Ten- vs. 14-day antibiotic therapy for culture-positive neonatal sepsis.

BACKGROUND: Neonatal sepsis is a major determinant of neonatal mortality. There is a scarcity of evidence-based guidelines for the duration of antibiotics in culture-positive sepsis. OBJECTIVES: The aim of this study was to compare the efficacy of 10- and 14-day antibiotic therapies in the management of culture-positive neonatal sepsis. METHODS: This randomized controlled trial was conducted in the neonatal intensive care unit of a tertiary care center among the neonates suffering from culture-positive sepsis (with signs of clinical remission on day 9 of antibiotic) between January 2023 and May 2023. Newborns with major congenital anomaly, deep-seated infections, multi-organ dysfunction, associated fungal infections/infection by multiple organisms and severe birth asphyxia were excluded. Two hundred and thirty-four newborns were randomized into two groups-study (received 10 days of antibiotics) and control (received 14 days of antibiotics). Treatment failure, hospital stay and adverse effects were compared between the two groups. p < 0.05 was taken as the limit of statistical significance. RESULTS: Median [interquartile range (IQR)] birth weight and gestational age of the study population (53.8% boys) were 2.424 kg (IQR: 2.183-2.695) and 37.3 weeks (IQR: 35.5-38.1), respectively. Acinetobacter was the most commonly isolated species (56, 23.9%). The baseline characteristics of both groups were almost similar. Treatment failure was similar in the study and control groups (3.8% vs. 1.7%, p = 0.40), with a shorter hospital stay [median (IQR): 14 (13-16) vs. 18 (17-19) days, p < 0.001]. CONCLUSION: Ten-day antibiotic therapy was comparable with 14-day antibiotic therapy in efficacy, with a shorter duration of hospital stay and without any significant increase in adverse effects.

Neonatal sepsis is a major cause of neonatal mortality in developing countries like India. Textbooks recommend 14-day antibiotic treatment for culture-positive neonatal sepsis. However, these guidelines are not strictly evidence based. Prolonged antibiotic treatment might be associated with drug resistance, secondary infections and organ damage. A shorter course of antibiotic, if found effective, would be beneficial especially in the resource-constrained settings like India. Hence, this study was undertaken to compare a shorter duration antibiotic treatment (10 days) with the conventional 14-day antibiotic therapy. Two hundred and thirty-four newborns with culture-positive sepsis were randomized into the study group (received 10 days of antibiotics) and the control group (received 14 days of antibiotics). Socio-demographic characters, clinical and laboratory features and bacteriological profile of both the groups were recorded. Both the groups were comparable in baseline features. Two-thirds of them were suffering from Gram-negative sepsis, Acinetobacter being the most commonly isolated organism. Incidence of treatment failure was similar in the study and control groups. Duration of hospital stay was significantly lower in the study group than in the control group. This observation was true irrespective of gestational age and type of organisms. There were no significant differences in adverse effects between the groups. However, there are certain limitations in the study, and hence, multi-centric research should be undertaken before making generalized recommendations of practising short duration of antibiotics.

Clinical Features and Adverse Prognostic Indicators in Datura Poisoning in Children.

We describe the clinical features and adverse prognostic indicators of Datura intoxication in 47 children. 15 (31.9%) children required intensive care and 1 (2.1%) died. Time elapsed >3.15 hour between ingestion and starting treatment [RR (95% CI): 9.4 (3.1-28.3)], age <9.5 year [RR (95% CI): 3.5 (1.5-8.0)], and seizure [RR (95% CI): 2.8 (1.4-5.8)] were the most important adverse prognostic features.

Serum (1,3)-b-D-Glucan for Screening of Neonatal Fungemia.

This study was conducted to identify the mycological pattern, and to calculate the diagnostic accuracy of serum (1,3)-b-D-glucan for screening fungal sepsis in 351 high-risk neonates. Candida tropicalis was the most common isolate (n=16, 38.1%). At optimum cut-off (47.2 pg/mL), sensitivity and specificity of serum (1,3)-b-D-glucan were 92.9% and 69.9%, respectively.

Role of cooked green banana in home management of acute diarrhea in under-5 children.

