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Aim: This study aims to analyse the developmental data from public health nurses (PHNs) to identify early indicators of neurodevelopmental disorders (NDDs) in young children using Bayesian network (BN) analysis to determine factor combinations that improve diagnosis accuracy. Methods: The study cohort was 501 children who underwent health checkups at 18 and 36‐month. Data included demographics, pregnancy, delivery, neonatal factors, maternal interviews, and physical and neurological findings. Diagnoses were made by paediatricians and child psychiatrists using standardised tools. Predictive accuracy was assessed by the receiver operating characteristic (ROC) curve analysis. Results: We identified several infant/toddler factors significantly associated with NDD diagnoses. Predictive factors included meconium‐stained amniotic fluid, 1 min Apgar score, and early developmental milestones. ROC curve analysis showed varying predictive accuracies based on evaluation timing. The 10‐month checkup was valid for screening but less reliable for excluding low‐risk cases. The 18‐month evaluation accurately identified children at NDD risk. Conclusion: The study demonstrates the potential of using developmental records for early NDD detection, emphasising early monitoring and intervention for at‐risk children. These findings could guide future infant mental health initiatives in the community. [ABSTRACT FROM AUTHOR]

Aim: Skin‐to‐skin contact (SSC) immediately after birth may improve breastfeeding outcomes. This study explored the effect of the duration of SSC in the delivery room on breastfeeding quality and duration. Methods: In this prospective observational cohort study, mother–infant pairs practising SSC were categorised into two groups based on SSC duration (≤45 or >45 min). Outcomes included breastfeeding quality in the delivery room and at 24 h of age assessed by the Infant‐Breastfeeding Assessment Tool (IBFAT) score, and long‐term breastfeeding duration up to 6 months while accounting for potential confounding variables. Results: The study included 72 mother–infant pairs. SSC for more than 45 min was significantly correlated with longer immediate breastfeeding (65 vs. 19 min, p < 0.001) and higher breastfeeding quality scores immediately after birth (IBFAT score of 10 vs. 7, p < 0.001). Regarding the long‐term effect, infants in the extended SSC group were breastfed longer (5.2 vs. 3.7 months, p = 0.005) and had exclusive breastfeeding (4.7 vs. 2.7 months, p > 0.001). No significant confounding variables were identified. Conclusion: Extended SSC (>45 min) correlated with prolonged, higher‐quality breastfeeding after birth and longer successful breastfeeding. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The aim of this study was to describe the evolution of a regional neonatal service in Sierra Leone and changes in mortality and service use as it transitioned from a non‐specialist service to a dedicated special care baby unit (SCBU).This was a retrospective observational study. Anonymised data were taken from the ward admissions books at Bo Government Hospital, and trends in admissions and mortality within the neonatal service were examined for each stage of the department's evolution.Four phases of the service's development were identified between November 2015 and October 2019. Records of 2377 admissions and 333 deaths were identified. The average number of admissions per month and deaths per month varied by service development phase. There was a trend towards reduced death rates and increased numbers of admissions as the unit evolved into a dedicated neonatal unit with a reliable electricity supply.The development of an adequately sized SCBU with a reliable electricity supply and specially trained staff was associated with a reduction in the death rate and an increase in admissions. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the definition and causes of neonatal bradycardias. Methods: This retrospective study included 135 term‐born newborns referred for 24‐hour Holter monitoring due to bradycardia. Bradycardia was defined as either a heart rate below 80 beats per minute (standard definition) or a heart rate below our recently published age‐specific reference values for neonatal heart rate. Results: The mean (SD) age was 6.1 (1.3) days. With standard definition, 107 newborns (79%) had bradycardia, whereas only 20 (15%) had a minimum heart rate lower than the age‐specific reference. Younger newborns had lower heart rates. Each day increased the minimum, mean and maximum heart rate by 1.8 (95% CI: 1.0, 2.6), 4.2 (95% CI: 3.0, 5.3) and 2.1 beats per minute (95% CI: 0.3, 3.8), respectively. Male sex and maternal levothyroxine medication were negatively associated with the mean and maximum heart rate. None of the newborns had a cardiac cause for low heart rate. Conclusion: Among term newborns with bradycardias, younger age, male sex and maternal levothyroxine medication were associated with a lower heart rate on Holter monitoring. Given the age‐related increase in heart rate, the 80 beats per minute limit as a universal threshold for abnormal heart rate in newborns appears inappropriate. [ABSTRACT FROM AUTHOR]

Aim: Review changes in neonatal ventilation practice within our regional transport service, Embrace, identifying interventions with greatest impact on improved rates of normocapnia during transfer. Methods: Using internal transport databases and UK Neonatal Transport Group data submissions, we tracked local and national rates of ventilation and normocapnia. We correlated this with internal changes in practice, including introduction of new equipment, staffing changes, educational interventions and quality improvement projects. Results: Data demonstrated improvement in normocapnia rates benchmarked against national figures, which was not explained by changes in ventilation methods or rates, or by changes in availability of post‐transfer gases. Greatest improvement was identified following introduction of transcutaneous CO2 monitoring and ventilators enabling volume‐guided ventilation strategies. Additionally, although less quantifiable, educational and quality improvement interventions, and case review mechanisms were felt to be influential. Conclusion: Volume guided ventilation and transcutaneous CO2 monitoring have had a positive influence on the maintenance of normocapnia during transfer at Embrace Transport Service, although introduction of new equipment still presents challenges which must be overcome. Recognising the significant impact of these technologies allows for ongoing financial, time and educational investment to emphasise their importance and ensure appropriate awareness of limitations and troubleshooting options, maximising their positive impact. [ABSTRACT FROM AUTHOR]

Aim: Blood component transfusion is a common intervention in the neonatal intensive care unit (NICU). Parents consent on their babies' behalf. This study aimed to explore parents' understandings and experiences of consenting and the subsequent blood transfusion. Methods: A "low inference" qualitative descriptive semi‐structured interview approach was utilised. Grounded theory was employed. Parents described their memories of babies' transfusions, their responses to the consent process and assessed the written information they were given. Results: A purposive sample of 17 parents whose babies required blood transfusion in the NICU participated. Parents talked about their initial fears of transfusion, later replaced by confidence in the process and results of transfusion and trust in the healthcare professional team. The main themes elicited by the interviews were parents' expectations and outcomes of transfusion, parents' prior and current opinions of transfusion, parents trust in healthcare professionals and how parents would like to receive information about transfusions in the NICU. Conclusion: Parents in our study trust information from the healthcare professionals caring for their baby and would like more specific information about how blood transfusion will impact their baby, in a variety of means. Parents felt that blood transfusions were beneficial for their babies. [ABSTRACT FROM AUTHOR]

