Pharmacia, near FMH Lahore
And from the internal Pharmacy of Hameed Latif Hospital, Lahore.
Updates on therapeutic hypothermia in neonates (Clinical report 2026 AAP )Summary by Dr Tauseef Omer
Updates on therapeutic hypothermia in neonates (Clinical report 2026 AAP )Summary by Dr Tauseef Omer
AAP 2026 Clinical Report: Updates on the management of therapeutic hypothermia in neonates
AAP 2026 Clinical Report: Updates on the management of therapeutic hypothermia in neonates
Summary by Dr. M. Tauseef Omer
Full link
Over 2014 guidelines on the management of therapeutic hypothermia in neonates, the American Academy of Pediatrics has published a clinical report in 2026.
Re-emphasis:
Analyses of aggregate data from randomized-controlled trials, as well as data from registries, indicate that moderate therapeutic hypothermia with a target temperature of 33.5 °C initiated within 6 hours of birth and continued for 72 hours is a safe and effective neural rescue strategy for infants with moderate-to-severe HIE who are born at or greater than 36 weeks’ gestation.
Infants offered therapeutic hypothermia should meet inclusion criteria from published clinical trials such as (CoolCap Selective head cooling, NICHD Whole body cooling, TOBY Whole body cooling, neo-neuro whole body cooling, ICE trial, Selective head cooling with mild systemic cooling in China) , however, sentinel event is not necessary to initiate therapeutic hypothermia.
Eligibility criteria include the following:
Evidence of a peri-partum hypoxic-ischemic event based on biochemical criteria.
Providers should advocate for the delivery team to draw cord blood gases for all depressed neonates and to facilitate the identification of neonates with HIE who may benefit from cooling.
If a cord gas cannot be obtained, a blood gas during the first hour or as soon as possible after birth should be obtained.
Evidence of moderate-to-severe encephalopathy by neurological exam (as below) or seizures is required. If moderate or severe encephalopathy is present and biochemical and clinical criteria are borderline without another identifiable cause, clinicians may consider therapeutic hypothermia.
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There is limited evidence regarding the safety and effectiveness of therapeutic hypothermia for infants born at 35 0/7 to 35 6/7 weeks’ gestation. And this should be discussed with parents.
May consider cooling up to 24 hours of life, but there is limited benefit in such cases, and this should be discussed with parents.
There is insufficient evidence to support the use of therapeutic hypothermia for infants with mild HIE
In all cases of possible HIE, even when therapeutic hypothermia is not administered, hyperthermia should be avoided.
Erythropoietin (EPO) does no offer any additional benefit to date. Previous studies explored its neuroprotective and anti-apoptotic effects. So, therapeutic hypothermia and EPO is not advised outside research settings
Medical centers offering therapeutic hypothermia should be capable of providing comprehensive clinical care, including mechanical ventilation; physiologic (vital signs, temperature) and biochemical (blood gas) monitoring; neuroimaging, including MRI prior to hospital discharge; continuous neuromonitoring and seizure detection with continuous EEG (preferred) or with aEEG; neurologic consultation accessible at all times, at minimum via telephone or telemedicine; family support; and a system in place for monitoring longitudinal neurodevelopmental outcomes.
Previously, we followed this criteria:
NICHD (National Institute of Child Health and Human Development) whole-Body Cooling
GA ≥36 weeks and ≤6 h of age
Moderate or severe encephalopathy
Non syndromic baby
Acidosis
pH ≤7.00 or base deficit ≥16 mmol/L on umbilical cord or any blood sample obtained within 60 min of birth
OR
If blood gas is not available or pH 7.01 to 7.15 or base deficit 10 to 15.9 mmol/L on blood sample obtained within 60 min of birth.
PLUS
2 additional criteria:
History of an acute sentinel/perinatal event (eg, cord prolapse, fetal heart rate decelerations)
AND
Need for assisted ventilation at birth and continued for 10 min
OR
Apgar score ≤5 at 10 min after birth
Preventing central line associated blood stream infections (CLABSI) in neonatal units
Several factors increase a neonate's risk of developing a CLABSI:
• Patient-Related: Prematurity and low birthweight are significant risk factors. Infants requiring a PICC are at increased risk due to poor skin integrity, an immature immune system, and multiple invasive procedures1.
