Objective: Although the benefits of pain control measures in neonates are well known, the actual usage was not optimal in our unit. Therefore, we implemented a quality improvement project to improve pain management practices through multiple Plan-Do-Study-Act (PDSA) cycles.
Method: Our project included hemodynamically stable newborns weighing ≥1300 g. We identified four common procedures: intravenous cannulation, venous sampling, heel prick, and nasogastric tube insertion. The selected pain control measures were skin-to-skin contact, breastfeeding, expressed breast milk orally, and oral sucrose. Between April 2019 and September 2019, we intervened multiple times and reassessed shortcomings. We encouraged evidence-based practices and gave solutions for shortcomings. Data were interpreted weekly to assess the compliance to pain control interventions.
Results: Minimal pain control measures (3-4%) were utilized for identified procedures before the project began. We could improve the use of pain control measures steadily and achieve the target of 80% of procedures after seven different interventions over five months. There was a retention of the effect on reassessing twice at second and fourth months of stopping further intervention once the target got achieved.
Conclusion: Quality Improvement science can identify the shortcomings and help to improve the compliance for pain control practices in neonates, as demonstrated in this neonatal unit.
Background: Neonatal mortality remains a prominent public health problem in developing countries. Particularly, Ethiopia has a higher neonatal mortality rate than the average sub-Saharan African countries. Hereafter, this review article was aimed at synthesizing existing predictors of neonatal mortality in Ethiopia.
Methods: A systematic search and review of peer-reviewed articles were conducted on the predictors of neonatal mortality in Ethiopia. A search of key terms across different databases including Web of Science, SCOPUS, Cochrane Library, PubMed, EMBASE, Hinari, and Google Scholar was conducted, supplemented by reference screening. The SANRA tool was used to critically appraise studies included in the review.
Results: After removing duplicates and applying the eligibility criteria, 14 of the 64 initially identified articles were included in the final review. These were original articles published between 2011 and 2021. The identified predictors were narrated and presented under different domains. Accordingly, sociodemographic predictors such as residence, distance from the health facility, and maternal age; service delivery-related predictors such as no ANC follow-up, not taking iron-folic acid supplementation during pregnancy, and no PNC visit; neonate-related predictors such as low birth weight, extreme prematurity/preterm, and low APGAR score; pregnancy and childbirth-related predictors such as birth interval < 18 months, twin pregnancy, and time of rupture of membrane > 12 hours; and maternal-related predictors such as maternal HIV infection, maternal childbirth-related complications, and maternal near-miss were stated to increase a likelihood of newborn death in Ethiopia.
Conclusion: Public health interventions directed at decreasing neonatal mortality should address the rural residents, mothers not having ANC follow-up, low birth weight, twin pregnancy, and maternal HIV infection. The wealth of data gathered during primary research should not only lead to identification of predictors, but should also provide guidance for health system intervention strategies in a country aiming to reduce neonatal mortality.
Background: Different epidemiologic aspects of drug-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children are scarce.
Aim: To compare the clinical and epidemiological features of patients with drug-induced SJS and TEN in children and adults.
Method: This retrospective study was conducted at two academic referral centers (Isfahan, Iran) over 5 years. SJS and TEN were clinically diagnosed and confirmed by skin biopsy as needed.
Results: One hundred one patients (31 children and 70 adults) with a female to male ratio of 1.1 : 1 was identified in the present study. SJS was more commonly diagnosed in both pediatric and adult patients. The most frequent reason for drug administration identified was the infection (45.2%) and seizure (45.2%) in children and infection (34.3%) and psychiatry disorder (27.1%) in adults (P = 0.001). The most common culprit drugs in the pediatric were phenobarbital (9/31), cotrimoxazole (4/31), and amoxicillin (4/31); however, in the adult group, the most common drugs were carbamazepine (11/70) and lamotrigine (9/70). Fever was significantly more common in adults (44.3%) compared to pediatric patients (22.6%) (P = 0.03). Multiple logistic regression models showed that pediatric patients had significantly lower odds of hospitalization (OR [odds ratio]: 0.14; 95% CI 0.02, 0.67). In addition, patients with SCORTEN 1 had significantly higher odds of hospitalization (OR: 6.3; 95% CI: 1.68, 23.79) compared to patients with SCORTEN 0.
Conclusions: The present study showed several differences between the pediatric and adult patients with SJS and TEN, including the reason for drug administration, culprit drugs, length of hospital stay, presence of fever, and final diagnosis of disease.
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