Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants

Pinto, Maria Cristina; Bueno, Arnaldo Costa; Vieira, Alan Araújo

doi:10.1016/j.jped.2013.01.009

Cited by 20 publications

(5 citation statements)

References 26 publications

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“…This management by risk assessment is unusual in Brazil, notably for VLBW infant sepsis evaluation, 9 , 10 and the authors hypothesize that this evaluation tends to have a significant impact on reducing the use of antibiotics in very low birth weight infants. Thus, this study aimed to evaluate the rates of culture-confirmed sepsis (CCS) and presumed EONS, as well as rates of ruled out neonatal sepsis (ROS) cases and rate of newborns not exposed to antibiotics in the first 48 h of life (NEATB), in the period from 2006 to 2017.…”

Section: Introductionmentioning

confidence: 99%

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use

Caldas

Montera

Calil

et al. 2021

Jornal de Pediatria

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Section: Introductionmentioning

confidence: 99%

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use

Caldas

Montera

Calil

et al. 2021

Jornal de Pediatria

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“…Twenty studies were identified that described aspects of guideline implementation or health systems strengthening to improve outcomes of preterm babies in LMICs [ 59 , 63 , 104 , 128 , 130 , 135 , 142 , 144 , 145 , 157 , 177 , 178 , 180 , 181 , 188 , 191 , 197 - 200 ].…”

Section: Resultsmentioning

confidence: 99%

Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review

et al. 2021

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Background Reducing preterm birth and stillbirth and improving outcomes for babies born too soon is essential to reduce under-5 mortality globally. In the context of a rapidly evolving evidence base and problems with extrapolating efficacy data from high- to low-income settings, an assessment of the evidence for maternal and newborn interventions specific to low- and middle-income countries (LMICs) is required. Methods A systematic review of the literature was done. We included all studies performed in LMICs since the Every Newborn Action Plan, between 2013 - 2018, which reported on interventions where the outcome assessed was reduction in preterm birth or stillbirth incidence and/or a reduction in preterm infant neonatal mortality. Evidence was categorised according to maternal or neonatal intervention groups and a narrative synthesis conducted. Results 179 studies (147 primary evidence studies and 32 systematic reviews) were identified in 82 LMICs. 81 studies reported on maternal interventions and 98 reported on neonatal interventions. Interventions in pregnant mothers which resulted in significant reductions in preterm birth and stillbirth were (i) multiple micronutrient supplementation and (ii) enhanced quality of antenatal care. Routine antenatal ultrasound in LMICs increased identification of fetal antenatal conditions but did not reduce stillbirth or preterm birth due to the absence of services to manage these diagnoses. Interventions in pre-term neonates which improved their survival included (i) feeding support including probiotics and (ii) thermal regulation. Improved provision of neonatal resuscitation did not improve pre-term mortality rates, highlighting the importance of post-resuscitation care. Community mobilisation, for example through community education packages, was found to be an effective way of delivering interventions. Conclusions Evidence supports the implementation of several low-cost interventions with the potential to deliver reductions in preterm birth and stillbirth and improve outcomes for preterm babies in LMICs. These, however, must be complemented by overall health systems strengthening to be effective. Quality improvement methodology and learning health systems approaches can provide important means of understanding and tackling implementation challenges within local contexts. Further pragmatic efficacy trials of interventions in LMICs are essential, particularly for interventions not previously tested in these contexts.

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“…As a particular indicator is analyzed, the reasons for the poor performance are identified which may include any number of health system bottlenecks. QI intervention studies found that simple interventions such as creation of a stepdown unit, involving mothers in infant care, and new antibiotic protocol reduced mortality in NICU [ 36 , 37 ]. Based on SQCI scores, in our intervention, similar actions were introduced in SNCU having low birth weight survival.…”

Section: Discussionmentioning

confidence: 99%

Addressing Quality of Care in Pediatric Units using a Digital Tool: Implementation Experience from 18 SNCU of India

Saboth¹,

Sarin²,

Kumar

et al. 2021

Journal of Tropical Pediatrics

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Lack of quality care is associated with newborn mortality and stillbirth. India launched the Special newborn care unit (SNCU) Quality of Care Index (SQCI) for measuring quality indicators in SNCU. The USAID Vriddhi project provided support to the use of SQCI in 19 SNCU across aspirational districts of Jharkhand, Uttarakhand, Himachal Pradesh, Punjab and Haryana. The objective was to provide holistic support to quality care processes by generating analyzed quarterly reports for action with the goal toward sustainability by capacitating SNCU personnel and program officers to use SQCI, over a 1period from April 2019 to June 2020. The composite index has seven indicators and converts them into indices, each having a range from 0.1 to 1, to measure performance of SNCU.7 of the 18 SNCU improved their composite scores from the first to the last quarter. Rational use of antibiotics showed improvement in 12 SNCU. Survival in newborns >2500 g and <2500, low birth weight admission and optimal bed utilization had the most variations between and within facilities. Based on quarterly data analysis, all facilities introduced KMC, 10 facilities improved equipment and drug supply, 9 facilities launched in-house capacity building to improve asphyxia management. The SQCI implementation helped to show a process of using SQCI data for identifying bottlenecks and addressing quality concerns. The project has transitioned to complete responsibility of SQCI usage by the district and facility teams. Use of an existing mechanism of quality monitoring without any major external support makes the SQCI usable and doable.

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Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants

Abstract: The implementation of the protocol allowed improvement of sepsis diagnosis by reducing the diagnosis of probable early-onset sepsis, thus promoting efficient antimicrobial use in this population.

Cited by 20 publications

References 26 publications

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use

Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review

Addressing Quality of Care in Pediatric Units using a Digital Tool: Implementation Experience from 18 SNCU of India

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