Background Overuse and abuse of antibiotics resulted in emergence of multidrug-resistant organisms (MDRO), increased rates of invasive candidiasis, prolonged hospital stay, NEC (Necrotizing enterocolitis), LOS (Late onset sepsis) or death. Restriction of the prescription, switching to a narrower spectrum and stopping antibiotics when not needed are some of the major approaches to antibiotic stewardship. Methods We identified restricted antimicrobials and devised an antimicrobial justification form. Clinicians needed to fill the form before prescribing restricted antimicrobials thereby comparing the antimicrobial usage pattern before and after the introduction of form. Babies enrolled before the introduction of the justification form were labelled as Group 1, and as Group 2 after justification form. The HIC (hospital infection control) staff nurse paid daily visits to NICU to monitor number of babies started on restricted antibiotics and whether the forms were duly filled or not. Any lag would be intimated to the Head HIC team for rectification. Any change of antibiotic within the restricted group also warranted justification. Culture report notified within 48 – 72 hrs so as to facilitate the stoppage of antibiotics in case of negative culture. Results There was a statistically significant reduction in the usage of restricted antimicrobials in the Group B as compared to Group A 150 (40.54%) vs 190 (49.35%) (p = 0.01). There was a statistically significant increase in the % of babies de-escalated from high end antimicrobials in Group B as compared to Group A 90 (60%) vs 56 (29.47%) (p = <0.0001). Duration of restricted antimicrobials reduced from 13.78 ± 2.7 days in Group A to 9.9 ±1.8 days in Group B (p = <0.0001). No difference in the number of babies started on any antibiotic between both the groups (p = 0.1). Conclusion Introduction of the antibiotic justification form as a part of antimicrobial stewardship program resulted in an overall reduced usage of restricted antimicrobials along with rapid de-escalation. Show less

Gastric pneumatosis though rare, when seen is cause for concern. It has been associated with fulminant necrotizing enterocolitis (NEC) and gastric outlet obstruction, although other associations have been identified. It is not to be confused with pneumoperitoneum and can be managed conservatively as it is not always a harbinger of intestinal perforation. This case report highlights gastric pneumatosis which occurred in association with necrotizing enterocolitis in two late preterm infants. NEC accounts for 5.4% of our Neonatal Intensive Care Unit admissions, however these are the first two cases of gastric pneumatosis seen in the history of our unit. It is crucial for clinical staff to be cognizant of this pathognomonic sign so that cases are not missed, and for the feeding policy that governs the management of late preterm infants to be revisited. That which specifically predisposes a baby with NEC to developing gastric pneumatosis remains unknown and warrants further research. Show less

The work emphasizes the need for additional research to create novel biomarkers based on the use of microRNAs as a less invasive and precise diagnostic technique for identifying diseases in newborns. Show less