M Monir Hossain

Determination of extended-interval gentamicin dosing for neonatal patients in developing countries.

Background: Infectious diseases account for an estimated 36% of neonatal deaths globally. The purpose of this study was to determine safe, effective, simplified dosing regimens of gentamicin for treatment of neonatal sepsis in developing countries. Methods: Neonates with suspected sepsis in the neonatal intensive care unit (NICU) at Christian Medical College and Hospital (CMC), Vellore, India (n = 49), and Dhaka Shishu Hospital (DSH), Bangladesh (n = 59), were administered gentamicin intravenously according to the following regimens: (1) 10 mg every 48 hours for neonates <2000 g; (2) 10 mg every 24 hours for neonates 2000–2249 g; and (3) 13.5 mg every 24 hours for neonates ≥2500 g. Serum gentamicin concentration (SGC) at steady state and pharmacokinetic indices were determined. Renal function was followed while under treatment and hearing was examined 6 weeks to 3 months after discharge. Results: All neonates, except 1 weighing 2000–2249 g at DSH, had a peak SGC >4 μg/mL. Overall, 5 (10%) and 17 (29%) infants had a peak SGC level ≥12 μg/mL from CMC and DSH, respectively, and 10 (20%) and 4 (7%) cases from CMC and DSH, respectively, had a trough SGC level ≥2 μg/mL. However, no infant <2000 g had a trough SGC level ≥2 μg/mL. We found no evidence of gentamicin nephrotoxicity or ototoxicity. Conclusion: Safe, therapeutic gentamicin dosing regimens were identified for treatment of neonatal sepsis in developing country settings. Administration of these doses could be simplified through use of Uniject, a prefilled, single injection device designed to make injections safe and easy to deliver in developing country settings.

Safety and effect of chlorhexidine skin cleansing on skin flora of neonates in Bangladesh.

Background: Chlorhexidine cleansing of newborn skin is a highly promising intervention for reducing neonatal mortality in developing countries, yet little is known of the mechanism of action. This study examined the impact of a single skin cleansing of hospitalized newborn infants in Bangladesh with baby wipes containing 0.25% chlorhexidine on both qualitative and quantitative skin flora. Methods: Within 72 hours of birth, the skin of newborns admitted to Dhaka Shishu Hospital was wiped with baby wipes containing 0.25% chlorhexidine (n = 67) or placebo (n = 66) solution. Skin condition was assessed and skin swabs were taken from 3 sites (axillary, peri-umbilical, inguinal) at baseline and 2 hours, 24 hours, 3 days and 7 days after treatment. Skin flora was quantified and colonizing species were identified. Findings: Skin cleansing with chlorhexidine had no adverse effects on skin condition, and resulted in minimal reduction (mean 0.5°C) in body temperature. Positive skin culture rates 2 hours after skin cleansing were approximately 35%–55% lower than the baseline rates for placebo and chlorhexidine groups at all 3 sites. For the chlorhexidine group, positive skin culture rates remained significantly lower than the baseline rates for 24 hours to 3 days, whereas for the placebo group, beyond the first 2-hour follow-up, these values were not lower than baseline in any of the 3 sites. Interpretation: Chlorhexidine skin treatment produced more extended skin cleansing effects than the placebo treatment. It is possible that the quantitative and qualitative reductions observed in the skin flora might contribute to reducing neonatal infections.

Comparative Study of Early Versus Delayed Enteral Feeding in Development of Necrotizing Enterocolitis for Preterm Small for Date Babies

Background: Growth-restricted preterm infants are at increased risk of developing necrotizing enterocolitis (NEC) and initiation of enteral feeding is frequently delayed, even though delayed enteral feeding could diminish the functional adaptation of the gastrointestinal tract and result in feeding intolerance later. Objectives: To evaluate the development of necrotizing enterocolitis of early and delayed enteral feeding in preterm small for date babies (weighing 1000-1499 grams). Materials and Methods: This was a consecutive sampling technique, conducted in the Department of Paediatrics Sylhet MAG Osmani Medical College Hospital during the period from July 2012 to June 2014. One hundred and forty neonates with preterm small for date babies were selected according to inclusion and exclusion criteria. Inclusion criteria were baby born preterm ( 0.05], death [10 (16.7%) vs 11 (16.9%); p>0.05], oral feeding not established [1 (1.7%) vs 2 (3.1%); p>0.05], referred to paediatric surgery [4 (6.7%) vs 5 (7.7%); p>0.05] did not differ significantly between early and late feeding group. Causes of death were sepsis in 3 (30.0%), recurrent apnoea in 4 (40.0%)] and hypothermia in 3 (30.0%) in early feeding group; while causes of death were sepsis in 5 (45.5%), recurrent apnoea in 4 (36.4%)] and hypothermia in 2 (18.1%) neonates in late feeding group (p=0.861,p=0.881,p=0.781 respectively). Conclusion: Findings of this consecutive sampling technique concludes that early enteral feeding with breast milk does not increase the incidence of NEC, sepsis and death. Bangladesh J Child Health 2017; VOL 41 (2) :84-91