Archives of Disease in Childhood - Fetal and Neonatal Edition
ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis R... more ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient safety.DesignMulticentre prospective studySettingTen perinatal hospitals in Wales, UK.PatientsAll live births ≥34 weeks’ gestation over a 12-month period (April 2019–March 2020) compared with infants in the preceding 15-month period (January 2018–March 2019) as a baseline.MethodsThe consensus guideline was introduced in clinical practice on 1 April 2019. It incorporated a modified SRC algorithm, enhanced in-hospital surveillance, ongoing quality assurance, standardised staff training and parent education. The main outcome measure was antibiotic usage/1000 live births, balancing this with analysis of harm from delayed diagnosis and treatment, disease severity and readmissions from true sepsis. Outcome measures were analysed using statistical process control charts.Main ...
Contemporary outcome data of preterm infants are essential to commission, evaluate and improve he... more Contemporary outcome data of preterm infants are essential to commission, evaluate and improve healthcare resources and outcomes while also assisting professionals and families in counselling and decision making. We analysed trends in clinical practice, morbidity, and mortality of extremely preterm infants over 10 years in South Wales, UK. This population-based study included live born infants
To the burgeoning population, the tiger reserves of central India have been islanded by human hab... more To the burgeoning population, the tiger reserves of central India have been islanded by human habitation and are interconnected by narrow ‘wildlife corridors’ for migration of wildlife. Pench-Satpuda wildlife corridor is one such critical wildlife corridor that interconnects the Pench Tiger Reserve and Satpuda Tiger Reserve in central India. Land Use Land Cover (LULC) change of this corridor between April 2002 and April 2019 was analyzed using GIS and Remote Sensing Techniques. The study finds a systematic loss of 10,376.74 ha and 7406.24 ha of dense forests and open forests respectively, thus indicating large scale degradation of the area. The study found that a net area of 2054.60 of dense forests and open forests were diverted for agriculture indicating extensive encroachment of forest land. Water bodies have reduced by 25.41% indicating shrinkage in water bodies in the period under study. The presence of rich coal deposits in the wildlife corridor and operational coal mines in t...
A strategy of early extubation to non-invasive respiratory support in preterm infants could be bo... more A strategy of early extubation to non-invasive respiratory support in preterm infants could be boosted by the availability of a decision-support tool for clinicians. Using the Heart Rate Characteristics index (HRCi) with clinical parameters, we derived and validated predictive models for extubation readiness and success.Peri-extubation demographic, clinical and HRCi data for up to 96 h were collected from mechanically ventilated infants in the control arm of a randomised trial involving 8 neonatal centres, where clinicians were blinded to the HRCi scores. The data was used to produce a multivariable regression model for the probability of subsequent re-intubation. Additionally, a survival model was produced to estimate the probability of reintubation in the period after extubation.Of the 577 eligible infants, data from 397 infants (2/3rd) were used to derive the pre-extubation model and 180 infants for validation. The model was also fitted and validated using all combinations of tra...
Archives of Disease in Childhood - Fetal and Neonatal Edition
ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset ... more ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS).DesignRetrospective multicentre study.SettingFive maternity services in South West of England and Wales.Patients70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture.MethodsRetrospective virtual application of NICE and SRC through review of maternal and neonatal notes.Main outcome measureThe number of infants recommended antibiotics by 4 hours of birth.ResultsThe incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies...
We aimed to model longitudinal data to create predictive growth charts for weight in preterm infa... more We aimed to model longitudinal data to create predictive growth charts for weight in preterm infants from birth till discharge, that took into account the differing growth rates post-birth when compared to in-utero growth and therefore was more representative of the data than the UK1990 reference charts. Data from birth until discharge (or death), was collected and rigorously cleaned for all infants born at <32 weeks of gestation over a 4-year period. Means and standard deviations from the UK1990 reference charts were used to compute standard deviation scores (SDS) for our cohort. 2/3rd of the data was randomly selected and used to create gestation and gender-specific predictive weight centile lines through novel application of mixed modelling methods. The remaining 1/3rd of the data was used to test model fit by comparing expected vs actual weights for the new model with those predicted by the UK1990 model. Data from 1,510 preterm infants was analysed. 1067 of these were used to...
Objective: To assess and compare the tensions and deformations (stresses and strains) generated a... more Objective: To assess and compare the tensions and deformations (stresses and strains) generated after application of two types of forces (traction and torsion) in miniscrews of two different materials (titanium and stainless steel) placed at five different angulations. Materials and Methods: Three-dimensional models of the posterior maxillary area and the mini-implants were constructed using computer-aided design software program (CATIA P3 V5-6 R2015 B26 / 2016; Dassault Systèmes). Titanium and stainless steel materials were used for miniscrews. The area constructed was in between the maxillary second premolar and first molar. The models with mini-implants were inserted at five different angulations (30°, 45°, 60°, 75° and 90°). Torsional and tractional forces were applied on these implants, and the models were solved using ANSYS 10.0. Stress generated in implant and in the cortical and cancellous bones was evaluated and compared at all the five angulations. Results: Stress generate...
