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Alarcon Martinez T, Hodgson KA, Baker E, Whitehead C, McKinlay CJD, Davis PG, Manley BJ. Caffeine therapy for very preterm infants in Australia and New Zealand: a bi-national survey. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-326874. [PMID: 38641418 DOI: 10.1136/archdischild-2024-326874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/21/2024]
Affiliation(s)
| | - Kate Alison Hodgson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Baker
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Whitehead
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
- Fetal Medicine Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Christopher Joel Dorman McKinlay
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Brett James Manley
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Puligandla P, Skarsgard E, Baird R, Guadagno E, Dimmer A, Ganescu O, Abbasi N, Altit G, Brindle M, Fernandes S, Dakshinamurti S, Flageole H, Hebert A, Keijzer R, Offringa M, Patel D, Ryan G, Traynor M, Zani A, Chiu P. Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative. Arch Dis Child Fetal Neonatal Ed 2024; 109:239-252. [PMID: 37879884 DOI: 10.1136/archdischild-2023-325865] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a 'living document'. DESIGN AND MAIN OUTCOME MEASURES Critical appraisal of CDH literature adhering to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence accumulated between 1 January 2017 and 30 August 2022 was analysed to inform changes to existing or the development of new CDH care recommendations. Strength of consensus was also determined using a modified Delphi process among national experts in the field. RESULTS Of the 3868 articles retrieved in our search that covered the 15 areas of CDH care, 459 underwent full-text review. Ultimately, 103 articles were used to inform 20 changes to existing recommendations, which included aspects related to prenatal diagnosis, echocardiographic evaluation, pulmonary hypertension management, surgical readiness criteria, the type of surgical repair and long-term health surveillance. Fifteen new CDH care recommendations were also created using this evidence, with most related to the management of pain and the provision of analgesia and neuromuscular blockade for patients with CDH. CONCLUSIONS The 2023 Canadian CDH Collaborative's clinical practice guideline update provides a management framework for infants and children with CDH based on the best available evidence and expert consensus.
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Affiliation(s)
- Pramod Puligandla
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Erik Skarsgard
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Baird
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena Guadagno
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexandra Dimmer
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Olivia Ganescu
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nimrah Abbasi
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Altit
- Neonatology, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mary Brindle
- Department of Surgery, Section of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Sairvan Fernandes
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shyamala Dakshinamurti
- Department of Pediatrics and Child Health, Section of Neonatology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helene Flageole
- Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Audrey Hebert
- Department of Pediatrics, Division of Neonatology, Laval University, Quebec City, Quebec, Canada
| | - Richard Keijzer
- Department of Pediatric Surgery and Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Dylan Patel
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Greg Ryan
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Michael Traynor
- Department of Anesthesia, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Augusto Zani
- Department of Surgery, Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Chiu
- Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Suonpera E, Lanceley A, Ni Y, Marlow N. Parenting stress and health-related quality of life among parents of extremely preterm born early adolescents in England: a cross-sectional study. Arch Dis Child Fetal Neonatal Ed 2024; 109:253-260. [PMID: 37879883 DOI: 10.1136/archdischild-2023-325429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine whether extremely preterm (EP) birth exerts persisting effects on parents in early adolescence. DESIGN Cross-sectional survey conducted between March 2017 and October 2018. SETTING Evaluation of a longitudinal population-based birth cohort in England at 11 years of age (EPICure2@11 Study). PARTICIPANTS Parents of EP (<27 weeks of gestation) adolescents and control parents of term born (≥37 weeks of gestation) classmates of similar age and sex. MAIN OUTCOME MEASURES The Parenting Stress Index Short Form (PSI-4-SF) and the Short Form Health Survey (SF-12v1). RESULTS The 163 EP and 125 comparison respondents were most commonly mothers in their mid-40s. EP parents reported higher total parenting stress scores compared with controls, overall (adjusted difference in means: 14 (95% CI 9 to 20)) and after exclusion of moderate and severe child disability and multiples (9 (95% CI 3 to 15). Average physical and mental health-related quality of life scores were similar in the two groups (adjusted difference in means physical health: -2 (95% CI -4 to 1) and mental health: -1 (95% CI -4 to 1)). Among EP parents, 12% (20/164) reported the combination of high parenting stress and low mental health scores. With increasing child age, parenting stress scores for preterm parents were lower in contrast to controls who reported increasing parenting stress. CONCLUSIONS In early adolescence, compared with parents of term-born children, EP parents experience increased levels of parenting stress that are particularly high among a proportion of parents and associated with lower mental health-related quality of life. Practitioner awareness of this continuing risk throughout childhood is important to support parental abilities and well-being.
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Affiliation(s)
- Emmi Suonpera
- EGA UCL Institute for Women's Health, University College London, London, UK
| | - Anne Lanceley
- EGA UCL Institute for Women's Health, University College London, London, UK
| | - Yanyan Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Neil Marlow
- EGA UCL Institute for Women's Health, University College London, London, UK
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Seaton SE, Battersby C, Davis PJ, Fenton AC, Anderson J, van Hasselt TJ, Draper E. Characteristics of children requiring admission to neonatal care and paediatric intensive care before the age of 2 years in England and Wales: a data linkage study. Arch Dis Child 2024; 109:387-394. [PMID: 38346868 DOI: 10.1136/archdischild-2023-325986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years. DESIGN A data linkage study of routinely collected data. SETTING National Health Service NNUs and PICUs in England and Wales PATIENTS: Children born from 2013 to 2018. INTERVENTIONS None. MAIN OUTCOME MEASURE Admission to PICU before the age of 2 years. RESULTS A total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU.The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (<37 weeks' gestational age, n=3550). A third of children admitted to PICU had more than one admission. CONCLUSIONS Healthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams.
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Affiliation(s)
- Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Alan C Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Tim J van Hasselt
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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McKay CM, Karayiannis S. Bilateral congenital knee dislocation. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327076. [PMID: 38636982 DOI: 10.1136/archdischild-2024-327076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Steven Karayiannis
- Paediatrics, Altnagelvin Hospitals Health and Social Services Trust, Derry, UK
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Dunne EA, Ni Chathasaigh CM, Geraghty LE, O'Donnell CP, McCarthy LK. Polyethylene bags before cord clamping in very preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:317-321. [PMID: 38212105 DOI: 10.1136/archdischild-2023-325808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Hypothermia on admission to the neonatal intensive care unit (NICU) is associated with an increased risk of death in preterm infants. There are currently no evidence-based recommendations for thermal care before cord clamping (CC). We wished to determine whether placing very preterm infants in a polyethylene bag (PB) before CC, compared with after CC, results in more infants with a temperature in the normal range on NICU admission. DESIGN Randomised controlled trial. SETTING Tertiary maternity hospital. PATIENTS Inborn infants<32 weeks' gestational age (GA). INTERVENTIONS Infants were randomly assigned to have a PB placed before or after CC. MAIN OUTCOME Rectal temperature within the normal range (36.5°C-37.5°C) on NICU admission. RESULTS Between July 2020 and September 2022, 198/220 (90%) eligible infants were enrolled in this study; 99 (44 (44%) girls) were randomly assigned to BEFORE and 99 (53 (54%) girls) to AFTER. Median (IQR) GA 29 (27-31) vs 29 (27-31) weeks, mean (SD) birth weight 1206 (429) vs 1138 (419) g, respectively. The proportion of infants who had normal temperature on NICU admission did not differ between the groups (BEFORE 54/99 (55%) vs AFTER 55/98 (56%), p 0.824). The proportion of infants with a temperature outside of the normal range was similar between the groups; hypothermia (BEFORE 34/99 (34%) vs AFTER 33/98 (34%), hyperthermia (BEFORE 10/99 (10%) vs AFTER 10/98 (10%)). CONCLUSIONS Placing a PB before CC did not increase the proportion of preterm infants with normal temperature on NICU admission. A large proportion of preterm infants had abnormal temperature. Further studies on thermoregulation before CC are needed. TRIAL REGISTRATION NUMBER NCT04463511.
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Affiliation(s)
- Emma A Dunne
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Caitriona M Ni Chathasaigh
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Lucy E Geraghty
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Colm Pf O'Donnell
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Lisa K McCarthy
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Mitra S, Whitehead L, Smith K, Maclean B, Nixon R, Veysey A, Campbell-Yeo M, Kuhle S, Gale C, Soll R, Dorling J, Johnston BC. Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences. Arch Dis Child Fetal Neonatal Ed 2024; 109:232-238. [PMID: 37419686 DOI: 10.1136/archdischild-2023-325445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
ImportanceProphylactic cyclo-oxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks' gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Our objective was to develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants. The Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including 5 experienced neonatal care providers, 2 methods experts, 1 pharmacist, 2 parents of former extremely preterm infants and 2 adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants (conditional recommendation, moderate certainty in estimate of effects). Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group (conditional recommendation, low certainty in the estimate of effects). The panel strongly recommended against use of prophylactic acetaminophen (strong recommendation, very low certainty in estimate of effects) until further research evidence is available.
