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Mashup Score: 13Development of a dedicated ‘drive-through’ pathway for neonates with bilious vomiting: a prospective cohort study - 2 day(s) ago
We report the findings of our multidisciplinary, polyperspective, collaborative quality improvement project. Infants with bile-stained vomit require an upper gastrointestinal (GI) contrast and review by a paediatric surgeon to exclude a midgut volvulus due to malrotation. Surgical and radiological findings of this potentially fatal condition1 are shown in figure 1. At our institution, a patient referred from a local neonatal unit (LNU) with bilious vomiting would be reviewed by the Southampton Oxford Neonatal Transport team (SONeT). SONeT would stabilise the baby and transfer to a surgical cot in the John Radcliffe Newborn Care Unit (NNU) where tertiary services are located. The baby would be prepared for contrast study; accompanied by two porters, a registrar and nurse to the …
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Mashup Score: 13Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research - 2 day(s) ago
Objective Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. Design and intervention International online survey. Results Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%–98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had 5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome.
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Mashup Score: 2Retinopathy of prematurity comes full circle - 3 day(s) ago
In the 70 years since the first description, retinopathy of prematurity (ROP) has been the focus of intensive basic and clinical research. Over time, worldwide, there have been several phenotypes of ROP described. Here, we explore whether these are part of a single spectrum or are separate and distinct entities. First described in 1942 by Terry, clinical1 and experimental studies2 3 provided compelling evidence that ‘retrolental fibroplasia’—as ROP was then known—was related to uncontrolled oxygen exposure, although some acknowledged that the mechanism was likely complex. This led clinicians to the restriction of supplemental oxygen concentrations to less than 40%, with predictions that this would eliminate an important cause of infant blindness. Sadly, such forecasts were not fulfilled, and ROP-induced blindness still occurred. Subsequently with increasing preterm survival, the population developing ROP had ever decreasing gestational age. Other risk factors for ROP were recognised, l
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Mashup Score: 6
Introduction There is insufficient evidence to determine if non-invasive transcutaneous bilirubin (TcB) measurement can replace serum bilirubin (SBR) in assessing rebound hyperbilirubinaemia after phototherapy. Objective To investigate if TcB can safely guide management of neonates after phototherapy. Subjects 100 well neonates ≥35 weeks’ gestation who had received inpatient phototherapy. Method Measurement of both helix (manufacturer’s recommendation) and earlobe TcB coincidentally with routine SBR 12 hours after cessation of phototherapy. All mothers gave written informed consent. Results Gestation ranged from 35+0 to 41+5 (median 37+6) weeks; birth weight 2018–4566 (median 3230) g; age 55–222 (median 109) hours at testing. 86% neonates were Caucasian. Outcomes determined by SBR included restarting phototherapy (n=0), repeat SBR next day (n=29), no further routine follow-up (n=71). TcB and SBR measurements were unpredictably inconsistent. Helix TcB tended to underestimate SBR (mean d
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Mashup Score: 6
Objective To determine the accuracy of two developmental screening questionnaires to detect cognitive or language delay, defined using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), in children born extremely preterm (EP: <28 weeks’ gestation) or extremely low birth weight (ELBW: <1000 g). Design Prospective cohort study. Setting State of Victoria, Australia. Patients 211 infants born EP/ELBW assessed at 2 years’ corrected age (mean 2.2, SD 0.2). Main outcome measures Cognitive and language delay (<−1 SD) on the Bayley-III. The screening questionnaires were the Parent Report of Children’s Abilities-Revised (PARCA-R) and the Ages & Stages Questionnaires Third Edition (ASQ-3). Results The PARCA-R performed better than the ASQ-3, but neither questionnaire had substantial agreement with the Bayley-III to detect cognitive delay; kappa (95% CI): PARCA-R 0.43 (0.23, 0.63); ASQ-3 0.15 (−0.05, 0.35); sensitivity (95% CI): PARCA-R 70% (53%, 84%) ASQ-3 62% (47%, 7
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Mashup Score: 12Gastrointestinal effects of caffeine in preterm infants: a systematic review and Bayesian meta-analysis - 6 day(s) ago
