13Outline of the research gaps
13.1. Vitamin K prophylaxis in newborns
Research to understand why vitamin K usage is low in developing countries
Need for more information on incidence of Vitamin K Dependent Bleeding in developing countries
Evaluation of intervention delivery issues and into How to best deliver the intervention in remote settings
Testing the possibility of combining with the birth dose of Hepatitis B vaccine
Research to improve injection safety
13.2. Prophylactic antibiotics to neonates with risk factors for infection
RCT for determining efficacy of prophylactic antibiotics to the neonate when the mother has risk factors for neonatal infection
What should be the duration of treatment?
What is the efficacy of a combination of oral antibiotic (e.g. amoxicillin) and IM gentamicin
Bacteriology data on neonatal sepsis
13.3. Skin-to-skin contact in the first hour of life
New studies to have high quality evidence of efficacy of this intervention. Also, to ascertain:
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effect on preterm and SGA infants?
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effect and feasibility after caesarean section?
The studies should be designed for the outcomes to include breastfeeding, hypothermia, engorgement, and bonding. Control group should receive immediate drying and wrapping, and counselling for early breastfeeding.
Health care providers and mothers views on acceptability of early skin-to-skin contact of neonates with mothers after birth
13.4. Management of neonatal jaundice
Non-invasive serum bilirubin measurement at point of care
RCTs evaluating different cut-offs for phototherapy in babies with hyperbilirubinaemia
Perceptions, care seeking and causes of prolonged jaundice
13.5. Kangaroo Mother Care
Implementation, scaling up issues
Ongoing KMC at home post-discharge, feasibility, how long to continue
Effectiveness, feasibility of early community initiation of KMC
13.6. Prevention of hypothermia immediately after birth in VLBW infants
The group recommended an RCT of plastic wraps for VLBW babies in district and provincial hospitals in developing country settings
13.7. Management of children with non-severe pneumonia and wheeze
Studies on withholding antibiotics in young children with wheeze, no fever and non-severe pneumonia need to be replicated in other settings, including health workers ability to identify these children at very low risk of bacterial infection, and the acceptability of withholding antibiotics
Studies testing accuracy of different diagnostic algorithms for pneumonia and definitions of treatment failure
13.8. Antibiotics for severe pneumonia
More data is needed to assess appropriate antibiotic therapy of severe pneumonia in high HIV settings
More research is needed on ambulatory care for severe pneumonia/requisites for safely treating such children at home or in day clinic settings
Research in moderately malnourished children with pneumonia
Repeat the clinical trials for treatment outcomes in countries with high Hib and pneumococcal vaccine coverage.
13.9. Antibiotics for very severe pneumonia
Data on shifts in bacterial patterns due to coverage of H. influenzae type b and S. pneumococcus vaccines and implications for treatment of pneumonia and antimicrobial resistance
Comparison of the recommended treatment (injectable ampicillin (or penicillin) and gentamicin) versus injectable ceftriaxone
What should be second line therapy for children failing on first line therapy?
Impact of improved comprehensive care packages on outcomes for children with very severe pneumonia.
13.10. Treatment of non-severe pneumonia
Studies to determine the duration of therapy in settings other than Asia
Repeat the clinical trials for treatment outcomes in countries with high Hib and pneumococcal vaccine coverage
Research on treatment failure definition, and choice of second line treatment
Research on increasing specificity of pneumonia diagnosis and aetiology of pneumonia
13.11. Antibiotics for Meningitis
There is need for comparative studies on dose and frequency of ceftriaxone,
Improved surveillance for antibiotic resistance among pathogens causing meningitis
The role and accuracy of rapid point of care diagnostic tests, that can be used in district hospitals that do not have culture facilities
Studies of the aetiology on meningoencephalitis in settings with high coverage of SP/Hib vaccine coverage
13.12. Antibiotics for Acute Otitis Media
RCTs in developing countries with pragmatic definition of otitis
Follow up studies in developing countries to quantify complication rates, especially in high prevalence HIV settings
Systematic review of treatment of otorrhoea (as may merit separate guidelines)
RCT of different durations of antibiotic treatment (including BD versus TID)
13.13. Antibiotics for Typhoid Fever
Develop point of care diagnostic tests with higher specificity than current tests
Define local resistance patterns
Studies of basic epidemiology of typhoid in Africa
Continuing need for effective vaccine
13.14. Antibiotics for severe acute malnutrition
The role of metronidazole in controlling intestinal bacterial overgrowth in children with Severe Acute Malnutrition? There is currently one ongoing trial in Senegal
The effectiveness of different antibiotic regimens in the treatment of complicated SAM.
A randomised controlled trial on the role of antibiotics in uncomplicated SAM.
13.15. Oxygen systems and delivery methods
Large-scale effectiveness trials of improved oxygen systems on outcomes from pneumonia
Studies of alternative power supplies to run oxygen concentrators and pulse oximeters in remote settings where power supplies are unreliable
The role of inexpensive forms of CPAP in the management of severe pneumonia
Are there safe methods for cleaning and reuse of oxygen delivery equipment in high HIV prevalence settings?
13.16. Pulse oximetry
Studies of different types of pulse oximetry – such as hand-held devices – in field settings
13.17. Thresholds for giving oxygen
Studies with adequate power to better define thresholds at high altitude (e.g. randomised cohorts using different thresholds with follow-up)
Clinical studies comparing outcomes when oxygen is given at different thresholds