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Affiliation(s)
- Souvik Mitra
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Whitehead
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Katie Smith
- School of Access, Education and Language, Nova Scotia Community College, Halifax, Nova Scotia, Canada
| | - Breagh Maclean
- Department of Service Nova Scotia, Government of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Rebekah Nixon
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Veysey
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Kuhle
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Chris Gale
- School of Public Health, Imperial College London, London, UK
| | - Roger Soll
- Department of Pediatrics, University of Vermont, Burlington, New Jersey, USA
| | - Jon Dorling
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
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Dempsey S, O' Grady MJ. Current management of neonatal abstinence syndrome: a survey of practice in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed 2024; 109:261-264. [PMID: 37879885 DOI: 10.1136/archdischild-2023-326204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To study the current management practices of neonatal abstinence syndrome (NAS) throughout the UK and Ireland and identify changes in practice from the most recent survey in 2008. DESIGN Postal questionnaire to a consultant paediatrician or neonatologist in all 215 neonatal units in the UK and Ireland in January 2020. RESULTS Response rate was 62%. An objective scoring tool was used in 97% of units and the Finnegan score was favoured by 70%. Morphine sulfate use as first line for the treatment of opiate withdrawal was almost universal and 70% used a dose of 40 µg/kg every 4 hours (240 µg/kg/day). Phenobarbitone administration as a second-line agent for opiate withdrawal increased to 61% of units with significant reductions in chloral hydrate and chlorpromazine use compared with the previous survey. Morphine sulfate and phenobarbitone remain the preferred first-line and second-line agents, respectively, for polysubstance withdrawal. There was a significant increase in chlorpromazine use as first line for polydrug withdrawal (1.5-14.2%). The practice of units discharging infants' home on medication increased to 46% from 29%. All units now permit breastfeeding in mothers taking methadone, compared with 81% previously. CONCLUSION AND RELEVANCE Compared with the previous survey, improvements in evidence-based practices were noted, highlighting the benefits of this type of research. Nonetheless, significant variation still exists in some aspects of the management of NAS. Post-discharge follow-up varies widely, with particular deficits in ophthalmology follow-up.
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Affiliation(s)
- Sharon Dempsey
- Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Westmeath, Ireland
| | - Michael J O' Grady
- Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Westmeath, Ireland
- Women's and Children's Health, University College Dublin, Dublin, Ireland
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Cornet MC, Wu YW, Forquer H, Avalos LA, Sriram A, Scheffler AW, Newman TB, Kuzniewicz MW. Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:294-300. [PMID: 38071585 DOI: 10.1136/archdischild-2023-326049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/02/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety. DESIGN, SETTING AND PATIENTS Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011-2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records. EXPOSURE Dispensed maternal SSRI prescription after 20 weeks of pregnancy. MAIN OUTCOME MEASURES Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures). RESULTS 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation. CONCLUSIONS Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship.
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Affiliation(s)
- Marie-Coralie Cornet
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Yvonne W Wu
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Heather Forquer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Achyuth Sriram
- Department of Pediatrics, Kaiser Permanente Northern California, Oakland, California, USA
| | - Aaron W Scheffler
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Thomas B Newman
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Michael W Kuzniewicz
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Pediatrics, Kaiser Permanente Northern California, Oakland, California, USA
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10
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Stolz C, Costa-Nobre DT, Sanudo A, Ferreira DMDLM, Sales Alves JM, Dos Santos JP, Miyoshi MH, Silva NMDM, Melo FPDG, da Silva RVC, Barcala D, Vale MS, de Souza Rugolo LMS, Diniz EMA, Ribeiro M, Marba STM, Cwajg S, Duarte JLMB, Gonçalves Ferri WA, Procianoy RS, Anchieta LM, de Andrade Lopes JM, de Almeida MFB, Guinsburg R. Bronchopulmonary dysplasia: temporal trend from 2010 to 2019 in the Brazilian Network on Neonatal Research. Arch Dis Child Fetal Neonatal Ed 2024; 109:328-335. [PMID: 38071522 DOI: 10.1136/archdischild-2023-325826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/15/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN Retrospective cohort with data retrieved from an ongoing national registry. SETTING 19 Brazilian university public hospitals. PATIENTS Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.
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Affiliation(s)
- Camila Stolz
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Milton Harumi Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Geral de Pirajussara, Taboão da Serra, São Paulo, Brazil
| | | | | | | | - Dafne Barcala
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | | | | | | | - Manoel Ribeiro
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sérgio T M Marba
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Silvia Cwajg
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Brazil
| | | | | | - Renato S Procianoy
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leni Marcia Anchieta
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Maria de Andrade Lopes
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Kutsukake M, Konishi T, Fujiogi M, Takamoto N, Morita K, Yasuhisa I, Hashimoto Y, Matsui H, Fushimi K, Fujishiro J, Yasunaga H. Treatment courses and outcomes of oesophageal atresia in patients with trisomy 18: a case series of 271 patients from a nationwide database in Japan. Arch Dis Child Fetal Neonatal Ed 2024; 109:336-341. [PMID: 38071520 DOI: 10.1136/archdischild-2023-326354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/25/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To describe characteristics, treatments and clinical outcomes of patients with trisomy 18 and oesophageal atresia, using a nationwide database in Japan. DESIGN Descriptive study using a retrospective cohort. SETTING A nationwide inpatient database including 90% of hospitals with neonatal intensive care units in Japan. PATIENTS Patients hospitalised within a day after birth for both oesophageal atresia and trisomy 18 between July 2010 and March 2020. INTERVENTIONS Radical surgery for oesophageal atresia. MAIN OUTCOME MEASURES Characteristics, treatment course and outcomes. RESULTS Among 271 patients with both oesophageal atresia and trisomy 18, 70 patients underwent radical surgery for oesophageal atresia. Patients who underwent radical surgery were less likely to have severe cardiac anomalies (17% vs 32%; p=0.020), but more likely to undergo cardiac surgery (21% vs 9.5%; p=0.012) than those who did not. The overall in-hospital mortality was lower (54% vs 79%; p<0.001) and the median age at death was higher (210 days vs 39 days; p<0.001) in patients who underwent radical surgery than the others. Postoperative mortality within 30 days after radical surgery was 5.7%. Patients who underwent radical surgery were likely to be discharged to home (50% vs 18%; p<0.001), whereas the age at home discharge (median 314 days vs 216 days; p=0.19) and the requirement for each home treatment did not differ significantly by radical surgery. CONCLUSION This study provides information that will aid the clinical decision-making process for patients with oesophageal atresia and trisomy 18. Radical surgery may be a safe and feasible treatment option.
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Affiliation(s)
- Mai Kutsukake
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Naohiro Takamoto
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ikuta Yasuhisa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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12
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Yager H, Tauzin M, Durrmeyer X, Todorova D, Storme L, Debillon T, Casagrande F, Jung C, Audureau E, Layese R, Caeymaex L. Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326679. [PMID: 38636983 DOI: 10.1136/archdischild-2023-326679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To compare reintubation rates after planned extubation and unplanned extubation (UE) in patients in neonatal intensive care units (NICUs), to analyse risk factors for reintubation after UE and to compare outcomes in patients with and without UE. DESIGN Prospective, observational study nested in a randomised controlled trial (SEPREVEN/Study on Epidemiology and PRevention of adverse EVEnts in Neonates). Outcomes were expected to be independent of the intervention tested. SETTING 12 NICUs in France with a 20-month follow-up, starting November 2015. PATIENTS n=2280 patients with a NICU stay >2 days, postmenstrual age ≤42 weeks on admission. INTERVENTIONS/EXPOSURE Characteristics of UE (context, timing, sedative administration in the preceding 6 hours, weaning from ventilation at time of UE) and patients. MAIN OUTCOME MEASURES Healthcare professional-reported UE rates, reintubation/timing after extubation, duration of mechanical ventilation, mortality and bronchopulmonary dysplasia (BPD). RESULTS There were 162 episodes of UE (139 patients, median gestational age (IQR) 27.3 (25.6-31.7) weeks). Cumulative reintubation rates within 24 hours and 7 days of UE were, respectively, 50.0% and 57.5%, compared with 5.5% and 12.3% after a planned extubation. Independent risk factors for reintubation within 7 days included absence of weaning at the time of UE (HR, 95% CI) and sedatives in the preceding 6 hours (HR 1.93, 95% CI 1.04 to 3.60). Mortality at discharge did not differ between patients with planned extubation or UE. UE was associated with a higher risk of BPD. CONCLUSION In the SEPREVEN trial, reintubation followed UE in 58% of the cases, compared with 12% after planned extubation. TRIAL REGISTRATION NUMBER NCT02598609.
