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1.
Artigo em Inglês | MEDLINE | ID: mdl-31700651

RESUMO

Objective: To determine predictors of nutritive-sucking in babies < 34 weeks and estimate the appropriate preterm sucking readiness (PTSR) score as an indicator of readiness of nutritive-sucking. Methods: Prospective longitudinal observational study conducted in Neonatal unit of a referral hospital attached to Medical College. Forty-nine inborn babies of 28-34 weeks' gestation and on full gavage feeds were enrolled. Results: (a) Nutritive-sucking was achieved at a median age of 14 days (Range 7-50). (b) Low birth weight (LBW) (< 1531.1 ± 142.8) and lesser gestational age (GA) (< 32.8 ± 1) were poor predictors (p < 0.05) and have a significant independent negative association (Correlation birth weight (BW) - 0.0222, GA - 2.2177) with age at which established nutritive-sucking was achieved. (c) PTSR score of ≥9 had the best prediction for achievement of nutritive-sucking at 14-days of life, with a sensitivity of 92.3% and specificity of 100%. Conclusion: PTSR score is a sensitive and specific tool to predict the readiness for nutritive-sucking in preterm babies < 34 weeks.

2.
Indian J Otolaryngol Head Neck Surg ; 71(Suppl 1): 614-617, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31742030

RESUMO

Ectopic cervical thymus (ECT) is a rare cause of solid cervical mass in the pediatric age group. The location of the mass along the path of thymic descent (thymopharyngeal duct), sonographic echo pattern and MR signal intensity identical to that of normal orthotopic thymus in the anterior mediastinum help us in making a confident diagnosis. To the best of our knowledge only nine cases have been reported in infants in the literature. We present a case of ECT presenting as a right upper neck mass in a 2 month old child.

3.
Indian Pediatr ; 56(4): 294-298, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064897

RESUMO

BACKGROUND: In preterm neonates, enteral feeding is advanced slowly, considering the risk of necrotizing enterocolitis. Prolonged intravenous alimentation in these neonates, however, may increase the risk of sepsis-related morbidity and mortality, particularly in low resource settings. OBJECTIVES: Objective of this was study to evaluate impact of aggressive enteral feeding on mortality and morbidities among preterm neonates. DESIGN: Randomized controlled trial. PARTICIPANTS: Neonates with birthweight 750-1250 g. INTERVENTIONS: 131 preterm neonates with birth weight 750-1250 g, admitted to neonatal intensive care unit between April 2012 and June 2014, were randomized to aggressive feeding or conservative feeding regimen. OUTCOMES: The primary outcome of the study was all-cause mortality during hospital stay. The secondary outcomes included proportion of sepsis (blood culture proven), necrotizing enterocolitis, feed intolerance, survival without major morbidity at discharge, time to reach full enteral feed (180 mL/kg/d), duration of hospitalization, and average daily weight gain (g/kg). RESULTS: All-cause mortality was 33.3% in aggressive regimen and 43.1% in conservative regimen, [RR (95%) CI 0.77 (0.49, 1.20)]. Neonates with aggressive feeding regimen reached full enteral feed earlier; median (IQR) 7 (6, 8) days compared to conservative regimen, 10 (9, 14) days; P <0.001. There was no difference in culture positive sepsis rate, survival without major morbidities, feed intolerance, necrotizing enterocolitis, duration of hospitalization and average daily weight gain. CONCLUSIONS: In neonates with birth weight 750-1250 g, early aggressive feeding regimen is feasible but not associated with significant reduction in all-cause mortality, culture positive sepsis or survival without major morbidities during hospital stay. Neonates with aggressive regimen have fewer days on IV fluids and reach full feed earlier.


Assuntos
Nutrição Enteral , Doenças do Prematuro , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Nutrição Enteral/mortalidade , Nutrição Enteral/estatística & dados numéricos , Enterocolite Necrosante , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Sepse
4.
J Matern Fetal Neonatal Med ; : 1-6, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30888887

RESUMO

OBJECTIVE: To evaluate the utility of superior mesenteric artery (SMA) flow velocity post feeding for predicting time to achieve full enteral feeds in very low birth weight (VLBW) neonates. SUBJECTS: In this prospective cohort study preterm VLBW infants were followed until they achieved full enteral feeding. RESULTS: There was no significant difference between prefeed and post feed SMA flow measurements in study subjects. At baseline, it was observed that Small for gestational age (SGA) babies had a significantly lower peak systolic velocity. Time-averaged mean velocity (TAMV) was significantly lower in SGA babies at baseline, 15, 30, 45, and 60 min post feed, but there were no within-group differences noted over time. CONCLUSION: SMA blood flow velocity measured pre-feed and post-feed times do not correlate with the time to achieve full enteral feeding in very low birth weight neonates. The clinical significance of lower Peak systolic velocity (PSV) and TAMV in SGA infants is unclear.

5.
Indian J Pediatr ; 86(7): 617-621, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30737624

RESUMO

RMNCH+A is a platform for delivering adolescent, maternal, newborn and child health in an integrated manner using a life cycle approach. The new initiatives under this strategy that would impact newborn health include antenatal corticosteroids in preterm labor, delayed clamping of cord at birth, skin-to-skin contact at birth and Kangaroo mother care, Family participatory care, Lactation management centers and care beyond newborn survival under the Rashtriya Bal Swasthya Karyakram. Even though the coverage of many of the existing initiatives has been moderately high, there are concerns about the quality of delivery of these interventions and slow progress in the roll out of the newer interventions. Quality assurance initiative such as Dakshata and LaQshaya will also contribute to improved newborn health as we proceed towards the Sustainable development goals (SDG) 2030 targets for newborn and child survival.

6.
Indian Pediatr ; 55(11): 975-978, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30587647

RESUMO

OBJECTIVE: Correlation of catch-up growth and Insulin-like Growth Factor -1 levels (IGF-I) in SGA babies. METHODS: 50 Full-term Small for Gestational Age children aged 12-18 months were analyzed for Catch-up growth (gain in weight and/or length, Standard Deviation Score/SDS >0.67). IGF-1 was measured after post-glucose load using ELISA method and correlated with catch-up growth. RESULTS: Mean (SD) birthweight and length were 2.1 (0.3) Kg and 44.4 (3.1) cm, respectively. At enrollment, mean (SD) age, weight and length were 15.0 (2.1) months, 7.7 (1.3) Kg, and 72.9 (5.6) cm, respectively. Catch-up growth was noted in 60% children. IGF-1 levels were significantly higher in children showing catch-up growth (56.6 (63.2) ng/mL) compared to those not having catch up growth (8.7 (8.3) ng/mL). IGF-1 was positively correlated with both weight and length catch-up. CONCLUSION: Majority of Small for Gestational Age showed catch-up growth by 18 months, which had good correlation with IGF-1 levels.


Assuntos
Desenvolvimento Infantil/fisiologia , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Fator de Crescimento Insulin-Like I/metabolismo , Antropometria/métodos , Peso ao Nascer , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
7.
Obstet Gynecol Sci ; 61(6): 655-661, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30474011

RESUMO

Objective: There is concern regarding the safety of delayed cord clamping (DCC) in babies born at less than 34 weeks' gestation. Therefore, the primary objective of this study was to compare the rates of hyperbilirubinemia and polycythemia during initial 7 days in infants born at less than 34 weeks' gestation and randomized to receive DCC by 120 seconds or early cord clamping (ECC) within less than 30 seconds. Methods: One hundred pregnant women were randomly subjected to DCC or ECC at the time of birth in a tertiary referral hospital setting. Blood samples were obtained from each newborn at 48 hours and 7 days for hematocrit measurement. Serum bilirubin levels were estimated once the infant had clinically significant jaundice or at 72 hours. For the statistical analysis, the χ2 test, student's t-test, or Wilcoxon rank sum test was used. Results: The hematocrit was significantly higher in the DCC group than in the ECC group (P<0.001). None of the babies had polycythemia. Mean total serum bilirubin level was 6.6 mg/dL in the DCC group and 8.7 mg/dL in the ECC group (P<0.001). There was no increased risk of hyperbilirubinemia in the DCC group. Conclusion: DCC benefits preterm neonates with no significant adverse effects.

