Completed Studies | 7 - India - Prevention of infection in neonates

India, with one of the world's largest populations, continues to struggle with extremely high infant and neonatal mortality rates. Sepsis now accounts for 50 of deaths among community-born (and 20 of mortality among hospital-born) infants. Closely linked with this is a burgeoning problem with antimicrobial resistance, which is increasingly restricting the therapeutic options for medical care providers.

To deal with these critical issues, we propose to establish a Research Unit for the study of maternal and child health in India, based on strong, existing collaborations between investigators in the Departments of Pediatrics and Epidemiology and Preventive Medicine at the University of Maryland School of Medicine, Baltimore, and the All India Institute of Medical Sciences (AIIMS), New Delhi; and hospitals and the Ministry of Health in the state of Orissa.

We will initially develop an infrastructure to monitor occurrence of neonatal sepsis in community- and hospital-born infants. This will include identification of all hospitalized children, and children brought to hospital, with the diagnosis of sepsis; obtaining blood cultures from these children; screening of all bacterial strains isolated from blood cultures for antimicrobial resistance; collecting basic demographic, risk factor, and treatment data on each case; and development of a computer-based system/network for data management. In villages in Orissa State, we will set up a village-level surveillance system, to identify women during their pregnancy; monitor pregnancy outcomes; and establish a mechanism for referral of all potentially septic infants to participating clinics or hospitals for evaluation, including collection of blood cultures.

In subsequent studies, we will identify potential sources of bacterial isolates causing sepsis: we will screen skin, nares, and stool cultures from infants (and skin, nares, and vaginal cultures from their mothers), and seek to match blood isolates with these colonizing isolates, using molecular epidemiologic techniques.

In the latter years of the grant, and with these data collection systems in place, we will initiate a series of interventions, including implementation of an hospital- and community-based system of "preferred" antimicrobials; use of probiotics to reduce the risk of neonatal sepsis; and implementation of alcohol-based hand-washing products in hospital and community-based healthcare settings to minimize pathogen transmission.