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Article ; Online: Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019)

Tanusha D. Ramdin / Vindana Chibabhai / Robin T. Saggers / Rossella M. Bandini / Daynia E. Ballot

Clinical Epidemiology and Global Health, Vol 20, Iss , Pp 101247- (2023)

2023

Abstract: Introduction: Candidaemia is a significant problem in neonatal units and is associated with high morbidity, including long-term neurodevelopmental impairment in survivors, and high mortality of very low birth weight infants (VLBWI). Method: A ... ...

Abstract	Introduction: Candidaemia is a significant problem in neonatal units and is associated with high morbidity, including long-term neurodevelopmental impairment in survivors, and high mortality of very low birth weight infants (VLBWI). Method: A retrospective cohort study amongst VLBWI admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa, from 1 January 2013 to 31 December 2019. All VLBWI were born at the hospital or transferred to the neonatal unit from birth to day 28 of life with blood culture confirmed candidaemia. Results: During the study period, 3414 VLBWI were admitted to the unit. Of these, 5.12% (n = 176) developed culture confirmed candidaemia. The incidence was 5.1 per 1000 admissions. The most common species, which persisted throughout the study period, was Candida parapsilosis, followed by Candida albicans. C. parapsilosis peaked in 2018 while C. albicans peaked in 2015. Emergence of C. auris occurred in 2019. Important risk factors associated with the development of candidaemia included necrotizing enterocolitis (p < 0.001, OR 4.63 [3.29–6.54]), surgery (p < 0.001 OR 7.02 [4.48–11.12]), conventional ventilation (p < 0.001, OR 6.23 [4.48–8.68]), patent ductus arteriosus (p < 0.001, OR 3.81 [2.67–5.44]), intraventricular haemorrhage (p < 0.001, OR 3.32 [2.99–5.44]) and prolonged hospital stay (p < 0.001). Mortality was not statistically different (p = 0.80 OR 0.95[0.68–1.31]) between the two groups. Conclusion: There is a high incidence of candidaemia in the neonatal unit. Several modifiable risk factors including improved antifungal stewardship and prevention of candidaemia with oral or systemic antifungal prophylaxis may decrease the incidence of candidaemia, and associated morbidity.
Keywords	Candidaemia ; Very low birth weight ; Low middle-income country setting ; Modifiable ; Risk factors ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Factors influencing survival and short-term outcomes of very low birth weight infants in a tertiary hospital in Johannesburg.

Ingemyr, Kristin / Elfvin, Anders / Hentz, Elisabet / Saggers, Robin T / Ballot, Daynia E

Frontiers in pediatrics

2022 Volume 10, Page(s) 930338

Abstract: Background: The neonatal mortality rate in South Africa is lower than the global average, but still approximately five times higher than some European and Scandinavian countries. Prematurity, and its complications, is the main cause (35%) of neonatal ... ...

Abstract	Background: The neonatal mortality rate in South Africa is lower than the global average, but still approximately five times higher than some European and Scandinavian countries. Prematurity, and its complications, is the main cause (35%) of neonatal deaths. Objective: To review the maternal, delivery period and infant characteristics in relation to mortality in very low birth weight (VLBW) infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This was a retrospective descriptive study of VLBW infants admitted to CMJAH between 1 January 2017 and 31 December 2018. All infants with a birth weight between 500 to ≤ 1,500 grams were included. The characteristics and survival of these infants were described using univariate analysis. Results: Overall survival was 66.5%. Provision of antenatal steroids, antenatal care, Cesarean section, female sex, resuscitation at birth, and 5-min Apgar score more than five was related with better survival to discharge. Among respiratory diagnoses, 82.8% were diagnosed with RDS, 70.8% received surfactant therapy and 90.7% received non-invasive respiratory support after resuscitation. At discharge, 59.5% of the mothers were breastfeeding and 30.8% spent time in kangaroo mother care. Conclusion: The two-thirds survival rate of VLBW infants is similar to those in other developing countries but still remains lower than developed countries. This may be improved with better antenatal care attendance, coverage of antenatal steroids, temperature control after birth, improving infection prevention and control practices, breastfeeding rates and kangaroo mother care. The survival rate was lowest amongst extremely low birth weight (ELBW) infants.
Language	English
Publishing date	2022-09-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2022.930338
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Article ; Online: The effects of exposure to HIV in neonates at a referral hospital in South Africa.

