Sepsis is a leading cause of intensive care unit (ICU) admission and mortality. Although early antibiotic therapy in the emergency department improves outcomes, the clinical impact of delays in ICU-based antibiotic escalation is not well established. This study evaluated the association between time to ICU-based initiation of newly prescribed antibiotics and ICU mortality using a Bayesian analytical framework. A prospective observational study (2019–2021) was conducted in a tertiary care hospital, including adult patients admitted to the ICU. New antibiotic administration represented an escalation of therapy for suspected new-onset or worsening infection. Delay was defined as the interval between prescription and actual administration. Repeated antibiotic escalation events within patients were analyzed using a Bayesian generalized linear mixed model (GLMM) accounting for within-patient correlation. A total of 695 antibiotic escalation events occurred in 467 patients (mean age 50.6 ± 17.7 years; 61.7% male). The majority of patients received antibiotics within 3 hours of sepsis recognition (90.6%), and 42.8% within 1 hour. Intensive care unit mortality was 25.9%. Each hour delay in administration of newly prescribed ICU antibiotics was associated with increased odds of ICU mortality [posterior odds ratio (OR): 1.13, 95% credible interval (CrI): 1.11–1.15]. Higher mortality was also associated with septic shock, hospital-acquired infection, higher delta sequential organ failure assessment (Δ SOFA), and higher Acute Physiology and Chronic Health Evaluation (APACHE II) Score. Delays in ICU-based antibiotic escalation are associated with increased mortality. Timely escalation may represent an important, modifiable target to improve outcomes in critically ill patients with suspected sepsis. Havaldar AA, Saji A, Thomas T, Selvam M, Josy J, Nandhini CS, et al. Time to Initiation of Antibiotic Therapy in Critically Ill Patients with Suspected Sepsis and Its Effect on Intensive Care Unit Mortality: Analysis Using Bayesian Approach. Indian J Crit Care Med 2026;30(3):204–210.

Background/Objectives: Linear growth faltering remains a major public health concern in low- and middle-income countries, wherein sub-optimal complementary feeding and hygiene practices are key modifiable factors. Inadequate complementary feeding is addressed through government-issued Take-Home Ration (THR) for <3-year-old children. This THR is not consumed regularly and does not bridge deficits in protein quality and fat intake among South Indian rural children. The addition of milk and legumes into a reformulated THR would address these gaps, but its efficacy remains unknown. Methods: In this 3-month cluster-randomized controlled trial among rural infants (6–9 months old), the intervention group (12 village clusters; n = 67) received a modified milk-and legume-based THR along with standard government THR, while the control group (12 village clusters; n = 67) received standard government THR alone. Caregivers of both groups were educated on nutrition and hygiene practices. Anthropometry, body composition (BC), morbidity, diet, and compliance data were collected. The primary outcome (length-for-age z-score (LAZ)) and secondary outcomes were analyzed using cluster-adjusted linear mixed models (LMM) in an intention-to-treat analysis. Results: While LAZ did not differ significantly between groups (β = 0.063 LAZ/month, 95%CI: −0.019, 0.145; p = 0.130), adjusted LMM showed significant differences in length (0.213 cm/month, 95%CI: 0.025, 0.400, p = 0.027), weight (0.040 kg/month, 95%CI: 0.001, 0.079, p = 0.044) and head circumference (0.067 cm/month, 95%CI: 0.005, 0.128, p = 0.033). LAZ decreased in both groups, with a significantly lower decline in the intervention group (slope difference: β = 0.05, 95% CI: 0.006, 0.095, p = 0.027). BC did not differ significantly. Conclusions: Improving protein quality and fat content of the government-issued THR showed a favourable LAZ trajectory among infants from rural South India. (Clinical Trial Registry-India: CTRI/2020/06/025825).

Background/Objectives: Inadequate macronutrient intake may affect neurodevelopment in early infancy. In India, government-supplied take-home rations (THRs) attempt to meet this gap but lack adequate fat and protein. This study evaluated the impact of a 3-month macronutrient modified-THR intervention on infant neurodevelopment using event-related potentials (ERPs). Methods: A two-group cluster randomized controlled trial (village clusters = 12/group; N = 67/group) enrolled healthy breastfed infants (6–9 months) in Karnataka, India. The intervention group received a milk–legume-based THR providing ~200 kcal/day (ML-THR, estimated protein:energy (PE) and fat:energy (FE) ratios: 12% and 45%) with the standard government THR (SG-THR, estimated PE and FE ratios: 7% and 4%), while controls received SG-THRs only. All mothers received education on infant and young child feeding practices, water sanitation and hygiene. Auditory, visual and attention processing ERPs were measured using a short, culturally adapted, infant-friendly paradigm. Linear mixed models evaluated intervention effects over time. Results: The intervention was associated with region-specific visual ERP changes: increased fractional latencies in anterior regions for face, nonface (500–750 ms); decreased fractional latencies in the central region for frequent (10–250 ms) and face (500–750 ms) and in the posterior region for frequent–rare difference (250–500 ms). The intervention group also demonstrated a reduced area under the curve for nonface stimuli (250–500 ms). No significant auditory or visual hemifield effects were observed. None of the observed effects remained significant after false discovery rate (FDR) correction. Conclusions: The findings are exploratory and suggest the need to examine the effects of improved protein quality and fat content in THRs on visual–cortical processing in larger samples.

Background: Anemia prevalence among Indian pregnant women in 2015-16 was 50.4% and has not declined from 49.7% in 1998-99 despite the national policies on iron-folic acid supplementation. New gestational age-specific cut-offs (INTERGROWTH cut-off) for risk of low Hemoglobin (Hb) have been identified. Aims and objectives: Compare prevalences of low Hb based on WHO and INTERGROWTH cut-offs Methods: The prevalence of anemia/low Hb among pregnant women in trimesters 2 and 3 from NFHS-4 data were estimated using the current WHO recommendations and the INTERGROWTH cut-offs. Results: Prevalence of low Hb by the INTERGROWTH cut-off was 28.1%(95% CI:26.9-29.4) and 21.7%(95% CI:20.6-22.9) in trimesters 2 and 3. Anemia prevalence by WHO cut-off was much higher at 41.2%(95% CI:39.8-42.5) and 54.8%(95 CI:53.2-56.3) in trimesters 2 and 3. The prevalence of low-Hb was similar between ANC and no-ANC reported groups in both trimesters (26.1% and 28.9% in trimester-2; 20.1% and 22.4% in trimester-3). Conclusion: The prevalence of low-Hb with gestational age specific cut-offs is much lower compared to earlier estimates using WHO cut-off. The universal iron supplementation program for pregnant women in India need to be re-examined in this light and a tragetter Hb testing based supplementation may be more beneficial in reducing anemia prevalence.

Saji A, et al. Clin Hypertens. 2026 Feb;32:e7. https://doi.org/10.5646/ch.2026.32.e7