MATERIALS AND METHODS: A single-centre, prospective, casecontrol study involving 32 subjects of preterm neonates was conducted at a tertiary care hospital in Malang, East Java, Indonesia between January to June 2022. A total of 15 preterm neonates with NEC and 17 preterm neonates without NEC were enrolled in this study. Data on demographic, clinical and laboratory findings were collected. Multiple logistic regression test was performed to analyse the risk factors for NEC development. Further profiling within 15 subjects with NEC, i.e., NEC grade ≥ II, were conducted to collect systemic, abdominal, laboratory, abdominal x-ray (AXR) and blood culture findings.
RESULTS: The risk factors related to NEC development in preterm infants were multi-morbidity (adjusted OR = 11.96; 95% CI 1.85 168.38; p = 0.046), antibiotic exposure (OR = 15.95; 95% CI 1.54 165.08; p = 0.020) and requiring advanced neonatal resuscitation at birth (OR = 10.04; 95% CI 1.09 92.11; p = 0.041). Further profiling within NEC cohorts highlighted respiratory distress (86.7%), (oro)gastric retention (80.0%), thrombocytopenia (53.3%), gastrointestinal dilatation in AXR (53.3%), and positive blood culture Klebsiella pneumoniae (40.0%) were most common findings.
CONCLUSION: Preterm neonates with multimorbidity, prolonged antibiotic exposure, and requiring advanced resuscitation at birth were more likely to develop NEC. Early detection of the risk factors and determinant factors for survival may help to improve the clinical outcome.
MATERIALS AND METHODS: We used cross-sectional and secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS). A total of 142 infants under 1 year were selected as the respondents. Chi-square test and binary logistic regression were used to examine factors associated with diarrhoea in infants with LBW in Indonesia.
RESULTS: There are several factors more likely to increase the incidence of diarrhoea in infants with LBW, which are living in rural areas [OR = 5.65, 95% CI = 1.08-29.5] and having internet access less than the last 12 months (OR = 13.03, 95% CI = 1.48-114). Meanwhile, factors more likely to decrease the incidence of diarrhoea in infants with LBW, which are maternal age (20-24 years old) [odds ratio (OR) = 0.07, 95% CI = 0.01-0.98], cell phone ownership (OR = 0.08, 95% CI= 0.01-0.45), and the use of feeding bottles (OR = 0.22, 95% CI = 0.05-0.92).
CONCLUSION: This study highlights that maternal age, cell phone ownership, internet access, area of residence, and use of feeding bottles are significant factors associated with diarrhoea in infants with LBW. Health workers must enhance health education related to those factors through the Community Integrated Child Health Service (Posyandu) programs.
PURPOSE: Minimum clinical standards for assessment and management of osteoporosis are needed in the Asia-Pacific (AP) region to inform clinical practice guidelines (CPGs) and to improve osteoporosis care. We present the framework of these clinical standards and describe its development.
METHODS: We conducted a structured comparative analysis of existing CPGs in the AP region using a "5IQ" model (identification, investigation, information, intervention, integration, and quality). One-hundred data elements were extracted from each guideline. We then employed a four-round Delphi consensus process to structure the framework, identify key components of guidance, and develop clinical care standards.
RESULTS: Eighteen guidelines were included. The 5IQ analysis demonstrated marked heterogeneity, notably in guidance on risk factors, the use of biochemical markers, self-care information for patients, indications for osteoporosis treatment, use of fracture risk assessment tools, and protocols for monitoring treatment. There was minimal guidance on long-term management plans or on strategies and systems for clinical quality improvement. Twenty-nine APCO members participated in the Delphi process, resulting in consensus on 16 clinical standards, with levels of attainment defined for those on identification and investigation of fragility fractures, vertebral fracture assessment, and inclusion of quality metrics in guidelines.
CONCLUSION: The 5IQ analysis confirmed previous anecdotal observations of marked heterogeneity of osteoporosis clinical guidelines in the AP region. The Framework provides practical, clear, and feasible recommendations for osteoporosis care and can be adapted for use in other such vastly diverse regions. Implementation of the standards is expected to significantly lessen the global burden of osteoporosis.
METHODS: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP.
RESULTS: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations.
CONCLUSIONS: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.