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Medical Education Journal of Tropical Pediatrics - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div>To assess the knowledge of health workers on neonatal management, describe neonatal care in the first 2 h of life, and health outcomes of neonates in Tanzania. A prospective cohort study was performed from January to April 2022 at a district hospital on Pemba Island, Tanzania. Women admitted in active labor, and their neonates were eligible for inclusion. Standardized observations in the first 2 h after birth, followed by a clinical examination, and interviews on days 7 and 28 were performed. Health workers were given multiple-choice questions on neonatal management. Immediate skin-to-skin care was performed in 23% of neonates and breastfeeding was initiated during the first hour of life in 46%. At 2 h of life, 10% had blood glucose <2.5 mmol/L (mean: 3.71, SD 1.1), 44.6% had hypothermia with temperature <36.5°C (mean: 36.5, SD 0.5), and 2% low saturation <90%. Health workers had on average 42% correct answers on “neonatal management”. The neonatal mortality rate (NMR) corresponds to 23 per 1000 livebirths. Considerable challenges in neonatal care were identified, including low-cost, high-impact interventions such as skin-to-skin care and immediate breastfeeding. The NMR was above the Sustainable Development Goal target. Further research is needed to assess the impact of training on neonatal care and outcomes in this and similar settings.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Failure to thrive (FTT) is a commonly used term in pediatric clinical practice, referring to a significant deviation from normal growth patterns. It can have multiple adverse effects on a child, including developmental delays, intellectual deficits, and insecure attachment. Inadequate nutritional intake is the most frequent underlying cause. This study aims to identify the risk factors contributing to FTT in infants in a rural North Indian setting. A case–control study was conducted on infants aged 2–12 months admitted to the pediatric ward of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. Detailed histories, clinical examinations, and relevant laboratory investigations were performed for all enrolled patients. Among the 456 study participants, 152 infants (33.33%) were diagnosed with FTT. The majority of cases (92.1%) were from rural areas. Multivariate regression analysis identified key independent risk factors for FTT, including rural residence, incomplete or lack of immunization, absence of exclusive breastfeeding, and lack of timely complementary feeding. This study underscores the significant role of rural residency, inadequate immunization, absence of exclusive breastfeeding, and delayed complementary feeding in increasing the risk of FTT among infants aged 2–12 months in rural North India. Early identification of these risk factors, timely diagnosis, and appropriate interventions are crucial for improving child health outcomes. It will also help in the efficient allocation of healthcare resources.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>This study aims to evaluate the efficacy of minimally invasive surfactant therapy (MIST) combined with nasal intermittent positive pressure ventilation (NIPPV) in treating neonatal respiratory distress syndrome (NRDS). The intubation-surfactant-extubation (INSURE) + NIPPV group [receiving INSURE combined with NIPPV] and NIPPV + MIST group (receiving NIPPV combined with MIST) were established. Total administration time, duration of noninvasive ventilation, rate of invasive ventilation after noninvasive ventilation failure, pulmonary surfactant (PS) dosage, length of hospital stay, re-administration of PS, blood gas parameters, serological markers, and complication incidence were assessed between both groups. The NIPPV + MIST group demonstrated a shorter total administration time, lower rate of invasive ventilation support, shorter duration of noninvasive ventilation, reduced hospital stay, and fewer cases requiring re-administration of PS than the INSURE + NIPPV group. After 48 h of treatment, compared to the INSURE + NIPPV group, the NIPPV + MIST group showed higher arterial partial pressure of oxygen, oxygenation index, and interleukin-4 (IL-4) levels, lower partial pressure of carbon dioxide, fraction of inspired oxygen, interferon-gamma (IFN-γ), and IFN-γ/IL-4 ratio, and lower bronchopulmonary dysplasia incidences, vocal cord injury, and laryngeal edema (all <span style="font-style:italic;">P</span> < .05). No significant differences were found in PS dosage, oxygen desaturation, bradycardia, nasal injury, air leak, intraventricular hemorrhage ≥ Grade II, or necrotizing enterocolitis (<span style="font-style:italic;">P </span>><span style="font-style:italic;"> </span>.05). MIST combined with NIPPV is effective in treating NRDS by improving ventilation and spontaneous breathing, regulating the Th1/Th2 immune balance, inhibiting pulmonary inflammation, reducing lung injury, and minimizing damage from invasive procedures.