Pediatrics and Neonatology最新文献

Neonatal sepsis is a leading cause of morbidity and mortality in Africa. This study aimed to examine neonatal sepsis treatment guidelines in Africa, compare them with WHO recommendations, identify similarities and deviations, and explore the impact of antimicrobial resistance and implementation challenges. A rapid systematic review was conducted following PRISMA-ScR guidelines. Five databases (Science Direct, PubMed, CINAHL, MEDLINE via Ovid, and Scopus) were systematically searched for studies published between 2014 and 2024 that reported national or regional guidelines on neonatal sepsis treatment. Data were extracted on first-line antibiotic selection, route of administration, treatment duration, supportive care measures, multidrug-resistant organisms and alignment with the WHO guidelines. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Overall, 29 studies were included in the review. Key findings revealed that while ampicillin/gentamicin, a WHO-recommended first-line regimen, was widely adopted, high microbial resistance rates necessitated alternatives such as carbapenems. Gram-negative pathogens, particularly Klebsiella pneumoniae (up to 92 % prevalence) dominated, with multidrug-resistant organisms (MDRO) showing a pooled prevalence of 59 % (95 % CI: 44.4-73.6 %). Regional disparities were evident: Eastern Africa reported 51 % MDRO, while Southern Africa reported 20.3 % MDRO. The high statistical heterogeneity (I² = 99.4 %) in the meta-analysis indicates variation in MDRO prevalence across studies, and the pooled estimate should therefore be interpreted with caution. Common implementation challenges included limited access to second-line antibiotics, inadequate training of healthcare workers and infrastructural constraints. Significant variations existed between neonatal sepsis treatment guidelines in a number of African countries and the WHO recommendations. These were driven by MDRO and healthcare resource limitations. While the WHO guidelines provide a global framework, country-specific adaptations are also necessary. There is a need to strengthen antimicrobial stewardship programs, improve diagnostic capacity, and enhance the training of healthcare workers.

Background: The optimal management of patent ductus arteriosus (PDA) in premature infants remains controversial. This study compares in-hospital and neurodevelopmental outcomes of different PDA treatment strategies in preterm infants.

Methods: This retrospective study included infants with PDA born between 2017 and 2021, with a gestational age of 22 0/7 to 29 6/7 weeks or a birth weight of 401-1500 g. They were categorized into conservative treatment, medical treatment, or invasive closure with/without medication.

Results: Among the 130 infants analyzed, 76 had hemodynamically significant PDA (hsPDA), which was present in 96.0 % of the invasive closure group, 76.1 % of the medical treatment group, and 2.6 % of the conservative group. For infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of bronchopulmonary dysplasia (BPD) ≥ grade II, retinopathy of prematurity (ROP) ≥ stage 3 and cognitive impairment compared with medical treatment. Among infants with PDA, compared to the conservative treatment group, infants receiving medication had a higher risk of death or BPD ≥ grade II. Invasive closure was associated with a higher risk of BPD ≥ grade II. No significant difference in neurodevelopmental outcomes was found, except for better cognitive outcome at 2 years of corrected age in the medical treatment group.

Conclusion: For preterm infants with hsPDA, invasive closure was associated with lower odds of mortality but higher odds of BPD ≥ grade II, ROP ≥ stage 3, and cognitive impairment compared to medical treatment. Among infants with PDA, despite a more turbulent postnatal course, neurodevelopmental outcomes for those receiving medication or invasive closure were comparable to those managed conservatively. Despite multiple statistical approaches, the limited sample size and potential reverse causality bias remain concerns. Further studies are needed to determine the optimal treatment strategy for PDA in preterm infants.

Background: Kasai portoenterostomy (KPE) is the key standard operation for biliary atresia (BA). Age at operation is an important factor that affects the outcome of KPE. The aim of the study is to evaluate the short-term outcome of KPE for biliary atresia infants in Upper Egypt.

Patients and methods: this was a cross-sectional, multicenter retrospective study done in three university hospitals in Upper Egypt. The data was collected from January 1, 2019 to September 30, 2021. All infants diagnosed with BA and managed by KPE were included in the study. The collected data were demographic data (age in months or days, sex, residence, parents' consanguinity, and parents' smoking status), history of present illness (the date of first symptoms, fecal color, skin itching, and associated anomalies), and general and abdominal examinations (liver size, skin, and sclera color).

Results: The total number of patients was 45 infants. Two-thirds of the cases were females. The mean age of KPE was 99 ± 13 days. The mean duration of jaundice clearance and resolution after surgery was 12.3 ± 5.5 weeks in 64.4 % of cases. During the five-year follow-up period, 26 (57.8 %) patients were still alive with native livers. Parental smoking, whether maternal or paternal, prenatal or postnatal, was present in 95.5 % of patients. A massive decrease in ALP level in the 1st postoperative week is an excellent predictor of a good outcome with a cutoff value of 560 U/L. Prophylaxis against developing cholangitis is important for the outcome.

Conclusion: Kasai portoenterostomy is an important operation for biliary atresia infants, whatever the age, under or above 4 months old. Kasai portoenterostomy increases the survival rate of native liver infants who suffer from BA. Jaundice clearance after KPE for BA can be predicted using postoperative AST, ALP, and GGT, as these enzymes decline dramatically at the end of the 3rd postoperative month. Unfortunately, the infants in this study had delayed diagnoses. To address this, targeted interventions such as continuing medical education for local doctors, improved transportation infrastructure, and financial support programs are needed to enhance early diagnosis. Despite the delay in the surgical intervention and the older infant's age, the results were good.

Clinicaltrials: gov Identifier: NCT05925543. Kasai portoenterostomy operation. in Biliary Atresia - Clinical Trials Registry - ICH GCP. The Registration Date was June 29, 2023.