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Affiliation(s)
- Helene Yager
- Faculty of Health, Paris Est Creteil University, 94000 Creteil, Val de Marne, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
- Délégation de Recherche en Santé et Innovation, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, France
| | - Xavier Durrmeyer
- Faculty of Health, Paris Est Creteil University, 94000 Creteil, Val de Marne, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
| | - Darina Todorova
- Service de Néonatologie, Centre Hospitalier René-Dubos, 95300 Pontoise, France
| | - Laurent Storme
- Clinique de Médecine Néonatale, Hopital Jeanne de Flandres, CHRU de Lille, Pôle Femme Mère et Nouveau-né, Lille, 59000, France
- Centre d'Investigation Clinique Pédiatrique, Hopital Jeanne de Flandres CHRU de Lille, 59000 Lille, France
| | - Thierry Debillon
- Service de Néonatologie, CHU de Grenoble, Grenoble, France
- Université Grenoble Alpes, Grenoble, France
| | - Florence Casagrande
- Service de Néonatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Camille Jung
- Délégation de Recherche en Santé et Innovation, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, France
| | - Etienne Audureau
- Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), Assistance Publique-Hôpitaux de Paris AP-HP, Hopital Henri Mondor, F-94010 Creteil, France
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France
| | - Richard Layese
- Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), Assistance Publique-Hôpitaux de Paris AP-HP, Hopital Henri Mondor, F-94010 Creteil, France
| | - Laurence Caeymaex
- Faculty of Health, Paris Est Creteil University, 94000 Creteil, Val de Marne, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
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13
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Tibboel D. New guidelines for congenital diaphragmatic hernia: what is next? Arch Dis Child Fetal Neonatal Ed 2024; 109:230-231. [PMID: 38253468 DOI: 10.1136/archdischild-2023-326267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Dick Tibboel
- Intensive Care, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
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14
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de Souza M, Melika R, Thebaud B, Barrowman NJ, Tsampalieros A, Lemyre B. Effects of prophylactic hydrocortisone in a tertiary Canadian NICU. Arch Dis Child Fetal Neonatal Ed 2024; 109:342. [PMID: 37827815 DOI: 10.1136/archdischild-2023-325913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Marisa de Souza
- Pediatrics, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Raymond Melika
- Pharmacy, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Bernard Thebaud
- Neonatology, Ottawa Hospital, Ottawa, Ontario, Canada
- Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas James Barrowman
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne Tsampalieros
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Brigitte Lemyre
- Neonatology, Ottawa Hospital, Ottawa, Ontario, Canada
- Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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15
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Rahtu M, Frerichs I, Pokka T, Becher T, Peltoniemi O, Kallio M. Effect of body position on ventilation distribution in healthy newborn infants: an observational study. Arch Dis Child Fetal Neonatal Ed 2024; 109:322-327. [PMID: 38071525 DOI: 10.1136/archdischild-2023-325967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/15/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Newborn infants have unique respiratory physiology compared with older children and adults due to their lungs' structural and functional immaturity and highly compliant chest wall. To date, ventilation distribution has seldom been studied in this age group. This study aims to assess the effect of body position on ventilation distribution in spontaneously breathing healthy neonates. DESIGN Prospective observational study. SETTING Maternity wards of Oulu University Hospital. PATIENTS 20 healthy, spontaneously breathing, newborn infants. INTERVENTIONS Electrical impedance tomography data were recorded with a 32-electrode belt (Sentec AG, Landquart, Switzerland) in six different body positions in random order. Ventilation distribution was retrospectively assessed 10 minutes after each position change. MAIN OUTCOME MEASURES In each position, regional tidal impedance variation (ΔZ) and ventral-to-dorsal and right-to-left centre of ventilation were measured. RESULTS The mean global ΔZ was the largest in supine position and it was smaller in prone and lateral positions. Yet, global ΔZ did not differ in supine positions, ventilation distribution was more directed towards the non-dependent lung region in supine tilted position (p<0.001). In prone, a reduction of global ΔZ was observed (p<0.05) corresponding to an amount of 10% of global tidal variation in supine position. In both lateral positions, tidal ventilation was distributed more to the corresponding non-dependent lung region. CONCLUSIONS Prone or lateral body positioning in healthy spontaneously breathing newborns leads to a redistribution of ventilation to the non-dependent lung regions and at the same time global tidal volume is reduced as compared with supine.
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Affiliation(s)
- Marika Rahtu
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tobias Becher
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Outi Peltoniemi
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
| | - Merja Kallio
- Department of Pediatrics and Adolescent Medicine and Research Unit of Clinical Medicine, Oulu University Hospital, Oulu, Finland
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16
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Silva AR, Hoffmann NG, Fernandez-Llimos F, Lima EC. Data quality review of the Brazilian nosocomial infections surveillance system. J Infect Public Health 2024; 17:687-695. [PMID: 38471259 DOI: 10.1016/j.jiph.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. METHODS Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. RESULTS Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. CONCLUSIONS While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.
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Affiliation(s)
- Alice Ramos Silva
- Pharmacy School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit (UCIBIO), Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Poletto E, Kanthimathinathan HK, Gyorgyi Z. How to perform and interpret a middle cerebral artery transcranial Doppler examination in children at risk of brain injury. Arch Dis Child Educ Pract Ed 2024; 109:98-104. [PMID: 37532292 DOI: 10.1136/archdischild-2023-325747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023]
Abstract
Transcranial Doppler (TCD) ultrasound is a non-invasive neuromonitoring technique that falls under the umbrella of point-of-care ultrasound. In this article, we provide a primer to encourage clinicians to perform TCD examinations and to aid them with accurately interpreting the scans. We focus on the middle cerebral artery waveforms and use traumatic brain injury as a model for brain insult.
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Affiliation(s)
- Elisa Poletto
- Division of Pediatric Intensive Care Unit, San Bortolo Hospital of Vicenza, Vicenza, Italy
| | | | - Zoltan Gyorgyi
- Paediatric Critical Care Unit, Royal Hospital for Children and Young People, Edinburgh, UK
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18
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Storm KK, Smits A, Hutten GJ, Simons SHP. Doxapram for apnea of prematurity - the importance of maintaining equipoise. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327012. [PMID: 38503483 DOI: 10.1136/archdischild-2024-327012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Kelly K Storm
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Anne Smits
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - G Jeroen Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Sinno H P Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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Shaniv D, Allegaert K. Applied pharmacokinetics to improve pharmacotherapy in neonatal and paediatric intensive care units: focus on correct dose selection. Arch Dis Child Educ Pract Ed 2024:edpract-2023-326325. [PMID: 38408792 DOI: 10.1136/archdischild-2023-326325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
Drug dosing and exposure throughout childhood are constantly affected by maturational changes like weight, age or body surface area. In neonatal and paediatric intensive care units (NICU and PICU, respectively), drug dosing and exposure are further impacted by non-maturational changes. These changes are related to factors such as sepsis, cardiac failure, acute kidney injury, extracorporeal circuits or drug-drug interactions (DDIs) resulting from polypharmacy.This potentially complex situation may alter drug pharmacokinetics to result in greater-than-usual intrapatient and interpatient drug exposure variability. These effects may call for individual dosage adjustments. Dosage adjustments may apply to both loading doses or maintenance doses, which should be used as appropriate, depending on the specific characteristics of a given drug. Phenobarbital and vancomycin dosing are hereby used as illustrations.To optimise dose selection in NICU/PICU settings, we suggest to consider therapeutic drug monitoring integrated in model-informed precision dosing, and to familiarise oneself with existing paediatric drug formularies as well as DDI databases/search engines. Paediatric clinical pharmacologists and pharmacists can hereby guide clinicians with no prior experience on how to properly apply these data sources to day-to-day practice in individual patients or specific subpopulations of NICU or PICU patients.
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Affiliation(s)
- Dotan Shaniv
- Pharmacy Services, Kaplan Medical Center, Clalit Health Services, Rehovot, Israel
- Neonatal Intensive Care Unit, Kaplan Medical Center, Clarit Health Services, Rehovot, Israel
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
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20
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Levene I, Quigley MA, Fewtrell M, O'Brien F. Does extremely early expression of colostrum after very preterm birth improve mother's own milk quantity? A cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326784. [PMID: 38442953 DOI: 10.1136/archdischild-2023-326784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN A cohort study (nested within a randomised trial). SETTING Four neonatal units in the UK. PATIENTS 132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES Time to the first attempt to express after birth. PRIMARY OUTCOMES 24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER ISRCTN 16356650.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Frances O'Brien
- Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK
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Burgess-Shannon J, Chehrazi M, Lanoue J, Modi N, Uthaya SN. Outcomes following the adoption of standard parenteral nutrition in preterm infants: a whole-population non-concurrent control study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-325712. [PMID: 38442954 DOI: 10.1136/archdischild-2023-325712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To evaluate the impact of a quality improvement project of the adoption of standard parenteral nutrition (SPN) in preterm infants. DESIGN Retrospective, multicentre, whole-population, non-concurrent control study using data from the UK National Neonatal Research Database between 1 January 2014 and 31 December 2020. SETTING Neonatal units in London UK organised by geographical network. PATIENTS Preterm infants <31 weeks' gestation. INTERVENTIONS Introduction of two SPN formulations previously tested in randomised controlled trials (NEON and SCAMP). SCAMP delivers a higher target macronutrient intake. MAIN OUTCOME MEASURES The primary outcome was survival to discharge from neonatal care without major morbidities. Secondary outcomes included the individual components of the primary outcome and a comparison of outcomes between the NEON and the SCAMP formulations. RESULTS Of 6538 eligible infants, 4693 were admitted to neonatal care before and 1845 after the adoption of SPN. Morbidity-free survival decreased by an average of 8.6% (95% CI 5.8% to 11.4%, p<0.0001) following adoption. The effect varied by type of formulation; the cohort that adopted NEON showed no difference in morbidity-free survival, whereas the cohort that adopted SCAMP showed a statistically significant decrease in morbidity-free survival. Overall survival decreased by an average of 2.0% (95% CI 0.01% to 4.0%, p=0.048). CONCLUSIONS Research is urgently needed to identify the optimal composition of parenteral nutrition for preterm babies. This study also adds to the growing body of evidence that suggests that early and high intakes of macronutrients in preterm babies may be harmful.
