Effect of a Low-Dose/High-Frequency Training on Real-Life Neonatal Resuscitation in a Low-Resource Setting.

BACKGROUND: As intrapartum-related events represent a quarter of all neonatal deaths, education on neonatal resuscitation is a critical priority. OBJECTIVE: To assess the impact of a low-dose/high-frequency neonatal resuscitation training on clinical practice of midwives in a low-resource setting. METHODS: Eight months after a modified Neonatal Resuscitation Program (NRP) course, we implemented a low-dose/high-frequency training for midwives at Beira Central Hospital, Mozambique. The training lasted 6 months and included weekly practice sessions. Fifty consecutive resuscitations after the low-dose/high-frequency training were compared with those registered before (n = 50) and after (n = 50) participation in the adapted NRP course using video recording. RESULTS: All 150 neonates received the initial steps; 103 required bag-mask ventilation and 41 required chest compressions. The scores for initial steps, bag-mask ventilation and chest compressions improved after the course (p < 0.0001, p = 0.005 and p = 0.03) and did not change after the low-dose/high-frequency training (p = 0.34, p = 0.99 and p = 0.30). The low-dose/high-frequency training decreased the total time of the procedure (p < 0.0001) and anticipated start time of airway suctioning and tactile stimulation (p = 0.003 and p < 0.0001), but had no effect on the time of initiation of bag-mask ventilation (p = 0.30). CONCLUSIONS: In a low- income setting, a low-dose/high-frequency training after participation in an adapted NRP course contributed to improving the initiation and times of some procedures. However, many aspects of neonatal resuscitation remained poor. Low-dose/high-frequency training should focus on improving the prevention of thermal loss, face mask ventilation and heart rate assessment.

Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

BACKGROUND: We assessed the effect of an adapted neonatal resuscitation program (NRP) course on healthcare providers' performances in a low-resource setting through the use of video recording. METHODS: A video recorder, mounted to the radiant warmers in the delivery rooms at Beira Central Hospital, Mozambique, was used to record all resuscitations. One-hundred resuscitations (50 before and 50 after participation in an adapted NRP course) were collected and assessed based on a previously published score. RESULTS: All 100 neonates received initial steps; from these, 77 and 32 needed bag-mask ventilation (BMV) and chest compressions (CC), respectively. There was a significant improvement in resuscitation scores in all levels of resuscitation from before to after the course: for "initial steps", the score increased from 33% (IQR 28-39) to 44% (IQR 39-56), p<0.0001; for BMV, from 20% (20-40) to 40% (40-60), p = 0.001; and for CC, from 0% (0-10) to 20% (0-50), p = 0.01. Times of resuscitative interventions after the course were improved in comparison to those obtained before the course, but remained non-compliant with the recommended algorithm. CONCLUSIONS: Although resuscitations remained below the recommended standards in terms of quality and time of execution, clinical practice of healthcare providers improved after participation in an adapted NRP course. Video recording was well-accepted by the staff, useful for objective assessment of performance during resuscitation, and can be used as an educational tool in a low-resource setting.

D-dimer evaluation of hemorrhagic orbital lymphangioma.

An 8-year-old boy with recurrent acute bleeding of lymphangioma of the left orbit is described. D-dimer levels increased as the size of the mass became stable, showing the effect of fibrinolysis within the hemorrhagic mass after clotting. D-dimer levels confirmed the possible use of conservative management of this lymphangioma.

Association between drug and vaccine use and acute immune thrombocytopenia in childhood: a case-control study in Italy.

Immune thrombocytopenic purpura (ITP) is an immunomediated disease characterized by a decrease in platelet count and, in its more severe forms, by bleeding symptoms. Many drugs have been implicated in the pathogenesis of drug-induced thrombocytopenia in adults; only limited data on drug-related ITP in children have been published. Our study was set up to evaluate the consistency of the association between drug and vaccine use and ITP in children. This study is part of an Italian multicentre study on adverse drug reactions in children, coordinated by the Italian National Institute of Health, which was started in November 1999 and is ongoing. The study was conducted by enrolling all children aged more than 1 month who were hospitalized through the paediatric emergency department for the following conditions: thrombocytopenia (platelet count <100 x 103/L); acute neurological disorders; non-infectious mucocutaneous diseases and vasculitis; and endoscopically confirmed gastroduodenal lesions and/or clinically defined haematemesis and melaena. Children with chronic pathologies or concomitant diagnoses of cancer or immunodeficiency were not included in our study. During hospital admission, a physician interviewed parents using a structured questionnaire. The main aim of the interview was to collect information on drug exposure in a time period of 3 weeks and vaccine exposure in a period of 6 weeks preceding hospitalization. Using a case-control study design, exposure of children with thrombocytopenia (cases) to drugs and vaccines was compared with similar exposure of children with gastroduodenal lesions and neurological disorders (controls); this allowed us to estimate the odds ratios (ORs) of the occurrence of thrombocytopenia associated with the use of drugs or vaccines. Up to December 2007, the study population included 387 cases of thrombocytopenia and 1924 controls. Despite the low platelet count, ITP was generally a mild disease, without serious bleeding in the majority of cases and associated with a short length of hospital stay. After adjusting for concurrent use of other drugs, use of the antibacterials was associated with a more than 2-fold increase in the risk of developing ITP (OR 2.4; 95% CI 1.8, 3.1). Mucolytics and NSAIDs were associated with an OR of 1.9; 95% CI 1.2, 2.9 and 1.5; 95% CI 1.0, 2.1 respectively, while paracetamol (acetaminophen) was associated with an OR of 1.5; 95% CI 1.2, 2.0. MMR vaccination was associated with an increased risk of developing ITP (OR 2.4; 95% CI 1.2, 4.7). The results of this study provide evidence for an association between ITP and exposure to selected antibacterials, NSAIDs, paracetamol, mucolytics and MMR vaccination.