Aim: To examine the association between Apgar score at 5 min and childhood developmental and educational outcome. Methods: A population‐based data linkage study of births ≥37 weeks' gestation linked to developmental outcomes at preparatory school and educational outcomes at school grades 3, 5 and 7 in Victoria, Australia. Multivariable logistic regressions and generalised estimating equations were used. Results: There were 167,126 singleton infants with developmental results and 392,933 singleton infants with at least one educational result. There was an inverse relationship between Apgar score at 5 min and poor developmental and educational outcomes, with the worst outcomes among Apgar scores of 0–3. Apgar scores of 7, 8 and 9 were all associated with poorer developmental outcomes (aOR = 1.31, 95% CI: 1.12–1.54; aOR = 1.17, 95% CI: 1.05–1.29; aOR = 1.08, 95% CI: 1.02–1.13 respectively), while Apgar scores of 7 and 8 were associated with poorer educational outcomes at grades 3, 5, and 7. With progression through grades 3, 5, and 7, the extent of the difference in educational outcomes diminished (e.g. for Apgar scores of 0–3: aOR = 3.33, 95% CI: 1.85–6.00 in grade 3 and aOR = 1.49, 95% CI: 0.75–2.96 in grade 7). Conclusion: Apgar scores below 10 at 5 min are associated with poorer developmental and educational outcomes in school. [ABSTRACT FROM AUTHOR]

Aim: We sought to validate neurological variables and relevant International Classification of Diseases, Tenth Revision (ICD‐10) codes in the Swedish Neonatal Quality (SNQ) Register. Methods: Register data were collected for 351 neonates, born between January 2009 and December 2016, who were treated at a neonatal unit in the Stockholm region on 385 occasions. They were eligible if the check‐box for central nervous system (CNS)‐induced seizures was ticked. The Register data, including relevant ICD‐10 codes, were validated by checking the patients' electronic medical charts. Results: Most of the neonates were born at term (76%) and weighed >2500 g (80%). The variable CNS‐induced seizures had a positive predictive value of 46%. The ICD‐10 diagnosis P90.9A had a positive predictive value of 90%. This comprises seizures validated with electroencephalography, amplitude‐integrated electroencephalography or continuous function monitoring. The majority of the associated neurological variables in the Register had positive predictive values above 85%. Conclusion: When the check‐box was ticked for central nervous system‐induced seizures, most of the neurological variables in the Register had high validity. However, the CNS‐induced seizures variable per se had a lower positive predictive value. Future SNQ Register‐based studies of such neonatal seizures should also include ICD‐10 P90.9A. [ABSTRACT FROM AUTHOR]

Aim: To retrospectively assess the indications for and findings on 24‐hour electrocardiographic (Holter) monitoring in newborns, focussing on bradycardias and extrasystoles. Methods: Data included 337 term‐born infants. Holter indications were categorised into bradycardias below 80 beats per minute, extrasystoles, any tachycardia and other. Heart rate below 60 beats per minute, pathological atrioventricular conduction, supraventricular or ventricular tachycardia, or either atrial premature contractions over 10% or ventricular premature contractions over 5% of total beats were defined as significant arrhythmia on Holter. Results: The median age was 6 days (range: 2–62 days). Bradycardia (42%) or extrasystoles (32%) were the most common Holter indications. Fifty‐three infants (16%) had significant arrhythmia on Holter. Heart disease or 12‐lead electrocardiogram expressing extrasystoles or conduction abnormalities were associated with significant arrhythmias (p = 0.046 and p < 0.001, respectively). Twenty‐seven of 109 infants (25%) with extrasystoles as a Holter indication had abnormal Holter results, but only seven (6.4%) had significant arrhythmia on Holter if the 12‐lead electrocardiogram was normal. No pathology was found behind bradycardias below 80 beats per minute in the absence of heart disease. Conclusion: Among term newborns with extrasystoles or bradycardias, Holter monitoring could be targeted to infants with heart disease or abnormal electrocardiograms. [ABSTRACT FROM AUTHOR]

Aim: Extremely preterm infants are separated from their mothers immediately after birth and not placed skin‐to‐skin in routine neonatal intensive care unit settings. Visual and physical contact in the delivery room as a first cuddle potentially can facilitate early parent‐infant interaction and reduce the trauma of separation. Our aim in this study was to explore mothers' experience of delivery room cuddle by collecting qualitative feedback via emotional mapping. Methods: Six mothers experiencing delivery room cuddle had been recruited (GA of their babies 24 + 5–29 + 0 weeks, birth weight 540–1019 g). Using a descriptive qualitative approach, semi‐structured interviews were performed with six mothers following consent via Zoom or phone between September 2020 and March 2021. Interviews were transcribed using AI Otter and then analysed using thematic analysis. Results: Analysis of the participants' experiences revealed five themes: fears and hopes around delivery; the moment of delivery—recognising uncertainty; reclaiming normalcy; forming connections; and the journey ahead as an empowered parent. Conclusion: All mothers reported positive emotions about the cuddle with their baby. They highlighted that this physical contact was often the only positive and 'normal' birth experience they had from the time of delivery. [ABSTRACT FROM AUTHOR]

Aim: Over two thirds of newborn deaths occur in Africa and South Asia, and respiratory failure is a major contributor of these deaths. The exact availability of continuous positive airway pressure (CPAP) and surfactant in Africa is unknown. The aim of this study was to describe the availability of newborn respiratory care treatments in the countries of Africa. Methods: Surveys, in English, French and Portuguese, were sent to neonatal leaders in all 48 continental countries and the two islands with populations over 1 million. Results: Forty‐nine (98%) countries responded. Twenty‐one countries reported less than 50 paediatricians, and 12 countries had no neonatologists. Speciality neonatal nursing was recognised in 57% of countries. Most units were able to provide supplemental oxygen. CPAP was available in 63% and 67% of the most well‐equipped government and private hospitals. Surfactant was available in 33% and 39% of the most well‐equipped public and private hospitals, respectively. Availability of CPAP and surfactant was greatly reduced in smaller cities. Continuous oxygen saturation monitoring was only available in 33% of countries. Conclusion: The availability of proven life‐saving interventions in Africa is inadequate. There is a need to sustainably improve availability and use of these interventions. [ABSTRACT FROM AUTHOR]