Mellqvist, Helena / Saggers, Robin T / Elfvin, Anders / Hentz, Elisabet / Ballot, Daynia E

BMC pediatrics

2021 Volume 21, Issue 1, Page(s) 485

Abstract: Background: Fewer infants are infected with HIV through mother-to-child transmission, making HIV-exposed but uninfected (HEU) infants a growing population. HIV-exposure seems to affect immunology, early growth and development, and is associated with ... ...

Abstract	Background: Fewer infants are infected with HIV through mother-to-child transmission, making HIV-exposed but uninfected (HEU) infants a growing population. HIV-exposure seems to affect immunology, early growth and development, and is associated with higher morbidity and mortality rates. Currently, there is a lack of information regarding the clinical effects of HIV-exposure during the neonatal period. Objectives: To identify a possible difference in mortality and common neonatal morbidities in HEU neonates compared to HIV-unexposed neonates. Methods: This was a retrospective, descriptive study of all neonates admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital between 1 January 2017 and 31 December 2018. HEU neonates were compared to HIV-unexposed neonates. Results: There were 3236 neonates included, where 855 neonates were HEU. The HEU neonates had significantly lower birth weight and gestational age. The HEU neonates had higher rates of neonatal sepsis (19.8% vs 14.2%, OR 1.49, p < 0.001), specifically for late onset sepsis, and required more respiratory support. NCPAP and invasive ventilation was more common in the HEU group (36.3% vs 31.3% required NCPAP, p = 0.008, and 20.1% vs 15,0% required invasive ventilation, p < 0.001). Chronic lung disease was more common among HIV-exposed neonates (12.2% vs 8.7%, OR 1.46, p = 0.003). The difference in mortality rates between the study groups was not significant (10.8% of HEU neonates and 13.3% of HIV-unexposed). Conclusions: HEU neonates had higher rates of neonatal sepsis, particularly late-onset sepsis, required more respiratory support and had higher rates of chronic lung disease. Mortality of HEU neonates was not different HIV-unexposed neonates.
MeSH term(s)	Female ; HIV Infections/epidemiology ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Prospective Studies ; Referral and Consultation ; Retrospective Studies ; South Africa/epidemiology
Language	English
Publishing date	2021-11-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041342-7
ISSN	1471-2431 ; 1471-2431
ISSN (online)	1471-2431
ISSN	1471-2431
DOI	10.1186/s12887-021-02969-6
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Article: Neurodevelopmental Outcomes of Extremely Low Birth Weight Survivors in Johannesburg, South Africa.

Ramdin, Tanusha D / Saggers, Robin T / Bandini, Rossella M / Magadla, Yoliswa / Mphaphuli, Aripfani V / Ballot, Daynia E

Frontiers in pediatrics

2022 Volume 10, Page(s) 902263

Abstract: Background: Improved survival in extremely low birth weight infants (ELBWI) in Sub-Saharan Africa has raised the question whether these survivors have an increased chance of adverse neurodevelopmental outcomes.: Objectives: To describe ... ...

Abstract	Background: Improved survival in extremely low birth weight infants (ELBWI) in Sub-Saharan Africa has raised the question whether these survivors have an increased chance of adverse neurodevelopmental outcomes. Objectives: To describe neurodevelopmental outcomes of ELBWI in a neonatal unit in South Africa. Methods: This was a prospective follow-up study. All ELBWI who survived to discharge between 1 July 2013 and 31 December 2017 were invited to attend the clinic. Bayley Scales of Infant and Toddler Development (version III) were conducted at 9 to 12 months and 18 to 24 months. Results: There were 723 ELBWI admissions during the study period, 292 (40.4%) survived to hospital discharge and 85/292 (29.1%) attended the neonatal follow up clinic. The mean birth weight was 857.7 g (95% CI: 838.2-877.2) and the mean gestational age was 27.5 weeks (95% CI 27.1-27.9). None of the infants had any major complication of prematurity. A total of 76/85 (89.4%) of the infants had a Bayley-III assessment at a mean corrected age of 17.21 months (95% CI: 16.2-18.3). The mean composite scores for cognition were 98.4 (95% CI 95.1-101.7), language 89.9 (95% CI 87.3-92.5) and motor 97.6 (95% CI 94.5-100.6). All mean scores fell within the normal range, The study found 28 (36.8%) infants to be " Conclusion: Our study demonstrates good neurodevelopmental outcome in a small group of surviving ELBWI, but these results must be interpreted in the context of the high mortality in this group of infants.
Language	English
Publishing date	2022-05-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2022.902263
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Article ; Online: COVID-19 Preparedness in a Neonatal Unit at a Tertiary Hospital in Johannesburg, South Africa

Saggers, Robin T. / Ramdin, Tanusha D. / Bandini, Rossella M. / Ballot, Daynia E.

