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Azithromycin has immunomodulatory actions, and its beneficial effects have been demonstrated in asthmatic adults. Data on children are limited.Does the addition of oral azithromycin to standard therapy in children with poorly controlled asthma improve asthma control compared with standard treatment alone?This open-label randomized controlled trial included children (5-15 years of age) with poorly controlled asthma defined by Asthma Control Test (ACT) and Childhood Asthma Control Test (CACT) score of ≤ 19. They were randomized to receive azithromycin (10 mg/kg) three times weekly for 3 months along with standard treatment or standard treatment alone. The primary outcome was the ACT and CACT scores at 3 months. Secondary outcomes were asthma control according to Global Initiative for Asthma (GINA) guidelines, the number of exacerbations, change in spirometry parameters, change in fractional exhaled nitric oxide (Feno) level, positive throat swab results, and side effects.The trial included 120 children (89 boys; 60 in each group). The mean ± SD age was 9.9 ± 3 years. The baseline parameters were similar between the groups. Mean ± SD ACT and CACT scores (available for 115 children) at 3 months of intervention were 21.71 ± 2.17 vs 18.33 ± 2.19 (P .001) in the azithromycin and control groups, respectively. The numbers of children with well-controlled asthma according to GINA guidelines were 41 of 56 vs 10 of 56 in the azithromycin and control groups, respectively (P .001). The median number of exacerbations requiring emergency visit and steroid use were fewer in the azithromycin group: 0 (interquartile range [IQR], 3) vs 1 [IQR, 6]; P .001). No difference was found in Feno level, spirometry parameters, positive throat swab results, and adverse effects between the groups.The use of azithromycin in children with poorly controlled asthma resulted in improved asthma control and reduced exacerbations.Clinical Trials Registry - India; No.: CTRI/2019/06/019727; URL: www.ctri.nic.in.

A 7-month-old male infant presented with history of fever for 2 weeks, multiple ecchymotic patches over face, trunk and lower limbs, and one episode of seizure. The infant had shock, respiratory failure, severe anaemia, thrombocytopenia and temporoparietal haematoma on CT scan of the head. He was managed with supportive care and broad-spectrum empiric antibiotics. Two consecutive blood cultures grewElizabethkingia anophelis, sensitive only to piperacillin–tazobactam. The infant responded to therapy and was discharged after 2 weeks of hospital stay. Repeated coagulation studies done to rule out an underlying bleeding disorder were negative. There was no clue in favour of non-accidental trauma. We report this case to highlight the unusual clinical presentation of this emerging pathogen. Mostly reported in outbreaks from surgical and post-operative intensive care units, it was worrisome to find this infant presenting with community-acquiredE. anophelisinfection.

Summary Background Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data. Methods Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics. Findings We observed 23 471 births and 840 mother–baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3–100) compared with observed coverage of 100% (99·9–100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1–89·5]) vs 99·4% [98·7–99·8] observed), bag-mask ventilation (0·8% [0·4–1·4]) vs 4·4% [1·9–8·1]), and antibiotics for neonatal infection (74·7% [55·3–90·1] vs 96·4% [94·0–98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4–66·8) vs 10·9% [3·8–21·0] observed). “Don’t know” responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8–99·5] vs 99·2% [98·6–99·7] observed), bag-mask ventilation (4·3% [2·1–7·3] vs 5·1% [2·0–9·6] observed), KMC (92·9% [84·2–98·5] vs 100% [99·9–100] observed), and overestimated early breastfeeding (85·9% (58·1–99·6) vs 12·5% [4·6–23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals. Interpretation Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth. Funding Children's Investment Fund Foundation and Swedish Research Council.

