Severe Pulmonary Arteriopathy in a Neonate with Congenital Rubella Syndrome and Patent Ductus Arteriosus

Neonates with congenital rubella syndrome (CRS) are known to have associated congenital cardiac malformations. Patent ductusarteriosus (PDA) is one the most common cardiac anomalies associated with CRS. PDA refractory to medical management andassociated with ventilatory dependence is considered for surgical ligation. However, the management of PDA can be challenging in thepresence of underlying lung disease or pulmonary vascular disease. Outcomes after closure in neonates are dependent upon age,weight, nutritional status, pre-operative pulmonary arterial hypertension and presence of chronic lung disease. We present a neonatewith CRS who required surgical PDA closure. The neonate developed severe pulmonary arterial hypertension which led to fatal outcome.The clinical course is corroborated with histo-pathological changes observed on the autopsy of this neonate.

Reducing Healthcare-associated Infections in Neonates by Standardizing and Improving Compliance to Aseptic Non-touch Techniques: A Quality Improvement Approach

Objective: To standardize and improve compliance to Asepticnon-touch techniques (ANTT) for commonly performedprocedures in Neonatal intensive care unit (NICU) throughapplication of Model for improvement, and study its impact onHealthcare-associated infection (HCAI) rates.Design: Quality improvement project utilizing multiple Plan-Do-Study-Act (PDSA) cycles.Setting: Tertiary-care neonatal unit.Participants: All resident doctors and nurses working in neonatalunit were subjects for assessment of compliance to ANTT. Alladmitted neonates staying in hospital for more than 48 hours weresubjects for HCAI data collection.Procedure: Most frequently performed procedures in NICU wereidentified and pictorial Standard Operating Procedures (SOP)were developed. Implementation and uptake was reinforced bymeans of PDSA cycles. Compliance to ANTT was assessed asproportion of components to which adherence was documented.Trend of HCAI rates in unit were analyzed using process controlcharts.Main outcome measure: Change in compliance to ANTT formost frequently performed procedures.Results: Significant improvement in compliance to ANTTpractices was observed, specifically in use of procedure tray/trolley (16% to 49%, P=0.001), iv hub scrubbing (0% to 60%,P=0.001), local skin cleaning (33% to 67%, P=0.004), personalprotective equipment use (55% to 80%, P=0.02) and disposal(27% to 51%, P=0.03), use of non-touch technique (50% to 70%,P=0.001) and reduction in key part contamination (45% to 31%,P=0.03). A modest decrease in HCAI rates was seen in the shortperiod of observation after implementation.Conclusions: Substantial improvements in compliance toaseptic non-touch techniques can be ensured by adopting acombination of initial intensive teaching and sustaining throughmultiple PDSA cycles, targeting specific areas revealed by audits.