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>India is an endemic country for scrub typhus, a common rickettsial infection caused by <span style="font-style:italic;">Orientia tsutsugamushi</span> contracted through the bite of infected mites. Though relatively common in the pediatric population, early diagnosis sometimes becomes difficult due to its atypical presentation. We reported five febrile children who had varied presentations like convulsion, jaundice, generalized edema, or features like Kawasaki disease, and only one had pathognomonic eschar. They were diagnosed with acute disseminated encephalomyelitis, nephrotic syndrome, hepatitis, or Kawasaki phenotype hyperinflammatory syndrome along with positive scrub typhus IgM in all cases. They recovered with doxycycline and other disease-specific treatments like intravenous methylprednisolone, immunoglobulin, and oral prednisolone. All of them were discharged in stable condition. The variety and rarity of some presentations of pediatric scrub typhus should prompt pediatricians to have a high index of suspicion for scrub typhus in cases that present similarly to these cases.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Paediatric septic shock is a life-threatening condition with high global morbidity and mortality rates. Prior guidelines for paediatric septic shock demonstrated varying levels of effectiveness. In 2017, the institutional paediatric septic shock guidelines were established, emphasizing three pivotal components: prompt recognition, early and appropriate resuscitation, and organ support with intensive stabilization. Herein, we aimed to assess the effect of paediatric septic shock guidelines on mortality and clinical outcomes. This single-centre retrospective cohort study investigating the pre- and postimplementation of paediatric septic shock guidelines was conducted in patients aged 1 month to 15 years diagnosed with septic shock from January 2014 to December 2022. The effectiveness of the guideline implementation was evaluated through propensity matching analysis to compare 30-day in-hospital mortality rates. Adherence to key components of the guidelines was also assessed. In total, 71 and 106 paediatric patients with septic shock were admitted to the paediatric intensive care unit during the pre- and postguideline periods, respectively. The postguideline group exhibited a significant reduction in mortality [adjusted odds ratio (aOR): 0.29, 95% confidence interval (CI): 0.12–0.71, <span style="font-style:italic;">P</span> = .007] and a decrease in respiratory dysfunction (aOR: 0.40, 95% CI: 0.18–0.91, <span style="font-style:italic;">P</span> = .03). Guideline adherence revealed a substantial increase in the use of peripheral inotropes and noninvasive cardiac monitoring. The number needed to treat for the protocol to prevent death was six. The implementation of the paediatric septic shock guidelines, emphasizing early shock recognition, prompt resuscitation, infection control, and appropriate organ management in intensive care, significantly improved outcomes.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Serological studies in infants can provide valuable information on the degree of protection conferred by IgG maternal passive transfer during early life. If infant levels are inadequate, protection may be incomplete, increasing the risk of life-threatening diseases such as pertussis and measles, before immunization completion. In addition, HIV infection, -highly prevalent in African countries like Malawi—may impair transplacental antibody transfer. We determined anti-Pertussis Toxin (PT) and anti-measles IgG in 86 6-week-old infants, born to mothers living with HIV (HIV-exposed uninfected, HEU, <span style="font-style:italic;">n</span> = 58) and to HIV-negative mothers (HIV-unexposed uninfected, HUU, <span style="font-style:italic;">n</span> = 28). The HEU group was divided into two subgroups: Infants born to mothers who initiated antiretroviral therapy (ART) during pregnancy (Short-ART, SA-HEU group, <span style="font-style:italic;">n</span> = 29) or already in stable ART (Long-term ART, LA-HEU group, <span style="font-style:italic;">n</span> = 29). The mean anti-PT and anti-measles IgG levels (1.97 IU/ml and 32.9 mIU/ml, respectively) were comparable between the HUU and HEU infants. Overall, only 12.8% and 18.6% of all infants had IgG levels above the protective thresholds for pertussis and measles, respectively. The duration of ART significantly influenced the infant’s serological profile, with SA-HEU infants showing significantly lower IgG levels compared to both HUU and LA-HEU infants. Protecting infants during early life remains a significant health challenge in many middle and low-income countries. Achieving better early serological protection requires the implementation of diverse vaccination strategies. This study emphasizes the crucial importance for women living with HIV to be on stable ART before pregnancy.