Aim: We investigated the timing of survival differences and effects on morbidity for foetuses alive at maternal admission to hospital delivered at 22 to 26 weeks' gestational age (GA). Methods: Data from the EXPRESS (Sweden, 2004–07), EPICure‐2 (England, 2006) and EPIPAGE‐2 (France, 2011) cohorts were harmonised. Survival, stratified by GA, was analysed to 112 days using Kaplan‐Meier analyses and Cox regression adjusted for population and pregnancy characteristics; neonatal morbidities, survival to discharge and follow‐up and outcomes at 2–3 years of age were compared. Results: Among 769 EXPRESS, 2310 EPICure‐2 and 1359 EPIPAGE‐2 foetuses, 112‐day survival was, respectively, 28.2%, 10.8% and 0.5% at 22–23 weeks' GA; 68.5%, 40.0% and 23.6% at 24 weeks; 80.5%, 64.8% and 56.9% at 25 weeks; and 86.6%, 77.1% and 74.4% at 26 weeks. Deaths were most marked in EPIPAGE‐2 before 1 day at 22–23 and 24 weeks GA. At 25 weeks, survival varied before 28 days; differences at 26 weeks were minimal. Cox analyses were consistent with the Kaplan‐Meier analyses. Variations in morbidities were not clearly associated with survival. Conclusion: Differences in survival and morbidity outcomes for extremely preterm births are evident despite adjustment for background characteristics. No clear relationship was identified between early mortality and later patterns of morbidity. [ABSTRACT FROM AUTHOR]

Aim: We systematically reviewed the literature to identify the benefits of early skin‐to‐skin contact (SSC) for all gestational ages. Methods: The MEDLINE, Embase and CINAHL databases were searched for papers published in English from 1 January 1975 to 31 March 2020. Early SSC was defined as when the infant was placed directly onto the mother's chest within 180 min of birth. Two authors independently searched the databases, appraised study quality and extracted the study design and outcome data. The primary outcomes were the infants' physiological stability after birth: thermoregulation and stabilisation. The secondary outcomes were exclusive breastfeeding and mother‐infant interaction. Results: We reviewed 30 studies that assessed the benefits of early SSC: 22 comprised term‐born healthy infants and eight focused on preterm or ill infants. These included various gestational ages, birth methods and cultural backgrounds. The studies demonstrated that early SSC stabilised neonatal physiological parameters, promoted exclusive breastfeeding and supported bonding. Most of the data were from term and late preterm births. Conclusion: This systematic review showed that early SSC could be beneficial. Further studies that focus on providing very and extremely preterm infants with SSC, and parental experiences, are needed to enable SSC to be adopted as routine practice. [ABSTRACT FROM AUTHOR]

Aim: To review the evidence on safety of maintaining family integrated care practices and the effects of restricting parental participation in neonatal care during the SARS-CoV-2 pandemic.Methods: MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched from inception to the 14th of October 2020. Records were included if they reported scientific, empirical research (qualitative, quantitative or mixed methods) on the effects of restricting or promoting family integrated care practices for parents of hospitalised neonates during the SARS-CoV-2 pandemic. Two authors independently screened abstracts, appraised study quality and extracted study and outcome data.Results: We retrieved 803 publications and assessed 75 full-text articles. Seven studies were included, reporting data on 854 healthcare professionals, 442 parents, 364 neonates and 26 other family members, within 286 neonatal units globally. The pandemic response resulted in significant changes in neonatal unit policies and restricting parents' access and participation in neonatal care. Breastfeeding, parental bonding, participation in caregiving, parental mental health and staff stress were negatively impacted.Conclusion: This review highlights that SARS-CoV-2 pandemic-related hospital restrictions had adverse effects on care delivery and outcomes for neonates, families and staff. Recommendations for restoring essential family integrated care practices are discussed. [ABSTRACT FROM AUTHOR]

Aim: Following extreme preterm birth, there has traditionally been felt an imperative to rush baby to the neonatal unit for ongoing intensive care. Immediate needs of parents to bond with their babies through direct early physical contact have often been overlooked; many weeks can pass before parents get to hold their babies for the first time. Recognition of the importance of early contact is growing. We aimed to review the safety and value of routinely practising delivery room cuddles for extremely preterm babies. Methods: We reviewed delivery room cuddles in babies born <27 weeks' gestation in our centre between 2006 and 2017 via case‐control. We also conducted a questionnaire survey of mothers who experienced a delivery room cuddle to gain their feedback and perspectives. Results: We found no difference in age or temperatures on neonatal unit admission. There was no case of inadvertent extubation associated with cuddles. Parental feedback was very positive. Conclusion: With appropriate safeguards, delivery room cuddles are feasible and achievable for extremely preterm babies irrespective of birth gestation. Facilitation of the cuddle is an early and very important family‐centred care practice which seems much appreciated by parents and which may improve bonding, lactation, and maternal mental health. [ABSTRACT FROM AUTHOR]

AimTo investigate the relationship between breastmilk feeding in very-low-birth-weight infants in the neonatal intensive care unit and breastmilk feeding rates for all newborns by hospital.MethodsThis was a cross-sectional study of 111 California hospitals in 2007 and 2008. Correlation coefficients were calculated between overall hospital breastfeeding rates and breastmilk feeding rates of very-low-birth-weight infants. Hospitals were categorized in quartiles by crude and adjusted very-low-birth-weight infant rates to compare rankings between measures.ResultsCorrelation between breastmilk feeding rates of very-low-birth-weight infants and overall breastfeeding rates varied by neonatal intensive care unit level of care from 0.13 for intermediate hospitals to 0.48 for regional hospitals. For hospitals categorized in the top quartile according to overall breastfeeding rate, only 46% were in the top quartile for both crude and adjusted very-low-birth-weight infant rates. On the other hand, when considering the lowest quartile for overall breastfeeding hospitals, three of 27 (11%) actually were performing in the top quartile of performance for very-low-birth-weight infant rates.ConclusionsReporting hospital overall breastfeeding rates and neonatal intensive care unit breastmilk provision rates separately may give an incomplete picture of quality of care.