Abstract: Background: The novel coronavirus disease 2019 (COVID-19) pandemic has spread to South Africa and poses an infection risk in pregnant women and their newborns, as well as health-care workers and other patients. Objective: To discuss the implementation of ...

Abstract	Background: The novel coronavirus disease 2019 (COVID-19) pandemic has spread to South Africa and poses an infection risk in pregnant women and their newborns, as well as health-care workers and other patients. Objective: To discuss the implementation of international and local recommendations, and any additional actions undertaken at our Neonatal Unit in order to prepare for COVID-19. Discussion: Standard precautions in order to prepare a facility and its personnel to safely care for COVID-19 patients as outlined by the World Health Organization procedures have been implemented. Further actions undertaken in our Neonatal Unit included the creation of standard operating procedures, increased communication between neonatal and obstetric teams, limiting staff exposure, the creation of disposable resuscitation boxes to attend deliveries, reallocation of a triage area in the high care ward to an isolation area for sick newborns of suspected or confirmed maternal COVID-19 cases, staff training on personal protective equipment procedures and initiation of an online resources portal for neonatal staff. Conclusion: A rational approach to suspected cases and infection control in-line with local and international guidelines as well as ongoing education should diminish anxiety amongst health-care professionals and provide the best possible care to patients. South Africa is a low-to-middle income country, and the lack of resources available means we cannot increase our capacity, staffing numbers or available equipment. Yet, we must be as prepared, adaptable and efficient as possible to maximize the resources and equipment we have available to us.
Keywords	covid19
Publisher	PMC
Document type	Article ; Online
DOI	10.18772/26180197.2020.v2nsia8
Database	COVID19

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Article ; Online: Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey.

Etti, Melanie / Alger, Jackeline / Salas, Sofía P / Saggers, Robin / Ramdin, Tanusha / Endler, Margit / Gemzell-Danielsson, Kristina / Alfvén, Tobias / Ahmed, Yusuf / Callejas, Allison / Eskenazi, Deborah / Khalil, Asma / Le Doare, Kirsty

PloS one

2021 Volume 16, Issue 9, Page(s) e0257516

Abstract: Background: The World Health Organization's "Coordinated Global Research Roadmap: 2019 Novel Coronavirus" outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported ... ...

Abstract	Background: The World Health Organization's "Coordinated Global Research Roadmap: 2019 Novel Coronavirus" outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID-19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health. Method: This project was undertaken using a modified Delphi method. An electronic questionnaire was disseminated to clinicians and researchers in three different languages (English, French and Spanish) via MNCH WG affiliated networks. Respondents were asked to select the five most urgent research priorities among a list of 17 identified by the MNCH WG. Analysis of questionnaire data was undertaken to identify key similarities and differences among respondents according to questionnaire language, location and specialty. Following elimination of the seven lowest ranking priorities, the questionnaire was recirculated to the original pool of respondents. Thematic analysis of final questionnaire data was undertaken by the MNCH WG from which four priority research themes emerged. Results: Questionnaire 1 was completed by 225 respondents from 29 countries. Questionnaire 2 was returned by 49 respondents. The four priority research themes which emerged from the analysis were 1) access to healthcare during the COVID-19 pandemic, 2) the direct and 3) indirect effects of COVID-19 on pregnant and breastfeeding women and children and 4) the transmission of COVID-19 and protection from infection. Conclusion: The results of these questionnaires indicated a high level of concordance among continents and specialties regarding priority research themes. This prioritized list of research uncertainties, developed to specifically highlight the most urgent clinical needs as perceived by healthcare professionals and researchers, could help funding organizations and researchers to answer the most pressing questions for clinicians and public health professionals during the pandemic. It is hoped that these identified priority research themes can help focus the discussion regarding the allocation of limited resources to enhance COVID-19 research in MNCH globally.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Child ; Child Health ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Maternal Health ; Pandemics ; Pregnancy ; Reproductive Health ; SARS-CoV-2
Language	English
Publishing date	2021-09-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0257516
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Global research priorities for COVID-19 in maternal, reproductive and child health: results of an international survey

