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Aim: We investigated the influence of physiological-based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life., Methods: This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups., Results: We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups., Conclusion: PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR)., Method: This was a retrospective observational cohort study in a single-centre neonatal intensive care unit and included all neonates born before 32 weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72 h of birth, bronchopulmonary dysplasia (BPD) and death., Results: There were 491 eligible babies during the 5-year epoch. 292 were stabilised using HF in the DR. The median admission temperature in babies transferred on HF was 36.8°C, and the median FiO 2 at admission was 25%. 45% of these infants received surfactant. At 72 postnatal hours, 78% were either sustained on HF or were either self-ventilating in air (SVIA) or receiving low-flow nasal cannula (LFNC) respiratory support. 27% were intubated within 7 days. At 36 weeks postmenstrual age, 36% of survivors had BPD., Conclusion: We have demonstrated that preterm babies <32 weeks can be effectively stabilised on HF in the DR., (©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: To evaluate the relationship between clinical assessment of infant colour and oxygen saturation at birth in a low-resource setting., Methods: Classification of infant colour (cyanotic, pink or unclear) by midwives was compared to pulse-oximeter data at 60-90-120-300 seconds after birth in 60 neonates., Results: Overall, oxygen saturation increased over time (P < .0001) and was different according to infant colour (P < .0001). Median oxygen saturation in pink infants was 87% at 60 seconds (n = 1), 90% (IQR 83-91) at 90 seconds (n = 5), 86% (IQR 81-94) at 120 seconds (n = 11) and 93% (IQR 90-96) at 300 seconds (n = 20). Median oxygen saturation in cyanotic infants was 60% (IQR 45-70) at 60 seconds (n = 52), 64% (IQR 52-69) at 90 seconds (n = 42), 63% (IQR 56-68) at 120 seconds (n = 35) and 66% (IQR 62-74) at 300 seconds (n = 22). Median oxygen saturation in unclear-coloured infants was 57% (IQR 56-60) at 60 seconds (n = 7), 78% (IQR 71-81) at 90 seconds (n = 13), 81% (IQR 79-88) at 120 seconds (n = 14) and 80% (IQR 76-84) at 300 seconds (n = 18). The proportion of infants with unclear colour ranged from 12% to 30%., Conclusion: The variability of oxygen saturation among pink and cyanotic infants, and the substantial proportion of unclear infant colour, suggest the possible benefit of the availability of pulse oximetry in low-resource settings., (©2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: Oxygen saturation is frequently monitored with pulse oximetry to assess vital signs in critically ill patients. Optimally, pulse oximetry closely tracks arterial oxygen tension (PaO 2 ), which provides guidance in oxygen titration. We investigated whether monitoring peripheral oxygen saturation (SpO 2 ) could accurately guide oxygen titration in newborn infants., Methods: Twenty seven thousand two hundred thirty seven SpO 2 readings were retrospectively paired with arterial oxygen saturation (SaO 2 ) and PaO 2 results from blood gas analyses performed in infants with arterial catheters in place., Results: SpO 2 overestimated SaO 2 readings by 2.9 ± 5.8%. When pulse oximetry readings were within the defined oxygen saturation target range, 7809 (20.9%) SaO 2 values were below and 2830 (7.6%) exceeded the target range. In 57% of patients, PaO 2 levels < 6 kPa was diagnosed while SpO 2 readings were > 90%. PaO 2  > 11 kPa was recorded in 19% of cases, when SpO 2 readings were < 95%. Infants treated with supplemental oxygen showed a threefold increased risk of hypoxaemia compared to infants breathing room air. Sensitivity and specificity for detecting upper and lower target range limits were fair to good. For SpO 2 values below 91%, ISO quality criteria were no longer fulfilled., Conclusions: Based on arterial blood gas analyses as reference, pulse oximetry readings did not fulfil the performance requirements for titrating oxygen in neonatal patients., (© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: To investigate interinstitutional differences in preterm infant stabilisation between two European tertiary neonatal centres with particular focus on intubation timing, surfactant administration, caffeine therapy and neonatal morbidity and mortality., Methods: Retrospective (2012-2014) study of very low birth weight (VLBW) preterm infants admitted to John Radcliffe Hospital (UK centre) and Charité Medical Centre (German centre). Timing of intubation, surfactant and caffeine administration and respiratory outcomes were examined., Results: Gestational age, birth weight and five-minute Apgar scores of VLBW infants from the UK centre (n = 86) were comparable to those from the German centre (n = 96). Significant differences in antenatal steroid therapy, intubation timing and surfactant therapy were noted. Timing of caffeine initiation differed significantly between centres (median 0 [0-2.5] UK vs. 2 [1.5-4] days German centre); however, caffeine was discontinued at a similar corrected gestational age of 34.7 weeks. Mechanical ventilation was significantly longer at the UK centre, but there was no difference in bronchopulmonary dysplasia (BPD) (44% UK vs. 36% German centre) or mortality (15% UK vs. 13% German centre)., Conclusion: Timing of primary intubation and caffeine therapy differed significantly between centres. However, earlier intubation and caffeine administration in the UK centre were not associated with a changed incidence of BPD., (© 2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress., Design: Prospective observational study., Setting: University hospital., Sample: CBG from 97 VDs and 124 CDs without fetal distress., Methods: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs., Main Outcome Measures: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO 2 ), partial pressure of carbon dioxide (pCO 2 ), pH, and postpartum haemorrhage., Results: Arterial cord blood pH, bicarbonate ( HCO 3 - , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO 3 -  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO 3 -  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO 2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit., Conclusions: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs., Tweetable Abstract: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively., (© 2019 Royal College of Obstetricians and Gynaecologists.)

Aim: Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence-based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age ≥35 + 0 weeks., Methods: A PubMed search-based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations., Results: Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold-based screening and treatment protocol presented as a flow chart was developed., Conclusion: An updated and evidence-based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia-related long-term sequelae., (©2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)