Objective: To evaluate the effect of the 2015 NRP recommendations of no routine endotracheal suctioning for non-vigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. Design: This was a single-center retrospective cohort study. We recorded data on Non-vigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n=95 (before the new guidelines, Jan 01, 2013-Dec 31, 2015) and prospective period 2, n=91 (after the implementation of new guidelines, Jan 01, 2017- Dec 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. Results: No significant differences in the occurrence of MAS ( 11% vs. 17% ) (Odds ratio of 1.46 (95% CI- 0.59-3.55)) or death (1% vs. 3% ) (Odds Ratio of 2.00 (95% CI- 0.18-21.57)) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37% vs. 61%), with an Odds Ratio of 2.31 (95% CI -1.10-4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12% vs. 28%) with an Odds ratio (OR) of 2.03 (95% CI- 1.02-4.51); p-value of 0.05). Conclusion: Our study did not observe a significant difference in the incidence of MAS or Death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased.
Escherichia coli infection is very common cause of early onset septicemia especially in very low-birth-weight newborns, but E. coli endocarditis has not been described in newborns. E. coli endocarditis, even in the adult population, is a rare and not well-characterized disease and is associated with high mortality. We report a very unusual presentation of persistent E. coli infection associated with endocarditis.
Background. The health personnel in low/low and middle-income countries have faced significant challenges during the COVID-19 pandemic. The International Community Access to Child Health (ICATCH) grants support locally initiated projects in those countries. The aim of this study was to highlight how the challenges countered by grant project teams continuing their projects and demonstrating their skills to adapt to an increasingly difficult environment. Methods. This was a mixed methodology study for which data were obtained from the evaluation of annual reports submitted by the projects. The annual reports review comprised of answers to questions on whether project objectives were met, problems or barriers encountered, and reviewer feedback in the form of specific concerns or recommendations. The reports were analyzed both quantitatively and qualitatively. Results. A total of 34 (92%) of annual reports were included with 17 (94%) received in 2020 and 17 (89%) in 2021. Compared to 2020, in 2021 the projects that indicated meeting objectives increased by more than half from 29% to 58%. Over one third of the projects encountered barriers in both years. The percentage of projects with major concerns decreased by almost 2/3 in 2021 while unexpected expenses decreased by 1/3. Four themes emerged from the qualitative analysis: Concerns over COVID-19, Barriers to accomplishing project goals, Positivity around adaptations, and Despair over lack of ability to overcome challenges. Conclusions. ICATCH funded projects demonstrated resiliency and adaptations to meet program objectives despite the challenges posed by the COVID-19 pandemic demonstrating greater success in 2021.
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