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Affiliation(s)
| | - Mohammad Chehrazi
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Julia Lanoue
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Neena Modi
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Sabita N Uthaya
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Clarke P, Embleton ND, Fewtrell M, Harrington DJ, Kelly AM, Moris N, Patto A, Ponnusamy V, Vasu V, Shearer MJ. Vitamin K: missed at peril-the case for extra supplementation to prevent deficiency in breastfed preterm infants. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326737. [PMID: 38429074 DOI: 10.1136/archdischild-2023-326737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care Unit, Norfolk Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mary Fewtrell
- Department of Population, Policy and Practice Research and Teaching, UCL Institute of Child Health, London, UK
- Department of Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dominic J Harrington
- The Nutristasis Unit, Synnovis, St Thomas' Hospital, London, UK
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Anne M Kelly
- Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Alexander Patto
- NanoPhotonics Centre, University of Cambridge, Cambridge, UK
| | - Vennila Ponnusamy
- Neonatal Intensive Care Unit, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Vimal Vasu
- Department of Neonatal Medicine, William Harvey Hospital, Ashford, UK
- School of Biosciences, University of Kent, Canterbury, UK
| | - Martin J Shearer
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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23
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Johnson MD, Tingay DG, Perkins EJ, Sett A, Devsam B, Douglas E, Charlton JK, Wildenhain P, Rumpel J, Wagner M, Nadkarni V, Johnston L, Herrick HM, Hartman T, Glass K, Jung P, DeMeo SD, Shay R, Kim JH, Unrau J, Moussa A, Nishisaki A, Foglia EE. Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326501. [PMID: 38418208 DOI: 10.1136/archdischild-2023-326501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation. DESIGN Retrospective analysis of prospectively collected data on intubations performed in the neonatal intensive care unit (NICU) and delivery room from the National Emergency Airway Registry for Neonates (NEAR4NEOS). SETTING Eighteen academic NICUs in NEAR4NEOS. PATIENTS Neonates requiring two or more attempts at intubation between October 2014 and December 2021. MAIN OUTCOME MEASURES The primary outcome was successful intubation on the second attempt, with severe tracheal intubation-associated events (TIAEs) or severe desaturation (≥20% decline in oxygen saturation) being secondary outcomes. Multivariate regression examined the associations between these outcomes and patient characteristics and changes in intubation practice. RESULTS 5805 of 13 126 (44%) encounters required two or more intubation attempts, with 3156 (54%) successful on the second attempt. Second attempt success was more likely with changes in any of the following: intubator (OR 1.80, 95% CI 1.56 to 2.07), stylet use (OR 1.65, 95% CI 1.36 to 2.01) or endotracheal tube (ETT) size (OR 2.11, 95% CI 1.74 to 2.56). Changes in stylet use were associated with a reduced chance of severe desaturation (OR 0.74, 95% CI 0.61 to 0.90), but changes in intubator, laryngoscope type or ETT size were not; no changes in intubator or equipment were associated with severe TIAEs. CONCLUSIONS Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.
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Affiliation(s)
- Mitchell David Johnson
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David Gerald Tingay
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Services, Western Health, St Albans, Victoria, Australia
| | - Bianca Devsam
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ellen Douglas
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julia K Charlton
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Division of Neonatology, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Paul Wildenhain
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Rumpel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Vinay Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lindsay Johnston
- Department of Pediatrics, Yale University, New Haven, Connecticut, USA
| | - Heidi M Herrick
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tyler Hartman
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kristen Glass
- Department of Pediatrics, Penn State Health Children's Hospital/Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Stephen D DeMeo
- Division of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Rebecca Shay
- Department of Pediatrics, Division of Neonatology, University of Colorado, Aurora, Colorado, USA
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Unrau
- Newborn Critical Care, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Quebec, Canada
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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24
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Guellec I, Brunet A, Lapillonne A, Taine M, Torchin H, Favrais G, Gascoin G, Simon L, Heude B, Scherdel P, Kayem G, Delorme P, Jarreau PH, Ancel PY. Birth weight and head circumference discordance and outcome in preterms: results from the EPIPAGE-2 cohort. Arch Dis Child 2024:archdischild-2023-326336. [PMID: 38408861 DOI: 10.1136/archdischild-2023-326336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To determine whether the relative measurement of birth weight (BW) and head circumference (HC) in preterm infants is associated with neurological outcomes. METHODS The EPIPAGE-2 Study included 3473 infants born before 32 weeks' gestation, classified based on their Z-score of BW and HC on the Fenton curves as concordant (≤1 SD apart) or discordant (>1 SD difference). We defined four mutually exclusive categories: discordant smaller BW (sBW) with BW-1SD and concordant small measurement (CsM) with BW and HC concordant and both ≤-1SD. Neurological outcomes at 5.5 years were evaluated with standard tests. RESULTS 2592 (74.8%) preterm neonates were categorised as CM, 258 (7.4%) CsM, 378 (10.9%) sHC and 239 (6.9%) sBW. Compared with the CM children, those born with CsM had significantly higher risks of cognitive deficiency (adjusted OR (aOR) 1.3, 95% CI (1.0 to 2.0)), developmental coordination disorders (aOR 2.6 (1.5 to 4.4)) and need for special school services (aOR 2.3 (1.5 to 3.7)). Those born with sBW had significantly lower risk of cognitive deficiency (aOR 0.6 (0.4 to 0.9)) and the sHC group significantly higher risk of developmental coordination disorders (aOR 1.8 (1.0 to 3.2)). CONCLUSIONS The relative discordance of these preterm infants' BW and HC was associated with their neurological outcomes. It merits further exploration as an indirect indicator of development. TRIAL REGISTRATION NUMBER NCT03078439.
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Affiliation(s)
- Isabelle Guellec
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Neonatal Intensive Care, Nice Cote d'Azur University Hospital, Nice, France
| | - Adelaide Brunet
- Neonatal Intensive Care Unit, Port Royal University Hospital, Assistance publique Hopitaux de Paris, Paris, France
| | | | - Marion Taine
- Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), INSERM, Paris, France
| | - Héloïse Torchin
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Neonatal Intensive Care Unit, Port Royal University Hospital, Assistance publique Hopitaux de Paris, Paris, France
| | - Geraldine Favrais
- Department of Neonatal Medicine, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | - Géraldine Gascoin
- Neonatal Intensive Care, University Hospital Centre Toulouse, Toulouse, France
| | - Laure Simon
- Department of Neonatalogy, CHU Nantes, Nantes, France
- INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Barbara Heude
- Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), INSERM, Paris, France
| | - Pauline Scherdel
- Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), INSERM, Paris, France
| | - Gilles Kayem
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Department of Gynecology and Obstetrics, Hôpital Armand Trousseau, APHP, Sorbonne University, Paris, France
| | - Pierre Delorme
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Department of Gynecology and Obstetrics, Hôpital Armand Trousseau, APHP, Sorbonne University, Paris, France
| | - Pierre-Henri Jarreau
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Neonatal Intensive Care Unit, Port Royal University Hospital, Assistance publique Hopitaux de Paris, Paris, France
| | - Pierre-Yves Ancel
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
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25
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Marks IR, Doyle LW, Mainzer RM, Spittle AJ, Clark M, Boland RA, Anderson PJ, Cheong JL. Neurosensory, cognitive and academic outcomes at 8 years in children born 22-23 weeks' gestation compared with more mature births. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326277. [PMID: 38395594 DOI: 10.1136/archdischild-2023-326277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/09/2024] [Indexed: 02/25/2024]
Abstract
Despite providing intensive care to more infants born <24 weeks' gestation, data on school-age outcomes, critical for counselling and decision-making, are sparse. OBJECTIVE To compare major neurosensory, cognitive and academic impairment among school-aged children born extremely preterm at 22-23 weeks' gestation (EP22-23) with those born 24-25 weeks (EP24-25), 26-27 weeks (EP26-27) and term (≥37 weeks). DESIGN Three prospective longitudinal cohorts. SETTING Victoria, Australia. PARTICIPANTS All EP live births (22-27 weeks) and term-born controls born in 1991-1992, 1997 and 2005. MAIN OUTCOME MEASURES At 8 years, major neurosensory disability (any of moderate/severe cerebral palsy, IQ <-2 SD relative to controls, blindness or deafness), motor, cognitive and academic impairment, executive dysfunction and poor health utility. Risk ratios (RRs) and risk differences between EP22-23 (reference) and other gestational age groups were estimated using generalised linear models, adjusted for era of birth, social risk and multiple birth. RESULTS The risk of major neurosensory disability was higher for EP22-23 (n=21) than more mature groups (168 EP24-25; 312 EP26-27; 576 term), with increasing magnitude of difference as the gestation increased (adjusted RR (95% CI) compared with EP24-25: 1.39 (0.70 to 2.76), p=0.35; EP26-27: 1.85 (0.95 to 3.61), p=0.07; term: 13.9 (5.75 to 33.7), p<0.001). Similar trends were seen with other outcomes. Two-thirds of EP22-23 survivors were free of major neurosensory disability. CONCLUSIONS Although children born EP22-23 experienced higher rates of disability and impairment at 8 years than children born more maturely, many were free of major neurosensory disability. These data support providing active care to infants born EP22-23.
