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Hospital acquired neonatal infections

Uduak Okomo describes the burden of hospital acquired neonatal infections and outlines approaches to prevent their occurrence.
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UDUAK OKOMO: My name is Doctor Uduak Okomo, and I’m a paediatrician working in the Gambia, West Africa. I did my PhD through the London School of Hygiene and Tropical Medicine on neonatal infections in hospital settings. Neonatal infections, such as sepsis and meningitis, are responsible for up to 600,000 newborn deaths each year. Babies kind of quiet infections from several sources, including the mother, the home, and the hospital environments. Infections acquired through the hospice environments are also known as nosocomial or health care-associated infections. Premature babies and low birth weight babies are particularly vulnerable to these infections because of developmental deficiencies in their adaptive and innate immune systems.
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In high income countries, advances in neonatal intensive care have led to the increasing survival of these newborn babies. These babies are nursed in intensive care units, where they are exposed to a wide variety of invasive monitoring, diagnostic, and therapeutic procedures and devices. And this is an unavoidable risk for these babies, which exposes them to infection pathogens that are endemic in the hospital environment. Prolonged hospital stays and exposure to broad spectrum antibiotics further puts these babies at risk of acquiring infection with antibiotic resistant organisms. Babies that are colonised or infected with these antibiotic resistant organisms serve as a reservoir of infection in the hospital with serious implications for other babies in the units.
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Hospital-acquired infections presents a high burden in low-income country settings where the risk of infection is up to three to 20 times higher than for babies in high-income country settings. In these settings, more babies are being born in the hospital. However, the hospitals vary in the quality of care provided and many present with poor environments, unhealthy and unclean environments, and poor infection control policies. In my study, there were two important findings. First was the fact that 90% of babies that were admitted were exposed to an antibiotic, but only 2% of babies had a lumbar puncture, and 1% of babies had a blood culture. Secondly, there was a high rate of infection with hospital-acquired pathogens, such as e.
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Coli and burkholderic cepacia that were found to be growing in the intravenous fluids and even the antibiotics, such as gentamicin, that these babies were receiving. This picture is commonly seen across many low-income country settings, where health care workers often work as if they are driving with a blindfold on, as they don’t have supported laboratory investigations to guide them in their management of these babies. As a result, there is a high rate of antimicrobial-resistant pathogens circulating in the hospitals in these environments. And there’s urgent need to address this. What can we do to address this? First of all, we can ensure that microbiological investigations are part of the routine workup for babies that are admitted with suspected infection.
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Secondly, we can ensure that antibiotic stewardship policies are instituted in our facilities. That means that babies are treated according to recommended guidelines using the recommended first line antibiotics and only moving to a second line or another antibiotic after microbiological investigation results have been reviewed. There’s also gap for innovations, innovations in the diagnosis of infections, particularly with blood culture and lumbar puncture. The average blood culture takes up to 45 days in a low-income country setting and could even take longer when one has to wait for antimicrobial susceptibility testing results. There’s also need for bedside diagnostics for use in areas where they don’t have access to good laboratories. Lastly, there’s room for vaccines for targeted pathogens, which are common in different settings.
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One example is GBS, which is a common cause of infection in newborns in many settings. Thank you.

Hospitals have a key role in reducing stillbirths and neonatal deaths through delivery care and care of the small and sick newborn. The benefit of this care comes with a risk: hospital acquired neonatal infections.

In this step Uduak Okomo describes the burden of these infections and outlines approaches to prevent their occurrence.

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