BACKGROUND: Acute diarrhea is an important contributor to under-5 mortality. Green banana is traditionally used as a home-based remedy for diarrhea. OBJECTIVES: To identify the effect of green banana on duration, recovery and prevention of severe dehydration in under-5 children with acute watery diarrhea with no/some dehydration. METHODS: This study was conducted in the rural field practice area of a tertiary care center between January 2020 and December 2021 in under-5 children presenting with acute diarrhea with no/some dehydration. One hundred fifty-three children were divided into group A (received cooked green banana supplementation along with standard management) and group B (received only standard management). Duration of diarrhea, proportion of children recovered, requirement of hospitalization, development of persistent diarrhea and number of diarrheal episodes in 1 year follow-up period were compared between two groups. RESULTS: Green banana supplementation was significantly associated with reduction in duration [median (interquartile range)-4 (1.5) day versus 5.5 (1) day, P < 0.001] of diarrhea, less hospitalization (9.2% versus 22.1%, P = 0.03) and early recovery, both at day 3 (17.1% versus 3.9%, P = 0.007) and day 7 (90.8% versus 77.9%, P = 0.03). Green banana also protected children from the development of persistent diarrhea (7.9% versus 19.5%, P = 0.04). It also reduced future episodes of diarrhea by 40.5%. CONCLUSION: Green banana supplementation could be a promising adjunct therapy in acute diarrhea and thereby it might reduce under-5 mortality.

Acute diarrhea is the second leading cause of under-5 mortality excluding neonatal causes in India where green banana has traditionally been used as a home-based remedy for diarrhea since ancient days. Some of the previous literatures have found promising results of green banana supplementation in prolonged diarrhea, dysentery and hospital management of acute diarrhea but none have considered it in the home management of diarrhea and have not reviewed its role on duration, recovery and prevention of severe dehydration in under-5 children with acute watery diarrhea with no/some dehydration. These issues along with the possible role of green banana in preventing future episodes of diarrhea have been addressed in our study. One hundred fifty-three under-5 children presenting with acute diarrhea with no/some dehydration were studied over 2 years dividing into group A (received cooked green banana supplementation along with standard management) and group B (received only standard management). Green banana supplementation was significantly associated with reduction in duration of diarrhea, less hospitalization and early recovery, lesser incidences of development of persistent diarrhea, and it also significantly reduced the future episodes of diarrhea. Hence, green banana could be a promising adjunct therapy in acute diarrhea and might reduce under-5 mortality.

Effect of Music on Outcomes of Birth Asphyxia: A Randomized Controlled Trial.

INTRODUCTION: Birth asphyxia may cause neuro-developmental impairment in the affected newborns especially those who had hypoxic-ischemic encephalopathy. Music therapy has been observed to help in reducing pain and stress in newborns and improve neurodevelopmental outcome. OBJECTIVES: The objective of this study is to determine the effects of music therapy on the outcomes of birth asphyxia. METHODS: A randomized controlled trial involving 3095 newborns born between January 2013 and August 2019 with birth asphyxia was conducted in the neonatal intensive care unit of Burdwan Medical College. They were distributed in two groups-A (received music therapy along with coventional management) and B (only received conventional management), using computer-generated randomization. Pain score was assessed during any painful procedure and the neurodevelopmental outcome was measured at 3rd, 6th, 12th, 18th and 24th months. p < 0.01 was considered statistically significant. RESULTS: A total of 3095 newborns were included with a mean gestation of 34.3 ± 2.1 weeks and 56.7% of them were male. Mean hospital stay, oxygen dependency, requirement of mechanical ventilation and incidence of apnea were significantly lesser among newborns of group A. Newborns of group B showed a significantly higher mean pain score, whereas newborns in Group A exhibited significantly greater mental and motor neurodevelopmental quotients. CONCLUSIONS: Music therapy was observed to help in reducing hospital stay, oxygen dependency, incidences of apnea, pain during procedures and also resulted in better neurodevelopmental outcome. However, before generalizing the findings, further multi-centric research should be undertaken.

Predictors of Renal Complications in Children With Hematotoxic Snakebite.

