Does Early BCG in Low Birth weight Newborn less than 2Kg provide survival advantage in the Newborn Period?

Saravanan, N (2014) Does Early BCG in Low Birth weight Newborn less than 2Kg provide survival advantage in the Newborn Period? Masters thesis, Madras Medical College, Chennai.


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Major advances in the management of the preterm low birth weight infants like surfactant, ventilator care, Total Parental Nutrition, central lines, Kangaroo Mother Care, breast milk banking, early feed advancement policy, better asepsis protocols, Antenatal steroids and developmentally oriented supportive care have failed to produce uniformly good outcomes. Sepsis is the major contributor to the mortality. Despite the usage of highly potent antimicrobials, emergence of resistant organisms plague the various newborn care facilities. This has led to a search for alternative therapies to combat sepsis like IVIG and GM-CSF. These have been proven to have doubtful efficacy in recent studies. Against this background BCG vaccine has generated great interest in the western world recently for its nonspecific immune modulatory effects in various diseases like Allergy, Cancer, Chronic diseases like Multiple Sclerosis and Diabetes. Historically, since its introduction it had reduced infant mortality rates nonspecifically in certain studies in the 1940’s and 1950’s. This went unrecognized till now and interest has been rekindled in this age old vaccine. Recently 2 RCT’s in West Africa had found that early BCG vaccine in low birth weight newborns reduced neonatal mortality significantly by decreasing the incidence of sepsis and pneumonia in these neonates. Based on these findings there is currently a trial going on in Netherlands to study the effect of BCG on infant morbidity. Another study is going on in Australia to determine if it reduces allergy and asthma. A recent large retrospective cohort study done in Australia studying a cohort distributed in many countries concluded that BCG reduced acute lower respiratory tract infections significantly. Molecular studies also support BCG vaccines’ ability to enhance immunity (both innate and adaptive) by novel mechanisms. Early BCG administered to low birth neonates less than 2000 grams within 48 hours of life did not confer any significant survival advantage to these neonates. Early BCG did not show reduction in the incidence of infections in low birth weight babies. Early BCG failed to reduce mortality in the neonatal period significantly Further larger studies are required to prove or disprove the hypothesis maybe with a lesser effect size and more immunogenic vaccine strain.

Item Type: Thesis (Masters)
Uncontrolled Keywords: low birth weight newborn; early BCG; survival advantage; Newborn Period
Subjects: MEDICAL > Neonatology
Depositing User: Kambaraman B
Date Deposited: 23 Jun 2017 06:05
Last Modified: 23 Jun 2017 06:34

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