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Affiliation(s)
- India Rm Marks
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Rheanna M Mainzer
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | - Marissa Clark
- Department of Neonatology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Rosemarie A Boland
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jeanie Ly Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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26
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Yuan JM, Nugent C, Wilson A, Verlander NQ, Alexander E, Fleming P, Modi N, Oughham K, Ratnaraja N, Wan Y, Thorn L, Felgate H, Webber MA, Ogundipe E, Brown CS, Paranthaman K, Demirjian A. Clinical outcomes of Staphylococcus capitis isolation from neonates, England, 2015-2021: a retrospective case-control study. Arch Dis Child Fetal Neonatal Ed 2024; 109:128-134. [PMID: 37751992 DOI: 10.1136/archdischild-2023-325887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Staphylococcus capitis, a coagulase-negative staphylococci (CoNS) species, has been increasingly detected from UK sterile site samples and has caused neonatal unit outbreaks worldwide. We compared survival to discharge and 30-day mortality for the detection of S. capitis versus other CoNS species. METHODS In this retrospective case-control study, we included hospitalised infants with any CoNS species detected from a normally sterile body site up to 90 days of age. We linked English laboratory reports from the Second Generation Surveillance System database, mortality data from the Personal Demographics Service, and neonatal unit admissions from the National Neonatal Research Database. In primary analysis, multivariable logistic regression was used, with two co-primary outcomes: survival to discharge and death within 30 days of positive specimen date. Sensitivity analyses using multiply imputed datasets followed. RESULTS We identified 16 636 CoNS episodes relating to 13 745 infants. CoNS episodes were highest among infants born extremely preterm (22-27 weeks) and with extremely low birth weight (400-999 g). In primary analysis, there were no differences in survival to discharge (p=0.71) or 30-day mortality (p=0.77) between CoNS species. In sensitivity analyses, there were no differences in outcomes between infection with four of the most common CoNS species (Staphylococcus epidermidis, S. capitis, Staphylococcus haemolyticus and Staphylococcus warneri) but the remaining CoNS species were at higher risk of adverse outcomes when treated in aggregate. CONCLUSION Infants with S. capitis detected from sterile site samples did not experience significant differences in either survival to discharge or 30-day mortality compared with infants with detection of other common CoNS species.
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Affiliation(s)
- Jin-Min Yuan
- Field Service, UK Health Security Agency, London, UK
| | - Christopher Nugent
- UK Field Epidemiology Training Programme, UK Health Security Agency, Belfast, UK
| | | | - Neville Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
| | | | - Paul Fleming
- Homerton Healthcare NHS Foundation Trust, London, UK
- Queen Mary University of London, London, UK
| | - Neena Modi
- Section of Neonatal Medicine, Imperial College London, London, UK
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Kayleigh Oughham
- Section of Neonatal Medicine, Imperial College London, London, UK
| | - Natasha Ratnaraja
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yu Wan
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Louise Thorn
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
| | | | | | - Enitan Ogundipe
- Chelsea and Westminster Healthcare NHS Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Colin S Brown
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | | | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
- Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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27
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van Blankenstein E, Sodiwala T, Lanoue J, Modi N, Uthaya SN, Battersby C. Two-year neurodevelopmental data for preterm infants born over an 11-year period in England and Wales, 2008-2018: a retrospective study using the National Neonatal Research Database. Arch Dis Child Fetal Neonatal Ed 2024; 109:143-150. [PMID: 37788897 PMCID: PMC10894848 DOI: 10.1136/archdischild-2023-325746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE United Kingdom guidelines recommend all infants born <30 weeks' gestation receive neurodevelopmental follow-up at 2 years corrected age. In this study, we describe completeness and results of 2-year neurodevelopmental records in the National Neonatal Research Database (NNRD). DESIGN This retrospective cohort study uses data from the NNRD, which holds data on all neonatal admissions in England and Wales, including 2year follow-up status. PATIENTS We included all preterm infants born <30 weeks' gestation between 1 January 2008 and 31 December 2018 in England and Wales, who survived to discharge from neonatal care. MAIN OUTCOME MEASURES Presence of a 2-year neurodevelopmental assessment record in the NNRD, use of standardised assessment tools, results of functional 2-year neurodevelopmental assessments (visual, auditory, neuromotor, communication, overall development). RESULTS Of the 41 505 infants included, 24 125 (58%) had a 2-year neurodevelopmental assessment recorded. This improved over time, from 32% to 71% for births in 2008 and 2018, respectively.Of those with available data: 0.4% were blind; 1% had a hearing impairment not correctable with aids; 13% had <5 meaningful words, vocalisations or signs; 8% could not walk without assistance and 9% had severe (≥12 months) developmental delay. CONCLUSIONS The proportion of infants admitted to neonatal units in England and Wales with a 2-year neurodevelopmental record has improved over time. Rates of follow-up data from recent years are comparable to those of bespoke observational studies. With continual improvement in data completeness, the potential for use of NNRD as a source of longer-term outcome data can be realised.
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Affiliation(s)
- Emily van Blankenstein
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tia Sodiwala
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Julia Lanoue
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Neena Modi
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sabita N Uthaya
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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28
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Shaw KL, Spry J, Cummins C, Ewer AK, Kilby MD, Mancini A. Advance care planning in perinatal settings: national survey of implementation using Normalisation Process Theory. Arch Dis Child Fetal Neonatal Ed 2024; 109:135-142. [PMID: 37709497 DOI: 10.1136/archdischild-2023-325649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Perinatal advance care planning (PnACP) is a process of formal decision-making to help families plan for their baby's care when recognised that they may have a life-limiting condition. While PnACP is recommended in policy, there is a lack of evidence to support implementation and development in the perinatal setting. OBJECTIVE To conduct an online survey of UK and Ireland perinatal providers to examine how PnACP is operationalised in current practice. METHODS A secure online questionnaire was developed to collect data on (1) 'what' is being implemented, (2) the 'processes' being used, (3) perceived impact and (4) unmet support needs. Data were analysed using basic descriptive statistics, thematic analysis and through a conceptual lens of Normalisation Process Theory. RESULTS Questionnaires were completed by 108 health professionals working in 108 maternity and neonatal services, representing 90 organisations across the UK and Ireland. This revealed many resources and examples of good practice to support PnACP. However, there was wide variation in how PnACP was conceptualised and implemented. Existing frameworks, pathways and planning tools are not routinely embedded into care, and respondents identified many barriers that negatively impact the quality of care. They called for better integration of palliative care principles into acute settings and more investment in staff training to support families at existentially difficult times. CONCLUSIONS Priorities for additional perinatal service development include greater sharing of best practice and effective strategies to target the unique challenges of PnACP, such as time-sensitive collaborative working and decision-making in the face of high uncertainty.
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Affiliation(s)
- Karen L Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Spry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew K Ewer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Mark D Kilby
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- The Medical Genomics Research Group, Illumina, Cambridge, UK
| | - Alexandra Mancini
- Corporate Nursing, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- True Colours Trust, London, UK
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29
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de Boer A, De Proost L, de Vries M, Hogeveen M, Verweij EJTJ, Geurtzen R. Perspectives of extremely prematurely born adults on what to consider in prenatal decision-making: a qualitative focus group study. Arch Dis Child Fetal Neonatal Ed 2024; 109:196-201. [PMID: 37726159 DOI: 10.1136/archdischild-2023-325997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE A shared decision-making (SDM) approach is recommended for prenatal decisions at the limit of viability, with a guiding role for parental values. People born extremely premature experience the consequences of the decision made, but information about their perspectives on prenatal decisions is lacking. Therefore, this study aims to describe their perspectives on what is important in decision-making at the limit of viability. DESIGN Semi-structured focus group discussions were conducted, recorded and transcribed verbatim. The data were independently analysed by two researchers in Atlas.ti. RESULTS Four focus groups were conducted in the Netherlands, with five to six participants each, born between 240/7 and 300/7 weeks gestation in the period between 1965 and 2002. Considering their personal life experiences and how their extremely premature birth affected their families, the participants reflected on decision-making at the limit of viability. Various considerations were discussed and summarised into the following themes: anticipated parental regret, the wish to look at the baby directly after birth, to give the infant a chance at survival, quality of life, long-term outcomes for the infant and the family, and religious or spiritual considerations. CONCLUSIONS Insights into the perspectives of adults born extremely premature deepened our understanding of values considered in decision-making at the limit of viability. Results point out the need for a more individualised prediction of the prognosis and more extensive information on the lifelong impact of an extremely premature birth on both the infant and the family. This could help future parents and healthcare professionals in value-laden decision-making.
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Affiliation(s)
- Angret de Boer
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lien De Proost
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences (iCIS), Radboud University, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E J T Joanne Verweij
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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Schouten TMR, Abu-Hanna A, van Kaam AH, van den Heuvel MEN, Bachman TE, van Leuteren RW, Hutten GJ, Onland W. Prolonged use of closed-loop inspired oxygen support in preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:221-226. [PMID: 37827816 DOI: 10.1136/archdischild-2023-325831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This randomised study in preterm infants on non-invasive respiratory support investigated the effectiveness of automated oxygen control (A-FiO2) in keeping the oxygen saturation (SpO2) within a target range (TR) during a 28-day period compared with manual titration (M-FiO2). DESIGN A single-centre randomised control trial. SETTING A level III neonatal intensive care unit. PATIENTS Preterm infants (<28 weeks' gestation) on non-invasive respiratory support. INTERVENTIONS A-FiO2 versus M-FiO2 control. METHODS Main outcomes were the proportion of time spent and median area of episodes in the TR, hyperoxaemia, hypoxaemia and the trend over 28 days using a linear random intercept model. RESULTS 23 preterm infants (median gestation 25.7 weeks; birth weight 820 g) were randomised. Compared with M-FiO2, the time spent within TR was higher in the A-FiO2 group (68.7% vs 48.0%, p<0.001). Infants in the A-FiO2 group spent less time in hyperoxaemia (13.8% vs 37.7%, p<0.001), but no difference was found in hypoxaemia. The time-based analyses showed that the A-FiO2 efficacy may differ over time, especially for hypoxaemia. Compared with the M-FiO2 group, the A-FiO2 group had a larger intercept but with an inversed slope for the daily median area below the TR (intercept 70.1 vs 36.3; estimate/day -0.70 vs 0.69, p<0.001). CONCLUSION A-FiO2 control was superior to manual control in keeping preterm infants on non-invasive respiratory support in a prespecified TR over a period of 28 days. This improvement may come at the expense of increased time below the TR in the first days after initiating A-FiO2 control. TRIAL REGISTRATION NUMBER NTR6731.