Etti, Melanie / Alger, Jackeline / Salas, Sofia P / Saggers, Robin / Ramdin, Tanusha / Endler, Margit / Gemzell-Danielsson, Kristina / Alfven, Tobias / Ahmed, Yusuf / Callejas, Allison / Eskenazi, Deborah / Khalil, Asma / Le Doare, Kirsty

medRxiv

Abstract: Background The World Health Organization′s ″Coordinated Global Research Roadmap: 2019 Novel Coronavirus″ outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported ... ...

Abstract	Background The World Health Organization′s ″Coordinated Global Research Roadmap: 2019 Novel Coronavirus″ outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case, significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID-19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health. Method This project was undertaken using a modified Delphi method. An electronic questionnaire was disseminated to clinicians and researchers in three different languages (English, French and Spanish) via MNCH WG affiliated networks. Respondents were asked to select the five most urgent research priorities among a list of 17 identified by the MNCH WG. Analysis of questionnaire data was undertaken to identify key similarities and differences among respondents according to questionnaire language, location and specialty. Following elimination of the seven lowest ranking priorities, the questionnaire was recirculated to the original pool of respondents. Thematic analysis of final questionnaire data was undertaken by the MNCH WG from which four priority research themes emerged. Results Questionnaire 1 was completed by 225 respondents from 29 countries. Questionnaire 2 was returned by 49 respondents. The four priority research themes were 1) access to healthcare during the COVID-19 pandemic, 2) the direct and 3) indirect effects of COVID-19 on pregnant and breastfeeding women and children and 4) the transmission of COVID-19 and protection from infection. Conclusion The results of these questionnaires indicated a high level of concordance among continents and specialties regarding priority research themes. This prioritized list of research uncertainties, developed to specifically highlight the most urgent clinical needs as perceived by healthcare professionals and researchers, could help funding organizations and researchers to answer the most pressing questions for clinicians and public health professionals during the pandemic. It is hoped that these identified priority research themes can help focus the discussion regarding the allocation of limited resources to enhance COVID-19 research in MNCH globally.
Keywords	covid19
Language	English
Publishing date	2021-07-15
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.07.13.21260207
Database	COVID19

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Article ; Online: Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS).

Russell, Neal J / Stöhr, Wolfgang / Plakkal, Nishad / Cook, Aislinn / Berkley, James A / Adhisivam, Bethou / Agarwal, Ramesh / Ahmed, Nawshad Uddin / Balasegaram, Manica / Ballot, Daynia / Bekker, Adrie / Berezin, Eitan Naaman / Bilardi, Davide / Boonkasidecha, Suppawat / Carvalheiro, Cristina G / Chami, Neema / Chaurasia, Suman / Chiurchiu, Sara / Colas, Viviane Rinaldi Favarin /

Cousens, Simon / Cressey, Tim R / de Assis, Ana Carolina Dantas / Dien, Tran Minh / Ding, Yijun / Dung, Nguyen Trong / Dong, Han / Dramowski, Angela / Ds, Madhusudhan / Dudeja, Ajay / Feng, Jinxing / Glupczynski, Youri / Goel, Srishti / Goossens, Herman / Hao, Doan Thi Huong / Khan, Mahmudul Islam / Huertas, Tatiana Munera / Islam, Mohammad Shahidul / Jarovsky, Daniel / Khavessian, Nathalie / Khorana, Meera / Kontou, Angeliki / Kostyanev, Tomislav / Laoyookhon, Premsak / Lochindarat, Sorasak / Larsson, Mattias / Luca, Maia De / Malhotra-Kumar, Surbhi / Mondal, Nivedita / Mundhra, Nitu / Musoke, Philippa / Mussi-Pinhata, Marisa M / Nanavati, Ruchi / Nakwa, Firdose / Nangia, Sushma / Nankunda, Jolly / Nardone, Alessandra / Nyaoke, Borna / Obiero, Christina W / Owor, Maxensia / Ping, Wang / Preedisripipat, Kanchana / Qazi, Shamim / Qi, Lifeng / Ramdin, Tanusha / Riddell, Amy / Romani, Lorenza / Roysuwan, Praewpan / Saggers, Robin / Roilides, Emmanuel / Saha, Samir K / Sarafidis, Kosmas / Tusubira, Valerie / Thomas, Reenu / Velaphi, Sithembiso / Vilken, Tuba / Wang, Xiaojiao / Wang, Yajuan / Yang, Yonghong / Zunjie, Liu / Ellis, Sally / Bielicki, Julia A / Walker, A Sarah / Heath, Paul T / Sharland, Mike

