Management of Newborn Infections in Primary Care Settings

Bhutta, Zulfiqar Ahmed; Zaidi, Anita K. M.; Thaver, Durrane; Humayun, Quratulain; Ali, Sajid; Darmstadt, Gary L.

doi:10.1097/inf.0b013e31819588ac

Cited by 39 publications

(20 citation statements)

References 31 publications

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“…However, two studies evaluating community-based neonatal care packages including injectable antibiotics found 44% and 34% reductions in neonatal mortality (RR 0.56, 95% CI 0.41,0.77; RR 0.66, 95% CI 0.47, 0.93 respectively), but the interpretation of these results is complicated by co-interventions [75]. Similar findings were reported by Bhutta et al in a review on community-based management of neonatal sepsis; the review reported 27% reduction in all-cause neonatal mortality (95% CI: 18, 35%), and 42% reduction in pneumonia specific mortality (95% CI: 22,57%) [76]. On the basis of available evidence it can be concluded that antibiotics have a clear role in reducing neonatal mortality in LMICs and can be effectively administered at homes via trained health workers as well as for hospital-based management of neonatal sepsis.…”

Section: Methodssupporting

confidence: 58%

Essential childbirth and postnatal interventions for improved maternal and neonatal health

et al. 2014

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Childbirth and the postnatal period, spanning from right after birth to the following several weeks, presents a time in which the number of deaths reported still remain alarmingly high. Worldwide, about 800 women die from pregnancy- or childbirth-related complications daily while almost 75% of neonatal deaths occur within the first seven days of delivery and a vast majority of these occur in the first 24 hours. Unfortunately, this alarming trend of mortality persists, as287,000 women lost their lives to pregnancy and childbirth related causes in 2010. Almost all of these deaths were preventable and occurred in low-resource settings, pointing towards dearth of adequate facilities in these parts of the world. The main objective of this paper is to review the evidence based childbirth and post natal interventions which have a beneficial impact on maternal and newborn outcomes. It is a compilation of existing, new and updated interventions designed to help physicians and policy makers and enable them to reduce the burden of maternal and neonatal morbidities and mortalities. Interventions during the post natal period that were found to be associated with a decrease in maternal and neonatal morbidity and mortality included: advice and support of family planning, support and promotion of early initiation and continued breastfeeding; thermal care or kangaroo mother care for preterm and/or low birth weight babies; hygienic care of umbilical cord and skin following delivery, training health personnel in basic neonatal resuscitation; and postnatal visits. Adequate delivery of these interventions is likely to bring an unprecedented decrease in the number of deaths reported during childbirth.

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Section: Methodssupporting

confidence: 58%

Essential childbirth and postnatal interventions for improved maternal and neonatal health

et al. 2014

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“…In cases of pneumonia in older children (6–59 months), the dose was 5 mL/day for 5 days (250 mg of SMX/day). No untoward effects, including any signs of central nervous system (CNS) toxicity, were mentioned in these reports (Bang et al, 1999, 2005; Bhutta et al, 2009). However, these reports do not confirm the presence or existence of any toxicity.…”

Section: Resultsmentioning

confidence: 95%

“…It is used orally in conjunction with gentamycin (injectable), the latter being effective mostly against Gram-negative organisms and the Gram-positive Staphylococcus . In neonates (≥2500 g body weight) diagnosed with sepsis or pneumonia, the course of an oral dose of Cotrimoxazole syrup (200 mg of SMX plus 40 mg of TMP in 4 mL) was 1.25 mL twice a day for 7 days (Bang et al, 1999, 2005; Bhutta et al, 2009). Therefore, each neonate received 125 mg of SMX per day.…”

Section: Resultsmentioning

confidence: 99%

“…However, the neonatal mortality rate still remains high as a result of inadequate healthcare facilities in developing countries. Recent advancement in home-based neonatal healthcare delivered by trained community health workers in villages and neonates receiving home-based antibiotic therapy has significantly reduced neonatal mortality (Bang et al, 1990, 1993; Bhutta et al, 2009; Khanal et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

“…SMX-TMP is a combination of sulfamethoxazole (SMX) and trimethoprim (TMP) that is used for the treatment of protozoan and bacterial infections, particularly for urinary and respiratory tract infections (Darmstadt et al, 2009; Ladhani & Garbash, 2005; Ogra & Faden, 1985; Paap & Nahata, 1990; Salter, 1982; Thaver et al, 2009; Velvis et al, 1986). This combination is extensively used in the home--based neonate care setting in developing countries for treating pneumonia and sepsis in neonates (Bang et al, 1993, 1999; Bhutta et al, 2009). Between 1988 and 1990, pneumonia-specific mortality rate in the control area was 29.1 in 1000 in the postnatal period (0–29 days), whereas intervention managed by community health workers (CHWs) using the combination of gentamicin and SMX-TMP resulted in a reduction in mortality to 17.4 in 1000 (40% decline) (Bang et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

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Cotrimoxazole and neonatal kernicterus: a review

Thyagarajan

Deshpande

2013

Drug and Chemical Toxicology

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Sulfamethoxazole (SMX) and trimethoprim (TMP) individually and a combination known as cotrimoxazole (SMX-TMP) are widely used for the treatment of protozoan and bacterial infections. SMX-TMP is also one of the widely used antibiotics administered orally in neonates, along with gentamicin injection, for treating pneumonia and sepsis by home-based healthcare providers in Asian countries. Although the use of this drug has successfully reduced neonate mortality, there is a concern for it causing neurotoxicity. Previous clinical studies with sulfisoxazole have demonstrated occurrence of kernicterus in neonates. This sulfonamide is thought to displace bilirubin from its albumin-binding sites in plasma leading to an elevation of plasma bilirubin, which crosses the blood-brain barrier, reaches central neurons to cause kernicterus. We performed an extensive review of clinical and animal studies with cotrimoxazole, which showed no reported incidences of kernicterus with SMX-TMP use in neonates. EndNote, BasicBiosis, Embase, PubMed and Toxline database searches were conducted using specific keywords yielding 74 full-length articles relevant to the review. This review has taken into account various factors, including the disease itself, direct effects of the drug and its metabolism through conjugation and acetylation through a thorough review of the literature to examine the potentials of SMX-TMP to cause kernicterus in neonates. SMX-TMP in oral doses administered to neonates for 7–10 days is unlikely to cause kernicterus. Also, this review recommends warranting the need of future studies using animal models and clinical studies in humans to address SMX-TMP toxicity.

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Developing Countries

Isaacs¹

2013

Evidence‐Based Neonatal Infections

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Management of Newborn Infections in Primary Care Settings

Cited by 39 publications

References 31 publications

Essential childbirth and postnatal interventions for improved maternal and neonatal health

Essential childbirth and postnatal interventions for improved maternal and neonatal health

Cotrimoxazole and neonatal kernicterus: a review

Developing Countries

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