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2.
Paediatr Int Child Health ; 33(2): 61-78, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23925279

RESUMO

BACKGROUND: Prevention of nosocomial infection is key to providing good quality, safe healthcare. Infection control programmes (hand-hygiene campaigns and antibiotic stewardship) are effective in reducing nosocomial infections in developed countries. However, the effectiveness of these programmes in developing countries is uncertain. OBJECTIVE: To evaluate the effectiveness of interventions for preventing nosocomial infections in developing countries. METHODS: A systematic search for studies which evaluated interventions to prevent nosocomial infection in both adults and children in developing countries was undertaken using PubMed. Only intervention trials with a randomized controlled, quasi-experimental or sequential design were included. Where there was adequate homogeneity, a meta-analysis of specific interventions was performed using the Mantel-Haenzel fixed effects method to estimate the pooled risk difference. RESULTS: Thirty-four studies were found. Most studies were from South America and Asia. Most were before-and-after intervention studies from tertiary urban hospitals. Hand-hygiene campaigns that were a major component of multifaceted interventions (18 studies) showed the strongest effectiveness for reducing nosocomial infection rates (median effect 49%, effect range 12.7-100%). Hand-hygiene campaigns alone and studies of antibiotic stewardship to improve rational antibiotic use reduced nosocomial infection rates in three studies [risk difference (RD) of -0.09 (95%CI -0.12 to -0.07) and RD of -0.02 (95% CI -0.02 to -0.01), respectively]. CONCLUSIONS: Multifaceted interventions including hand-hygiene campaigns, antibiotic stewardship and other elementary infection control practices are effective in developing countries. The modest effect size of hand-hygiene campaigns alone and negligible effect size of antibiotic stewardship reflect the limited number of studies with sufficient homogeneity to conduct meta-analyses.


Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Antibacterianos/uso terapêutico , Ásia , Países em Desenvolvimento , Prescrições de Medicamentos/normas , Desinfecção das Mãos/métodos , Humanos , América do Sul
3.
J Pediatr ; 153(2): 170-5, 175.e1, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18534228

RESUMO

OBJECTIVES: To test the hypothesis that the impact of postnatal sepsis/necrotizing enterocolitis (NEC) on neurodevelopment may be mediated by white matter abnormality (WMA), which can be demonstrated with magnetic resonance imaging (MRI). STUDY DESIGN: A prospective cohort of 192 unselected preterm infants (gestational age <30 weeks), who were evaluated for sepsis and NEC, underwent imaging at term-equivalent age and neurodevelopmental outcome at 2 years corrected age with the Bayley Scales of Infant Development. RESULTS: Sixty-eight preterm (35%) infants had 100 episodes of confirmed sepsis, and 9 (5%) infants had confirmed NEC. Coagulase-negative staphylococci accounted for 73% (73/100) of the episodes of confirmed sepsis. Infants with sepsis/NEC had significantly more WMA on MRI at term compared with infants in the no-sepsis/NEC group. They also had poorer psychomotor development that persisted after adjusting for potential confounders but which became nonsignificant after adjusting for WMA. CONCLUSIONS: Preterm infants with sepsis/NEC are at greater risk of motor impairment at 2 years, which appears to be mediated by WMA. These findings may assist in defining a neuroprotective target in preterm infants with sepsis/NEC.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Enterocolite Necrosante/epidemiologia , Doenças do Prematuro/epidemiologia , Sepse/epidemiologia , Causalidade , Pré-Escolar , Estudos de Coortes , Comorbidade , Deficiências do Desenvolvimento/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Recém-Nascido de muito Baixo Peso , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de Doença
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