8.
BMJ Paediatr Open ; 2(1): e000245, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29637198

RESUMO

Although therapeutic hypothermia (TH) is the standard of care for hypoxic ischaemic encephalopathy in high-income countries, the safety and efficacy of this therapy in low-income and middle-income countries (LMICs) is unknown. We aimed to describe the feasibility of TH using a low-cost servo-controlled cooling device and the short-term outcomes of the cooled babies in LMIC. Design: We recruited babies with moderate or severe hypoxic ischaemic encephalopathy (aged <6 hours) admitted to public sector tertiary neonatal units in India over a 28-month period. We administered whole-body cooling (set core temperature 33.5°C) using a servo-controlled device for 72 hours, followed by passive rewarming. We collected the data on short-term neonatal outcomes prior to hospital discharge. Results: Eighty-two babies were included-61 (74%) had moderate and 21 (26%) had severe encephalopathy. Mean (SD) hypothermia cooling induction time was 1.7 hour (1.5) and the effective cooling time 95% (0.08). The mean (SD) hypothermia induction time was 1.7 hour (1.5 hour), core temperature during cooling was 33.4°C (0.2), rewarming rate was 0.34°C (0.16°C) per hour and the effective cooling time was 95% (8%). Twenty-five (51%) babies had gastric bleeds, 6 (12%) had pulmonary bleeds and 21 (27%) had meconium on delivery. Fifteen (18%) babies died before discharge from hospital. Heart rate more than 120 bpm during cooling (P=0.01) and gastric bleeds (P<0.001) were associated with neonatal mortality. Conclusions: The low-cost servo-controlled cooling device maintained the core temperature well within the target range. Adequately powered clinical trials are required to establish the safety and efficacy of TH in LMICs. Clinical trial registration number: NCT01760629.

9.
Indian Pediatr ; 54(11): 969-970, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29217807

RESUMO

This cross-sectional web-based survey suggests that cooling therapy is offered as standard of care for babies with neonatal encephalopathy in 10/25 (40%) of public and 37/68 (51%) of private level 2 or 3 neonatal units in India. 25 (53%) used locally improvised cooling methods, and the cooling practices differed from established protocols in high-income countries.


Assuntos
Encefalopatias/terapia , Hipotermia Induzida/estatística & dados numéricos , Doenças do Recém-Nascido/terapia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Humanos , Índia , Recém-Nascido , Inquéritos e Questionários
10.
Trials ; 18(1): 432, 2017 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-28923118

RESUMO

BACKGROUND: Therapeutic hypothermia reduces death and disability after moderate or severe neonatal encephalopathy in high-income countries and is used as standard therapy in these settings. However, the safety and efficacy of cooling therapy in low- and middle-income countries (LMICs), where 99% of the disease burden occurs, remains unclear. We will examine whether whole body cooling reduces death or neurodisability at 18-22 months after neonatal encephalopathy, in LMICs. METHODS: We will randomly allocate 408 term or near-term babies (aged ≤ 6 h) with moderate or severe neonatal encephalopathy admitted to public sector neonatal units in LMIC countries (India, Bangladesh or Sri Lanka), to either usual care alone or whole-body cooling with usual care. Babies allocated to the cooling arm will have core body temperature maintained at 33.5 °C using a servo-controlled cooling device for 72 h, followed by re-warming at 0.5 °C per hour. All babies will have detailed infection screening at the time of recruitment and 3 Telsa cerebral magnetic resonance imaging and spectroscopy at 1-2 weeks after birth. Our primary endpoint is death or moderate or severe disability at the age of 18 months. DISCUSSION: Upon completion, HELIX will be the largest cooling trial in neonatal encephalopathy and will provide a definitive answer regarding the safety and efficacy of cooling therapy for neonatal encephalopathy in LMICs. The trial will also provide important data about the influence of co-existent perinatal infection on the efficacy of hypothermic neuroprotection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02387385 . Registered on 27 February 2015.


Assuntos
Encefalopatias/terapia , Países em Desenvolvimento , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Ásia Ocidental , Regulação da Temperatura Corporal , Encefalopatias/diagnóstico , Encefalopatias/mortalidade , Encefalopatias/fisiopatologia , Desenvolvimento Infantil , Protocolos Clínicos , Países em Desenvolvimento/economia , Avaliação da Deficiência , Mortalidade Hospitalar , Humanos , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/economia , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/mortalidade , Hipóxia-Isquemia Encefálica/fisiopatologia , Lactente , Mortalidade Infantil , Recém-Nascido , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Pobreza , Projetos de Pesquisa , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
11.
Indian J Clin Biochem ; 32(3): 266-274, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28811685