Objective Caffeine is widely used in preterm infants to prevent or treat apnoea of prematurity. Adverse gastrointestinal effects of caffeine have not been thoroughly researched in preterm infants. With this systematic review and meta-analysis, we aim to summarise the results of trials on the gastrointestinal effects of caffeine in preterm infants. Design We searched MEDLINE, Web of Science, Scopus and ClinicalTrials.gov up to 21 April 2023. We included randomised controlled trials assessing caffeine versus placebo in preterm neonates and reporting gastrointestinal side effects. Risk of bias was assessed using the Cochrane Risk of Bias tool. A Bayesian meta-analysis was performed to estimate the pooled OR of gastrointestinal side effects. Results Nine trials involving 2746 preterm infants were analysed. Seven trials assessing necrotising enterocolitis and four trials assessing feeding intolerance in our meta-analysis found no differences between caffeine and placebo (OR=1.007 (95% credi
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Mashup Score: 2Deferred cord clamping and polythene bags at delivery: measuring and improving quality - 7 day(s) ago
Deferring cord clamping (DCC) at birth reduces mortality in preterm infants by around a third.1 This extraordinary reduction in mortality occurs in babies of all gestations, meaning the biggest reductions in mortality could be seen in the least mature infants, who have the highest baseline risk of death. While mortality is reduced, is it almost as striking that DCC does not appear to affect major complications of prematurity such as brain injury, bronchopulmonary dysplasia, necrotising enterocolitis or late onset infection,1 leaving the intriguing question of how the benefit is mediated. Since the publication of a systematic review in 2018,2 there has been a rapid increase in the proportion of very preterm infants (VPIs: born <32 weeks) who receive DCC. In the UK, the proportion increased from 28.9% in 2020 to 55.4% in 2022, an increase we expect to continue. Some centres exceed the 75% adherence that was managed in the trials without the use of cord intact stabilisation. However, in 2
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Mashup Score: 1
In 2015, both the European Resuscitation Council and the American Heart Association neonatal resuscitation guidelines recommended delayed cord clamping (DCC) for term and preterm neonates. This change in practice produced a gap in knowledge regarding normative neonatal heart rate (HR) during the extrauterine transition with an intact cord. In this issue, Rettedal et al ’s study of 4876 neonates with HR measured by dry electrode ECG presents informative data on HR in the first minute after birth with an intact cord.1 In their study of neonates ≥28 weeks gestation, the median time to cord clamping was 301 s (quartiles 222, 396 s) after birth, and the median time of the first registered HR was 16 s (quartiles 11, 28 s) after birth. In this population, 16.3% of neonates had a first measured HR <100 beats per minute (bpm). Furthermore, 25% of neonates had a registered HR <100 bpm at some point during the first minute after birth. HR among neonates who were initially bradycardic nearly alway
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Mashup Score: 13Caffeine therapy for very preterm infants in Australia and New Zealand: a bi-national survey - 8 day(s) ago
The largest randomised controlled trial (RCT) of neonatal caffeine therapy, the Caffeine for Apnea of Prematurity (CAP) trial, evaluated caffeine citrate at a loading dose of 20 mg/kg and a maintenance dose of 5–10 mg/kg/day.1 Although caffeine is among the most commonly used neonatal medications, practice varies widely, and higher dosing has been reported.2 We hypothesised that caffeine practice may have evolved since the last survey conducted in the Australian and New Zealand Neonatal Network (ANZNN),3 despite limited data supporting higher caffeine doses.2 We aimed to describe the current use of caffeine in very preterm infants as a fundamental step towards large RCTs of caffeine dosing. A web-based 24-question survey was sent to 195 consultant neonatologists from 31 tertiary neonatal units within the ANZNN in March 2023. The survey inquired about the individual’s use of caffeine in preterm infants, including dosage and duration. Unit caffeine guidelines were also requested. We rece
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Mashup Score: 9Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial - 9 day(s) ago
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 dysplasi
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Development of a dedicated ‘drive-through’ pathway for neonates with bilious vomiting Local unit 👉 transport team 👉 fluoroscopy suite ⬇️Time to contrast study ⬇️Surgical cot days ⬇️Cost Prospective cohort study https://t.co/PZZzKtW8jC https://t.co/Ac54pZ66QM