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The febrile illness caused by dengue is a global public health problem whose incidence is increasing. This infection can range from mild fever to severe illness with plasma leakage and shock; therefore, biomarkers of severity are urgently needed to elucidate the pathological mechanism of the disease. To explore the levels of interleukin (IL)-10 and interferon (IFN)-β in children with dengue to identify these proteins as biomarkers of severity. This study compared the serum levels of IL-10 and IFN-β in 208 Colombian paediatric patients with different degrees of severity of dengue virus infection. A total of three study groups (dengue without warning signs, dengue with warning signs, and severe dengue) were designated according to the World Health Organization classification system. Serotype type 2 was the most prevalent type, and the most frequently reported symptom was vomiting, followed by abdominal pain. Platelet values, aspartate transaminase and alanine transaminase levels and clotting times were the most altered laboratory parameters among the study groups and were more pathological in patients with severe dengue. In addition, IL-10 levels were significantly higher in those with severe dengue than in those with milder forms of infection (<span style="font-style:italic;">P </span><<span style="font-style:italic;"> </span>.05), and IFN-β levels were much lower in the group of patients with severe dengue than in the group with dengue without warning signs (<span style="font-style:italic;">P </span><<span style="font-style:italic;"> </span>.05). These results demonstrate differences in immune responses to dengue infections and suggest several molecular targets for the future development of biomarkers that can serve as diagnostic and prognostic tools for the severity of dengue disease.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The aims of this prospective study were to describe feeding difficulties in term infants with perinatal asphyxia and to determine whether the time it takes to achieve full oral feeding correlates with early neurological outcome in a high-income setting. Recruitment included 52 term infants with perinatal asphyxia: 32 without hypoxic-ischaemic encephalopathy (HIE), 9 with mild HIE, and 11 with moderate HIE. The time in days it takes to achieve full oral independent feeding was used as a marker of feeding difficulty. Early neurological outcome was evaluated using neonatal brain magnetic resonance imaging (MRI) and Hammersmith Infant Neurological Examination (HINE) at 3 months. In this cohort, 85% of infants (44/52) needed short-term assisted feeding after birth. The time it takes to achieve full oral feeding correlated with neonatal brain MRI findings and structured neurological examination results at three months. The time it takes to achieve full oral feeding could be a useful clinical measure to assess neurologic recovery after perinatal asphyxia, especially in low-resource settings.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Pneumonia remains an important cause of morbidity and mortality among children in low- and middle-income countries. Poor outcomes are associated with undernutrition. Nutritional supplementation may be beneficial. We examined the effect of supplementation with lipid-based ready-to-use therapeutic food (RUTF) on the body composition of children with severe pneumonia. Non-severely malnourished children (6–59 months) with severe pneumonia enrolled into the Children’s Oxygen Administration Strategies and Nutrition trial in Uganda and Kenya, and randomized to receive a diet supplemented with RUTF (500 Kcal/day) for 56 days versus usual diet alone (control) were included. We assessed arm anthropometry and bioimpedance analysis at admission and days 28, 90, and 180 of follow-up. We used mixed effects linear regression to compare body composition between groups. We included 737 participants (369 in intervention; 368 in control group). The median age was 16 months (IQR; 9, 26), and 58.1% were male. Overall, baseline mean arm fat area (AFA), arm muscle area, and arm muscle circumference were 5.8 ± 1.8 cm<sup>2</sup>, 11.6 ± 2.3 cm<sup>2</sup>, and 12.3 ± 1.2 cm<sup>2</sup>, respectively. The mean fat mass and fat-free mass calculated in 116 participants were 5.5 ± 1.5 kg and 5.5 ± 1.5 kg, respectively. There were modest increases in most body composition parameters. RUTF significantly increased AFA at days 28 and 90 but not at day 180 (<span style="font-style:italic;">P</span>-value = .03, .02, and .99, respectively). RUTF did not change other body composition parameters. Despite initial increases in AFA, RUTF did not change the body composition of children with severe pneumonia.