RESUMO

Deficiency or diminished activity of a cobalamin dependent enzyme methylmalonyl-CoA mutase causes inborn error of metabolism called methylmalonic acidemia (MMA). In this study we elucidated the spectrum of mutations in 21 Indian mut MMA patients by direct sequencing. Sequence analysis identified a total of 70 mutations in exon 2, 9, 11 and 12 of MUT gene. Out of which 26 mutations were predicted to be deleterious and rest were benign. The 23 novel mutations consist of four nonsense mutations (p.N6*, p.G539*, p.E609* and p.I671*), twelve missense mutations (p.K128I, p.N547T, p.D554Y, p.A558T, p.R559P, p.A631T, p.I647T, p.E656D, p.V657E, p.Q660H, p.K679N, and p.G696Y) and seven frame shift mutations (c.375_376insA, c.1642delA, c.1655delC, c.1825_1826insT, c.1957delGA, c.2014delA and c.2062_2063insGA). All of them are point mutations or micro rearrangements. Three of these mutations (p.K621N, p.G648D, p.G630E) have been previously reported; all of them are missense mutations. The mutations are distributed throughout the exon 2, 9, 11 and 12, 38.4 % mutation are located in exon 12.

12.
BMC Pharmacol Toxicol ; 18(1): 56, 2017 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-28693558

RESUMO

BACKGROUND: An estimated 2.7 of the 5.9 million deaths in children under 5 years of age occur in the neonatal period. Severe infections contribute to almost a quarter of these deaths. Mortality due to severe infections in developing country settings is substantial despite antibiotic therapy. Effective interventions that can be added to standard therapy for severe infections are required to reduce case fatality. METHODS/DESIGN: This is a double-blind randomized placebo-controlled parallel group superiority trial to investigate the effect of zinc administered orally as an adjunct to standard therapy to infants aged 3 days up to 2 months (59 days) hospitalized with clinical severe infection, that will be undertaken in seven hospitals in Delhi, India and Kathmandu, Nepal. In a 1:1 ratio, we will randomly assign young infants to receive 10 mg of elemental zinc or placebo orally in addition to the standard therapy for a total of 14 days. The primary outcomes hospital case fatality, which is death due to any cause and at any time after enrolment while hospitalized for the illness episode, and extended case fatality, which encompasses the period until 12 weeks after enrolment. DISCUSSION: A previous study showed a beneficial effect of zinc in reducing the risk of treatment failure, as well as a non-significant effect on case fatality. This study was not powered to detect an effect on case fatality, which this current study is. If the results are consistent with this earlier trial, we would have provided strong evidence for recommending zinc as an adjunct to standard therapy for clinical severe infection in young infants. TRIAL REGISTRATION: Universal Trial Number: U1111-1187-6479, Clinical Trials Registry - India: CTRI/2017/02/007966 : Registered on February 27, 2017.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Mortalidade Hospitalar , Zinco/uso terapêutico , Antibacterianos/efeitos adversos , Quimioterapia Adjuvante , Método Duplo-Cego , Humanos , Lactente , Recém-Nascido , Resultado do Tratamento , Zinco/efeitos adversos
13.
Indian J Med Res ; 145(2): 209-214, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28639597

RESUMO

BACKGROUND & OBJECTIVES: There is no consensus regarding optimal standard for diagnosis of gestational diabetes mellitus (GDM). In this study, use of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study Group of India (DIPSI) criteria] as a diagnostic test for GDM in pregnant women was compared with different oral glucose tolerance tests (OGTTs). METHODS: This prospective study included 936 pregnant women, who underwent plasma glucose evaluation two hours after the challenge of 75 g glucose load irrespective of the timing of last meal (DIPSI criteria for GDM). After three days, standard 75 g OGTT was done in all women irrespective of previous plasma glucose value. Accuracy of the first result was compared to OGTT using cut-offs as per the World Health Organization (WHO) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM. RESULTS: Of the total 936 pregnant women, 73 (7.8%) patients had plasma glucose value ≥140 mg/dl when measured two hours after glucose load. When comparing with the WHO and IADPSG criteria, the sensitivity values were 65.1 and 74.1 per cent, respectively, and the corresponding specificity values were 96.3 and 96.9 per cent, respectively. On comparing with the WHO OGTT, only 41 of the 73 (56.2%) were true positives, whereas when IADPSG criteria were used, true positives were 46 (63%). False negative cases were also present when classified by the WHO and IADPSG criteria though in lesser numbers than false positives. The positive predictive values (PPVs) for the WHO and IADPSG criteria were 56.1 and 63 per cent, respectively, and their corresponding negative predictive values were 97.7 and 97.9 per cent, respectively. INTERPRETATION & CONCLUSIONS: Our findings showed that when 75 g glucose load in non-fasting state was used as a diagnostic test for GDM, almost one quarter of patients with GDM escaped diagnosis as sensitivity values were low. On the other hand, some GDM cases were falsely labelled as normal as this test did not account for cases of fasting hyperglycaemia. In addition, comparison with other OGTTs showed low PPVs. Hence, use of DIPSI criteria for diagnosing GDM must be reconsidered till further validation.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/metabolismo , Teste de Tolerância a Glucose/métodos , Glucose/administração & dosagem , Adulto , Glicemia , Diabetes Gestacional/patologia , Feminino , Humanos , Gravidez
15.
Indian J Clin Biochem ; 31(4): 414-22, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27605738