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Affiliation(s)
- Tim M R Schouten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | | | | | - Ruud W van Leuteren
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | - G Jeroen Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
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31
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Wheeler R. Anticipatory declarations for vaccination of the newborn. Arch Dis Child 2024; 109:179-180. [PMID: 38123942 DOI: 10.1136/archdischild-2023-326329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Robert Wheeler
- Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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32
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Mullaly R, El-Khuffash AF. Haemodynamic assessment and management of hypotension in the preterm. Arch Dis Child Fetal Neonatal Ed 2024; 109:120-127. [PMID: 37173119 DOI: 10.1136/archdischild-2022-324935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
The management of low blood flow states in premature neonates is fraught with many challenges. We remain over-reliant on regimented stepwise protocols that use mean blood pressure as a threshold for intervention to guide treatment, without giving due consideration to the underlying pathophysiology. The current available evidence does not reflect the need to concentrate on the unique pathophysiology of the preterm infant and thus leads to widespread misuse of vasoactive agents that often do not provide the desired clinical effect. Therefore, understanding the underlying pathophysiological underpinnings of haemodynamic compromise may better guide choice of agent and assess physiological response to the selected intervention.
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Affiliation(s)
- Rachel Mullaly
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Yazdi S, Carlo WA, Nakhmani A, Boateng EO, Aban I, Ambalavanan N, Travers CP. Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical trial. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326605. [PMID: 38365446 DOI: 10.1136/archdischild-2023-326605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Optimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia (IH) and respiratory instability in preterm infants meeting criteria to discontinue CPAP. DESIGN Single-centre randomised clinical trial. SETTING Level 4 neonatal intensive care unit. PATIENTS 36 infants <34 weeks' gestation receiving CPAP≤5 cmH2O and fraction of inspired oxygen (FiO2) ≤0.30 and meeting respiratory stability criteria. INTERVENTIONS Extended CPAP was compared with weaning to low-flow NC (0.5 L/kg/min with a limit of 1.0 L/min) for 24 hours. OUTCOMES The primary outcome was IH (number of episodes with SpO2<85% lasting ≥10 s). Secondary outcomes included: coefficient of variability of SpO2, proportion of time in various SpO2 ranges, episodes (≥10 s) with SpO2<80%, median cerebral and renal oxygenation, median effective FiO2, median transcutaneous carbon dioxide and bradycardia (<100/min for≥10 s). RESULTS The median (IQR) episodes of IH per 24-hour period was 20 (6-48) in the CPAP group and 76 (18-101) in the NC group (p=0.03). Infants continued on CPAP had less bradycardia, time with SpO2 <91% and <85%, and lower FiO2 (all p<0.05). There were no statistically significant differences in IH<80%, median transcutaneous carbon dioxide or median cerebral or renal oxygenation. CONCLUSION In preterm infants meeting respiratory stability criteria for CPAP cessation, extended CPAP decreased IH, bradycardia and other hypoxaemia measures compared with weaning to low-flow NC during the 24-hour intervention. TRIAL REGISTRATION NUMBER NCT04792099.
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Affiliation(s)
- Siamak Yazdi
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Waldemar A Carlo
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Arie Nakhmani
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ernestina O Boateng
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Immaculada Aban
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Namasivayam Ambalavanan
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Colm P Travers
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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34
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Agathos E, Kantyka C, Clarke P. State of skin antiseptic choices in UK neonatal intensive care units in 2023. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-326858. [PMID: 38350708 DOI: 10.1136/archdischild-2024-326858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Elisabeth Agathos
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Carla Kantyka
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Paul Clarke
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Tracy MB, Hinder M, Morakeas S, Lowe K, Priyadarshi A, Crott M, Boustred M, Culcer M. Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326256. [PMID: 38336472 DOI: 10.1136/archdischild-2023-326256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Respiratory function monitors (RFMs) have been used extensively in manikin and infant studies yet have not become the standard of training. We report the outcomes of a new portable, lightweight RFM, the Juno, designed to show mask leak and deflation tidal volume to assist in positive pressure ventilation (PPV) competency training using manikins. METHODS Two leak-free manikins (preterm and term) were used. Participants provided PPV to manikins using two randomised devices, self-inflating bag (SIB) and T-piece resuscitator (TPR), with Juno display initially blinded then unblinded in four 90 s paired sequences, aiming for adequate chest wall rise and target minimal mask leak with appropriate target delivered volume when using the monitor. RESULTS 49 experienced neonatal staff delivered 15 569 inflations to the term manikin and 14 580 inflations to the preterm. Comparing blinded to unblinded RFM display, there were significant reductions in all groups in the number of inflations out of target range volumes (preterm: SIB 22.6-6.6%, TPR 7.1-4.2% and term: SIB 54.8-37.8%, TPR 67.2-63.8%). The percentage of mask leak inflations >60% was reduced in preterm: SIB 20.7-7.2%, TPR 23.4-7.4% and in term: SIB 8.7-3.6%, TPR 23.5-6.2%). CONCLUSIONS Using the Juno monitor during simulated resuscitation significantly improved mask leak and delivered ventilation among otherwise experienced staff using preterm and term manikins. The Juno is a novel RFM that may assist in teaching and self-assessment of resuscitation PPV technique.
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Affiliation(s)
- Mark Brian Tracy
- Westmead Hospital, Sydney, New South Wales, Australia
- Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
| | - Murray Hinder
- Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephanie Morakeas
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney University, Sydney, New South Wales, Australia
| | - Krista Lowe
- Newborn Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Archana Priyadarshi
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Matthew Crott
- Sydney University, Sydney, New South Wales, Australia
| | | | - Mihaela Culcer
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
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Gifford A, Wooding EL, Ng KF. Is it safe for neonates with probable bacterial infection to be treated with oral antibiotics in high-income countries? Arch Dis Child 2024:archdischild-2023-326496. [PMID: 38307705 DOI: 10.1136/archdischild-2023-326496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 02/04/2024]
Affiliation(s)
- Alison Gifford
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Eva Louise Wooding
- Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Khuen Foong Ng
- Paediatric Immunology and Infectious Diseases, Noah's Ark Children's Hospital, University Hospital of Wales, Cardiff, UK
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Stewart CE, Holloway R, Pounds P, Ofasi R, Petrunin Y, Gotea L, Collier J, Cole L, Henry C, Wadhwani V, Gozar I, Godambe SV. Multidisciplinary training initiative for postnatal clinical environments to increase staff's confidence in managing babies requiring neonatal transitional care. Arch Dis Child Educ Pract Ed 2024:edpract-2023-325860. [PMID: 38242682 DOI: 10.1136/archdischild-2023-325860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Affiliation(s)
| | - Ross Holloway
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Patience Pounds
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | | | - Yury Petrunin
- Neonatal Intensive Care, The Royal London Hospital, London, UK
| | | | | | - Lisa Cole
- Queen Charlotte's and Chelsea Hospital, London, UK
| | | | - Veena Wadhwani
- Neonatal Intensive Care, Imperial College Healthcare NHS Trust, London, UK
| | - Ioana Gozar
- Neonatal Intensive Care, Imperial College Healthcare NHS Trust, London, UK
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Rajaraman N, Gowda H. Does the use of point of care ultrasound (POCUS) improve umbilical venous catheter (UVC) positioning in neonates? Arch Dis Child 2024:archdischild-2023-326653. [PMID: 38199817 DOI: 10.1136/archdischild-2023-326653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Nikitha Rajaraman
- Neonatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Harsha Gowda
- Neonatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
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Razzaghy J, Shukla VV, Gunawan E, Reeves A, Nguyen K, Salas AA. Early and exclusive enteral nutrition in infants born very preterm. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-325969. [PMID: 38135494 DOI: 10.1136/archdischild-2023-325969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To characterise the effects of early and exclusive enteral nutrition with either maternal or donor milk in infants born very preterm (280/7-326/7 weeks of gestation). DESIGN Parallel-group, unmasked randomised controlled trial. SETTING Regional, tertiary neonatal intensive care unit. PARTICIPANTS 102 infants born very preterm between 2021 and 2022 (51 in each group). INTERVENTION Infants randomised to the intervention group received 60-80 mL/kg/day within the first 36 hours after birth. Infants randomised to the control group received 20-30 mL/kg/day (standard trophic feeding volumes). MAIN OUTCOME MEASURES The primary outcome was the number of full enteral feeding days (>150 mL/kg/day) in the first 28 days after birth. Secondary outcomes included growth and body composition at the end of the first two postnatal weeks, and length of hospitalisation. RESULTS The mean birth weight was 1477 g (SD: 334). Half of the infants were male, and 44% were black. Early and exclusive enteral nutrition increased the number of full enteral feeding days (+2; 0-2 days; p=0.004), the fat-free mass-for-age z-scores at postnatal day 14 (+0.5; 0.1-1.0; p=0.02) and the length-for-age z-scores at the time of hospital discharge (+0.6; 0.2-1.0; p=0.002). Hospitalisation costs differed between groups (mean difference favouring the intervention group: -$28 754; -$647 to -$56 861; p=0.04). CONCLUSIONS In infants born very preterm, early and exclusive enteral nutrition increases the number of full enteral feeding days. This feeding practice may also improve fat-free mass accretion, increase length and reduce hospitalisation costs. TRIAL REGISTRATION NUMBER NCT04337710.