Provider concordance regarding elements of goals-of-care discussions in neonatal intensive care Keywords: end of life; neonatal; palliative care EN end of life neonatal palliative care 776 778 3 03/11/22 20220401 NES 220401 Clinicians may struggle to discuss goals of care with parents in the Neonatal Intensive Care Unit (NICU) and may view key elements of such conversations differently. We assessed simple percentage agreement of the responses for each Williams Instrument item amongst participants from the same discussion. [Extracted from the article]

Aim: To compare composite outcomes of neonatal mortality or morbidity using a split-week gestational age (GA) model to completed weeks GA maturity at 23-26 weeks gestation.Methods: This was a retrospective cohort study of infants born at 23-26 weeks GA. Outcomes using a split-week GA model defined as early (X, 0-3) and late (X, 4-6) with X being 23-26 weeks GA were compared to outcomes using completed weeks GA, with a similar comparison between the late split of the preceding week (X, 4-6) and early split of the subsequent week (X + 1, 0-3).Results: A total of 1345 infants were included in the study. Statistically significant differences were noted in outcomes between the early and late split of the gestational week at 24 (early vs late, 85.6% vs 73.0%), 25 (69.6% vs 56.6%) and 26 weeks (55.9% vs 37.4%), but not at 23 weeks GA (95.2% vs 94.5%). No statistically significant differences were noted between the late vs early part of the subsequent week (23, 4-6) vs (24, 0-3), and (24, 4-6) vs (25, 0-3) GA.Conclusion: Neonatal outcome estimates using a split week model differs from that based on the use of completed weeks of gestational maturity. [ABSTRACT FROM AUTHOR]

Aim: This study explored the attitudes of medical professionals to organ and tissue donation in paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the Netherlands. It also examined their compliance with the existing Dutch donation protocol and assessed whether a paediatric donation protocol was needed.Methods: We invited 966 professionals working in all eight PICUs and the two largest NICUs to complete an online survey from December 2016 until April 2017.Results: A quarter (25%) took part and they included PICU intensivists, neonatologists, nurses and other health and allied professionals. Most were female and nurses. More than half (54%) of the PICU respondents considered paediatric organ donation to be very important and 53% supported tissue donation. In contrast, only 22% of the NICU respondents believed that both neonatal organ and tissue donation were very important. Familiarity and compliance with the existing national donation protocol were low. PICU nurses had significantly less experience than PICU intensivists and felt less comfortable with the donation process. None of the NICU respondents had prior donation experience.Conclusion: Paediatric intensive care units and NICU professionals lack specialised knowledge and experience on organ and tissue donation. A comprehensive and clear paediatric donation protocol is clearly needed. [ABSTRACT FROM AUTHOR]

Aim: The aim was to determine whether preterm and full-term newborn infants could process maternal breast odour at a cortical level.Methods: Newborn infants were exposed to cloths containing their own mother's breast odour and freshly laundered control cloths for 10 seconds, while functional near-infrared spectroscopy measured cortical activation in their olfactory processing areas. We studied 45 newborn infants born at 28-41 weeks of gestation and divided them into three groups: full-term (37-41 weeks), late preterm (33-36 weeks) and very preterm (28-32 weeks). Cortical activation was defined as a regional increase of oxyhaemoglobin following maternal breast odour stimuli.Results: Full-term infants demonstrated bilateral activation of their olfactory cortices following exposure to maternal breast odour. Late preterm infants and very preterm boys exhibited unilateral cortical activation, unlike very preterm girls.Conclusion: Infants born from 32 weeks, and possibly earlier, could process low concentration maternal odours at a cortical level, which suggests they were more aware of their environment. These findings could make a significant contribution to improving the sensory environment of preterm infants and improve bonding. [ABSTRACT FROM AUTHOR]

Aim: Pulmonary hypertension (PH) frequently complicates neonatal hypoxaemic respiratory failure, but is inconsistently defined. We aimed to describe the variation among randomised controlled trials (RCTs) of inhaled nitric oxide (iNO), in relation to the definition of PH and/or hypoxaemic respiratory failure used to select patients for trial inclusion.Methods: PubMed, Cochrane Library and ClinicalTrials.gov were systematically searched for RCTs of iNO in neonates. Included studies were assessed for clinical and/or echocardiography criteria used to define PH/hypoxaemic respiratory failure.Results: Thirty-two trials were included in this review, of which 23 enrolled infants ≥34 weeks' gestation. Echocardiographic diagnosis was used in 21 studies, but there was considerable variation in the echocardiographic parameters used to diagnose PH. The most commonly used indices included markers of tricuspid regurgitation and extrapulmonary shunt.Conclusion: There is wide variation in the definition of PH used to select infants for inclusion into RCTs of iNO therapy in neonates. We recommend that an international consensus be reached on which parameters should be used and the thresholds defining severity of disease. [ABSTRACT FROM AUTHOR]

Aim: National survey to evaluate the uptake of Less Invasive Surfactant Administration (LISA) in neonatal units across England.Methods: A web-based survey was sent out by email to all 150 neonatal units in England. It consisted of questions regarding indications for LISA, the practicalities of the procedure and reasons for not using this technique.Results: The response rate was 96% (144/150 units). Only 11% of units are using LISA, but majority (78%) would consider implementing LISA on their unit. 56% would also consider LISA on delivery suite. Challenges identified are having a guideline and staff training. 61% of units have set the target population ≥27 weeks. On sub-analysis, for tertiary units, the trend for LISA is ≥26 weeks. The median FiO2 threshold for LISA is 0.3 (IQR 0.3-0.4) in less than 28 weeks gestational age (GA), and 0.4 in higher gestations. The most common suggestion for premedication is fentanyl (32%).Conclusion: The uptake of LISA in England is low comparing to the rest of Europe. Even though many units are considering implementing LISA, there is lack of training and national guidelines. There is urgent need for standardisation of practice and clear indications for LISA. [ABSTRACT FROM AUTHOR]

Aim: To determine agreement between neonatal capillary blood gases taken with plastic and glass tubes.Methods: An agreement study was carried out in a regional tertiary neonatal unit. Inpatient babies ≥1 kg were recruited to the study when parents gave consent. After taking the routine glass capillary tube sample, a plastic tube sample was taken and run if the heel continued to bleed. Successful sample pairs were recorded and analysed against pre-defined acceptable differences. Assessment was also made of differences in failure rates between tube types for each parameter.Results: Twenty-eight babies provided 135 blood gas pairs, of which five pairs were excluded. Successful pairing of results was achieved for pH in 105 valid samples. There were more failed plastic samples than glass, reaching significance for almost all parameters. pH, pO2 and pCO2 showed poor agreement (<80%) between glass and plastic tubes. On limited analysis of one successful blood gas pair per neonate to minimise bias, results remained non-reassuring.Conclusion: The findings of this study do not advocate switching from glass to plastic capillary tubes in our Newborn Intensive Care Unit. Further studies are required to assess agreement of glass and plastic capillary tubes for neonatal blood gas sampling. [ABSTRACT FROM AUTHOR]

Aim: Humidifying noninvasively ventilated preterm infants is critical to prevent dehydration of respiratory mucosa, but over-humidification can result in impaired airway patency and lung mechanics. This neonatal bench study investigated the humidity delivered using invasive and noninvasive humidification modes during nasal continuous positive airway pressure.Methods: The study was conducted at the neonatal intensive care unit of Emma Children's Hospital, the Netherlands, in March 2014. A mannequin was connected to a CareFusion Infant Flow SiPAP system, combined with a Fisher & Paykel MR850 humidifier and a Carefusion Infant Flow LP Generator. We measured the temperature, relative humidity and absolute humidity at the humidification chamber's expiratory port and at the patient's mask.Results: The absolute humidity at the mask was 35-40 mg H2 O/L at 38-39°C (relative humidity 74-80%) for the invasive mode of the humidifier and 23-27 mg H2 O/L at 34-35°C (relative humidity 63-70%) for the noninvasive mode. The absolute humidities exceeded the recommended values for the invasive mode of the humidifier, but not the noninvasive mode, and could be associated with increased condensation.Conclusion: The absolute humidity delivered by the humidifier in invasive mode could be associated with increased condensation, which has been associated with airway impairment. [ABSTRACT FROM AUTHOR]

Aim: This study determined the accuracy and speed of the NeoTapLifeSupport (NeoTapLS), a free smartphone application that aims to assess a neonate's heart rate.Methods: We asked 30 participants with a variety of backgrounds to test the NeoTapLS, which was developed by our own nonprofit organisation Tap4Life, to determine a randomly selected heart rate by auscultation or palpation. The study was carried out in 2014 at Sachs' Children and Youth Hospital, Sweden, using a Laerdal SimNewB manikin that simulates true values. The NeoTapLS calculates the heart rate based on the user's last three taps on the smartphone screen.Results: A total of 1200 measurements were carried out. A high correlation was found between measured and true values by auscultation (correlation coefficient 0.993) as well as by palpation (correlation coefficient 0.986) with 93.5% of the auscultations and 86.3% of the palpations differing from the true value by five beats or fewer. The mean time to the first estimated heart rate was 14.9 seconds for auscultation and 16.3 seconds for palpation.Conclusion: Heart rates could be accurately and rapidly assessed using the NeoTapLS on a manikin. A globally accessible mobile health system could offer a low-cost alternative to expensive medical equipment. [ABSTRACT FROM AUTHOR]

Aim: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).Methods: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.Results: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66-1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03-0.23, effect size d = 0.26.Conclusion: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress. [ABSTRACT FROM AUTHOR]

Aim: Serratia marcescens is a rare, but important, pathogen in hospital-acquired infections, especially in neonatal units. Outbreaks may cause significant mortality among neonates. This study describes how an outbreak of S. marcescens was handled in a neonatal intensive care unit in Finland in June 2015.Methods: Tampere University Hospital is the only hospital that offers intensive care for preterm neonates in the Pirkanmaa health district area in Finland. Between June 9, 2015 and June 29, 2015, seven neonates were screened positive for S. marcescens in the hospital. We examined the management and outcomes, including environmental sampling.Results: Two of the seven neonates developed a bloodstream infection, and one with S. marcescens sepsis died after six days of antibiotic treatment. The outbreak was rapidly managed with active hospital hygiene interventions, including strict hand hygiene, cleaning, patient screening, contact precautions and education. Environmental sampling was limited to one water tap and a ventilator, and the results were negative. The outbreak was contained within three weeks, and no further cases appeared. The screening of healthcare workers was not necessary.Conclusion: A S. marcescens outbreak caused significant morbidity in neonates and one death. Rapid hospital hygiene interventions and patient screening effectively contained the outbreak. [ABSTRACT FROM AUTHOR]

In a preceding study in the same setting, the CDC guidelines recommended empirical antibiotics to 7% more newborn infants than the EOS calculator (15% vs. 8%).2 Using these guidelines would have meant treating an additional 7691 newborn infants (7% of 109 877) as a trade-off for avoiding a treatment delay in only 8. Keywords: early-onset sepsis; EOS calculator; neonatal EN early-onset sepsis EOS calculator neonatal 1460 1461 2 06/10/22 20220701 NES 220701 Abbreviations CDC Centers for Disease Control and Prevention EOS early onset sepsis h hours We were very interested to read the paper by Hershkovich-Shporen et al.1 which retrospectively compared the Centers for Disease Control and Prevention (CDC) guidelines and the early-onset sepsis (EOS) calculator. A better sensitivity of centers for disease control guidelines for early-onset sepsis at four hours of age may not represent actual clinical superiority. [Extracted from the article]

Neonatologists have begun using superior vena cava flow as assessed by functional echocardiography to facilitate real-time decision-making on cardiovascular care. This review aims to describe the basis of the technique, summarise the evidence for its use and compare the technique to existing clinical, biochemical and radiological techniques for assessing neonatal circulatory status.Conclusion: Although echocardiographic measurements of superior vena cava flow, like other measures of perfusion, are not perfect, their noninvasive nature and ability to facilitate real-time decision-making means that at present, they remain the best available methodology of monitoring central perfusion in the neonatal population. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the reported use of data monitoring committees (DMCs), the frequency of interim analysis, prespecified stopping rules and early trial termination in neonatal randomised controlled trials (RCTs).Methods: We reviewed neonatal RCTs published in four high-impact general medical journals, specifically looking at safety issues including documented involvement of a DMC, stated interim analysis, stopping rules and early trial termination. We searched all journal issues over an 11-year period (2003-2013) and recorded predefined parameters on each item for RCTs meeting inclusion criteria.Results: Seventy neonatal trials were identified in four general medical journals: Lancet, New England Journal of Medicine (NEJM), British Medical Journal and Journal of American Medical Association. A total of 43 (61.4%) studies reported the presence of a DMC, 36 (51.4%) explicitly mentioned interim analysis, stopping rules were reported in 15 (21.4%) RCTs and seven (10%) trials were terminated early. The NEJM most frequently reported these parameters compared to the other three journals reviewed.Conclusion: While the majority of neonatal RCTs report on DMC involvement and interim analysis, there is still scope for improvement. Clear documentation of safety-related issues should be a central component of reporting in neonatal trials involving newborn infants. [ABSTRACT FROM AUTHOR]