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Fluid management in the first postnatal week among infants with perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) is an important knowledge gap. We aimed to evaluate the effects of fluid restriction on short- and long-term outcomes in infants with HIE. Term infants with moderate or severe HIE on therapeutic hypothermia were randomized within 6 hours of age to receive either restricted intravenous maintenance fluids (45 ml/kg/day on day 1 to a maximum of 120 ml/kg/day on day 6) vs conventional fluid (60 ml/kg/day on day 1 to a maximum of 150 ml/kg/day on day 6). The primary outcome was a composite of mortality or neurological abnormality at hospital discharge. We studied neurodevelopmental disability at 18–24 months using Bayley Scales of Infant Development, third edition. A total of 210 infants were randomized. Three infants died during the hospital stay. The primary outcome of mortality or neurological abnormality at discharge was not significantly different between the restricted and the conventional fluid group [57% vs 53%, RR: 1.07 (95% CI: 0.83, 1.37), <span style="font-style:italic;">P</span>-value .58]. The incidence of cranial magnetic resonance imaging abnormalities was similar in the groups (65% vs 71%, <span style="font-style:italic;">P</span>-value .30). There were no differences in the rates of severe neurodevelopmental disability at 18–24 months in the two groups [27% vs 28%, RR: 0.96 (95% CI: 0.62, 1.50), <span style="font-style:italic;">P</span>-value .88]. Adverse outcomes were similar in both groups. Fluid restriction in the first postnatal week of life did not improve short- and long-term neurodevelopmental outcomes in term infants with moderate or severe HIE.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Congenital syphilis (CS) is transmitted to the fetus through the transplacental route at any stage of gestation when the pregnant women are either untreated or inadequately treated. In this study, we aimed to analyze trends in epidemiological indicators of CS in Brazil. This is a cross-sectional study utilizing data on CS across Brazilian regions from 1 January 2012 to 31 December 2021. Epidemiological indicators such as incidence, prevalence, and case-fatality rates were calculated. During the evaluated period, 192 055 CS cases were recorded in Brazil. Among pregnant women who underwent prenatal care, 58.5% were diagnosed during pregnancy, 33.9% at the time of birth, and 7.5% after birth. In 77.5% of the notifications, the partners were not treated. The average number of cases diagnosed during prenatal care was 5.6 times higher than those not reported. The Southeast region presented the highest incidence rate per 1000 live births, whereas the Midwest region had the lowest incidence. Despite an increase in rates across all regions and Brazil overall, there was no significant difference (<span style="font-style:italic;">P</span>-value > .05) between the means for the two evaluated periods. However, there was a significant decrease (<span style="font-style:italic;">P</span>-value < .05) in the case-fatality rate in the Northeast (1.9%–1.25%) and South (2.15%–0.92%) regions, as well as throughout Brazil (from 1.77% to 1.24%). The findings indicate that the incidence rates of CS continue to rise, suggesting that the disease remains a significant public health issue in Brazil. Effective preventive measures are urgently required.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Septic pulmonary embolism (SPE) is a rare, life-threatening disease in children. We assessed the clinical, microbiological, radiological, and treatment results of patients who developed SPE due to <span style="font-style:italic;">Staphylococcus aureus</span> (<span style="font-style:italic;">S. aureus</span>). We retrospectively reviewed the medical records of patients with SPE associated with <span style="font-style:italic;">S. aureus</span> between 2012 and 2023. Six patients were included in the study; the median age was 13 years (range: 9–16 years), and four (66.7%) of them were boys. At admission, the most common complaints were chest pain (83.3%), respiratory distress (83.3%), limb swelling (83.3%), limitation of movement in the extremities (83.3%), fever (50%), fatigue (50%), and cough (16.7%). Extrapulmonary septic foci were identified as follows: septic arthritis in four patients (66.7%), soft tissue infection in one patient (16.7%), and deep vein thrombosis in one patient (16.7%). Methicillin-resistant <span style="font-style:italic;">S. aureus</span> was the most common causative pathogen (66.7%) and methicillin-susceptible <span style="font-style:italic;">S. aureus</span> was found in 33% of patients. The median length of hospital stay was 43.5 days (range: 25-45 days). Three (50%) patients required intensive care, and one required mechanical ventilation support. No mortality was observed. In our study, the clinical and radiological features of staphylococcal SPE in children were nonspecific, similar to the literature. Although no mortality was observed in our study, previous studies have reported mortality rates of up to 11.8% in children with SPE. Early diagnosis, appropriate antibiotic treatment, and respiratory support are important in patients with SPE, especially in low-income settings where timely access to healthcare and diagnostic resources may be limited.