Background The literature is limited on staphylococcal infection in children with cystic fibrosis (CF) from tropical countries. We aimed to study the risk factors and clinical course of children with CF infected with Staphylococcus aureus. Methods In this chart review we compared demographic, clinical and spirometry characteristics in CF children with S. aureus alone (group A), both S. aureus and Pseudomonas aeruginosa (group B) and P. aeruginosa alone (group C) colonization. Results We included 79 cases (group A, 22; group B, 19; group C, 38). There was no difference in age of onset of symptoms, age of diagnosis, age of first isolation and spirometry parameters before colonization between the groups. The median duration of follow-up was shorter in group A. After colonization, children in group A and group B had significantly lower mean Shwachman and Kulczycki (SK) scores (44.7±5.4 and 40.8±5.8, respectively) compared with group C (49.9±6.8). Pulmonary exacerbations and hospitalizations were significantly greater in the combined group. After colonization, group A had a significant deterioration in SK score and forced vital capacity (FVC). Conclusions S. aureus colonization, especially in combination with P. aeruginosa, in children with CF was associated with worsening of FVC and clinical severity score and increased pulmonary exacerbations.

Aims: This study was conducted to identify the causes and the outcome of neonates admitted to SNCU of Western Regional Hospital.Methods: A retrospective study was conducted at SNCU of western Regional Hospital, a referral tertiary centre of Western Region of Nepal from March 2016 to March 2017.Results: Total of 1144 neonates were admitted in NICU comprised of 562 (49.12.%) neonatal sepsis, 164 (14.33%) neonatal hyperbilirubinemia, 120 (10.48%) birth asphyxia, 109 (9.52%) premature, 92 (8.04%) Meconium Aspiration Syndrome, 96 (8.39%) Congenital anomalies and 14 (1.22%) necrotizing enterocolitis. Out of neonatal sepsis, 20.62% were early onset and 28.49% late onset conditions. Among Birth asphyxia, 102 (85.00%) were of HIE I& II and 18 (15%) of HIE III. Overall mortality observed was 3.32%. Those who required mechanical ventilation had higher mortality (87.50%) than the cases that were kept for CPAP (14.81%).Conclusions: Neonatal Sepsis, birth asphyxia, prematurity and Neonatal hyperbilirubinemia were major causes for admission in SNCU.

Background: Neonatal sepsis is leading cause of mortality in neonates. The organism responsible for sepsis differed depending on the site of Neonatal care unit and country. In this study, we aimed to look at cause of sepsis and antibiotic sensitivity. Materials and Methods: Neonates admitted in the neonatal care unit of western regional hospital from 14th August 2012 to 14th July 2014were included in the study. Septic workup was done and culture was sent. Results of culture sensitivity were noted along with the sensitivity pattern. Results: Neonatal sepsis accounted for 38 percent of total admission in the neonatal unit. Staphylococcus aureus was the most common organism isolated which was followed by Escherichia coli (E coli). Staphylococcus aureus isolated was sensitive to Cloxacillin in 97% of cases. There were 5 % mortalities during the study period. Conclusion: Neonatal sepsis was the most common reason for admission and staphylococcus aureus was the most common organism.

Introduction: HIV in children is a public health problem in a developing country like Nepal. The aim of the study was to determine the clinical, nutritional and immunological profile of HIV +ve children enrolled in the ART clinic of Pokhara Academy of Health Sciences (PAHS).Materials and Method: This was a retrospective study of children enrolled in the ART clinic over a period of 10 years from July 2007 to June 2017. Clinical characters, Nutritional status and immunological status of children enrolled in the ART clinic were noted in the predesigned pro forma from the record of the clinic and review of the chart of the patients.Results: One hundred twelve children were enrolled in the Clinic during the study duration. Out of them 57 were males and 55 were females. All the children acquired infection through mother to child transmission. Majority of them from age group 1 to 5 years at the time of presentation. Forty-six percent were in the clinical stage III. The median CD4 count was 283.Fifty percent of the children were undernourished. Most of the children were started on AZT/3TC/NVP as first line ART.Conclusion: Although perinatal route was the most common route of transmission of HIV in children, diagnosis was late in the age group of 1-5 years and most of them were diagnosed in the advanced stage of HIV with Low CD4 count.

Background: To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. Methods: EN-BIRTH is an observational study including >20000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses. Conclusions: To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.