Aim: This study investigated whether chorioamnionitis was associated with increased inflammation, dyslipidaemia and adverse cardiovascular phenotypes in the immediate postnatal period.Methods: This prospective case-control study included preterm infants (30(+0) -35(+6) weeks gestational age, GA) whose mothers did not have pregnancy-related conditions that may influence outcomes. Chorioamnionitis was diagnosed by placental histology, and infants were divided retrospectively into cases (chorioamnionitis-exposed) and controls (unexposed). Serum high-sensitivity C-reactive protein (hsCRP), lipid profile, far-wall abdominal aortic intima-media thickness (aIMT) and blood pressure (BP) were measured in the first week of life.Results: There were 20 (16 male, mean GA 32.4 weeks) cases and 31 (12 male, mean GA 32.6 weeks) controls. Histological chorioamnionitis was associated with a significant increase in hsCRP and a non-significant trend towards an adverse lipid profile. There was no evidence of differences in aIMT or BP.Conclusion: Preterm infants exposed to chorioamnionitis have greater postnatal inflammation. There were no early postnatal differences in aIMT or BP. The inflammatory stimulus of chorioamnionitis late in gestation may be of insufficient intensity and duration to result in immediate postnatal alterations to arterial structure. Cardiovascular follow-up of infants exposed to chorioamnionitis may identify differential risk trajectories and subsequent inflammatory responses. [ABSTRACT FROM AUTHOR]

Aim: To examine user ability and preference in performing bag-mask ventilation (BMV) with four different configurations of infant mannequins.Methods: Participants provided a 30-second period of BMV to a Resusci Baby mannequin (RB), NeoNatalie mannequin (NN), NN filled with air (NNA), NN filled with water (NNW) and NN filled with 50% air and 50% water mix (NNAW). Participants rated the fidelity of each configuration.Results: Of the 20 participants, 65% rated NNW as having a high level of fidelity (HLF) 'to hold' (50% for NNAW, 10% for RB and 0% for NNA) (p < 0.001). Half rated NNAW as having a HLF in 'tone' (40% for NNW, 20% for RB and 5% for NNA) (p = 0.008). About 45% of participants rated NNAW as having a HLF in 'appearance' (45% for the RB, 20% for NNA and 15% for NNW) (p = 0.035). About 35% of participants rated NNAW as having a HLF in how it 'felt to touch' (30% for NNW, 15% for RB and 10% for NNA) (p = 0.008). Half of participants rated NNAW as having a HLF in terms of 'weight' (45% for NNW, 40% for RB and 0% for NNA) (p = 0.003). Participants delivered the greatest number of effective ventilations to the NNW mannequin.Conclusion: The NNW and NNAW configurations had the highest fidelity and had the highest percentage of effective ventilations delivered. [ABSTRACT FROM AUTHOR]

Aim: To determine the accuracy of current methods of heart rate (HR) assessment.Methods: All participants palpated a simulated pulsating umbilicus (UMB), listened to a tapping rate (TAP) and auscultated a simulated HR (AUSC). A simulated HR of 54, 88 and 128 beats per minute (bpm) was randomised for all methods.Results: Twenty-nine healthcare staff participated in this study. Correct assessment of HR of 54 bpm as being within the 0-59 range occurred in 17.2% UMB, 17.2% TAP and 31% AUSC and was obtained in <10 seconds by 48.3%, 65.5% and 62.1%, respectively. A rate of 88 bpm was correctly assessed as within the 60-100 range in 82.8% UMB, 79.3% TAP and 79.3% AUSC and was obtained in <10 seconds by 55.2%, 58.6% and 55.2%, respectively. A rate of 128 bpm was identified as >100 bpm by 96.6% UMB, 93.1% TAP, and 93.1% AUSC and was obtained in <10 seconds by 51.7%, 55.2% and 62.1%, respectively.Conclusion: Current methods in assessing rates below 60 bpm are inaccurate and may overestimate HR. We recommend that these methods alone should not be relied upon in neonatal resuscitation and objective assessment of heart rate should be readily available at all newborn resuscitations. [ABSTRACT FROM AUTHOR]

Aim: To compare oesophageal and axilla temperatures in routine neonatal intensive care unit (NICU) care.Methods: Prospective observational study of NICU infants with indwelling oral/nasogastric tubes. Three simultaneous temperature measurements were taken: Physitemp axilla, digital Premie Faichney axilla in predictive mode and Physitemp oesophageal. Temperatures were measured on two separate days.Results: Fifty infants were studied over a range of gestational ages (median 28.9 weeks, IQR 25.8-30.6 weeks) and birthweights (median 1140 g, IQR 742-1498 g). Mean Physitemp oesophageal temperatures were 0.3 ± 0.1°C (range 0.1-0.6°C) higher than Physitemp axilla temperatures. After adjustment for weight, the Physitemp oesophageal-Physitemp axilla difference remained constant over the average oesophageal-axilla temperature range studied (p = 0.07). Physitemp oesophageal temperatures were not affected by weight (p = 0.2) or postmenstrual age (p = 0.51). Physitemp axilla temperatures decreased with increasing weight (p = 0.03) and postmenstrual age (p = 0.048). The Physitemp oesophageal-Physitemp axilla difference was greater for infants in cribs (mean ± SD = 0.4 ± 0.1°C) than in incubators (mean ± SD = 0.3 ± 0.1°C, p < 0.001). The relationship between oesophageal and digital Premie Faichney axilla temperature was similar to oesophageal and axilla Physitemp temperatures.Conclusion: Over a range of infant temperatures encountered in routine NICU care, oesophageal temperature is higher than axilla temperature, although the difference is small. Axillary temperatures measured by digital thermometers in predictive mode are comparable to core oesophageal temperatures. [ABSTRACT FROM AUTHOR]

Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27 weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies. [ABSTRACT FROM AUTHOR]

Aim: Despite the importance of neonatal skin stimulation, little is known about activation of the newborn human infant brain by sensory stimulation of the skin. We carried out functional magnetic resonance imaging (fMRI) to assess the feasibility of measuring brain activation to a range of mechanical stimuli applied to the skin of neonatal infants. Methods: We studied 19 term infants with a mean age of 13 days. Brain activation was measured in response to brushing, von Frey hair (vFh) punctate stimulation and, in one case, nontissue damaging pinprick stimulation of the plantar surface of the foot. Initial whole brain analysis was followed by region of interest analysis of specific brain areas. Results: Distinct patterns of functional brain activation were evoked by brush and vFh punctate stimulation, which were reduced, but still present, under chloral hydrate sedation. Brain activation increased with increasing stimulus intensity. The feasibility of using pinprick stimulation in fMRI studies was established in one unsedated healthy full-term infant. Conclusion: Distinct brain activity patterns can be measured in response to different modalities and intensities of skin sensory stimulation in term infants. This indicates the potential for fMRI studies in exploring tactile and nociceptive processing in the infant brain. [ABSTRACT FROM AUTHOR]