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Red blood cell (RBC) transfusion is crucial in treating anemia in the pediatric intensive care unit (PICU), though safety and necessity concerns persist. This prospective observational study examined the frequency and predictors of RBC transfusions among critically ill children, highlighting implications for low- and middle-income countries (LMICs). A single-center observational study enrolled 104 children admitted to a PICU from January to September 2021. Demographic details, past medical history, Pediatric Index of Mortality-3 scores, sedation, inotrope administration, ventilator-associated pneumonia (VAP), new-onset shock, respiratory failure, sepsis, renal failure, new or progressive multiple organ dysfunction syndrome (MODS), and duration of ventilation were recorded. Our results showed that 37 patients (35.6%) received RBC transfusions. The mean pre-transfusion hemoglobin level was 6.58 grams per deciliter (g/dl) (SD 1.71). The transfused group required more sedation (<span style="font-style:italic;">P</span> < .001) and vasoactive agents (<span style="font-style:italic;">P</span> < .001), had longer PICU stays (<span style="font-style:italic;">P</span> = .013), and developed VAP (<span style="font-style:italic;">P</span> = .037), new-onset shock (<span style="font-style:italic;">P</span> = .025), respiratory failure (<span style="font-style:italic;">P</span> = .021), and MODS (<span style="font-style:italic;">P</span> = .023) more often than the non-transfused group. Logistic regression analysis showed that hemoglobin >10 g/dl at admission reduced the odds of RBC transfusion [odds ratio (OR) = 0.57, confidence interval (CI) = 0.43–0.74], while sepsis at admission increased the odds (OR = 3.24, CI = 1.09–9.60). The current study demonstrates that about one-third of critically ill children received RBC transfusions. Hemoglobin above 10 g/dl at admission was associated with significantly lower odds of RBC transfusion, while sepsis at admission significantly increased the odds. These findings are particularly relevant for LMICs, where resource constraints necessitate careful evaluation of transfusion practices to optimize patient outcomes and resource utilization.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>To estimate the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among hospitalized children aged between 1 and 12 years. A cross-sectional study was conducted to determine the seroprevalence of SARS-CoV-2 antibodies among hospitalized children at a tertiary care hospital in the North-East region of India for a period of 13 months (October 2022–November 2023). The presence of SARS-CoV-2 antibodies was estimated using enzyme-linked immunosorbent assay method. Sociodemographic characteristics and clinical profile of the participants were analyzed. The seroprevalence of SARS-CoV-2 infection among hospitalized children aged between 1 and 12 years was estimated to be 98.4%. This was comparable for children between the age groups 1–5 years (97.9%) and 6–12 years (99.1%) (<span style="font-style:italic;">P-</span>value <span style="font-style:italic;">=</span> .478). The most commonly reported symptoms among the seropositive children were fever (76.8%), nasal stuffiness (69.5%), cough (67.8%), diarrhea (23.6%), and nausea/vomiting (23.2%). None of the study participants had a prior history of laboratory confirmed coronavirus disease (COVID-19) infection in the past and none were vaccinated against COVID-19. Results of the univariate analysis showed that there was no significant difference between the seropositive and seronegative children in the distribution of sociodemographic characteristics, clinical profile, and laboratory findings. Our study observed a remarkably high anti-SARS-CoV-2 seropositivity rate of 98.4%, suggesting a significant under-recognized burden of COVID-19 in the pediatric population. The findings highlight the need for continued preventive measures and the development of age-appropriate vaccination strategies, particularly in tropical settings.