SARS-CoV-2 infection in children accounts for about 1-8% of cases world-wide, most of them asymptomatic or mildly symptomatic. Neonatal infection is rare and usually asymptomatic. Since April 2020, severe manifestations were seen in children in Europe and North America, presenting as Kawasaki disease-like illness involving multiple organs. The Centers for Disease Control and Prevention termed this multisystem inflammatory syndrome in children (MIS-C) and developed a case definition. The World Health Organization developed a similar case definition with slight modifications. The appropriateness of this definition for neonatal scenarios is debatable. Anecdotal reports reveal that the second wave of SARS-CoV-2 in the Indian context has affected neonates with more severity and a wide spectrum of presentations. Neurological manifestations presenting as seizures and encephalopathy, cardiac manifestations with shock, coronary artery dilatation, arrhythmias, disseminated intravascular coagulation, renal problems and death are seen. [1][2][3][4] We report a case of SARS-CoV-2 infection in a 7-day-old term neonate with possible MIS-C, presenting with features of encephalitis.

BackgroundKangaroo mother care (KMC) is a proven intervention for improving intact survival in low birthweight babies. Despite the evidence, its adoption and implementation have been low. Availability of mothers for the first few days of life is a specific challenge at outborn units. We used a quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies (<2000 g) from a baseline of 2.7 hours/baby/day to 6 hours/baby/day (prolonged KMC) over a period of 2 years in our unit through a series of Plan-Do-Study-Act (PDSA) cycles.MethodsAll babies with birth weight <2000 g not on any respiratory support or jaundice were eligible. The key quantitative outcome was KMC hours/baby/day. A QI team consisting of nurses, nursing in charge and consultants of the unit was formed. The potential barriers for prolonged KMC were evaluated using fishbone analysis. A variety of parent-centric measures (provision of bed to mothers apart from KMC chairs, foster KMC, structured KMC counselling through a video, making KMC an integral part of treatment order) were introduced and subsequently tested by multiple PDSA cycles. Data on the duration of KMC per day were measured by bedside nurses on a daily basis.ResultsA total of 134 mother–baby dyads were enrolled over 2 years. The mean gestation (SD) and mean birth weight (SD) were 33 (2) weeks and 1557 (295) g, respectively. 78 (58%) babies were outborns. We implemented prolonged KMC over 9 months and sustained it over the next 18 months. KMC duration increased from a median of 2.7 hours/baby/day from baseline to a median of 7.4 hours/baby/day after implementation.ConclusionsProlonged KMC could be implemented and sustained over 2 years by implementing parent-centric best practices even in a predominant outborn unit.

Background: A traditional medical curriculum has limited emphasis on communication skills, teamworking, and human factors. Simulation-based training emphasizes these skills and positively impacts patient safety. A group of Indian neonatologists in collaboration with their UK colleagues conducted adapted Neonatal Emergencies Simulation Team-training (NEST) courses in India. Aim: To evaluate the effectiveness of NEST courses in India and analyze the participant’s feedback Methods: A total of 16 NEST courses were conducted between November 2014 and February 2016. Structured pre- and postcourse feedback from participants was analyzed. Key domains studied included structured approach, human factors, situation-background-assessment-recommendation tool, and teamwork in an emergency. Each category was rated from 1 to 5, indicating a low to high scale. Pre- and posttraining scores and scores between centers were compared using the Wilcoxon signed-rank test and Kruskal-Wallis test, respectively. Results: A total of 191 feedbacks from 58 nurses and 133 doctors from 4 centers were analyzed. The comparison of self-reported pre- and postcourses showed a significant improvement across all domains. There was no statistical difference between scores from different centers showing consistent course results. Conclusions: We have demonstrated that the NEST multiprofessional course can be collaboratively delivered. The analysis of feedback shows a significant improvement in the candidate’s self-reported ability across all domains related to the application of the course principles to simulated neonatal emergencies.

BackgroundLack of standardisation and failure to maintain aseptic techniques during procedures contributes to healthcare-associated infections (HCAI). Although numerous procedures are performed in neonatal intensive care units (NICU), handling peripheral intravenous lines is one of the simple and common procedures performed daily. Despite evidence-based care bundle approach variability is higher, and compliance to asepsis is less in routine clinical practice. In this study, we aimed to standardise and improve compliance with Aseptic non-technique (ANTT) in intravenous line maintenance of neonates admitted to NICU to reduce HCAI by 50% over 6 months.MethodsAll nurses were subjects of assessment for compliance with intravenous line maintenance. All admitted neonates with intravenous lines were subjects for the HCAI data collection. At baseline, the current practices for intravenous line maintenance were observed on a generic ANTT audit proforma. Pictorial standard operating procedure (SOP) was developed based on ANTT. Implementation and sustenance were ensured by Plan-Do-Study-Act cycles. Audit data on compliance to ANTT and trends of HCAI rates were displayed using run charts monthly. Qualitative experience from the nursing staff was also recorded.ResultsSignificant improvement was seen in compliance to various components—use of the aseptic field (0% to 100%), closed ports (0% to 100%), key part contamination reduction (80% to 0%), and intravenous hub scrubbing (0% to 72%). SOP of intravenous line maintenance based on ANTT could be implemented and sustained throughout for 9 months. There was a reduction of HCAI from 26 per 1000 patient days to 8 per 1000 patient days. Qualitative experience showed the main determinant of compliance to scrub the hub was the neonate’s sickness level.ConclusionsUsing a quality improvement model of improvement, ANTT in intravenous line maintenance was implemented stepwise. Improving compliance with ANTT principles in intravenous line maintenance reduced HCAI. Scrub the hub requires longer sustained efforts to become part of the practice.

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