Autosomal dominant hypocalcaemia (ADH) is caused by activating variants in the calcium-sensing receptor (CASR) gene, but detailed information on the paediatric phenotype is limited. The current paper presents a case of severe ADH and systematically reviews the literature on ADH in children. Conclusion: We found that the severity of clinical neurological symptoms was inversely related to serum calcium levels and a high prevalence of renal calcifications and/or basal ganglia calcifications in children with ADH. [ABSTRACT FROM AUTHOR]

Aim Extremely premature infants experience long hospitalisation and high readmission rates within 30 days of discharge. This quality control investigation retrospectively explored the impact of the Creating Opportunities for Parent Empowerment ( COPE©) programme on these rates in an all referral, Level- IV small baby intensive care unit setting. Methods The parents of 303 extremely premature infants participated in the study. Of those, 135 were admitted before the implementation of COPE© and served as baseline historical controls, and the remaining 168 neonates received the intervention. Length of stay and readmission rates were analysed using parametric and nonparametric tests. Additional analyses were used to compare the two groups in terms of gestational age, birthweight and other acuity measures. Results Neonates who received COPE© required significantly reduced lengths of stay than the control neonates ( COPE© 127.1 ± 55.8 days vs. control 139.6 ± 61.9 days, p < 0.05) and significantly lower readmission rates ( COPE© 23.9% vs. control 13.2%, p = 0.05). Conclusion The COPE© programme promoted active parental engagement in the unit and significantly reduced hospital stays and readmission rates. Future interventions should identify the specific components of the programme that support the parents of extremely premature infants during the various phases of hospitalisation. [ABSTRACT FROM AUTHOR]

Atherosclerosis is a chronic inflammatory process that begins in early life. Improved identification of markers of early atherosclerosis via neonatal aortic intima-media thickness ( aIMT) measurement may allow the development of interventions to prevent or reduce later cardiovascular disease. Conclusion Using aIMT, studies have shown that antenatal factors such as intra-uterine growth retardation, prematurity, maternal factors and inflammation are associated with early cardiovascular changes. [ABSTRACT FROM AUTHOR]

Aim Various analgesic strategies are used before tracheal intubation of preterm newborns in the delivery room, due to the lack of a standard protocol and difficult venous access. This study evaluated the feasibility and efficacy of short venous catheter insertion and immediate ketamine analgesia for tracheal intubation of preterm newborns at birth in the delivery room. Methods Prospective observational pilot study, with ketamine and atropine used at the paediatrician's discretion. Pain score, heart rate, SpO2 nadirs, procedure duration and neonatal intensive care unit morbidity were recorded. Results Fifty-seven consecutive preterm newborns were included between January I and June 30, 2012: 15 in the no analgesia group and 39 in the intravenous ketamine group. Short catheter insertion failed in three newborns. The pain score was lower during laryngoscopy in the ketamine group (4 ± 0.7 vs. 2.9 ± 3.2 in the no analgesia group, p < 0.001). The heart rate nadir during tracheal intubation was 150.7 ± 29.6 bpm (vs. 112.6 ± 35.5 bpm in the no analgesia group, p < 0.01). Surfactant therapy was administered to 79.5% of newborns in the ketamine group (vs. 92.3%, p = 0.29) in the first 30 min of life. Conclusion Short venous catheter insertion with immediate ketamine analgesia plus atropine for tracheal intubation of preterm newborns in the delivery room was effective in decreasing pain and preventing vagal bradycardia. [ABSTRACT FROM AUTHOR]

There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20 mL at birth. Conclusion: A stomach capacity of 20 mL translates to a feeding interval of approximately 1 h for a term neonate. This corresponds to the gastric emptying time for human milk, as well as the normal neonatal sleep cycle. Larger feeding volumes at longer intervals may therefore be stressful and the cause of spitting up, reflux and hypoglycaemia. Outcomes for low birthweight infants could possibly be improved if stress from overfeeding was avoided while supporting the development of normal gastrointestinal physiology. Cycles between feeding and sleeping at 1‐h intervals likely meet the evolutionary expectations of human neonates. [ABSTRACT FROM AUTHOR]

Aims To test the hypothesis that exposure to ambient language in the womb alters phonetic perception shortly after birth. This two-country study aimed to see whether neonates demonstrated prenatal learning by how they responded to vowels in a category from their native language and another non-native language, regardless of how much postnatal experience the infants had. Method A counterbalanced experiment was conducted in Sweden (n = 40) and the USA (n = 40) using Swedish and English vowel sounds. The neonates (mean postnatal age = 33 h) controlled audio presentation of either native or non-native vowels by sucking on a pacifier, with the number of times they sucked their pacifier being used to demonstrate what vowel sounds attracted their attention. The vowels were either the English/i/or Swedish/y/in the form of a prototype plus 16 variants of the prototype. Results The infants in the native and non-native groups responded differently. As predicted, the infants responded to the unfamiliar non-native language with higher mean sucks. They also sucked more to the non-native prototype. Time since birth (range: 7-75 h) did not affect the outcome. Conclusion The ambient language to which foetuses are exposed in the womb starts to affect their perception of their native language at a phonetic level. This can be measured shortly after birth by differences in responding to familiar vs. unfamiliar vowels. [ABSTRACT FROM AUTHOR]

In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parent-infant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed. Conclusions: Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parent-infant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parent-infant closeness is a priority within neonatal care. [ABSTRACT FROM AUTHOR]

Aim: To evaluate implementation and results of neonatal hearing screening with automated auditory brainstem response (AABR) by bedside nurses in a single-centre neonatal intensive care unit (NICU). Methods: Retrospective review of charts of 2074 newborns admitted over a 4-year period. Results: One thousand eight hundred and 24 newborns (88%) were screened. A 'pass' result was obtained in 1761 patients (96.5%). From 63 infants with 'refer', 40 were tested with auditory brainstem response: in 28 hearing loss was confirmed. Three hundred and nine neonates were screened before postmenstrual age (PMA) of 34 weeks: 78% successfully passed the first test. Sixty-seven infants with 'refer' at the first test before PMA of 34 weeks were re-evaluated: 48 had normal hearing tests, 24 of whom still younger than 34 weeks. For 12 of 19 infants with 'refer' before 34 weeks, follow-up was available: in 7 hearing loss was confirmed. Conclusion: Neonatal hearing screening with AABR can be easily performed by the bedside nurse in the NICU even in premature babies before 34 weeks PMA. A 'pass' result can be obtained in almost 80% of them; a 'refer' result at that age, however, must be interpreted cautiously, as false 'refer' occurred in 5/12 of these infants. [ABSTRACT FROM AUTHOR]