• Device-Related: Use of Central Venous Catheters (CVCs), including peripherally inserted central venous catheters (PICCs) and umbilical catheters, with risk increasing with the duration of central venous access.
• Medication-Related: Prolonged parenteral nutrition and the use of IV lipid emulsions are known risk factors, as lipid emulsions can potentiate microbial growth and impair host defenses. Postnatal administration of corticosteroids also increases risk.
Common Pathogens in CLABSI
• Coagulase-Negative Staphylococci (CoNS): These are the most predominant pathogens, accounting for over 50% of infections. Staphylococcus epidermidis is a common example8. CoNS are lower-virulence pathogens but can form biofilms on devices.
• Gram-Negative Organisms: Account for approximately 20% of infections.
• Staphylococcus aureus: Accounts for 4%–9% of CLABSIs1. Methicillin-resistant S. aureus (MRSA) is an increasing concern.
• Enterococcus species: Account for 3%–5% of infections.
• Candida species (Fungi): Account for approximately 10% of infections1. Malassezia furfur is an unusual lipophilic yeast that can cause catheter-related infections in infants receiving intralipid therapy.
Management and Prevention Strategies
Prevention is paramount in controlling CLABSIs. Key strategies include:
• Hand Hygiene: The single most important strategy for avoiding transmission of contagions in the NICU.
• Infection Control Bundles: Most institutions adopt "care bundles" of practices for central line insertion and maintenance that have proven effective in reducing CLABSI rates12. These bundles were disseminated through collaboratives like the California Perinatal Quality Care Collaborative (CPQCC).
◦ During Catheter Insertion:
▪ Hand hygiene.
▪ Aseptic technique.
▪ Skin antisepsis: Chlorhexidine is the preferred antiseptic for catheter site care over povidone-iodine13. The solution must be allowed to air-dry completely.
▪ Sterile dressing technique.
◦ During Catheter Maintenance:
▪ Daily review of line necessity: CVCs should be removed as soon as they are no longer necessary. Line stewardship focuses on this daily review.
▪ Daily inspection of the insertion site and dressing: Opaque dressings should be removed and the site inspected visually if there are signs of possible CLABSI.
▪ Standardization of practices around IV tubing changes.
▪ "Scrubbing the hub" of the central line to minimize contamination.
▪ Replacing transparent dressings on short-term central line sites at least every 7 days, with consideration for pediatric patients where the risk of dislodging may outweigh the benefit.
▪ Some NICUs have incorporated bathing strategies for patients with central lines.
• Antibiotic Stewardship: Minimizing indiscriminate use of antibiotics is mandatory as it has been associated with increased nosocomial sepsis. Prophylactic antibiotics for central lines are generally not recommended due to limited data and concerns about resistance and side effects.
• Breastfeeding: Promotion of fresh maternal milk is considered a key step in preventing NICU infections due to its anti-infective properties.
• Probiotics: May help restore gut immune function and potentially reduce the risk of late-onset sepsis (LOS).
• Antifungal Prophylaxis: Specific antifungal prophylaxis with fluconazole has been associated with a significant reduction in invasive fungal infections and is recommended in NICUs with high rates of invasive candidiasis.
Treatment of CLABSI
• Empiric Antibiotic Therapy: Treatment is often initiated before a definitive causative agent is identified. For nosocomial sepsis, which includes CLABSIs, the flora of the NICU must be considered. Vancomycin plus an aminoglycoside (e.g., gentamicin or amikacin) is usually begun for staphylococcal coverage. Some NICUs use cefazolin or nafcillin instead of vancomycin for staphylococcal coverage.
• Catheter Removal:
◦ For CLABSIs due to gram-negative or fungal pathogens, catheters should be removed as early as possible.
◦ For CLABSIs caused by CoNS, catheter removal should occur if culture results are persistently positive or if the patient’s condition is unstable17. Delaying CVC removal for 3 to 5 days after starting anticoagulant therapy may be considered due to emboli risk, though this is controversial.
• Duration of Therapy: The length of antibiotic therapy is not data-driven, but 7 to 10 days is a common duration of treatment. Inflammatory markers like C-reactive protein (CRP) may be used to guide the length of therapy.
Protocols for disinfection of medical devices and medical equipment in resource limited neonatal units
Protocols for disinfection of medical devices and medical equipment in resource limited neonatal units
Dr. M Tauseef Omer
Assistant Professor of Neonatology
Cleaning
Definition: The physical removal of dust, secretions, blood, etc from objects and surfaces using water, detergents, or enzymatic cleaners.
Purpose: Reduces bioburden and prepares items for disinfection or sterilization.
Key Point: Cleaning must precede any disinfection or sterilization process because residual debris can interfere with germicidal efficacy.
___________________________________________________________________
Disinfection
Definition: The process that eliminates many or all pathogenic microorganisms (except bacterial spores) on inanimate objects.
Levels:
High-level disinfection: Kills all microbes except large numbers of bacterial spores.
Intermediate-level: Inactivates Mycobacterium tuberculosis, most viruses, and fungi.
Low-level: Eliminates most vegetative bacteria, some fungi, and some viruses.
Agents: Chemical disinfectants mentioned below with concentration and time of contact.
Sterilization
Definition: The complete elimination or destruction of all forms of microbial life, including bacterial spores.
Methods:
Steam under pressure (autoclaving)
Ethylene oxide gas
Hydrogen peroxide
Use: Critical items that enter sterile tissue or the vascular system (e.g., surgical instruments, catheters)
Medical devices and medical equipment:
Incubator surfaces
Mattress covers
Radiant warmers
Temperature probes
SpO2 probes
Blood pressure apparatus and BP cuffs
Cardiac monitors
Glucometers
Laryngoscope blades and handles
Reusable breathing circuits of ventilators and nasal CPAP
Handles of doors
Anything that is reusable, is touched by healthcare providers or baby or attendants of baby.
Single use (only) items:
Endotracheal tube
Suction Catheters
Nasal cannulas
Breathing circuits
Umbilical venous catheters
IV cannulas
Syringes and needles
Lancets
Feeding tubes
ECG electrodes
Cord clamps
Specimen collection containers
General Principals of disinfection:
Cleaning must precede any disinfection or sterilization process because residual debris can interfere with germicidal efficacy.
Every device or equipment has cleaning, disinfection, and sterilization recommendations from manufacturer. These recommendations may include safe chemicals for disinfection or safe temperature ranges for sterilization and duration for both disinfection and sterilization.
For every disinfectant, use correct dilution, application method, and contact time. Contact time can vary depending on dilution (concentration) and manufacturer recommendations.
If the equipment is powered using electricity, power off the device, remove the plug from electric mains, and let the equipment cool down. Then, cleaning and surface disinfection must not affect the electronic circuity, no liquid should trickle inside the buttons. Once cleaning and surface disinfection has been done, let the device dry completely, then plug the device into mains and test run the device before connecting it to the patient.
For any device to be cleaned and disinfected, disassemble it to maximum parts. And dry completely after disinfection before assembling again.
Do not clean/disinfect single use items.
Prepare/dilute disinfectant in well-ventilated areas. Freshly prepared solution is mandatory.
Train staff adequately about personal safety from fumes/vapors of disinfectant.
Prepare check lists for disinfection of high dependency equipment. Maintain logs of disinfection.
Chemicals, concentrations, and contact time for disinfection:
For Floors:
Bleach (sodium hypochlorite) – For general floor areas with no spills of blood use 0.05% concentration while the areas with blood spills use 0.5% concentration.
To prepare 0.5 % of bleach, mix 75 mL (1/3 cup) of bleach in 4 Liters of water.
To Prepare 0.05% of bleach, mix 7.5 mL of bleach in 4 L of water
Tablet Presept 2.5g (sodium troclosene)
Mixing 1 tablet in 1.5 L of cold water gives 1000 ppm of presept which is used for general cleaning of NICU floors.
Places with blood spills will need to be cleaned with solution containing 4 tablets in 1L of cold water (5000 ppm). Always prepare the solution in a well ventilated space to avoid inhaling fumes.
For surfaces of incubators, warmers, ventilators, cardiac monitors:
Bleach 0.5%
Presept 1000 ppm (1 tablet of 2.5 grams in 1.5L of water)
Laryngoscope blades, respiratory tubings, instruments:
Glutaraldehyde 2.4% commercially available as cidex, soak for 8 to 20 minutes.
Triacid is an alternative, but less effective. May need soaking for upto hours.
Procedures:
NICU Cleaning Protocol for Silicone AMBU Bags & Face Masks
Wear personnel protective equipment, mark, gloves.
1. Disassembly
Separate all detachable parts: bag, valves, mask, reservoir, and connectors.
2. Pre-Cleaning
Rinse each part under cool running water to remove visible debris.
Use a soft brush and neutral pH detergent to scrub internal and external surfaces.
3. Cleaning
Immerse parts in warm water with detergent.
Gently agitate or manually clean for 5–10 minutes.
Rinse thoroughly with clean water to remove all detergent residue.
4. Disinfection
Chemical disinfection: Soak in a 2.4 % glutaraldehyde (Cidex) solution for the manufacturer-recommended time (usually 10–20 minutes).
Ensure full submersion and no air bubbles.
Rinse thoroughly with sterile or filtered water (3 times) to remove chemical residue.
OR
Thermal disinfection: If the item is autoclavable (check label), autoclave at 121°C for 15–20 minutes.
5. Drying
Air-dry on a clean, lint-free surface or hang in a drying cabinet.
Avoid wiping with clothes
6. Inspection & Storage
Check for cracks, discoloration, or valve malfunction.
Store in a clean, dry, closed container labeled “Ready for Use.”
Laryngoscopes
Laryngoscope blades are to be disinfected after each use.
Wear gloves, face mask, and gown.
Disassemble the laryngoscope, detach blade, and remove cells.
Clean the blades by thoroughly washing under running water, then use soap or detergent to remove all visible secretions and blood.
Next,
Dip in disinfectant solution (Cidex 2.4%) for 8 to 20 minutes. If multiple blades are being disinfected, then dip these separately.
Then,
Rinse with sterile distilled water or normal saline thoroughly to remove all disinfectant from the blades.
Let blades air dry.
Infusion pumps, syringe pumps, cardiac monitors, nebulizer machines
Turn off the electric supply.
Unplug from electric mains.
Let the device cool down.
Wear mask, gloves, gown.
Tablet Presept (2.5 gram) prepared to the dilution of 1:500 ppm by mixing ½ tablet in 1.5 Liter of water may be used as disinfectant solution.
Incubators and warmers
Turn off the electric supply.
Unplug from electric mains.
Let the device cool down.
Wear mask, gloves, gown.
The outer surface and inner surface of incubator may be wipes with 1:500 diluted presept tablet (prepared by mixing ½ tablet in 1.5L of water)
Remove mattress, and clean it.
Remove humidifier tray, discard water inside, clean the inner and outer surfaces of water container using soap and water to remove any visible dirt, and then soak in 1000 ppm of Presept for 8 to 20 minutes. (Mix 1 tablet 2.5 gram of presept tablet in 1.5L of water)
Suction machine
Wear mask, gloves, gown.
Clean the outer surface of machine with 1000 ppm of Presept tablet solution.
Remove tubing and dip in 1000 ppm solution of Presept tablet.
Empty the jars of suction machine and rinse with water and soap to remove all visible debris. Then clean them inside and outside with 1000ppm of presept tablet solution.
Remove tubings from solution, and let these air dry with the jars.
Assemble tubings and jars.
Check proper functioning of the suction machine and suction pressures.
Oxygen Flow meters
Disinfect when oxygen flow meter is not in use.
Remove it from the fitting.
Open the water container and discard water.
Clean the outer and inner surface of water jar with soap and water and let it air dry.
Clean the surface of flow meter and its knob with tablet Presept solution 1000ppm .
Assemble all once dry.
Do not use alcohol wipes or bleach for the risk of fire.
Cleaning of Feeding Bottles
Cleaning, sanitizing, and storing feeding bottles
Dr. M Tauseef Omer
Assistant Professor of Neonatology
Cleaning, sanitizing, and properly storing infant feeding items helps to prevent germs from contaminating the milk fed to baby.
How often to clean feeding bottles
Clean baby bottles after every feeding. If baby did not finish drinking a bottle within 2 hours, discard the unfinished formula. Germs can grow quickly if breast milk or formula is added to a partially used bottle, or if a used bottle is only rinsed, rather than cleaned.
Cleaning the feeding bottle:
1. Wash hands and clean four bowls/containers
Wash your hands with soap and water for 60 seconds.
Wash 4 containers with soap and water in which parts of bottle will be placed at different steps.
2. Separate all bottle parts (bottle, nipple, cap, ring) and place these in a clean container.
3. Rinse with warm or cold tap water
Rinse bottle parts by holding them under running water. Do not set them in the sink. Rinse to remove maximum visible milk or dirt if any. After rinsing, place these in a clean container.
4. Wash feeding items
Fill another clean container with hot water and add soap.
Scrub all bottle parts using a clean brush that is used only to clean infant feeding bottle.
Squeeze water through nipple holes to be sure they get clean.
5. Rinse again
Rinse by holding items under running tap water and remove all visible soap, and place all parts in another container one by one after rinsing.
6. Allow to air-dry
Allow all parts to air dry thoroughly.
Do not use a dish towel to rub items dry because doing so may transfer germs to the items.
7. Clean all containers, bottle brush
Rinse the containers and brush well and allow them to air dry after each use. Wash them every few days with soap and warm water.
If baby is less than 2 months old, was born prematurely, or has a weakened immune system due to illness, wash all containers and bottle brush with soap and water after every use.
Next,
2. Sanitization of feeding bottles.
How often to sanitize: Sanitize daily if baby is less than 2 months old, was born prematurely, or has a weakened immune system due to illness.
The manufacturers of feeding bottles may give recommendations to help choose between boiling method or steam sanitization method. In Pakistan, majority of the people use plastic made low-cost feeding bottles that cannot withstand boiling temperature of water or steam. In this case, use bleach for sanitization if the recommended method. If you use a dishwasher with hot water and a heated drying cycle (or sanitizing setting) to clean infant feeding items, a separate sanitizing step is not necessary.
Bleach (use this option if you can't boil, steam, or use a dishwasher)
1. Prepare a bleach solution of 2 teaspoons of unscented bleach in 16 cups/4 Liter of water in a clean washing container.
2. Put all items completely underwater. Make sure the solution touches all parts and there are no air bubbles in the bottles.
3. Squeeze solution through nipple holes.
4. Soak items in solution for at least 2 minutes.
5. Remove with clean hands or tongs. Do not rinse because germs could get back onto the sanitized items. Any remaining bleach will break down quickly as it dries and will not hurt the baby. This process is similar to what is done to sanitize dishes in restaurants.
6. After sanitizing, place items in a clean container. Allow to air-dry thoroughly before storing. Do not use a dish towel to rub items dry because doing so may transfer germs to the items.
Boiling water method for sanitization (Not recommended for plastic bottles or where recommendation of manufacturer are not available, may be used for glass made feeding bottles)
1. Place disassembled feeding items into a pot and cover with water.
2. Put the pot over heat and bring to a boil.
3. Boil for 5 minutes.
4. Remove items with clean tongs.
Steam (Not recommended in Pakistan unless the manufacturer of feeding bottles recommends this)
Place disassembled items in feeding bottle steamer and follow the manufacturer's instructions for duration of steaming the feeding bottle parts.
Storage
Air dry first: Allow the clean feeding items, bottle brushes, and containers to air-dry thoroughly before storing to help prevent germs and mold from growing. Do not use towel, or a drying rack. Just place in a clean dry container to let all parts air dry.
Put items back together: You may need to wash hands again. Once the items are completely dry, wash your hands well with soap and water. Put the clean, dry bottle parts back together.
Store safely: Place reassembled bottles inside a closed kitchen cabinet that is used only to store clean dishes.
Note: If formula milk is being given to baby due to certain reasons where expressed breast milk is not available, use a disinfectant wet wipe to clean the outside of the formula container and its lid before it is opened for the first time. Do not submerge the container or place it under running water. Wait until the surfaces are completely dry before opening the container. Do not clean the inside of the infant formula container. When powdered formula stays dry, it's less likely to get contaminated. To keep liquids away from the powdered formula, don't clean the formula scoop unless it gets dirty. If the scoop was dropped on the floor or otherwise soiled, clean it as carefully as you would your baby's bottles and allow it to air-dry completely before placing it in the formula container.
فیڈنگ بوتل کی صفائی
Patient Information
فیڈنگ بوتل کی صفائی
Dr. M. Tauseef Omer
Assistant Professor of Neonatology
بوتلوں کو کتنی بار صاف کرنا چاہیے
ہر فیڈنگ کے بعد بوتل کو صاف کریں۔ اگر بچہ 2 گھنٹے کے اندر بوتل ختم نہ کرے تو باقی دودھ ضائع کر دیں۔ جزوی استعمال شدہ بوتل میں دوبارہ دودھ ڈالنے یا صرف دھونے سے جراثیم تیزی سے بڑھ سکتے ہیں۔
فیڈنگ بوتل کی صفائی
ہاتھ دھونا اور چار برتن صاف کرنا
صابن اور پانی سے 60 سیکنڈ تک ہاتھ دھوئیں۔
چار برتن صابن اور پانی سے دھوئیں جن میں بوتل کے حصے مختلف مراحل پر رکھے جائیں گے۔
بوتل کے تمام حصے الگ کریں
بوتل، نپل، ڈھکن، رنگ وغیرہ الگ کریں اور صاف برتن میں رکھیں۔
نل کے پانی سے دھونا
گرم یا ٹھنڈے پانی سے بہتے نل کے نیچے دھوئیں۔ سنک میں نہ رکھیں۔
دودھ یا میل کو زیادہ سے زیادہ صاف کریں اور صاف برتن میں رکھ دیں۔
پانی اور صابن سے دھونا
ایک اور صاف برتن میں گرم پانی اور صابن ڈالیں۔
صرف فیڈنگ بوتلوں کے لیے مخصوص صاف برش سے تمام حصے رگڑیں۔
نپل کے سوراخوں میں پانی نچوڑیں تاکہ اندرونی صفائی ہو۔
دوبارہ دھونا
بہتے پانی کے نیچے دھو کر صابن کو مکمل طور پر ہٹا دیں۔
ہر حصہ دھونے کے بعد صاف برتن میں رکھیں۔
ہوا میں خشک ہونے دیں
تمام حصوں کو مکمل طور پر ہوا میں خشک ہونے دیں۔
تولیہ استعمال نہ کریں کیونکہ اس سے جراثیم منتقل ہو سکتے ہیں۔
تمام برتن اور برش کی صفائی
ہر استعمال کے بعد برتن اور برش کو دھو کر خشک کریں۔
ہر چند دن بعد صابن اور گرم پانی سے دھوئیں۔
اگر بچہ 2 ماہ سے کم عمر ہے، قبل از وقت پیدا ہوا ہے، یا بیماری کی وجہ سے مدافعتی نظام کمزور ہے تو ہر استعمال کے بعد برتن اور برش کو دھونا ضروری ہے۔
جراثیم کشی (Sanitization)
کتنی بار جراثیم کشی کریں
روزانہ کریں۔
طریقہ انتخاب
بوتل بنانے والے ادارے اُبالنے یا بھاپ سے جراثیم کشی کے متعلق ہدایات دے سکتے ہیں۔ پاکستان میں زیادہ تر لوگ کم قیمت پلاسٹک بوتلیں استعمال کرتے ہیں جو اُبالنے یا بھاپ برداشت نہیں کرتیں۔ ایسے میں بلیچ کا طریقہ استعمال کریں۔
بلیچ سے جراثیم کشی (اگر اُبال یا بھاپ ممکن نہ ہو)
چائے کے 2
چمچ بغیر خوشبو والے بلیچ کو 16 کپ (4 لیٹر) پانی میں صاف برتن میں ملائیں۔
تمام اشیاء کو مکمل طور پر پانی میں ڈبو دیں۔
نپل کے سوراخوں میں محلول نچوڑیں۔
کم از کم 2 منٹ تک محلول میں بھگو کر رکھیں۔
صاف ہاتھوں یا چمٹے سے نکالیں۔ دھونا نہیں کیونکہ جراثیم دوبارہ لگ سکتے ہیں۔
صاف برتن میں رکھ کر مکمل طور پر خشک ہونے دیں۔ تولیہ استعمال نہ کریں۔
خشک ہونے پر جراثیم ختم اور بلیچ بے ضرر ہو جاتا ہے۔"
اُبالنے کا طریقہ (صرف شیشے کی بوتلوں کے لیے)
تمام حصے الگ کر کے برتن میں رکھیں اور پانی سے ڈھانپ دیں۔
برتن کو چولہے پر رکھ کر اُبالیں۔
منٹ تک اُبالیں 5 ۔
صاف چمٹے سے نکالیں۔
بھاپ سے جراثیم کشی (صرف اگر بوتل بنانے والا ادارہ تجویز کرے)
فیڈنگ بوتل اسٹیمر میں تمام حصے رکھ کر ادارے کی ہدایات کے مطابق بھاپ دیں۔
ہوا میں خشک کریں
تمام اشیاء کو مکمل طور پر خشک ہونے دیں۔ تولیہ یا ڈرائنگ ریک استعمال نہ کریں۔
صاف خشک برتن میں رکھیں۔
مکمل خشک ہونے کے بعد ہاتھ دھو کر بوتل کے حصے جوڑیں۔
محفوظ طریقے سے ذخیرہ کریں
جوڑی گئی بوتلوں کو بندالماری
میں رکھیں جو صرف صاف برتنوں کے لیے مخصوص ہو۔
فارمولا دودھ کے لیے احتیاط
اگر ماں کا دودھ دستیاب نہ ہو اور فارمولا دودھ دیا جا رہا ہو:
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کنٹینر کو پانی میں نہ ڈبوئیں اور نہ ہی نل کے نیچے رکھیں۔
مکمل خشک ہونے کے بعد ہی کھولیں۔
اندرونی حصہ صاف نہ کریں۔
فارمولا پاؤڈر خشک رہے تو جراثیم کم لگتے ہیں۔
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اگر اسکوپ زمین پر گر جائے تو بوتل کی طرح صاف کر کے مکمل خشک کریں۔
Kaiser-Permanente Sepsis Risk Calculator
Probable neontal EOS risk based on maternal risk factor and infant's clinical presentation.
For 35 week or more gestation.
Probability of EOS per 1000 babies
EOS 2.0 Calculator 2024 Update by American Academy of Pediatrics
Sensitivity of the Kaiser EOS calculator is about 67% (by definition: ability to correctly identify true sepsis cases).
Specificity is about 92% (by definition: ability to correctly identify non-sepsis cases).
It reduces unnecessary antibiotics but may miss some sepsis cases.
The 2017 EOS calculator was based on data from 1993–2007 and classified maternal antibiotics per older CDC guidance.
The 2024 update (EOS 2.0) incorporates universal GBS screening, revised definitions of intrapartum antibiotic prophylaxis, and updated antibiotic classifications reflecting modern susceptibility and transplacental transfer.
In short, the 2024 model aligns with current obstetric practice, making risk estimates more accurate and clinically relevant.
Guidelines for early onset and late onset infection management in neonates
I. Early-Onset Neonatal Infection (First 72 Hours)
• Risk Factors:
◦ Red Flag: Suspected or confirmed infection in another baby in a multiple pregnancy.
◦ Other Factors: Invasive Group B streptococcal (GBS) infection in a previous baby, maternal GBS colonization/infection in the current pregnancy, preterm birth (<37 weeks) following spontaneous labor, and confirmed rupture of membranes for >18 hours (preterm) or >24 hours (term).
• Clinical Indicators:
◦ Red Flags: Apnea, seizures, signs of shock, need for cardiopulmonary resuscitation, or need for mechanical ventilation.
◦ Other Indicators: Altered behavior (floppiness), feeding difficulties (intolerance, refusal, abdominal distension), jaundice within 24 hours of life, respiratory distress (grunting, tachypnea), and temperature instability (<36°C or >38°C).
• Management Actions:
◦ Antibiotics should be started if any red flag is present, or if there are two or more non-red-flag risk factors or clinical indicators.
◦ If only one non-red-flag risk factor or clinical indicator is present, clinicians may use judgement to withhold antibiotics and monitor the baby's vital signs for at least 12 hours from birth.
• Investigations and Empirical Treatment:
◦ Perform a blood culture, send CBC, and measure C-reactive protein (CRP) before starting treatment.
◦ First-line antibiotics are ampicillin and amikacin.
If ampicillin is not available, add co-amoxiclav and amikacin, or cefotaxime and amikacin.