PLoS medicine

2023 Volume 20, Issue 6, Page(s) e1004179

Abstract: Background: There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting ...

Abstract	Background: There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. Methods and findings: Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa). Prospective daily observational data was collected on clinical signs, supportive care, antibiotic treatment, microbiology, and 28-day mortality. Two prediction models were developed for (1) 28-day mortality from baseline variables (baseline NeoSep Severity Score); and (2) daily risk of death on IV antibiotics from daily updated assessments (NeoSep Recovery Score). Multivariable Cox regression models included a randomly selected 85% of infants, with 15% for validation. A total of 3,204 infants were enrolled, with median birth weight of 2,500 g (IQR 1,400 to 3,000) and postnatal age of 5 days (IQR 1 to 15). 206 different empiric antibiotic combinations were started in 3,141 infants, which were structured into 5 groups based on the World Health Organization (WHO) AWaRe classification. Approximately 25.9% (n = 814) of infants started WHO first line regimens (Group 1-Access) and 13.8% (n = 432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2-"Low" Watch). The largest group (34.0%, n = 1,068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3-"Medium" Watch), 18.0% (n = 566) started a carbapenem (Group 4-"High" Watch), and 1.8% (n = 57) a Reserve antibiotic (Group 5, largely colistin-based), and 728/2,880 (25.3%) of initial regimens in Groups 1 to 4 were escalated, mainly to carbapenems, usually for clinical deterioration (n = 480; 65.9%). A total of 564/3,195 infants (17.7%) were blood culture pathogen positive, of whom 62.9% (n = 355) had a gram-negative organism, predominantly Klebsiella pneumoniae (n = 132) or Acinetobacter spp. (n = 72). Both were commonly resistant to WHO-recommended regimens and to carbapenems in 43 (32.6%) and 50 (71.4%) of cases, respectively. MRSA accounted for 33 (61.1%) of 54 Staphylococcus aureus isolates. Overall, 350/3,204 infants died (11.3%; 95% CI 10.2% to 12.5%), 17.7% if blood cultures were positive for pathogens (95% CI 14.7% to 21.1%, n = 99/564). A baseline NeoSep Severity Score had a C-index of 0.76 (0.69 to 0.82) in the validation sample, with mortality of 1.6% (3/189; 95% CI: 0.5% to 4.6%), 11.0% (27/245; 7.7% to 15.6%), and 27.3% (12/44; 16.3% to 41.8%) in low (score 0 to 4), medium (5 to 8), and high (9 to 16) risk groups, respectively, with similar performance across subgroups. A related NeoSep Recovery Score had an area under the receiver operating curve for predicting death the next day between 0.8 and 0.9 over the first week. There was significant variation in outcomes between sites and external validation would strengthen score applicability. Conclusion: Antibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis. Trial registration: ClinicalTrials.gov, (NCT03721302).
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Anti-Bacterial Agents/therapeutic use ; Neonatal Sepsis/diagnosis ; Neonatal Sepsis/drug therapy ; Prospective Studies ; Sepsis/diagnosis ; Sepsis/drug therapy ; Sepsis/microbiology ; Cohort Studies ; Carbapenems/therapeutic use
Chemical Substances	Anti-Bacterial Agents ; Carbapenems
Language	English
Publishing date	2023-06-08
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2185925-5
ISSN	1549-1676 ; 1549-1277
ISSN (online)	1549-1676
ISSN	1549-1277
DOI	10.1371/journal.pmed.1004179
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis

Neal J. Russell / Wolfgang Stöhr / Nishad Plakkal / Aislinn Cook / James A. Berkley / Bethou Adhisivam / Ramesh Agarwal / Nawshad Uddin Ahmed / Manica Balasegaram / Daynia Ballot / Adrie Bekker / Eitan Naaman Berezin / Davide Bilardi / Suppawat Boonkasidecha / Cristina G. Carvalheiro / Neema Chami / Suman Chaurasia / Sara Chiurchiu / Viviane Rinaldi Favarin Colas /

Simon Cousens / Tim R. Cressey / Ana Carolina Dantas de Assis / Tran Minh Dien / Yijun Ding / Nguyen Trong Dung / Han Dong / Angela Dramowski / Madhusudhan DS / Ajay Dudeja / Jinxing Feng / Youri Glupczynski / Srishti Goel / Herman Goossens / Doan Thi Huong Hao / Mahmudul Islam Khan / Tatiana Munera Huertas / Mohammad Shahidul Islam / Daniel Jarovsky / Nathalie Khavessian / Meera Khorana / Angeliki Kontou / Tomislav Kostyanev / Premsak Laoyookhon / Sorasak Lochindarat / Mattias Larsson / Maia De Luca / Surbhi Malhotra-Kumar / Nivedita Mondal / Nitu Mundhra / Philippa Musoke / Marisa M. Mussi-Pinhata / Ruchi Nanavati / Firdose Nakwa / Sushma Nangia / Jolly Nankunda / Alessandra Nardone / Borna Nyaoke / Christina W. Obiero / Maxensia Owor / Wang Ping / Kanchana Preedisripipat / Shamim Qazi / Lifeng Qi / Tanusha Ramdin / Amy Riddell / Lorenza Romani / Praewpan Roysuwan / Robin Saggers / Emmanuel Roilides / Samir K. Saha / Kosmas Sarafidis / Valerie Tusubira / Reenu Thomas / Sithembiso Velaphi / Tuba Vilken / Xiaojiao Wang / Yajuan Wang / Yonghong Yang / Liu Zunjie / Sally Ellis / Julia A. Bielicki / A. Sarah Walker / Paul T. Heath / Mike Sharland

PLoS Medicine, Vol 20, Iss

A global neonatal sepsis observational cohort study (NeoOBS)

2023 Volume 6

Abstract: Background There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting ... ...

Abstract	Background There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. Methods and findings Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa). Prospective daily observational data was collected on clinical signs, supportive care, antibiotic treatment, microbiology, and 28-day mortality. Two prediction models were developed for (1) 28-day mortality from baseline variables (baseline NeoSep Severity Score); and (2) daily risk of death on IV antibiotics from daily updated assessments (NeoSep Recovery Score). Multivariable Cox regression models included a randomly selected 85% of infants, with 15% for validation. A total of 3,204 infants were enrolled, with median birth weight of 2,500 g (IQR 1,400 to 3,000) and postnatal age of 5 days (IQR 1 to 15). 206 different empiric antibiotic combinations were started in 3,141 infants, which were structured into 5 groups based on the World Health Organization (WHO) AWaRe classification. Approximately 25.9% (n = 814) of infants started WHO first line regimens (Group 1—Access) and 13.8% (n = 432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2—“Low” Watch). The largest group (34.0%, n = 1,068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3—“Medium” Watch), 18.0% (n = 566) started a carbapenem (Group 4—“High” Watch), and 1.8% (n = 57) a Reserve antibiotic (Group 5, largely colistin-based), and 728/2,880 (25.3%) of initial regimens in Groups 1 to 4 were escalated, mainly to carbapenems, usually for clinical deterioration (n = 480; 65.9%). A total of 564/3,195 infants (17.7%) were blood culture ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019)

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Article: Factors influencing survival and short-term outcomes of very low birth weight infants in a tertiary hospital in Johannesburg.

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Article ; Online: The effects of exposure to HIV in neonates at a referral hospital in South Africa.

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Article: Neurodevelopmental Outcomes of Extremely Low Birth Weight Survivors in Johannesburg, South Africa.

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Article ; Online: COVID-19 Preparedness in a Neonatal Unit at a Tertiary Hospital in Johannesburg, South Africa

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Article ; Online: Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey.

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Article ; Online: Global research priorities for COVID-19 in maternal, reproductive and child health: results of an international survey

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Article ; Online: Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS).

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Article ; Online: Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis

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Inter-library loan at ZB MED