Aim: This study explored inter-rater reliability, discriminative, construct and predictive validity of the Neurobehavioral Assessment of the Preterm Infant (NAPI) in a gestational-age-based cohort. Methods: The NAPI was conducted at 35 weeks post-menstrual age for 170 infants born <32 weeks. Cognitive and motor development was assessed at 2 years using the Mental Development Index (MDI) and Psychomotor Development Index (PDI) of Bayley Scales of Infant Development-II for 159 infants. Results: Only NAPI motor and irritability scores were significantly different between very (29-3 w) and extremely preterm (<28 w) infants. Results regarding construct validity were variable: there were weak correlations between NAPI motor scores and gestational age (r = −0.23; p = 0.003), days in NICU (r = −0.24; p = 0.001); NAPI alertness scores and days in NICU (r = −0.16; p = 0.037); and NAPI irritability scores and gestational age (r = 0.21; p = 0.006). There were no significant associations with other markers of adverse outcome. Only NAPI irritability scores were correlated with MDI scores (r = −0.16; p = 0.040) but accounted for little additional variance after adjustment for neonatal factors (ΔR2 = 0.035; p = 0.012). Conclusion: We found little evidence of the utility of the NAPI as a measure of short-term neurobehavioural function or for predicting neurodevelopmental outcomes in very preterm infants. It may have greater predictive power when used serially to detect delayed neurobehavioural maturation. [ABSTRACT FROM AUTHOR]

Aim: To explore the possible effects of hyaluronan, an endogenous mediator of inflammation, on monocyte surface expression of Toll-like receptors 2 and 4 in human umbilical cord blood ex vivo, and in a model mimicking Gram-negative neonatal sepsis. Methods: Term infant cord blood was obtained after elective caesarean sections, n = 15. Both unstimulated and lipopolysaccharide-stimulated (10 ng/mL) blood was incubated with 500 μg/mL high- or low-molecular-weight hyaluronan for 6 h. Expression of Toll-like receptors 2 and 4 on monocytes was measured using flow cytometry, and plasma concentrations of proinflammatory cytokines and matrix metalloproteinase 9 were analysed. Results (mean ± SEM): We found a significant decrease in Toll-like receptor 4 expression in the presence of high-molecular-weight hyaluronan (HMW HA) in unstimulated blood (median fluorescence intensity 141 ± 7.3 vs. 163 ± 9.8, p = 0.019). There were no significant changes in Toll-like receptor 2 expression. Levels of cytokines and matrix metalloproteinase 9 increased in the presence of both forms of hyaluronan. Conclusions: Our results confirm that hyaluronan affects the neonatal immune response. The biological significance of these findings requires further clarification. More studies are needed to validate the possible down-modulation of Toll-like receptor 4 exerted by HMW HA. [ABSTRACT FROM AUTHOR]

It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines. A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools. The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions. The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment. [ABSTRACT FROM AUTHOR]

Ventilator frequency is one of the determinants of tidal volume delivery during high-frequency ventilation. Clinicians increasingly use data on ventilator displays to inform their decisions. To measure the frequencies delivered by the Dräger Babylog 8000 plus ventilator when used in high-frequency mode. Ventilator waveforms using a test lung were recorded at the full range of settings 5-20 Hz using Spectra software at 1000 Hz. The changes in frequency produced by a 1- Hz change in set frequency were calculated. Actual and displayed frequencies were compared. For settings up to 12 Hz, median (range) difference between set and delivered frequencies was 0 (−0.4 to +0.1) Hz. Above 12 Hz, delivered frequency varied by −0.3 (−1.9 to +0.3) Hz. For 1- Hz changes in frequency settings, in the range 5-12 Hz, 1- Hz changes produced a change in delivered frequency of 1.0 (0.6-1.4) Hz. Above 12 Hz, the corresponding changes were 0.7 (0-2.9) Hz. The ventilator displays the set frequency during operation rather than the delivered frequency. At 12 Hz and below, the differences between set and delivered frequencies were relatively small compared with those at 13 Hz and higher. Above 13 Hz, the difference between set and delivered frequencies was up to 2.9 Hz. Some frequency setting changes did not result in a change in delivered frequency. [ABSTRACT FROM AUTHOR]

Objective: Meticillin-resistant staphylococcus aureus (MRSA) colonization on neonatal units is a common and important clinical problem. Effectiveness of polymerase chain reaction (PCR) for detecting MRSA nasal colonization of infants was evaluated and compared to culture-based methods. The effect of skin decolonization in affected infants was studied. Methods: Paired nasal swabs were collected from infants in our neonatal unit over a 12-month period (September 2007-2008). Colonization with MRSA was determined with a commercially available PCR method and compared to culture. Results: A total of 696 paired nasal swabs were taken. Three infants were colonized at the beginning and were included. There were positive PCRs in 12 infants. Five infants cultured MRSA from a nasal swab at the same time. No infants were culture-positive when PCR was negative (sensitivity 100%, specificity 99% compared to culture). PCR results were available within 24 h. Five infants were PCR+ and isolated meticillin-sensitive Staphylococcus aureus. This organism gave a false-positive PCR result. Two infants transferred in on broad-spectrum antibiotics were PCR+ and negative by culture. Decolonization led to negative nasal PCR and culture in 4/5 infants to discharge. Conclusions: PCR methods are sensitive and specific for detection of MRSA colonization in newborn infants of all gestations with results 1-2 days before culture. [ABSTRACT FROM AUTHOR]

Aim: To estimate mean costs of neonatal care for babies with birthweights ≤1800 g in a regional Level 3 unit and three Level 2 units providing short-term intensive care. Method: Babies ≤1800 g admitted to units in four hospitals in England over 15 months in 2001–2002 were audited until discharge. Unit costs (2005–2006 prices) were attributed to their resource items, including neonatal cot occupancy, pharmaceuticals, blood products and ambulance transfers. Bootstrapped mean costs were derived for the Level 3 unit and the Level 2 units combined. Results: The mean gestation period for 199 Level 3 babies was 29.5 weeks compared with 30.4 weeks for 192 Level 2 babies (p = 0.003). Mean costs excluding ambulance journeys were £17  861 per Level 3 baby and £12  344 per Level 2 baby. Level 3 babies <1000 g averaged £26  815, whereas Level 2 babies <1000 g were generally less costly than babies 1000–1499 g. Ambulances transported 76 Level 3 babies and 62 Level 2 babies; their adjusted mean costs were £18  495 and £12  881, respectively. Conclusion: By comprehensively costing resource components, the magnitude of total costs for low-birthweight babies has been revealed, thus demonstrating the importance of budgets for neonatal units being realistically determined by commissioners of neonatal services. [ABSTRACT FROM AUTHOR]