Predictors of Mortality in Neonatal Pneumonia: An INCLEN Childhood Pneumonia Study.

BACKGROUND: Neonatal pneumonia contributes significantly to mortality due to pneumonia in the under-five age group, but the predictors of mortality are largely unknown. OBJECTIVES: To evaluate the clinical and microbiological characteristics and other risk factors that predict mortality in neonates admitted with pneumonia in tertiary care centres. STUDY DESIGN: Prospective observational cohort study. PARTICIPANTS: Term and preterm (32 weeks to 36 6/7 weeks) neonates (<28 days of life) admitted with clinical and radiological features suggestive of pneumonia. INTERVENTION: Baseline sociodemographic data, clinical details, blood culture and nasopharyngeal swabs for virologic assay (RT PCR for RSV, Influenza) were collected at admission and the neonates were observed throughout their hospital stay. OUTCOME: The primary outcome was predictors of mortality in neonatal pneumonia. RESULTS: Five hundred neonates were enrolled in the study. Out of 476 neonates with known outcomes, 39 (8.2%) died. On multivariate analysis, blood culture positive sepsis was independently associated with mortality (adjusted OR 2.51, 95% CI1.23 to 5.11; P-0.01). CONCLUSIONS: Neonates with blood culture positive pneumonia positive are at a higher risk of death.

Quality improvement initiative approach to decrease the unindicated usage of antibiotics in a neonatal intensive care unit of a tertiary care teaching hospital in Hyderabad, India.

Antimicrobial resistance is an emerging global problem concerned with patient safety. It is even more challenging in developing countries like India. Antibiotic stewardship initiative is the best arrow in the quiver to prevent and control this antimicrobial resistance. We observed 61% of the neonates admitted to neonatal intensive care unit of Niloufer hospital, Hyderabad, India were receiving improper antibiotics with respect to choice of drug or dosage or duration. Subsequently, an antibiotic stewardship team was formed to address the antibiotic misuse. Team consisted of neonatology faculty, residents, staff nurses, infection control nurses and microbiologist. We identified problems related to staff awareness, policy issues like lack of display of the antibiotic policy and lack of antibiotic lock, process issues like low rate of documentation of indication for initiation or escalation of antibiotic and a lack of dynamic review plan regarding continuation or de-escalation. We used the Plan-Do-Study-Act cycles to test and adapt solutions to these problems. Within 10 weeks of starting our quality improvement (QI) project, the proportion of unindicated antibiotic usage decreased from 61% to 27%. Timely de-escalation of antibiotic is a neglected intervention in neonates, and yielded the maximum result in our study. We conclude that QI projects are simple, doable yet powerful effective tools to address the burning problems like antibiotic misuse. This result was very satisfying and encouraging boosting our team's faith in the effectiveness of QI approach.