OBJECTIVE: To study the predictors of renal complications following hematotoxic snakebite in children. METHODS: This comparative study was conducted in the pediatric ward of a tertiary-care centre among 364 consecutively children admitted with hematotoxic snakebite between January 2016 and December 2017. Clinical and laboratory indicators were compared between children who developed acute kidney injury and those who did not. RESULTS: Acute kidney injury was seen in 139 children (38.2%), majority being stage 2 (55, 39.5%). 59 children (16.2%) developed permanent renal damage and 16 (4.4%) died due to envenomation. Acute tubular necrosis was the most common (25, 39.1%) histopathological change. CONCLUSIONS: Receiving anti-snake venom more than one hour after bite was the most significant adverse prognostic indicator, both for renal complications and mortality.

Effect of Virgin Coconut Oil Application on the Skin of Preterm Newborns: A Randomized Controlled Trial.

BACKGROUND: Preterm constitutes a major part of neonatal mortality, particularly in India. Due to dermal immaturity, preterm neonates are susceptible to various complications like infection, hypothermia, etc. Emollient application is a traditional practice in our subcontinent. AIMS: To find out the efficacy of coconut oil application for skin maturity, prevention of sepsis, hypothermia and apnea, its effect on long-term neurodevelopment and adverse effect of it, if any. MATERIAL AND METHODS: A randomized controlled trial was conducted in the rural field practice area of Department of Community Medicine, Burdwan Medical College from March 2014 to August 2018. Preterm born in the study period was divided into Group A (received virgin coconut oil application) and Group B (received body massage without any application). Neonatal skin condition was assessed on 7th, 14th, 21st and 28th day of life. Neurodevelopmental status was assessed on 3rd, 6th and 12th months. RESULTS: A total of 2294 preterm were included in the study. Groups A and B consisted of 1146 and 1148 preterm infants, consecutively. Mean gestational age of the study population was 31.9 ± 3.4 weeks and 50.4% were male. Mean weight loss in first few days was less in group A but mean weight gain per day was higher in group B. Lesser incidences of hypothermia and apnea, and better skin maturity and neurodevelopmental outcome were noted in group A. No significant adverse effect was noted with coconut oil application. CONCLUSION: Use of coconut oil helps in dermal maturity and better neurodevelopmental outcome. Further studies are warranted for universal recommendation.

A study on the prevalence and correlates of nicotine dependence among adolescents of Burdwan Town, West Bengal.

CONTEXT: Tobacco will cause one billion deaths in the 21st century. The use of tobacco causes dependence both psychological and physical. AIMS: To find out the level of nicotine dependence and it correlates among adolescents. SETTINGS AND DESIGN: A community-based, cross-sectional, observational study was conducted in the Burdwan town, West Bengal, among 1354 adolescent tobacco users. MATERIALS AND METHODS: Data were collected by direct interview using a pretested, predesigned, semistructured schedule containing the Fagerström Test for Nicotine Dependence (FTND) questionnaire. STATISTICAL ANALYSIS: Pearson's Chi-square test, Student's unpaired t-test, one-way analysis of variance, Pearson's product-moment correlation coefficient, and multivariable linear regression were used. All the statistical analyses were performed using SPSS version 19.0. RESULTS: The mean FTND score was significantly higher among adolescents aged >15 years, males, Hindu, tobacco users from joint family, who belonged to lower socioeconomic status, who started using tobacco at the age of 10-12 years, using tobacco for ≥5 years, who were not married, were illiterate, working, and not aware of the injurious effect of tobacco to health. CONCLUSIONS: A suitable individualized approach should be used for those who want to quit tobacco depending on their FTND score.

Tobacco-related morbidity and nicotine dependence: An experience in an urban slum of Burdwan district, West Bengal, India.

Tobacco use causes many diseases irrespective of age and sex. More the addiction, more is the occurrence of morbidity in terms of frequency and severity. This community-based study was conducted to find out any relationship between the morbidity associated with tobacco use and nicotine dependence. In an urban slum - Alamganj, district Burdwan, West Bengal, India, from January to October 2012 among 128 current adult tobacco users using Fagerström test for nicotine dependence (FTND) questionnaire. Tobacco users were maximally suffering from chronic obstructive pulmonary disease (COPD) (27.27%), gastritis (25.45%), and leukoplakia (25.45%). For individual diseases, the difference in FTND score was significantly high in cases of gastritis, hypertension, and COPDs. All types of morbidity were more common in the group of high nicotine dependence. FTND score can be suitably used to assess nicotine dependence of the tobacco users, who can be counseled accordingly to reduce the tobacco-related morbidity and mortality.