(For drug doses, refer to the latest edition of Harriet Lane)
◦ The "Golden Hour": Antibiotics must be administered as soon as possible and always within one hour of the decision to treat.
• Monitoring and Stopping Treatment:
◦ Re-measure CRP 18–24 hours after presentation.
◦ Review at 36 hours: Stop antibiotics if blood cultures are negative, leukocyte count and platelet counts are normal, the baby is clinically well, and CRP levels are <15 mg/L.
II. Late-Onset Neonatal Infection (>72 Hours)
• Clinical Presentation: Signs can be vague, including mottled or ashen appearance, bulging fontanelle, petechiae, reduced bowel sounds, and "parent or care-giver concern" regarding behavior changes, seizures, reluctance to feed, breathing difficulty, respiratory distress, jaundice, hypothermia, or lethargy.
• Investigations:
◦ Blood Culture: Obtain from a peripheral vein using a closed, non-touch aseptic technique.
◦ CRP: Measure at presentation and again 18–24 hours later, as there is often a delay in serum CRP rising after symptom onset.
. CBC
◦ Lumbar Puncture (LP): Perform if there is a strong clinical suspicion of infection or signs suggested of meningitis.
• Treatment:
◦ First-line empirical treatment is typically a combination of co-amoxiclav and amikacin (non CNS infection, as co-amoxiclav and amikacin do not cross blood brain barrier)
... If CNS infection is considered, start with ampicillin and cefotaxime in meningitic doses.
... Add metronidazole if NEC is suspected. (If Tazobactam-piperacillim or meropenem are being given and the diagnosis of NEC is considered, do not add metronidazole as per NHS guidelines)
◦ Antifungal Prophylaxis (after approval from consultant): Give prophylactic oral nystatin to babies ≤1500g or <30 weeks' gestation who are receiving antibiotics.
...Once cultures are available, switch to targetted antibiotic therapy reported in the blood culture.
... 2nd line antibiotics: Linezolid and Tazobactam-piperacillin
...3rd line antibiotics: Vancomycin and meropenem
Guidelines for admission to neonatal unit and the immediate management
Avoid unnecessary separation of mother and baby to protect maternal bonding. All babies admitted to the NNU must have a newborn infant physical examination (NIPE) within 72 hours of birth and again once they reach 34+0 weeks corrected age.
Criteria for Admission:
• Gestational age <34 weeks or a birth weight <1700 g.
• Clinical conditions requiring constant monitoring.
• Unwell babies, such as those requiring prolonged resuscitation (>10 min), those with respiratory distress, cyanosis, apnoea, or signs of encephalopathy.
• Babies with seizures, major congenital abnormalities, or jaundice requiring intensive phototherapy or exchange transfusion.
• Inability to tolerate enteral feeds accompanied by vomiting or abdominal distension.
• Symptomatic hypoglycaemia or hypoglycaemia not responding to standard treatment.
Immediate management of life-threatening clinical problems regarding airway, breathing, circulation, and seizures must take priority. The admitting team must explain the reason for NNU admission to the parents and show them the baby.
• Document a relevant history and physical examination.• Measure and plot birth weight and head circumference on growth charts.• Measure admission temperature and non-invasive blood pressure.• Immediate Management and InvestigationsFor babies who are <32 weeks, <1500 g, or ventilated, standard investigations include CBC, blood glucose, and blood gases. If sepsis is suspected, a blood culture and CRP should be obtained before starting antibiotics, which should be administered within one hour if indicated. Vitamin K should also be administered unless already given. Respiratory support, including oxygen or ventilation, takes priority over other procedures.
The unit utilizes minimal handling during monitoring. Standard monitoring includes:• Cardiorespiratory monitoring via skin electrodes (not used for babies <26 weeks).• Pulse oximetry to maintain target SpO2 levels based on gestation.• Temperature and blood glucose monitoring.
Multistrain Probiotics dosage for prevention of NEC
Hi flora plus hydopack
1 billion CFU dose per day
0.9 ml PO x BD
Benprost (beraprost) dosage in neonates to keep ductus arteriosus patent
Benprost (beraprost 20ug/tab)
1ug/kg/dose 6 hrly (reduce to 8hrly or 12 hrly if adverse effects are noted)
TO KEEP DUCTUS ARTERIOSUS OPEN
It is used for pulmonary hypertension primarily.
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