Antimicrobial Justification form for Restricting Antibiotic Use in a Pediatric Intensive Care Unit.

Objective: To study whether introduction of an ‘antimicrobial justification form’ deters clinicians from prescribing restricted antimicrobials and results in de-escalation of these antimicrobials. Methods: Clinicians were asked to fill a justification form if prescribing an antimicrobial from the pre-identified restricted group. Antimicrobial usage pattern over next year was compared with that in the one year preceding the introduction of justification form. Results: Significant overall decrease in antimicrobial usage (40.5% vs 34.6%) was noted in the post-intervention group along with a significant increase in the de-escalation of antibiotics. Conclusion: Introduction of a justification form before prescribing antimicrobials or at the time of deferring de-escalation can be useful in restricting usage of antimicrobials

ATP-binding Cassette Transporter A3 (ABCA3) Mutation in a Late Preterm with Respiratory Distress Syndrome.

Background: Surfactant protein abnormalities are rare causes of respiratory distress syndrome. Case characteristics: A late preterm (36 wks) who presented with respiratory distress syndrome.Observation: He was found to be a homozygous for a G to T transversion at the first base in intron 24, of ABCA3 gene which is necessary for lamellar body formation and surfactant production. Outcome: He died of severe respiratory failure even after multiple doses of surfactants and ventilation. Message: Surfactant deficiency with ABCA3 gene mutation needs to be suspected in late preterms who present with respiratory distress syndrome.

Rescue High Frequency Oscillation in Neonates with Acute Respiratory Failure.

The aim was to study the efficacy of rescue High Frequency Oscillatory Ventilation (HFOV) in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing Conventional Mechanical Ventilation (CMV). Primary outcome was short term oxygenation, lung recruitment, and ventilation and secondary outcome studied was survival. 675 babies were ventilated and 97 of them received HFOV. HFOV significantly improved oxygenation index, alveolararterial oxygen gradient, pH, PCO2, PO2 and caused better lung recruitment within 2 hours. Fifty seven babies (58.77%) survived and the mortality was more in <28 weeks, babies with pulmonary hemorrhage, sepsis and CDH.