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, the investigators propose to establish a Research Unit for the study of MCH in India, based on strong, existing collaborations between investigators in the Department of Pediatrics and Epidemiology and Preventive Medicine at the UMSM, Baltimore, and the AIIMS, New Delhi, and hospitals and the Ministry of Health in the state of Orissa, India. The applicant will initially develop an infrastructure to monitor occurrence of neonatal sepsis in community- and hospital-born infants. This will include: 1) identification of all hospitalized children, and children brought to hospital, with the diagnosis of sepsis; 2) obtaining blood cultures from these children; 3) screening of all bacterial strains isolated from blood cultures for antimicrobial resistance; 4) collecting basic demographic, risk factor, and treatment data on each case; and 5) development of a computer-based system and network for data management. In villages of Orissa State, the applicants 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. Subsequent studies will identify potential sources of bacterial isolates causing sepsis. To this end, the applicants 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 period, and with these data collection systems in place, the applicants will initiate a series of interventions, including implementation of a hospital- and community-based system of """"""""preferred"""""""" antimicrobials, use of probiotics to reduce the risk of neonatal sepsis, and implement alcohol-based hand-washing products in hospital and community-based healthcare settings to minimize pathogen transmission.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01HD040574-03
Application #
6618063
Study Section
Special Emphasis Panel (ZHD1-DSR-R (07))
Program Officer
Wright, Linda
Project Start
2001-09-03
Project End
2006-04-30
Budget Start
2003-05-01
Budget End
2004-04-30
Support Year
3
Fiscal Year
2003
Total Cost
$688,696
Indirect Cost
Name
University of Maryland Baltimore
Department
Pediatrics
Type
Schools of Medicine
DUNS #
188435911
City
Baltimore
State
MD
Country
United States
Zip Code
21201
Chandel, Dinesh S; Perez-Munoz, Maria E; Yu, Fang et al. (2017) Changes in the Gut Microbiota After Early Administration of Oral Synbiotics to Young Infants in India. J Pediatr Gastroenterol Nutr 65:218-224
Harrison, Margo S; Pasha, Omrana; Saleem, Sarah et al. (2017) A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries. Acta Obstet Gynecol Scand 96:410-420
Panigrahi, Pinaki; Parida, Sailajanandan; Nanda, Nimai C et al. (2017) A randomized synbiotic trial to prevent sepsis among infants in rural India. Nature 548:407-412
Panigrahi, P; Chandel, D S; Hansen, N I et al. (2017) Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting. J Perinatol 37:911-921
Goudar, Shivaprasad S; Stolka, Kristen B; Koso-Thomas, Marion et al. (2015) Data quality monitoring and performance metrics of a prospective, population-based observational study of maternal and newborn health in low resource settings. Reprod Health 12 Suppl 2:S2
Goudar, Shivaprasad S; Goco, Norman; Somannavar, Manjunath S et al. (2015) Institutional deliveries and perinatal and neonatal mortality in Southern and Central India. Reprod Health 12 Suppl 2:S13
Goudar, Shivaprasad S; Carlo, Waldemar A; McClure, Elizabeth M et al. (2012) The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research. Int J Gynaecol Obstet 118:190-3
Chandel, Dinesh S; Johnson, Judith A; Chaudhry, Rama et al. (2011) Extended-spectrum beta-lactamase-producing Gram-negative bacteria causing neonatal sepsis in India in rural and urban settings. J Med Microbiol 60:500-7
Carlo, Waldemar A; Goudar, Shivaprasad S; Jehan, Imtiaz et al. (2010) High mortality rates for very low birth weight infants in developing countries despite training. Pediatrics 126:e1072-80
Carlo, Waldemar A; Goudar, Shivaprasad S; Jehan, Imtiaz et al. (2010) Newborn-care training and perinatal mortality in developing countries. N Engl J Med 362:614-23

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