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Affiliation(s)
- Jacqueline Razzaghy
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vivek V Shukla
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Gunawan
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Audrey Reeves
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly Nguyen
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ariel A Salas
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Maiwald CA, Schwarz CE, Böckmann K, Springer L, Poets CF, Franz A. Randomised crossover study on pulse oximeter readings from different sensors in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-325961. [PMID: 38129130 DOI: 10.1136/archdischild-2023-325961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE In extremely preterm infants, different target ranges for pulse oximeter saturation (SpO2) may affect mortality and morbidity. Thus, the impact of technical changes potentially affecting measurements should be assessed. We studied SpO2 readings from different sensors for systematic deviations. DESIGN Single-centre, randomised, triple crossover study. SETTING Tertiary neonatal intensive care unit. PATIENTS 24 infants, born at <32 weeks' gestation, with current weight <1500 g and without right-to-left shunt via a patent ductus arteriosus. INTERVENTIONS Simultaneous readings from three SpO2 sensors (Red Diamond (RD), Photoplethysmography (PPG), Low Noise Cabled Sensors (LNCS)) were logged at 0.5 Hz over 6 hour/infant and compared with LNCS as control using analysis of variance. Sensor position was randomly allocated and rotated every 2 hours. Seven different batches each were used. OUTCOMES Primary outcome was the difference in SpO2 readings. Secondary outcomes were differences between sensors in the proportion of time within the SpO2-target range (90-95 (100)%). RESULTS Mean gestational age at birth (±SD) was 274/7 (±23/7) weeks, postnatal age 20 (±20) days. 134 hours of recording were analysed. Mean SpO2 (±SD) was 94.0% (±3.8; LNCS) versus 92.2% (±4.0; RD; p<0.0001) and 94.5% (±3.9; PPG; p<0.0001), respectively. Mean SpO2 difference (95% CI) was -1.8% (-1.9 to -1.8; RD) and 0.5% (0.4 to 0.5; PPG). Proportion of time in target was significantly lower with RD sensors (84.8% vs 91.7%; p=0.0001) and similar with PPG sensors (91.1% vs 91.7%; p=0.63). CONCLUSION There were systematic differences in SpO2 readings between RD sensors versus LNCS. These findings may impact mortality and morbidity of preterm infants, particularly when aiming for higher SpO2-target ranges (eg, 90-95%). TRIAL REGISTRATION NUMBER DRKS00027285.
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Affiliation(s)
- Christian Achim Maiwald
- Department of Pediatrics, Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Germany
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Christoph E Schwarz
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, University of Heidelberg, Heidelberg, Germany
| | - Katrin Böckmann
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Laila Springer
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Axel Franz
- Department of Pediatrics, Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Germany
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
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Karupaiah A, Abdurrazaq A, Quaynor J, Abdelhady A. Survey of use of probiotics in neonatal units in the UK. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-326404. [PMID: 38123976 DOI: 10.1136/archdischild-2023-326404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Ashok Karupaiah
- Paediatrics and Neonates, Walsall Manor Hospital, Walsall, UK
| | | | | | - Ammar Abdelhady
- Paediatrics and Neonates, Walsall Manor Hospital, Walsall, UK
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Embleton ND, Berrington J, Clarke P, Deierl A, Luyt K, Spruce M, Oddie SJ. Probiotics for preterm infants and the recent FDA alert in the USA. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-326580. [PMID: 38123949 DOI: 10.1136/archdischild-2023-326580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Nicholas D Embleton
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Berrington
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Clarke
- Neonatal Intensive Care Unit, Norfolk Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Aniko Deierl
- Neonatology, Imperial College Healthcare NHS Trust, London, UK
| | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sam J Oddie
- Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire, UK
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Moore CM, Lorusso A, Morgan L, Brazil S, Croxon H, Waters A, Farrelly A, Hervig T, Curley A. Safety and feasibility of platelet transfusion through long catheters in the neonatal intensive care unit: an in vitro study. Arch Dis Child Fetal Neonatal Ed 2023; 109:70-73. [PMID: 37433587 PMCID: PMC10803993 DOI: 10.1136/archdischild-2023-325632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To assess the safety and feasibility of platelet transfusion through small-bore long lines used in the neonatal intensive care unit (NICU), including double-lumen umbilical venous catheters (UVCs) and 24 G and 28 G peripherally inserted central catheters (PICCs). DESIGN Prospective in vitro controlled study. SETTING Blood transfusion service laboratory. METHODS In vitro platelet transfusions were set up as per NICU practice. Transfusion line pressure was monitored. Post-transfusion swirling, presence of aggregates, pH analysis and automated cell count in vitro activation response by flow cytometry assessing CD62P expression were assessed. MAIN OUTCOME MEASURES All transfusions completed successfully. The rate of infusion was reduced in 5 of 16 transfusions through 28 G lines due to 'pressure high' alarms. There was no difference in swirling values or transfusion aggregate formation, CD62P expression levels, platelet count, platelet distribution width, mean platelet volume, plateletcrit or platelet to large cell ratio across transfusions post-transfusion. CONCLUSIONS This study showed that in vitro platelet transfusion performed through 24 G and 28 G neonatal PICC lines and double-lumen UVCs is non-inferior to 24 G short cannulas, using outcome measures of platelet clumping, platelet activation and line occlusion. This suggests that where available these lines can be used if necessary for platelet transfusion.
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Affiliation(s)
- Carmel Maria Moore
- School of Medicine, University College Dublin, Dublin, Ireland
- Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Alice Lorusso
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
| | - Liam Morgan
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
| | - Sinead Brazil
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
| | - Harry Croxon
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
| | - Allison Waters
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Aileen Farrelly
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
| | - Tor Hervig
- National Blood Centre, Irish Blood Transfusion Service, Dublin, Ireland
| | - Anna Curley
- School of Medicine, University College Dublin, Dublin, Ireland
- Neonatology, National Maternity Hospital, Dublin, Ireland
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Marshall A, Ladlow OJ, Bannink C, Lim K, Ali SKM, Gale TJ, Dargaville PA. Apnoea-triggered increase in fraction of inspired oxygen in preterm infants: a randomised cross-over study. Arch Dis Child Fetal Neonatal Ed 2023; 109:81-86. [PMID: 37640527 DOI: 10.1136/archdischild-2023-325849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To investigate the impact of a pre-emptive apnoea triggered oxygen response on oxygen saturation (SpO2) targeting following central apnoea in preterm infants. DESIGN Interventional crossover study of a 12-hour period of automated oxygen control with an apnoea response (AR) module, nested within a crossover study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking 12-hour periods of manual control. SETTING Neonatal intensive care unit PATIENTS: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median (IQR) birth gestation 27 (26-28) weeks, postnatal age 17 (12-23) days. INTERVENTION Automated oxygen titration with an automated control algorithm modified to include an AR module. Alterations to inspired oxygen concentration (FiO2) were actuated by a motorised blender. Desired SpO2 range was 90-94%. Apnoea detection was by capsule pneumography. MAIN OUTCOME MEASURES Duration, magnitude and area under the curve (AUC) of SpO2 deviations following apnoea; frequency and duration of apnoeic events. Comparisons between periods of manual, automated and automated control with AR module. RESULTS In 60 studies in 35 infants, inclusion of the AR module significantly reduced AUC for SpO2 deviations below baseline compared with both automated and manual control (manual: 87.1%±107.6% s, automated: 84.6%±102.8% s, AR module: 79.4%±102.7% s). However, there was a coincident increase in SpO2 overshoot (AUC (SpO2>SpO2(onset)); manual: 44.3±99.9% s, automated: 54.7%±103.4% s, AR module: 65.7%±126.2% s). CONCLUSION Automated control with a pre-emptive apnoea-triggered FiO2 boost resulted in a modest reduction in post-apnoea hypoxaemia, but was followed by a greater SpO2 overshoot. TRIAL REGISTRATION NUMBER ACTRN12616000300471.