Archives of Disease in Childhood - Fetal and Neonatal Edition
ObjectiveTo compare management recommendations of the National Institute for Health and Care Exce... more ObjectiveTo compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS).DesignMulticentre prospective observational projection study.SettingEight maternity hospitals in Wales, UK.PatientsAll live births ≥34 weeks gestation over a 3-month period (February–April 2018).MethodsDemographics, maternal and infant risk factors, infant’s clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC.Main outcome measureProportion of infants recommended for antibiotics on either tool.ResultsOf 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction o...
To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics ind... more To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics index (HRCi) can be combined with a clinical model for predicting extubation outcomes in neonates. HRCi and clinical data for all intended intubation-extubation events (episodes) were retrospectively analyzed between June 2014 and January 2015. Each episode started 6 hours pre-extubation or at the time of primary intubation if ventilation duration was shorter than 6 hours (baseline). The episodes ended at 72 hours postextubation for successful extubations or at reintubation for failed extubations. Mean of 6 hourly epoch HRCi-scores (baseline) or fold-changes (postextubation) were analyzed. Results are expressed as medians (IQR) for continuous data and proportions for categorical data. Multivariable logistic regression mixed model was used for statistical analysis. Sixty-six infants contributed to 96 episodes (18 failed extubations, 78 successful extubations) in the study. Failed extubations...
Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic o... more Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic overuse and limited investment in new antibiotic research. Inappropriate perinatal antibiotic exposure is increasingly linked to lifelong adverse outcomes through its impact on the developing microbiome. Antibiotic stewardship may be the only effective preventative strategy currently available. As the first tertiary neonatal unit in the UK to collaborate in an international quality improvement programme (QIP) with Vermont Oxford Network (VON), we present the results of our antibiotic stewardship initiative. The QIP was officially launched in January 2016 and aimed to reduce antibiotic usage rate (AUR) by 20% of baseline by 31st December 2016 without compromising patient safety. A multidisciplinary team of professionals and parent representatives shared good practices and improvement strategies through international webinars and local meetings, devised uniform data collection methodology a...
Abstract Penicillin acylase, an industrially important biocatalyst catalyzes the conversion of pe... more Abstract Penicillin acylase, an industrially important biocatalyst catalyzes the conversion of penicillins to 6-amino penicillanic acid (6-APA) which is the main precursor for the production of semisynthetic ß-lactam antibiotics. The present work involves the continuous ...
Archives of Disease in Childhood - Fetal and Neonatal Edition
ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis R... more ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient safety.DesignMulticentre prospective studySettingTen perinatal hospitals in Wales, UK.PatientsAll live births ≥34 weeks’ gestation over a 12-month period (April 2019–March 2020) compared with infants in the preceding 15-month period (January 2018–March 2019) as a baseline.MethodsThe consensus guideline was introduced in clinical practice on 1 April 2019. It incorporated a modified SRC algorithm, enhanced in-hospital surveillance, ongoing quality assurance, standardised staff training and parent education. The main outcome measure was antibiotic usage/1000 live births, balancing this with analysis of harm from delayed diagnosis and treatment, disease severity and readmissions from true sepsis. Outcome measures were analysed using statistical process control charts.Main ...
Contemporary outcome data of preterm infants are essential to commission, evaluate and improve he... more Contemporary outcome data of preterm infants are essential to commission, evaluate and improve healthcare resources and outcomes while also assisting professionals and families in counselling and decision making. We analysed trends in clinical practice, morbidity, and mortality of extremely preterm infants over 10 years in South Wales, UK. This population-based study included live born infants
To the burgeoning population, the tiger reserves of central India have been islanded by human hab... more To the burgeoning population, the tiger reserves of central India have been islanded by human habitation and are interconnected by narrow ‘wildlife corridors’ for migration of wildlife. Pench-Satpuda wildlife corridor is one such critical wildlife corridor that interconnects the Pench Tiger Reserve and Satpuda Tiger Reserve in central India. Land Use Land Cover (LULC) change of this corridor between April 2002 and April 2019 was analyzed using GIS and Remote Sensing Techniques. The study finds a systematic loss of 10,376.74 ha and 7406.24 ha of dense forests and open forests respectively, thus indicating large scale degradation of the area. The study found that a net area of 2054.60 of dense forests and open forests were diverted for agriculture indicating extensive encroachment of forest land. Water bodies have reduced by 25.41% indicating shrinkage in water bodies in the period under study. The presence of rich coal deposits in the wildlife corridor and operational coal mines in t...
A strategy of early extubation to non-invasive respiratory support in preterm infants could be bo... more A strategy of early extubation to non-invasive respiratory support in preterm infants could be boosted by the availability of a decision-support tool for clinicians. Using the Heart Rate Characteristics index (HRCi) with clinical parameters, we derived and validated predictive models for extubation readiness and success.Peri-extubation demographic, clinical and HRCi data for up to 96 h were collected from mechanically ventilated infants in the control arm of a randomised trial involving 8 neonatal centres, where clinicians were blinded to the HRCi scores. The data was used to produce a multivariable regression model for the probability of subsequent re-intubation. Additionally, a survival model was produced to estimate the probability of reintubation in the period after extubation.Of the 577 eligible infants, data from 397 infants (2/3rd) were used to derive the pre-extubation model and 180 infants for validation. The model was also fitted and validated using all combinations of tra...
Archives of Disease in Childhood - Fetal and Neonatal Edition
ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset ... more ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS).DesignRetrospective multicentre study.SettingFive maternity services in South West of England and Wales.Patients70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture.MethodsRetrospective virtual application of NICE and SRC through review of maternal and neonatal notes.Main outcome measureThe number of infants recommended antibiotics by 4 hours of birth.ResultsThe incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies...
We aimed to model longitudinal data to create predictive growth charts for weight in preterm infa... more We aimed to model longitudinal data to create predictive growth charts for weight in preterm infants from birth till discharge, that took into account the differing growth rates post-birth when compared to in-utero growth and therefore was more representative of the data than the UK1990 reference charts. Data from birth until discharge (or death), was collected and rigorously cleaned for all infants born at <32 weeks of gestation over a 4-year period. Means and standard deviations from the UK1990 reference charts were used to compute standard deviation scores (SDS) for our cohort. 2/3rd of the data was randomly selected and used to create gestation and gender-specific predictive weight centile lines through novel application of mixed modelling methods. The remaining 1/3rd of the data was used to test model fit by comparing expected vs actual weights for the new model with those predicted by the UK1990 model. Data from 1,510 preterm infants was analysed. 1067 of these were used to...
Objective: To assess and compare the tensions and deformations (stresses and strains) generated a... more Objective: To assess and compare the tensions and deformations (stresses and strains) generated after application of two types of forces (traction and torsion) in miniscrews of two different materials (titanium and stainless steel) placed at five different angulations. Materials and Methods: Three-dimensional models of the posterior maxillary area and the mini-implants were constructed using computer-aided design software program (CATIA P3 V5-6 R2015 B26 / 2016; Dassault Systèmes). Titanium and stainless steel materials were used for miniscrews. The area constructed was in between the maxillary second premolar and first molar. The models with mini-implants were inserted at five different angulations (30°, 45°, 60°, 75° and 90°). Torsional and tractional forces were applied on these implants, and the models were solved using ANSYS 10.0. Stress generated in implant and in the cortical and cancellous bones was evaluated and compared at all the five angulations. Results: Stress generate...
Archives of Disease in Childhood - Fetal and Neonatal Edition
ObjectiveTo compare management recommendations of the National Institute for Health and Care Exce... more ObjectiveTo compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS).DesignMulticentre prospective observational projection study.SettingEight maternity hospitals in Wales, UK.PatientsAll live births ≥34 weeks gestation over a 3-month period (February–April 2018).MethodsDemographics, maternal and infant risk factors, infant’s clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC.Main outcome measureProportion of infants recommended for antibiotics on either tool.ResultsOf 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction o...
To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics ind... more To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics index (HRCi) can be combined with a clinical model for predicting extubation outcomes in neonates. HRCi and clinical data for all intended intubation-extubation events (episodes) were retrospectively analyzed between June 2014 and January 2015. Each episode started 6 hours pre-extubation or at the time of primary intubation if ventilation duration was shorter than 6 hours (baseline). The episodes ended at 72 hours postextubation for successful extubations or at reintubation for failed extubations. Mean of 6 hourly epoch HRCi-scores (baseline) or fold-changes (postextubation) were analyzed. Results are expressed as medians (IQR) for continuous data and proportions for categorical data. Multivariable logistic regression mixed model was used for statistical analysis. Sixty-six infants contributed to 96 episodes (18 failed extubations, 78 successful extubations) in the study. Failed extubations...
Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic o... more Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic overuse and limited investment in new antibiotic research. Inappropriate perinatal antibiotic exposure is increasingly linked to lifelong adverse outcomes through its impact on the developing microbiome. Antibiotic stewardship may be the only effective preventative strategy currently available. As the first tertiary neonatal unit in the UK to collaborate in an international quality improvement programme (QIP) with Vermont Oxford Network (VON), we present the results of our antibiotic stewardship initiative. The QIP was officially launched in January 2016 and aimed to reduce antibiotic usage rate (AUR) by 20% of baseline by 31st December 2016 without compromising patient safety. A multidisciplinary team of professionals and parent representatives shared good practices and improvement strategies through international webinars and local meetings, devised uniform data collection methodology a...
Abstract Penicillin acylase, an industrially important biocatalyst catalyzes the conversion of pe... more Abstract Penicillin acylase, an industrially important biocatalyst catalyzes the conversion of penicillins to 6-amino penicillanic acid (6-APA) which is the main precursor for the production of semisynthetic ß-lactam antibiotics. The present work involves the continuous ...
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