A study on association of iron deficiency with attention deficit hyperactivity disorder in a tertiary care center.

BACKGROUND: Iron is important for brain development and cognitive function. Iron deficiency may cause alteration of neurotransmitters and may be manifested by different central nervous system disorders including attention deficit hyperactivity disorder (ADHD). AIMS: As studies are scarce in the Indian context, we had undertaken this study to find out the association between iron deficiency and ADHD. SETTINGS AND DESIGN: Hospital-based cross-sectional study. MATERIALS AND METHODS: Hematological parameters indicating iron status (hemoglobin [Hb], ferritin, Iron, total iron binding capacity [TIBC], mean corpuscular volume [MCV], and mean corpuscular Hb [MCH]) were measured among 119 ADHD patients selected by complete enumeration method and 119 controls. STATISTICAL ANALYSIS: Shapiro-Wilk test, Mann-Whitney U-test, Spearman's correlation, and binary logistic regression were used. P < 0.01 was taken as statistically significant. RESULTS: Hb, iron, ferritin, MCV, and MCH were lower among cases and negatively correlated to ADHD, while reverse is true for TIBC and ADHD. Iron deficiency anemia makes one 3.82 times more prone for ADHD. CONCLUSION: Iron deficiency was associated with ADHD.

Nicotine dependence and its correlates among the adult tobacco users in a slum of Burdwan district, West Bengal, India.

BACKGROUND: Tobacco kills half of its users, with smoking and smokeless tobacco killing nearly 6 million people worldwide - one death every 6 s in each year. Use of tobacco over time causes a physical and psychological addiction due to the presence of nicotine. To find out the level of nicotine dependence among adult (18 years and above) tobacco users and the factors responsible for it. MATERIALS AND METHODS: A cross-sectional community-based study was conducted among 128 current tobacco users in an urban slum of Burdwan District, West Bengal, India. Study tools comprised of predesigned, pretested, semi-structured schedule, containing Fagerström test for nicotine dependence (FTND) questionnaire. Data were collected by interview after getting consent from the participants. Chi-square test, unpaired student t-test, ANOVA, correlation coefficient, and linear regression was calculated. SPSS software (Statistical Package for the Social Sciences Inc, Chicago, IL, USA). was used for analysis. RESULTS: High level of nicotine dependence was maximally seen among increased in age group, prolonged duration of use and daily users. Age, duration of tobacco use and habit of tobacco use had a significant positive correlation with FTND score while starting age of tobacco had a significant negative correlation. Then in multivariable linear regression, starting age of tobacco use, habit of tobacco use and duration of tobacco use emerged as a significant predictor of FTND score and could explain 27.3% of total variation in FTND score. CONCLUSIONS: Suitable plan for quitting may be developed based on the FTND score of an individual, the most important determinant of quitting.

Predictors of quitting behaviour with special reference to nicotine dependence among adult tobacco-users in a slum of Burdwan district, West Bengal, India.

BACKGROUND & OBJECTIVES: Information on predictors of quitting behaviour in adult tobacco users is scarce in Indian context. Hence, this study was undertaken to assess the intention of tobacco-users towards quitting and its predictors with reference to nicotine dependence. METHODS: A community-based observational, cross-sectional study was conducted on 128 adult tobacco-users (89.8% male) with mean age of 41.1 ± 15.7 yr selected by complete enumeration method. Data were collected by interview using pre-designed, pre-tested schedule. Nicotine dependence was assessed by Fagerstrφm Test for Nicotine Dependence (FTND) questionnaire. RESULT: Of the 128 users, 63.3 per cent had intention to quit. Majority of the tobacco users who did not intend to quit belonged to the age group of > 40 yr (66.0%), were illiterate (55.3%), started tobacco use at 11 - 15 yr of age (57.4%), had been using tobacco for 20 yr or more (70.2%), were daily tobacco users (91.5%), and highly dependent on nicotine (80.9%). Tobacco users having high FTND score and who started tobacco use early in life were 1.83 and 3.30 times more unintended to quit, respectively. INTERPRETATION & CONCLUSIONS: Suitable plan for quitting should be developed depending on the FTND score of an individual, the most important determinant of quitting that would be beneficial for categorization of the treatment leading to successful quitting.