34.1%), Staphylococcus aureus (17.1%), Psuedomonas aeroginosa (12.4%), Kelebsiella (11%) and Staphylococcus epidermidis (5.7%). The most effective antibiotics against both gram positive and gram negative bacteria were ceftriaoxne, nitrofurantoin, nalidixic acid, amikacin and gentamycin. Conclusion The gram negative bacteria in particular Escherichia coli, Psuedomonas aeroginosa and Kelebsiella are the predominant causes of bacterial infections in children under 14 in these regions. Most species showed a high relative resisitance to routine antibiotics such as ampicillin, trimethoprim and chloramphenicol.

A major concern with preterm birth is the risk of neurodevelopmental disability. Poor cerebral circulation leading to periods of hypoxia is believed to play a significant role in the etiology of preterm brain injury, with the first three days of life considered the period when the brain is most vulnerable. This study focused on monitoring cerebral perfusion and metabolism during the first 72 h after birth in preterm infants weighing less than 1500 g. Brain monitoring was performed by combining hyperspectral near-infrared spectroscopy to assess oxygen saturation and the oxidation state of cytochrome c oxidase (oxCCO), with diffuse correlation spectroscopy to monitor cerebral blood flow (CBF). In seven of eight patients, oxCCO remained independent of CBF, indicating adequate oxygen delivery despite any fluctuations in cerebral hemodynamics. In the remaining infant, a significant correlation between CBF and oxCCO was found during the monitoring periods on days 1 and 3. This infant also had the lowest baseline CBF, suggesting the impact of CBF instabilities on metabolism depends on the level of blood supply to the brain. In summary, this study demonstrated for the first time how continuous perfusion and metabolic monitoring can be achieved, opening the possibility to investigate if CBF/oxCCO monitoring could help identify preterm infants at risk of brain injury.

Germinal Matrix-Intraventricular Hemorrhage (GMH-IVH) remains a significant cause of adverse neurodevelopment in preterm infants. Current management relies on 2-dimensional cranial ultrasound (2D cUS) ventricular measurements. Reliable biomarkers are needed to aid in the early detection of posthemorrhagic ventricular dilatation (PHVD) and subsequent neurodevelopment. In a prospective cohort study, we incorporated 3-dimensional (3D) cUS and functional near-infrared spectroscopy (fNIRS) to monitor neonates with GMH-IVH. Preterm neonates (≤ 32 weeks' gestation) were enrolled following a GMH-IVH diagnosis. Neonates underwent sequential measurements: 3D cUS images were manually segmented using in-house software, and the ventricle volumes (VV) were extracted. Multichannel fNIRS data were acquired using a high-density system, and spontaneous functional connectivity (sFC) was calculated. Of the 30 neonates enrolled in the study, 19 (63.3%) had grade I–II and 11 (36.7%) grade III–IV GMH-IVH; of these, 7 neonates (23%) underwent surgical interventions to divert cerebrospinal fluid (CSF). In infants with severe GMH-IVH, larger VV were significantly associated with decreased |sFC|. Our findings of increased VV and reduced sFC suggest that regional disruptions of ventricular size may impact the development of the underlying white matter. Hence, 3D cUS and fNIRS are promising bedside tools for monitoring the progression of GMH-IVH in preterm neonates.

Background HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Methods In this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p < 0.001 at 10 weeks]. Conclusions These results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. Trial registration PACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3449

On completion of the project, the participants demonstrated an increase in knowledge and skills on newborn resuscitation, which led to a significant reduction in admission of newborns with birth asphyxia to the newborn unit.

Germinal Matrix-Intraventricular hemorrhage (GMH-IVH) remains a significant cause of adverse neurodevelopment in preterm infants. Current management relies on 2-dimensional cranial ultrasound (2D cUS) ventricular measurements. Reliable biomarkers are needed to aid in the early detection of posthemorrhagic ventricular dilatation (PHVD) and subsequent neurodevelopment. In a prospective cohort study, we incorporated 3-dimensional (3D) cUS and functional infrared spectroscopy (fNIRS) to monitor neonates with GMH-IVH. Preterm neonates (<32 weeks' gestation) were enrolled following a GMH-IVH diagnosis. Neonates underwent sequential measurements: 3D cUS images were manually segmented using in-house software, and the ventricle volumes (VV) were extracted. Multichannel fNIRS data were acquired using a high-density system, and spontaneous functional connectivity (sFC) was calculated. Of the 30 neonates enrolled in the study, 21 (70%) had grade I-II and 12 (40%) grade III-IV GMH-IVH, and 23 neonates (77%) underwent surgical interventions to divert cerebrospinal fluid (CSF). Infants with severe GMH-IVH who underwent CSF diversion had larger VV and significantly decreased sFC (p<0.001). Our findings of increased VV and reduced sFC suggest that regional disruptions of ventricular size may impact the development of the underlying grey matter. Hence, 3D cUS and fNIRS are promising bedside tools for monitoring the progression of GMH-IVH in preterm neonates.

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Background: Hypoxic ischemic encephalopathy (HIE) is a severe brain injury impacting term-born neonates. Despite treatment with therapeutic hypothermia (TH), HIE is associated with myriad adverse developmental outcomes suggesting the involvement of subcortical structures, including the thalamus and basal ganglia, which may be vulnerable to perinatal asphyxia, particularly during the acute period. Aims: 1) To examine subcortical macrostructure in the first few days of life in neonates with HIE compared to age- and sex-matched healthy neonates. 2) To determine whether subcortical volumetric maturation is associated with HIE severity. Methods: A cohort of 28 neonates (19 males [67.9%], median gestational age [GA]=38.6 weeks, interquartile range [IQR]=36.8-39.6) with HIE (mild=4, moderate=21, severe=3 based on Sarnat Staging) were scanned with MRI within the first four days of life (median postmenstrual age [PMA]=39.2, IQR=37.6-40.3), with the majority of scans occurring in the post-cooling period (n=23[82%]). The control group included 28 healthy neonates matched for GA, birth weight and PMA at the scan. Subcortical volumes (thalamus, basal ganglia, hippocampus, cerebellum) were automatically extracted from T1-weighted images. General linear models assessed between-group differences in subcortical volumes, adjusting for sex, GA, PMA, and total cerebral volumes. Within-group analyses evaluated the association between subcortical volumes and HIE severity. Results: Neonates with HIE had significantly smaller bilateral thalamic, basal ganglia and right hippocampal and cerebellar volumes compared to healthy neonates (all, p<0.02). Within the HIE group, milder HIE severity was associated with smaller volumes of the left and right basal ganglia (both, p<0.007) and the left hippocampus and thalamus (both, p<0.04) when adjusting for TH, days of mechanical ventilation and other clinical and demographic factors. Conclusions: Consistent with findings from childhood survivors of HIE, newborns with HIE, scanned with MRI within the first days of life, had smaller subcortical volumes impacting sensory and motor regions, including the thalamus, basal ganglia and cerebellum compared to healthy newborns. Additionally, HIE severity was associated with subcortical volumes, particularly impacting the basal ganglia, suggesting these regions may be important brain-based biomarkers in newborns impacted by the hypoxic-ischaemic injury. Findings suggest that despite advances in neonatal care, HIE is associated with significant alterations in brain macrostructure.