Neonatal sepsis is a fatal condition and can lead to mortality in infants

Health Care, Heart Care Foundation of India, Medicine, Social Health Community Comments Off

India witnesses more than 50,000 infant deaths due to this condition every year

New Delhi, 09 July 2018: Hospitalized infants are at high risk of developing drug-resistant hospital-acquired infections due to a rise in bacterial resistance. The susceptibility of newborns to sepsis is compounded, as diagnosing serious bacterial infections in them is challenging and symptoms difficult to detect. About 40% of the global burden of sepsis-related neonatal deaths is in South Asia. In India alone, about 56,500 neonatal deaths every year are attributable to sepsis caused by anti-microbial resistance to drugs.

Neonatal sepsis is a systemic infection occurring in infants at ≤28 days of life and is an important cause of morbidity and mortality of newborns. Early-onset sepsis is seen in the first week of life occurs after 1 week and before 3 months of age. This condition can be attributed to bacteria such as Escherichia coli (E.coli), Listeria, and some strains of streptococcus.

In a Joint Statement, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, & Dr Akhil Saxena, Senior Paediatricians Kota said, “The immune systems in newborns are not fully developed and therefore, sepsis at this stage can be potentially life threatening. The infection is mostly passed on from the pregnant mother to the baby. However, in less common cases, it can also be picked up from the immediate environment. Most babies with such infections can recover completely with timely intervention. The more quickly an infant gets treatment, the better the outcome. In the absence of this, they can develop complications including lifelong disability. In case of infants with this condition, the normal immune system response is sent into overdrive, causing a blood condition which is potentially harmful to the baby’s health. Under such conditions, the body produces excessive white blood cells to fight the infection.

Symptoms of neonatal sepsis in infants include changes in body temperature, breathing problems, diarrhea, low blood sugar, reduced movements, reduced sucking, seizures, slow or fast heart rate, swollen belly area, vomiting, and yellow skin and whites of the eyes (jaundice).

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Complications during pregnancy and after birth can create high-risk conditions for neonatal sepsis. Infants who do not receive timely treatment can succumb to multiple organ failure. In other cases, the blood pressure may drop – what can be called a septic shock. This can be fatal if the doctor does not administer antibiotics and large quantities of intravenous fluids to flush out and fight the infection in the blood.”

Some prevention tips to avert neonatal sepsis

  • Pregnant women should maintain proper hygiene. They should be given preventive antibiotics in case of Chorioamnionitis, Group B strep colonization, or a previous baby with sepsis caused by bacteria.
  • It is important to prevent and treat infections in mothers, including HSV
  • There should be a provision of a clean place for birth.

·         The baby should be delivered within 12 to 24 hours of when the membranes break. In case of complications, a cesarean delivery should be done in women within 4 to 6 hours or sooner of membranes breaking.

Small labs may now quite possibly be run by non doctors: Who will bear the interpretation charges?

Health Care Comments Off

The govt. has formulated new rules for pathological labs in the amended Clinical Establishments (Central Government) Amendment Rules, 2018 notified earlier this year. The rules have specified minimum standards of services and facilities for medical diagnostic labs or path labs.

These new rules have categorized diagnostic labs into types: Basic composite (small), medium and advanced. The scope of services, infrastructure, staffing, records, equipments including legal requirements have also been clearly defined for each type of lab.

What is of utmost importance to note in these rules is that while a minimum qualification of MD/DNB in Pathology and Biochemistry or Medical Microbiology or Laboratory Medicine or MBBS with PhD in any of the above mentioned subjects has been made an essential requirement for medium and advanced labs, no such qualification/s has been specified for small labs. An MBBS/MS has been mentioned only as ‘desirable’ but not mandatory.

This means that now small labs may quite possibly be run by non doctors.

The irony of the situation is that the rules for small labs go on to state that “whenever interpretation of lab results or opinion thereon are required, a registered MBBS medical practitioner is essential”. These small labs can therefore only report results as values but not give an interpretation or a clinical opinion.

So, who will interpret the lab report? Reading the values and interpreting them in context of the individual patient will now have to be done by the treating doctor. And, this will be another head in the consultation charges. Because a consultation charge is not just the fee for consultation alone. It also includes non treatment costs such as the interpretation of lab/x-ray reports, making patient summary, administrative charges etc.

If these rules stay as such, then this would increase the cost of care, which will have to be borne by the patients.

When doctors voice their opposition to such a move, the public criticizes doctors. But, the patient has a right to know if his/her lab report has been signed and interpreted by a qualified doctor. All labs must be supervised by a qualified doctor, be it MBBS/MD.

In the light of these new rules, it is for the public to decide if they accept these rules of the govt. or not.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Oral honey after button battery ingestion in children may reduce esophageal injury

Health Care, Medicine Comments Off

Up till now, the usual practice in cases of asymptomatic children with acute button battery ingestion has been to keep the child nil orally until radiographic localization and emergency endoscopic removal of esophageal button batteries.

Now, based on findings in laboratory animals, a new study reported online June 11, 2018 in the journal The Laryngoscope says that early and frequent oral administration of either honey or sucralfate until the battery is removed may reduce the severity of esophageal burns or injury.

The child who is older than one year of age, with acute button battery ingestion (witnessed or likely to have occurred within 1 to 2 hours) can be given 5-10 ml of pure honey orally at the earliest after ingestion followed by more doses of honey at regular intervals. In the emergency department, the child may receive another dose of honey or a single dose of sucralfate 500 mg before confirmation of esophageal impaction and emergency battery removal.

The authors recommend that parents give honey till the child reaches a hospital, while physicians can use sucralfate before proceeding to remove the battery. However, they cautioned against using honey or sucralfate in children who have a clinical suspicion of existing sepsis or perforation of the esophagus, known severe allergy to honey or sucralfate, or in children younger than one year, due to a risk of botulism, even though small.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA