URL: www.pediatrics.org/cgi/doi/10.1542/peds.2014–3330L Somashekhar Nimbalkar, a Ankush Khanna, a Dipen Patel, a Archana Nimbalkar, a Ajay Phatak b a Pramukhswami Medical College, India; and b Charutar Arogya Mandal, India Report on Kangaroo Care Practices in a Tertiary Level NICU in Western India—Scope for Improvement BACKGROUND: High-risk low birth weight neonates admitted to NICUs require prolonged care, which is expensive. Kangaroo care (KC) involves skin-to-skin contact between a family member and the newborn, frequent and exclusive (or nearly exclusive) breastfeeding, and early discharge from the hospital. It has many benefits, with decreased mortality, decreased morbidity, better bonding, early dis- charge, and rapid establishment of birth weight being the foremost among them. OBJECTIVES: We studied the association of KC duration with reduced hospital stay and reduced mortality and mor- bidity, as well as factors governing delivery of KC. METHODS: Data were collected from the charts of neonates ,2 kg who were admitted to the NICU from January 2012 until June 2014. The data included sociodemographic var- iables, the clinical profile of neonates including treatment, details of KC, and important outcomes such as mortality, weight gain, antibiotic usage, and ventilator care. Descrip- tive statistics were used to report on the study population profile, and t tests and regression were used to explore associations. RESULTS: A total of 106 neonates were included (68 boys, 38 girls). KC was provided to 52 (49.1%) neonates. Three (2.8%) neonates were term, 49 (46.2) were late preterm, 34 (32.1%) were moderate preterm, 16 (15.1%) were very preterm, and 2 (1.9%) were extremely preterm. A significant proportion required a cesarean delivery (n 5 45 [42.5%]). About one-half of the neonates (n 5 51) required ventilator support, and most neonates (n 5 69) required continuous positive airway pressure support. The mean 6 SD birth weight of the neonates was 1538.07 6 337.88 g. KC was provided for a mean of 13.92 6 21.67 hours. The mean duration of KC was significantly greater for neonates who gained weight compared with those who experienced weight loss (20.92 6 27.89 hours vs 6.38 6 6.38 hours; P 5 .016). The mean duration of KC was significantly greater for neonates who did not require antibiotics versus those who required antibiotics (17.73 6 24.68 hours vs 4.23 6 3.39 hours; P 5 .002). The mean number of KC hours per day was 2.86 6 1.89. Linear regression revealed that mother’s age was the only significant predictor of KC hours per day (P 5 .074). There was no significant difference between mean KC duration for neonates who required ventilator support versus those who did not require it. CONCLUSIONS: The few hours of KC given per day suggest that this intervention with proven benefits is not being used optimally. Qualitative research is warranted to de- termine the barriers for this lacuna. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2014–3330M Amee Amin, a Dipen Patel, a Nikhil Shah, a Ajay Phatak, b Somashekhar Nimbalkar a a Pramukhswami Medical College, India; and b Charutar Arogya Mandal, India A Prospective Study of Nosocomial Infection in a Neonatal ICU (NICU) A prospective study of nosocomial sepsis was performed in the NICU of Surgiscope Pvt. Hospital to determine the organisms causing nosocomial infection in neonates and their resistance patterns; also studied were risk factors, clinical presentation, hematologic parameters, and out- comes over a 12-month period. A total of 363 neonates were admitted to the ICU. A total of 250 blood samples were sent for culture and sensitivity testing in suspicious cases of nosocomial infection. All patients were on anti- biotics. Of these, 36.8% (92 of 250) had a positive result on culture. Isolated bacteria were mostly gram-negative bacilli (80.43%) with a marked predominance of Klebsiella (n 5 32 [43.2%]) followed by Escherichia coli (n 5 18 [24.32%]), Pseudomonas (n 5 16 [21.62%]), and acinetobacter (n 5 5 [6.75%]). Resistance to gentamicin was 100% for all organisms. Resistance to amikacin was 100% for E coli, Pseudomonas, and acinetobacter and 40% for Klebsiella. Resistance of these gram-negative rods ranged from 70% to 100% and 50% to 100% for ceftriaxone and ceftazidime, respectively. Among the culture-positive cases, prematurity (67.39%) and low birth weight (60.86%) were the main risk factors. Refusal to feed (78%) and lethargy (68%) were the 2 main clinical presentations of nosocomial sepsis. It was also observed that in the culture-positive group, 68.5% (63 of 92) had low hemoglobin levels (,14 gm /dL), 18.5% (17 of 92) had leukopenia (total leukocyte count ,5000 mm 3 ), and 63% (58 of 92) of patients had thrombocytopenia (platelet count ,100 000 mm 3 ), 75% (69 of 92) had an elevated immature to total neutrophil ratio. C-reactive protein was positive in 84.78% (78 of 92) of cases, and 30.43% (28 of 92) of culture-positive neonates died. Mortality was high in preterm low birth weight infants (37% [23 of 62]). Emergence of multidrug-resistant organisms in the ICU is a serious problem causing high mortality and should be prevented with strict S8 BEST ARTICLES RELEVANT TO PEDIATRIC ALLERGY AND IMMUNOLOGY by guest on June 20, 2017 Downloaded from