Chorioamnionitis and fetal inflammatory response syndrome (FIRS) are significant risk factors for early onset sepsis (EOS). Recently, the use “Intrauterine Inflammation or Infection or both” or tri...

Background: ISO certification is widely implemented as a quality assurance tool in healthcare services; however, its impact on patient safety culture (PSC) in public hospitals remains insufficiently explored. Aim: This study aims to assess the effect of ISO certification procedures on different dimensions of PSC in public hospital departments by comparing ISO-certified and non-certified departments across two phases (Phase A: pre-certification; Phase B: 18 months post-certification). Methods: A two-phase cross-sectional study was conducted in a tertiary public hospital in Greece. Healthcare professionals from both ISO-certified and non-certified departments participated. The Hospital Survey on Patient Safety Culture (HSOPSC v1.0) was administered at two time points (Phase A: baseline, pre-certification; Phase B: 18 months post-certification). A repeated measures analysis was performed to assess the changes over time and differences between the two groups. Results: The findings suggest that ISO certification has a mixed impact on the PSC dimensions. A significant improvement was observed in “Supervisor’s/Manager’s Expectations and Actions Promoting Safety” (p = 0.012), while “Teamwork Within Units” (p = 0.026) and “Handoffs and Transitions” (p = 0.037) showed statistically significant changes. These results indicate that certification may enhance structured managerial oversight and interdepartmental collaboration, but at the same time, may negatively impact the teamwork within hospital units. However, no statistically significant changes were observed in “Overall Perception of Safety” (p = 0.135) and “Non-Punitive Response to Error” (p = 0.101), suggesting that while there was a trend towards a stricter safety evaluation, this was not statistically confirmed. Additionally, the staffing perceptions remained unchanged (p = 0.745). Conclusions: ISO certification appears to reinforce managerial safety expectations and interdepartmental teamwork, yet does not significantly improve the overall perceptions of patient safety or non-punitive error responses. The results indicate the need for targeted interventions to ensure that certification processes do not increase administrative burdens or negatively impact staff perceptions. Future research should explore whether these effects persist over time and how hospitals can optimize certification processes to strengthen PSC without unintended consequences.

Antibiotics are commonly prescribed in Neonatal Intensive Care Units (NICU), where stewardship interventions are challenging. Lowering antibiotic consumption is desperately needed in Greece, a country with high antibiotic resistance rates. We sought to assess the effectiveness of a low-cost and -resource intervention to reduce antibiotic use in Greek NICUs implementing a “low-hanging fruit” approach. A prospective quasi-experimental study was conducted in 15/17 public NICUs in Greece (9/2016–06/2019). The intervention selected was discontinuation of antibiotics within 5 days for neonates with gestational age ≥ 37 weeks, no documented signs or symptoms of sepsis, CRP ≤ 10 mg/L and negative cultures within 3 days of antibiotic initiation. Impact was evaluated by the percentage of discontinued regimens by day 5, length of therapy (LOT) and stay. Trends of antibiotic consumption were assessed with days of therapy (DOT) per 1000 patient-days. Overall, there was a 9% increase (p = 0.003) of antibiotic discontinuation in ≤5 days. In total, 7/13 (53.8%) units showed a ≥10% increase. Overall, 615 days on antibiotics per 1000 patients were saved. Interrupted time-series analysis established a declining trend in DOT/1000 patient-days relative to the pre-intervention trend (p = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days (p = 0.001, 95%CI [−45.33, −12.60]). The intervention had no impact on antibiotic choice. Antibiotic use was successfully reduced in Greek NICUs using a “low-hanging fruit” approach. In resource-limited settings, similar targeted stewardship interventions can be applied.

Background/Objectives: Failure to thrive (FTT) is mostly caused by insufficient consumption of nutrient-rich food, recurrent infections like diarrhea and intestinal worms, substandard caregiving practices, and limited availability of health and other vital services. Furthermore, there was a correlation between the educational level of mothers and the occurrence of FTT in children aged 6–12 months. Thus, the objective of the current research is twofold: (i) to investigate other factors related to FTT and (ii) to evaluate the impact of them on FTT in Sub-Saharan African countries and their urban areas. Methods: We used weight entropy and TOPSIS methods to approach the research question. In particular, the entropy-weight method is effective for precisely evaluating the relative significance of the selected criteria for TOPSIS computation. Thus, data were retrieved from the database of UNICEF for the year 2019 for nine Sub-Saharan countries, and based on the methods used, five criteria have been selected for consideration. Those of mothers in higher education were identified as having a higher weight, which means that this can affect positively the ability of mothers to mitigate the situation of FTT and protect their children. Results: The findings of the study highlight the factors of maternal education at a higher level and unhealthy habits as those with the greatest weight and impact on the FTT. Moreover, the results indicate that the association between maternal education, and especially higher education, and FTT is stronger in Ethiopia. Despite the limited amount of research on the specified relationship in Sub-Saharan countries, this study is among the initial ones to examine it. Conclusions: The current study can aid policymakers in devising appropriate policies and implementing effective measures to tackle FTT in Sub-Saharan Africa, like enhancing the number of mothers in these countries to be integrated into the educational system to help both themselves and their children mitigate or avoid the symptoms of FTT.

Background: The composition of breast milk is influenced by a variety of factors, including maternal anthropometric characteristics, dietary and lifestyle habits, and lactation and feeding parameters. Emerging evidence also suggests that an infant’s sex may play a role in shaping breast milk composition. Objective: This study aims to investigate the macronutrient composition of early breast milk up to 3 months postpartum, with a particular focus on potential differences related to the infant’s sex. Methods: A total of 102 breast milk samples were collected at four time points across three lactation stages, representing colostrum, transitional, and mature milk, from a cohort consisting of 51 consenting mothers of Mediterranean origin who met the inclusion criteria. The samples were analyzed using mid-infrared spectroscopy to determine their macronutrient composition. Results: Colostrum from mothers of male infants contained approximately 60% higher levels of nitrogenous compounds, crude protein, true protein, and non-protein nitrogen compared to colostrum from mothers of female infants. Transitional milk for female infants contained higher fat, total solids, and energy. No significant differences in macronutrient composition were observed in mature milk between the sexes. For both sexes, colostrum contained more nitrogenous compounds and fewer total solids than mature milk. Male colostrum had lower carbohydrate levels compared to the later stages of lactation, while female samples showed no significant changes. Strong positive correlations between fat and crude protein were found for both sexes during the transitional and mature milk stages. In male colostrum, all macronutrients were interrelated. Conclusions: The observed differences in the composition of colostrum and transitional breast milk for male and female neonates suggest potential sex-specific nutritional adaptations during early lactation. These findings may have implications for personalized infant nutrition strategies in cases where breast feeding is hampered, as well as for understanding early neonatal adaptations.