Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting.

BACKGROUND: Late-onset neonatal sepsis (LONS) is a significant contributor to morbidity and mortality in very low birthweight (VLBW) neonates with indwelling central lines. Compliance to central line care bundles is suboptimal in low-and-middle-income country settings. Point of care quality improvement (POCQI) method may be used to improve the compliance gap. We used the POCQI method to achieve an improvement in compliance to central line care bundles with an aim to reduce LONS in a subset of VLBW neonates. METHODS: A pre and post-intervention study consisting of three phases was conducted in a tertiary care neonatal intensive care unit. A root-cause analysis was undertaken to find the causes of LONS in VLBW babies with central lines. Multiple change ideas were identified and tested using sequential Plan-Do-Study-Act (PDSA) cycles to address the issue of reduced compliance to the central line care bundles. The change ideas tested in PDSA cycles which were successful were adopted. Compliance to the insertion and maintenance bundles was measured as process indicators. LONS, central line associated bloodstream infections and all-cause mortality rates were measured as outcome indicators. RESULTS: A total of 10 PDSA cycles testing multiple change ideas (staff education, audio-visual aids, supply issues) were undertaken during the study duration. Bundles were not being used in the study setting prior to the initiation of the study. Insertion bundle compliance was above 90% and maintenance bundle compliance increased from 23.3% to 42.2% during the intervention and sustenance phases, respectively. A 43.3% statistically significant reduction in LONS rates was achieved at the end of the study. No effect on mortality was seen. CONCLUSION: POCQI method can be used to improve compliance to central line care bundles which can lead to a reduction of LONS in VLBW neonates with central lines in situ.

Therapeutic effect of vitamin D in acute lower respiratory infection: A randomized controlled trial.

OBJECTIVES: To study the effect of vitamin D supplementation on the outcome of acute lower respiratory infection in hospitalized children. STUDY DESIGN: This is an open label parallel group randomized trial. Total of 154 children aged 2 mo-5 yrs (mean age 13 mo) admitted with acute lower respiratory infection (ALRI) were randomized to receive standard care therapy alone or standard care therapy for the respiratory infection along with a single oral dose of 100,000 IU of vitamin D3. Serum 25(OH)D levels were measured at admission in all the children and 72 h after administration of vitamin D in the supplemented group. Primary outcome measured was the duration of hospital stay. Secondary outcomes measured were mortality, incidence of complications, admission to PICU and recurrence of respiratory infections within 90 days of discharge. Primary outcome was compared using Mann Whitney U test and secondary outcomes were compared using chi-square or Fischer's exact test. RESULTS: Baseline characteristics were comparable between the two groups. There was no statistically significant difference in the primary outcome (Median duration of hospital stay in both the groups) and also in secondary outcomes (mortality, PICU admission, complications and recurrence of respiratory infections within 90 days of discharge). CONCLUSION: Single oral dose of 100,000 IU of vitamin D3 did not lead to reduction in duration of hospital stay, mortality, PICU admission or complications related to ALRI when compared to standard therapy alone in under five children hospitalized with ALRI but was able to achieve serum vitamin D sufficiency within 72 h of administration. Registered under clinical trial Registry of India Identifier no: CTRI/2014/09/005032.