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Reference
1 Patrick SW et al. Pediatrics 2016; 137: e20152901.
Reviewer: David Isaacs, Children’s Hospital at Westmead, Sydney
(david.isaacs@health.nsw.gov.au)
Kangaroo Mother Care and neonatal
outcomes: A meta-analysis
Kangaroo Mother Care (KMC) originated in South America
as a low cost alternative to incubators for low birth weight
(LBW) infants. The key feature of KMC is early, continu-
ous, and prolonged skin-to-skin contact between LBW
newborn and mother. Ideally, KMC also includes exclusive
breastfeeding; early hospital discharge; and close follow-up at
home. A recent systematic review and meta-analysis exam-
ined the association between KMC and neonatal outcomes.1
A total of 124 studies met inclusion criteria, of which half
were randomized controlled trials and the others observa-
tional. Results were resoundingly positive. Among LBW new-
borns, KMC (compared to conventional care) was associated
with a 36% reduction in mortality (RR = 0.64; 95% CI 0.46
to 0.89). KMC also significantly decreased risk of neonatal
sepsis (RR = 0.53; 95% CI 0.34 to 0.83); hypothermia
(RR = 0.22; 95% CI 0.12 to 0.41); hypoglycemia (RR = 0.12;
95% CI 0.05 to 0.32); hospital re-admission (RR = 0.42;
95% CI 0.23 to 0.76); and increased exclusive breastfeeding
(RR =1.50; 95% CI 1.26 to1.78). Not surprisingly, the au-
thors concluded; “interventions to scale up KMC implementa-
tion are warranted”.
Reference
1 Boundy EO et al. Pediatrics 2016; 137: 1–16.
Reviewer: Craig Mellis, Sydney Medical School, University of Sydney,
Sydney (craig.mellis@sydney.edu.au)
Journal of Paediatrics and Child Health 52 (2016) 578–579
© 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)
Scabies control with ivermectin
Infestation with the mite Sarcoptes scabiei causes an extremely itchy
rash, scabies, which can be complicated by impetigo due to Staphy-
lococcus aureus or Streptococcus pyogenes. In tropical environments in-
cluding Northern Australia and the Pacific, impetigo can cause
pyogenic complications, but serious non-pyogenic complications
of S. pyogenes infection include rheumatic fever and glomerulone-
phritis. Consequently, scabies control might reduce rheumatic
heart disease. An innovative study randomised three island com-
munities in Fiji to one of three interventions for scabies: standard
care (topical permethrin to affected persons and contacts,
n = 803); permethrin (mass administration of permethrin,
n = 532); or ivermectin (mass administration of single-dose oral
ivermectin, n = 716).1 Ivermectin was taken under direct observa-
tion. Before treatment, the prevalence and severity of scabies was
similar. The prevalence of scabies declined in all three groups over
the 12-month intervention period: standard care group by 49%
(95% confidence interval (CI) 37–60%), permethrin group by
62% (95% CI 49–75%) and ivermectin group by 94% (95% CI
83–100%). The prevalence of impetigo also decreased significantly
in all groups: relative reduction 32% (95% CI 14–50%), 54%
(95% CI 35–73%) and 67% (95% CI 52–83%), respectively. The
decrease in impetigo in the ivermectin group was significantly
greater than in the other two groups (P < 0.05). Adverse events,
mostly itch and headache, were more common in the ivermectin
than the permethrin group (15.6% vs. 6.8%) but were mild. Mass
administration of ivermectin is safe and reduces both scabies and
impetigo.
Reference
1 Romani L et al. N. Engl. J. Med. 2015; 373: 2305–13.
Reviewers: David Isaacs, Philip Britton, Children’s Hospital at
Westmead, Sydney (david.isaacs@health.nsw.gov.au)
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