Introduction: Leave against medical advice is a condition in which a patient leaves the hospital against the treating physician's recommendation and is a sensitive issue occurring frequently in neonatal intensive care units across the developing world. Investigating the causes of newborn deaths is essential as there is high neonatal mortality rate in context of Nepal and a huge gap between that rate and desired outcomes. Self-discharge of sick neonates from hospitals further increases the chance of death. Hence, this study aimed to find out the prevalence of leave against medical advice among neonates admitted to the neonatal intensive care unit in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients admitted to the Neonatal Intensive Care Unit from 14 April 2021 to 13 April 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: 077/78-021). The patient’s demographic and clinical characteristics and reasons for self-discharge were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1352 neonates, the prevalence of leave against medical advice was 119 (8.80%) (7.29-10.31, 95% Confidence Interval). Conclusions: The prevalence of leave against medical advice from the neonatal intensive care unit was lower than in other studies done in similar settings.
Introduction: Preterm birth, one of the leading causes of admissions to the Neonatal intensive care unit, is a major contributor to neonatal morbidity and mortality in developing countries. This study aimed to find out the prevalence of premature neonates admitted to the Neonatal Intensive Care Unit of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from clinical records of preterm neonates (born before 37 completed weeks of gestation) admitted in the Neonatal Intensive Care Unit from 16 July 2020 to 14 July 2021. Following ethical approval from the Institutional Review Committee (Reference number: 077/78-018), the patient’s clinical characteristics and systemic morbidities were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 646 admissions, the prevalence of preterm neonates was found to be 147 (22.75%) (19.52-25.98, 95% Confidence Interval). The male: female ratio was 1.53:1. The median gestational age and birth weight were 33 weeks (Range: 24–36 weeks) and 1680 g respectively. A total of 73 (49.65%) delivery was followed by premature rupture of membrane. The morbidity due to respiratory problems was highest at 127 (86.39%), followed by metabolic at 104 (70.74%) and sepsis at 91 (61.90%). The renal system was the least affected 5 (3.40%). Conclusions: The prevalence of preterm neonates in the neonatal intensive care unit was higher than in other studies done in similar settings.
Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care Unit
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