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Managing West syndrome (WS) becomes arduous in regions where access to adrenocorticotropic hormone and vigabatrin is limited, particularly in developing nations. This study aimed to evaluate the efficacy of very high-dose oral prednisolone in children diagnosed with WS. Children aged 2–36 months presenting with WS were consecutively enrolled and given oral prednisolone @ 8 mg/kg/day (maximum 40 mg) for two weeks followed by tapering doses over the subsequent two weeks. Weekly follow-ups were conducted until therapy completion, followed by bi-weekly assessments for three months. Responses (primary outcome) were assessed at two weeks and categorized as complete (spasm-free), partial (>25% reduction), or no response (<25% reduction). Neurodevelopmental outcomes, clinical–radiological profiles, safety, and therapy response predictors were also assessed. Of the 80 children, 73.7% exhibited a complete response, while 21.2% and 5% showed partial and no response, respectively. The mean age at spasm onset and presentation was 4.98 ± 4.37 months and 14.36 ± 7.13 months, respectively. Perinatal brain injury accounted for 87.5% of WS cases. Adverse effects, including weight gain (8.7%), irritability, hypertension, and disturbed sleep (3.7% each), were noted. Spasm cessation at 2 weeks, appropriate gestational age, and the absence of other seizure types were predictive of a favorable response. High-dose oral prednisolone emerges as an effective, low-cost, and safer first-line treatment option with minimal adverse effects in the Uttar Pradesh region in India, and this would likely be true in other resource-limited settings.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Emergence of multidrug-resistant strain of <span style="font-style:italic;">Klebsiella pneumoniae</span> has led to limited number of antimicrobial options for treatment. Even though outbreaks of colistin–carbapenem-resistant <span style="font-style:italic;">K. pneumoniae</span> (CCRKp) are evolving, reported literature is scarce. This is a retrospective case series of three infants who acquired CCRKp sepsis during an outbreak in a Level III neonatal intensive care unit (NICU) of a tertiary care centre in Northern India. Data were retrieved from medical records of patients. Three babies developed new onset clinical worsening during an outbreak of sepsis. All had respiratory comorbidities and previous antibiotic exposure prior to isolation of CCRKp sepsis from blood. The organism was sensitive to combination of ceftazidime plus avibactam and tetracyclines in two infants; in one other newborn, no sensitive antibiotic was found. Two neonates deceased due to multiorgan dysfunction. An outbreak investigation revealed one common source of sterile water used in a humidifier. The outbreak was resolved by temporarily closing the NICU, segregating the infected infants and using corrective measures such as procuring a fresh batch of sterile water bottles, disinfecting the NICU, and reinforcing the use of antiseptic techniques. The emergence of CCRKp is alarming, particularly in low- and middle-income countries and tropical regions where such outbreaks are difficult to control due to limited healthcare infrastructure. These findings highlight the urgent need for stringent antimicrobial stewardship practices, enhanced infection control, and tailored interventions in resource-limited settings. It is also to be emphasized that the main mechanism of carbapenem resistance in Kp organisms in Asia seems to be different from the West and is mainly mediated by metallo-beta-lactamases and Class D carbapenemases.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Neonates with meconium aspiration syndrome (MAS) frequently require respiratory support. However, the initial mode of respiratory support in these patients remains unclear. We aimed to assess whether early nasal continuous positive airway pressure (nCPAP), compared to conventional oxygen therapy, reduces the need for invasive mechanical ventilation (IMV) in neonates with MAS. In this open-label randomized controlled trial, neonates born at >34 weeks of gestation who developed mild to moderate respiratory distress within the first 24 hours were randomly allocated to the nCPAP or oxygen hood (5–10 l/min) group. The primary outcome was the need for intubation and IMV during the first 72 hours of life. The secondary outcomes included all-cause mortality before discharge, air leaks, sepsis, pulmonary hypertension, duration of respiratory support, and hospital stay. We analyzed the data using the intention-to-treat method. Eighty neonates (40 in each group) were enrolled. There was no statistically significant difference in the need for IMV between the nCPAP and oxygen hood groups (4 [10%] vs. 5 [12.5%]; relative risk, 0.80; 95% CI: 0.23–2.76). Primary respiratory support failure rates, mortality, pulmonary hypertension, and other outcomes were comparable between the groups. In this trial, nCPAP therapy was not superior to conventional oxygen therapy for the treatment of mild to moderate MAS.<div class="boxTitle">Trial registration</div>Clinical Trial Registry of India (CRTI/2020/02/023529)</span>
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