RESUMEN
In low-income and middle-income countries, courses of antibiotics are routinely given to term newborns whose mothers had prolonged rupture of membranes (PROM). Rational antibiotic use is vital given rising rates of antimicrobial resistance and potential adverse effects of antibiotic exposure in newborns. However missing cases of sepsis can be life-threatening.This is a quality improvement evaluation of a protocol for minimal or no antibiotics in term babies born after PROM in Papua New Guinea. Asymptomatic, term babies born to women with PROM >12 hours prior to birth were given a stat dose of antibiotics, or no antibiotics if the mother had received intrapartum antibiotics, reviewed and discharged at 48-72 hours with follow-up. Clinical signs of sepsis within the first week and the neonatal period were assessed. Of 170 newborns whose mothers had PROM, 133 were assessed at 7 days: signs of sepsis occurred in 10 babies (7.5%; 95% CI 4.4% to 13.2%) in the first week. Five had isolated fever, four had skin pustules and one had fever with periumbilical erythema. An additional four (3%) had any sign of sepsis between 8 and 28 days. There was one case of bacteraemia and no deaths. 37 were lost to follow-up, but hospital records did not identify any subsequent admissions for infection. A rate of sepsis was documented that was comparable with other studies in low-income countries. This protocol may reduce antimicrobial resistance and consequences of antibiotic exposure in newborns, provided safeguards are in place to monitor for signs of sepsis.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Rotura Prematura de Membranas Fetales/tratamiento farmacológico , Sepsis Neonatal/tratamiento farmacológico , Sepsis Neonatal/prevención & control , Atención Prenatal , Adulto , Amoxicilina/uso terapéutico , Protocolos Clínicos , Países en Desarrollo , Farmacorresistencia Bacteriana , Femenino , Estudios de Seguimiento , Gentamicinas/uso terapéutico , Humanos , Recién Nacido , Inyecciones Intramusculares , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Papúa Nueva Guinea/epidemiología , Embarazo , Estudios Prospectivos , Mejoramiento de la Calidad , Adulto JovenRESUMEN
Fifty children admitted for malnutrition were age matched with 50 admitted for other reasons. These children were more likely to be female (p = 0.003), born low birth weight (p = 0.02), after a short birth interval (p = 0.014) and to be incompletely vaccinated (p < 0.001) than control children, and to be living in rural villages or settlement housing (p < 0.001) with inadequate water supply (p < 0.001) and sanitation (p = 0.037), with overcrowding (p = 0.016) and low household income (p = 0.04). Their parents were more likely to have had no or only rudimentary education than parents of control children [Odds ratio (OR) 3.58 for mothers, 4.12 for fathers]. Parental consumption of alcohol as well as smoking in the mother was more common in the malnourished children. Running water in the house was an independent protective factor (OR 0.23) and the fathers' poor employment status (OR 4.12) an independent risk factor. The solution to malnutrition involves improving community understanding of nutrition and in reducing social inequalities.