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Affiliation(s)
- Andrew Marshall
- School of Engineering, College of Sciences and Engineering, University of Tasmania, Hobart, Tasmania, Australia
| | - Oliver J Ladlow
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Charlotte Bannink
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kathleen Lim
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sanoj K M Ali
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Timothy J Gale
- School of Engineering, College of Sciences and Engineering, University of Tasmania, Hobart, Tasmania, Australia
| | - Peter A Dargaville
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Hagan J. Statistical power in 'Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial'. Arch Dis Child Fetal Neonatal Ed 2023; 109:113. [PMID: 37739775 DOI: 10.1136/archdischild-2023-325832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Joseph Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas, USA
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Tho ALW, Rath CP, Tan JKG, Rao SC. Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2023; 109:52-58. [PMID: 37419685 DOI: 10.1136/archdischild-2023-325525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Fetoscopic endoluminal tracheal occlusion (FETO) has been shown to improve survival of infants with congenital diaphragmatic hernia (CDH). However, there are concerns that FETO may lead to tracheomegaly, tracheomalacia and related complications. METHODS A systematic review was conducted to estimate the prevalence of symptomatic tracheal complications in infants who underwent FETO for CDH. Presence of one or more of the following was considered as tracheal complication: tracheomalacia, stenosis, laceration or tracheomegaly with symptoms such as stridor, effort-induced barking cough, recurrent chest infections or the need for tracheostomy, tracheal suturing, or stenting. Isolated tracheomegaly on imaging or routine bronchoscopy without clinical symptoms was not considered as tracheal morbidity. Statistical analysis was performed using the metaprop command on Stata V.16.0. RESULTS A total of 10 studies (449 infants) were included (6 retrospective cohort, 2 prospective cohort and 2 randomised controlled trials). There were 228 infants who survived to discharge. Prevalence rates of tracheal complications in infants born alive were 6% (95% CI 2% to 12%) and 12% (95% CI 4% to 22%) in those who survived to discharge. The spectrum of severity ranged from relatively mild symptoms such as effort-induced barking cough to the need for tracheostomy/tracheal stenting. CONCLUSION A significant proportion of FETO survivors have symptomatic tracheal morbidities of varying severity. Units that are planning to adopt FETO for managing CDH should consider ongoing surveillance of survivors to enable early identification of upper airway issues. Inventing FETO devices that minimise tracheal injury is needed.
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Affiliation(s)
- Adam Lye Wye Tho
- Neonatology, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chandra Prakash Rath
- Neonatology, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason Khay Ghim Tan
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Neonatal Unit, Paediatrics, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Shripada C Rao
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
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Puzone S, Diplomatico M, Caredda E, Maietta A, Miraglia Del Giudice E, Montaldo P. Hypoglycaemia and hyperglycaemia in neonatal encephalopathy: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2023; 109:18-25. [PMID: 37316160 DOI: 10.1136/archdischild-2023-325592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
IMPORTANCE Although hypoglycaemia and hyperglycaemia represent the most common metabolic problem in neonates, there is still uncertainty regarding the effects of glucose homoeostasis on the neurological outcomes of infants with neonatal encephalopathy (NE). OBJECTIVE To systematically investigate the association between neonatal hypoglycaemia and hyperglycaemia with adverse outcome in children who suffered from NE. STUDY SELECTION We searched Pubmed, Embase and Web of Science databases to identify studies which reported prespecified outcomes and compared infants with NE who had been exposed to neonatal hypoglycaemia or hyperglycaemia with infants not exposed. DATA ANALYSIS We assessed the risk of bias (ROBINS-I), quality of evidence (Grading of Recommendations, Assessment, Development and Evaluation (GRADE)) for each of the studies. RevMan was used for meta-analysis (inverse variance, fixed effects). MAIN OUTCOME Death or neurodevelopmental outcomes at 18 months of age or later. RESULTS 82 studies were screened, 28 reviewed in full and 12 included. Children who were exposed to neonatal hypoglycaemia had higher odds of neurodevelopmental impairment or death (6 studies, 685 infants; 40.6% vs 25.4%; OR=2.17, 95% CI 1.46 to 3.25; p=0.0001). Neonatal exposure to hyperglycaemia was associated with death or neurodisability at 18 months or later (7 studies, 807 infants; 46.1% vs 28.0%; OR=3.07, 95% CI 2.17 to 4.35; p<0.00001). These findings were confirmed in the subgroup analysis, which included only the infants who underwent therapeutic hypothermia. CONCLUSIONS These data suggest that neonatal hypoglycaemia and hyperglycaemia may be associated with the neurodevelopmental outcome later on in infants with NE. Further studies with long-term follow-up are needed to optimise the metabolic management of these high-risk infants. PROSPERO REGISTRATION NUMBER CRD42022368870.
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Affiliation(s)
- Simona Puzone
- Department of Neonatal Intensive Care, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Diplomatico
- Department of Neonatal Intensive Care, AORN San Giuseppe Moscati, Avellino, Italy
| | - Elisabetta Caredda
- Department of Neonatal Intensive Care, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Maietta
- Department of Neonatal Intensive Care, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paolo Montaldo
- Imperial Neonatal Service, Centre for Perinatal Neuroscience, Department of Paediatrics, Imperial College London, London, UK
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Levkovitz O, Schujovitzky D, Stackievicz R, Fayoux P, Morag I, Litmanovitz I, Arnon S, Bauer S. Ultrasound assessment of endotracheal tube depth in neonates: a prospective feasibility study. Arch Dis Child Fetal Neonatal Ed 2023; 109:94-99. [PMID: 37553228 DOI: 10.1136/archdischild-2023-325855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To examine the reliability of a novel ultrasound (US) method for assessment of endotracheal tube (ETT) position in neonates. DESIGN Prospective, observational, single-centre, feasibility study. SETTING Level III neonatal intensive care unit. PATIENTS Term and preterm neonates requiring endotracheal intubation. INTERVENTION US measurement of the ETT tip to right pulmonary artery (RPA) distance was used to determine ETT position according to one-fourth to three-fourths estimated tracheal length for weight. US demonstration of pleural sliding and diaphragmatic movement was also assessed. Chest radiography (CXR) was performed following each intubation. MAIN OUTCOME MEASURES Agreement between US assessment of ETT tip position and CXR served as the gold standard. Sensitivity, specificity, positive and negative predictive values for each US method and correlation between ETT tip to RPA distance on US, and ETT tip to carina distance on CXR were assessed. RESULTS Forty-two US studies were performed on 33 intubated neonates. US evaluation of ETT-RPA distance identified 100% of ETTs positioned correctly: 77% deep and 80% high, demonstrating strong agreement with CXR (kappa=0.822). Sensitivity was 78%, specificity 100%, positive predictive value 100% and negative predictive value 86%. US ETT-RPA distance strongly correlated with CXR ETT-carina distance (r=0.826). No significant agreement was found between CXR and US assessment of pleural sliding and diaphragmatic movement. No adverse events were encountered during US scans. CONCLUSION US evaluation of ETT-RPA distance demonstrated excellent accuracy for determining ETT position in neonates compared with CXR. More research is needed to support its feasibility in clinical settings.
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Affiliation(s)
- Orly Levkovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
| | | | | | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Université de Lille, Lille, France
| | - Iris Morag
- Department of Neonatology, Shamir Medical Center Assaf Harofeh, Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sofia Bauer
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
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Benitz WE. Perils of meta-analysis. Arch Dis Child Fetal Neonatal Ed 2023; 109:2-3. [PMID: 37673594 DOI: 10.1136/archdischild-2023-326132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Affiliation(s)
- William E Benitz
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Nair V, Kannan Loganathan P, Lal MK, Bachman TE, Fantl R. Randomised control trial of oxygen assist module in preterm infants on high-flow nasal cannula support. Arch Dis Child Fetal Neonatal Ed 2023; 109:65-69. [PMID: 37451840 DOI: 10.1136/archdischild-2023-325661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To evaluate the efficacy of automatic oxygen control (A-FiO2) in reducing the extremes of oxygen saturations (SpO2<80% and SpO2>98%) in preterm infants on high-flow nasal cannula (HFNC) respiratory support using Vapotherm Precision Flow. DESIGN A parallel-arm randomised controlled trial. SETTING A level-III neonatal intensive care unit. PATIENTS Preterm infants born <33 (23+0 to 32+6) weeks receiving HFNC as respiratory support. INTERVENTIONS A-FiO2 versus manual (M-FiO2) oxygen control during the full course of HFNC support. OUTCOMES The primary outcome of this study is percentage of time spent in extreme oxygen saturations (<80% and >98%) in preterm infants when receiving HFNC as respiratory support. Secondary outcomes were time with SpO2 between 90% and 95% plus time >95% without supplemental oxygen. RESULTS 60 infants were randomised equally to either A-FiO2 or M-FiO2 arm. Their baseline characteristics were comparable. They spent a median of 5.3 (IQR: 2.0-8.4) and 6.5 (IQR: 2.9-13.7) days in the study, A-FiO2 and M-FiO2, respectively. The percentage of time spent in SpO2<80% (median of 0.4% (0.1%-0.8%) vs 1.6% (0.6%-2.6%), p=0.002) and >98% (median 0.2% (0.1%-0.9%) vs 1.9% (0.7%-4%), p<0.001) were significantly lower in A-FiO2 compared with M-FiO2. The difference in median percentage of time in target range between the two arms was 26% (81% (74%-93%) in A-FiO2 vs 55% (48%-72%) in M-FiO2). CONCLUSION A-FiO2 was associated with statistically significant reduction in the percentage of time spent in extremes of saturation when compared with M-FiO2 in preterm infants receiving HFNC. TRIAL REGISTRATION NUMBER NCT04687618.
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Affiliation(s)
- Vrinda Nair
- Neonatal Intensive Care Unit, James Cook University Hospital, Middlesbrough, UK
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Mithilesh Kumar Lal
- Neonatal Intensive Care Unit, James Cook University Hospital, Middlesbrough, UK
| | - Thomas Edward Bachman
- School of Biomedical Engineering, Ceske vysoke uceni technicke v Praze, Praha, Czech Republic
| | - Ron Fantl
- Clinical Informatics, Spectrum Medical, Gloucester, UK
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