RESUMO

Pre analytical process of extraction for accurate detection of organic acids is a crucial step in diagnosis of organic acidemias by GCMS analysis. This process is accomplished either by solid phase extraction (SPE) or by liquid-liquid extraction (LLE). Both extraction procedures are used in different metabolic laboratories all over the world. In this study we compared these two extraction procedures in respect of precision, accuracy, percent recovery of metabolites, number of metabolites isolated, time and cost in a resource constraint setup. We observed that the mean recovery from SPE was 84.1 % and by LLE it was 77.4 % (p value <0.05). Moreover, the average number of metabolites isolated by SPE and LLE was 161.8 ± 18.6 and 140.1 ± 20.4 respectively. The processing cost of LLE was economical. In a cost constraint setting using LLE may be the practical option if used for organic acid analysis.

19.
PLoS One ; 10(4): e0123589, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25898362

RESUMO

BACKGROUND: While infections are a major cause of neonatal mortality in India even in full-term neonates, this is an especial problem in the large proportion (~20%) of neonates born underweight (or small-for-gestational-age; SGA). One potential contributory factor for this susceptibility is the possibility that immune system maturation may be affected along with intrauterine growth retardation. METHODS: In order to examine the possibility that differences in immune status may underlie the susceptibility of SGA neonates to infections, we enumerated the frequencies and concentrations of 22 leukocyte subset populations as well as IgM and IgA levels in umbilical cord blood from full-term SGA neonates and compared them with values from normal-weight (or appropriate-for-gestational-age; AGA) full-term neonates. We eliminated most SGA-associated risk factors in the exclusion criteria so as to ensure that AGA-SGA differences, if any, would be more likely to be associated with the underweight status itself. RESULTS: An analysis of 502 such samples, including 50 from SGA neonates, showed that SGA neonates have significantly fewer plasmacytoid dendritic cells (pDCs), a higher myeloid DC (mDC) to pDC ratio, more natural killer (NK) cells, and higher IgM levels in cord blood in comparison with AGA neonates. Other differences were also observed such as tendencies to lower CD4:CD8 ratios and greater prominence of inflammatory monocytes, mDCs and neutrophils, but while some of them had substantial differences, they did not quite reach the standard level of statistical significance. CONCLUSIONS: These differences in cellular lineages of the immune system possibly reflect stress responses in utero associated with growth restriction. Increased susceptibility to infections may thus be linked to complex immune system dysregulation rather than simply retarded immune system maturation.


Assuntos
Retardo do Crescimento Fetal/sangue , Recém-Nascido Pequeno para a Idade Gestacional/sangue , Linfócitos/fisiologia , Neutrófilos/fisiologia , Adulto , Estudos Transversais , Feminino , Sangue Fetal/citologia , Idade Gestacional , Humanos , Imunoglobulina M/sangue , Índia , Recém-Nascido , Masculino , Idade Materna , Fenótipo , Adulto Jovem
20.
Cochrane Database Syst Rev ; (3): CD007835, 2015 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-25739381

