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Frantzis I, Levasseur S, Huebner J, Mahida M, Larussa P, James W, Abebe W, Ngwenya C, Mupere E, Rosenthal SL, Patterson J, Johnson J, Strehlau R, Lulseged S, Stanberry LR, Saiman L. Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS). Int J Hyg Environ Health 2024; 259:114357. [PMID: 38564877 PMCID: PMC11163474 DOI: 10.1016/j.ijheh.2024.114357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. METHODS We performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. RESULTS We recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. DISCUSSION This study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.
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Affiliation(s)
- Irene Frantzis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
| | - Stéphanie Levasseur
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jack Huebner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Maitry Mahida
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Larussa
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wilmot James
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Workeabeba Abebe
- Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crispen Ngwenya
- Paediatrics department at Midlands State University faculty of Medicine, Gweru, Zimbabwe
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Janna Patterson
- Global Child Health and Life Support, American Academia of Pediatrics, Itasca, IL, USA
| | - Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renate Strehlau
- VIDA Nkanyezi Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sileshi Lulseged
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Abbaba, Ethiopia
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Johansson MW, Lilliesköld S, Jonas W, Thernström Blomqvist Y, Skiöld B, Linnér A. Early skin-to-skin contact and the risk of intraventricular haemorrhage and sepsis in preterm infants. Acta Paediatr 2024. [PMID: 38803030 DOI: 10.1111/apa.17302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
AIM This study aimed to investigate the risks of intraventricular haemorrhage (IVH) or sepsis in extremely and very preterm infants exposed to early skin-to-skin contact (SSC). METHODS Data from the Swedish Neonatal Quality Register from 2015 to 2021 were extracted to compare the proportions of infants exposed and not exposed to SSC on day 0 and/or 1 in life that developed IVH or sepsis. RESULTS A total of 2514 infants, 1005 extremely preterm and 1509 very preterm, were included. This amounted to 69% of all extremely and very preterm infants born during the study period. The proportion of infants with IVH exposed and not exposed to early SSC was 11% and 27%, an adjusted odds ratio (aOR) of 0.67 (95%CI 0.52-0.86, p = 0.002). The proportion of infants with sepsis exposed and not exposed to early SSC was 16% and 30%, an aOR of 0.94 (95%CI 0.75-1.2, p = 0.60). For extremely preterm infants, the proportion with sepsis when exposed and not exposed to early SSC was 29% and 44%, an aOR of 0.65 (95%CI 0.46-0.92, p = 0.015). CONCLUSION In the current setting, the risk of IVH or sepsis is not increased when an extremely or very preterm infant is exposed to early SSC.
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Affiliation(s)
| | - Siri Lilliesköld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Béatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Agnes Linnér
- Neonatal Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Aneja A, Johnson J, Prochaska EC, Milstone AM. Microbiome dysbiosis: a modifiable state and target to prevent Staphylococcus aureus infections and other diseases in neonates. J Perinatol 2024; 44:125-130. [PMID: 37904005 PMCID: PMC10842217 DOI: 10.1038/s41372-023-01810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023]
Abstract
Bacterial infections present a significant threat to neonates. Increasingly, studies demonstrate associations between human diseases and the microbiota, the communities of microorganisms on or in the body. A "healthy" microbiota with a great diversity and balance of microorganisms can resist harmful pathogens and protect against infections, whereas a microbiota suffering from dysbiosis, can predispose to pathogen colonization and subsequent infection. For decades, strategies such as bacterial interference, decolonization, prebiotics, and probiotics have been tested to reduce Staphylococcus aureus disease and other infections in neonates. More recently, microbiota transplant has emerged as a strategy to broadly correct dysbiosis, promote colonization resistance, and prevent infections. This paper discusses the benefits of a healthy neonate's microbiota, exposures that alter the microbiota, associations of dysbiosis and neonatal disease, strategies to prevent dysbiosis, such as microbiota transplantation, and presents a framework of microbiome manipulation to reduce Staphylococcus aureus (S. aureus) and other infections in neonates.
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Affiliation(s)
- Anushree Aneja
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Johnson
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica C Prochaska
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Klemming S, Lilliesköld S, Arwehed S, Jonas W, Lehtonen L, Westrup B. Mother-newborn couplet care: Nordic country experiences of organization, models and practice. J Perinatol 2023; 43:17-25. [PMID: 38086962 PMCID: PMC10716037 DOI: 10.1038/s41372-023-01812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023]
Abstract
Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized.
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Affiliation(s)
- Stina Klemming
- Lund-Malmö NIDCAP Training and Research Center, Department of Neonatology, Skåne University Hospital, Lund, Sweden.
| | - Siri Lilliesköld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Uppsala University Hospital, Uppsala, Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescence Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Björn Westrup
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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