Status of Oxygen Monitoring in Four Selected Special Care Newborn Units in India

Abstract

Background: Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting w4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. Methods: An initial audit of admission diagnosis and antibiotic use was performed between 8 th May-6 th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies 'at risk of' versus 'with' clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. Results: Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P<0.0001). Re-audit after 5 months demonstrated a decrease in antibiotic prescribing at admission and discharge. Babies prescribed antibiotics at admission decreased from 449 (98%) to 96 (51%), P<0.0001. Inpatient days of therapy (DOT) reduced from 1243 to 1110/1000 patient-days. Oral amoxicillin prescription at discharge reduced from 349/354 (99%) to 1% 1/161 (P<0.0001).

ROP screening and treatment in four district-level special newborn care units in India: a cross-sectional study of screening and treatment rates

“…Other explanations are that neonatal staff and/or parents may not have been convinced of the need for screening more mature, healthier babies. Although the staff was interviewed regarding oxygen practices, 15 the attitudes of staff regarding screening and of parents not reporting for screening, was not captured in this study. Sicker and more preterm infants may have been transferred to another more advanced unit before the data of first screening as these SNCUs are level II NICUs.…”

“…Results on the availability of equipment, and practices and attitudes regarding oxygen monitoring have already been published. 15 …”

Rationalising oxygen usage in a level II special newborn care unit in Madhya Pradesh, India

“…There is inadequate knowledge and lack of adherence to saturation targets. 10 Nurses can play a pivotal role in ensuring optimal oxygen therapy and therefore reducing its undesirable consequences like ROP. 11 Similar context adapted changes in the oxygen delivery practices have helped in achieving better compliance to the best oxygen therapy practices in other settings.…”

Retinopathy of prematurity in India – what can we learn from the polio legacy?

“…The majority (84%) of nurses were not aware of the ideal oxygen saturation targets. 59 A recent analysis of retinal images from Indian NICUs showed that a significant proportion (75%) of larger preterm infants who were exposed to 100% oxygen experienced vascularization loss. These infants were relatively more mature (mean gestation: 31.7 weeks) and heavier at birth (mean birthweight: 1572 g).…”

“…Despite the existence of established guidelines and standards for ACS administration, oxygen administration and saturation targeting, and screening for ROP, adherence to these guidelines by healthcare providers remains suboptimal. 34 , 59 Effective measures are required to promote adherence to established guidelines for ROP management. Focusing on addressing attitudinal barriers among healthcare providers can facilitate the uptake of best practices in ROP management, ultimately improving patient outcomes.…”