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13. Outline of the research gaps
13.1 Vitamin K prophylaxis in newborns
1. Research to understand why vitamin K usage is low in developing countries 2. Need for more information on incidence of Vitamin K Dependent Bleeding in
developing countries 3. Evaluation of intervention delivery issues and into How to best deliver the
intervention in remote settings 4. Testing the possibility of combining with the birth dose of Hepatitis B vaccine
5. Research to improve injection safety
13.2
Prophylactic antibiotics to neonates with risk factors for infection
1. RCT for determining eicacy of prophylactic antibiotics to the neonate when the mother has risk factors for neonatal infection
2. What should be the duration of treatment? 3. What is the eicacy of a combination of oral antibiotic e.g. amoxicillin and IM
gentamicin 4. Bacteriology data on neonatal sepsis
13.3 Skin-to-skin contact in the first hour of life
1. New studies to have high quality evidence of eicacy of this intervention. Also, to ascertain:
— efect on preterm and SGA infants? — efect and feasibility ater caesarean section?
2. he 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. 3. Health care providers and mothers views on acceptability of early skin-to-skin
contact of neonates with mothers ater birth
13.4 Management of neonatal jaundice
1. Non-invasive serum bilirubin measurement at point of care 2. RCTs evaluating diferent cut-ofs for phototherapy in babies with hyperbilirubi-
naemia 3. Perceptions, care seeking and causes of prolonged jaundice
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13.5 Kangaroo Mother Care
1. Implementation, scaling up issues 2. Ongoing KMC at home post-discharge, feasibility, how long to continue
3. Efectiveness, feasibility of early community initiation of KMC
13.6 Prevention of hypothermia immediately after birth in VLBW infants
1. he 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
1. 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
2. Studies testing accuracy of diferent diagnostic algorithms for pneumonia and deinitions of treatment failure
13.8 Antibiotics for severe pneumonia
1. More data is needed to assess appropriate antibiotic therapy of severe pneumonia in high HIV settings
2. More research is needed on ambulatory care for severe pneumoniarequisites for safely treating such children at home or in day clinic settings
3. Research in moderately malnourished children with pneumonia 4. Repeat the clinical trials for treatment outcomes in countries with high Hib and
pneumococcal vaccine coverage.
13.9 Antibiotics for very severe pneumonia
1. Data on shits in bacterial patterns due to coverage of H. inluenzae type b and S. pneumococcus vaccines and implications for treatment of pneumonia and
antimicrobial resistance 2. Comparison of the recommended treatment injectable ampicillin or penicillin
and gentamicin versus injectable cetriaxone 3. What should be second line therapy for children failing on irst line therapy?
4. Impact of improved comprehensive care packages on outcomes for children with very severe pneumonia.
13.10 Treatment of non-severe pneumonia
1. Studies to determine the duration of therapy in settings other than Asia 2. Repeat the clinical trials for treatment outcomes in countries with high Hib and
pneumococcal vaccine coverage 3. Research on treatment failure deinition, and choice of second line treatment
4. Research on increasing speciicity of pneumonia diagnosis and aetiology of pneumonia
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