RESUMO

BACKGROUND: Affordable, feasible and efficacious interventions to reduce neonatal infections and improve neonatal survival are needed. Chlorhexidine, a broad spectrum topical antiseptic agent, is active against aerobic and anaerobic organisms and reduces neonatal bacterial colonisation and may reduce infection. OBJECTIVES: To evaluate the efficacy of neonatal skin or cord care with chlorhexidine versus routine care or no treatment for prevention of infections in late preterm or term newborn infants in hospital and community settings. SEARCH METHODS: We searched CENTRAL, latest issue of The Cochrane Library, MEDLINE (1966 to November 2013), EMBASE (1980 to November 2013), and CINAHL (1982 to November 2013). Ongoing trials were detected by searching the following databases: www.clinicaltrials.gov and www.controlled-trials.com. SELECTION CRITERIA: Cluster and individual patient randomised controlled trials of chlorhexidine use (for skin care, or cord care, or both) in term or late preterm neonates in hospital and community settings were eligible for inclusion. Three authors independently screened and selected studies for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, and assessed study risk of bias. The quality of evidence for each outcome was assessed using GRADE. We calculated pooled risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs), and presented results using GRADE 'Summary of findings' tables. MAIN RESULTS: We included 12 trials in this review. There were seven hospital-based and five community-based studies. In four studies maternal vaginal wash with chlorhexidine was done in addition to neonatal skin and cord care. Newborn skin or cord cleansing with chlorhexidine compared to usual care in hospitalsLow-quality evidence from one trial showed that chlorhexidine cord cleansing compared to dry cord care may lead to no difference in neonatal mortality (RR 0.11, 95% CI 0.01 to 2.04). Moderate-quality evidence from two trials showed that chlorhexidine cord cleansing compared to dry cord care probably reduces the risk of omphalitis/infections (RR 0.48, 95% CI 0.28 to 0.84).Low-quality evidence from two trials showed that chlorhexidine skin cleansing compared to dry cord care may lead to no difference in omphalitis/infections (RR 0.88, 95% CI 0.56 to 1.39). None of the studies in this comparison reported effects of the treatments on neonatal mortality. Newborn skin or cord cleansing with chlorhexidine compared to usual care in the communityHigh-quality evidence from three trials showed that chlorhexidine cord cleansing compared to dry cord care reduces neonatal mortality (RR 0.81, 95% CI 0.71 to 0.92) and omphalitis/infections (RR 0.48, 95% CI 0.40 to 0.57).High-quality evidence from one trial showed no difference between chlorhexidine skin cleansing and usual skin care on neonatal mortality (RR 1.03, 95% CI 0.87 to 1.23). None of the studies in this comparison reported effects of the treatments on omphalitis/infections. Maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention (sterile saline solution) in hospitalsModerate-quality evidence from one trial showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on neonatal mortality (RR 0.98, 95% CI 0.67 to 1.42). High-quality evidence from two trials showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on the risk of infections (RR 0.93, 95% CI 0.82 to 1.16).Findings from one trial showed that maternal vaginal cleansing in addition to total body cleansing results in increased risk of hypothermia (RR 1.33, 95% CI 1.19 to 1.49). Maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention (sterile saline solution) in the communityLow-quality evidence from one trial showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on neonatal mortality (RR 0.20, 95% CI 0.01 to 4.03). Moderate-quality evidence from one trial showed that maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention probably reduces the risk of neonatal infections (RR 0.69, 95% CI 0.49 to 0.95). These studies did not report effect on omphalitis. AUTHORS' CONCLUSIONS: There is some uncertainty as to the effect of chlorhexidine applied to the umbilical cords of newborns in hospital settings on neonatal mortality. The quality of evidence for the effects on infection are moderate for cord application and low for application to skin. There is high-quality evidence that chlorhexidine skin or cord care in the community setting results in a 50% reduction in the incidence of omphalitis and a 12% reduction in neonatal mortality. Maternal vaginal chlorhexidine compared to usual care probably leads to no difference in neonatal mortality in hospital settings. Maternal vaginal chlorhexidine compared to usual care results in no difference in the risk of infections in hospital settings. The uncertainty over the effect of maternal vaginal chlorhexidine on mortality outcomes reflects small sample sizes and low event rates in the community settings.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Infecções Bacterianas/prevenção & controle , Clorexidina/uso terapêutico , Mortalidade Infantil , Pele/microbiologia , Cordão Umbilical/microbiologia , Infecções Bacterianas/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Inflamação/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Umbigo , Vagina/microbiologia
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