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Background: With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3–5 times more likely than other mothers to experience maternal mortality; babies are 2–3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements. Methods: Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation. Discussion: Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up. Trial registration: Australia & New Zealand Clinical Trial Registry #ACTRN12620000874910 (2 September 2020). [ABSTRACT FROM AUTHOR]

The article deals with the use of a property tax assessment method in ascertaining the market value of continuing care retirement communities (CCRC). Several legal arguments are raised in support of the method including the computation of the value based on all revenues generated by the real estate, the revenues of the CCRC include the entrance fees and the ambiguity in determining the character of the interest in state property tax laws. The types of life care contract are discussed.

The article cites a research study that examines the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors. It is said that the continuity of midwifery care benefits women at low risk of pregnancy complications. In this study, pregnant women were randomly assigned to either caseload midwifery care or standard maternity care.

Very preterm infants are at high risk of death and serious permanent brain damage, as occurs with intraventricular hemorrhage (IVH). Detrended fluctuation analysis (DFA) that quantifies the fractal correlation properties of physiological signals has been proposed as a potential method for clinical risk assessment. This study examined whether DFA of the arterial blood pressure (ABP) signal could derive markers for the identification of preterm infants who developed IVH. ABP data were recorded from a prospective cohort of 30 critically ill preterm infants in the first 1-3 h of life, 10 of which developed IVH. DFA was performed on the beat-to-beat sequences of mean arterial pressure (MAP), systolic blood pressure (SBP) and pulse interval, with short-term exponent ( α, for timescale of 4-15 beats) and long-term exponent ( α, for timescale of 15-50 beats) computed accordingly. The IVH infants were found to have higher short-term scaling exponents of both MAP and SBP ( α = 1.06 ± 0.18 and 0.98 ± 0.20) compared to the non-IVH infants ( α = 0.84 ± 0.25 and 0.78 ± 0.25, P = 0.017 and 0.038, respectively). The results have demonstrated that fractal dynamics embedded in the arterial pressure waveform could provide useful information that facilitates early identification of IVH in preterm infants. [ABSTRACT FROM AUTHOR]

Abstract: This paper describes a new polar-embedded stationary phase that contains an internal sulfonamide functional group coupled with an ether linkage. The synthesis involves functionalization of spherical silica particles with ligands prepared in a multi-step synthesis. The resulting material contains 16.5% carbon, corresponding to a ligand coverage of 2.4μmol/m2. Chromatographic evaluations indicates that the new stationary phase exhibits lower polarity than any other polar-embedded packings investigated, with additional features such as low silanol activity, excellent compatibility with 100% aqueous mobile phases, higher shape selectivity for polycyclic aromatic hydrocarbons, and strong affinity to nitro-containing compounds. [Copyright &y& Elsevier]

Purpose: Decreased peripheral lymphocyte counts are associated with survival after radiation therapy (RT) in several solid tumors, although they appear late during or after the radiation course and often correlate with other clinical factors. Here we investigate if absolute lymphocyte counts (ALCs) are independently associated with recurrence in pediatric medulloblastoma early during RT.Methods and Materials: We assessed 202 patients with medulloblastoma treated between 2000 and 2016 and analyzed ALC throughout therapy, focusing on both early markers (ALC during week 1 - ALCwk1; grade 3+ Lymphopenia during week 2 - Lymphopeniawk2) and late markers (ALC nadir). Uni- and multivariable regressions were used to assess association of clinical and treatment variables with ALC and of ALC with recurrence.Results: Thirty-six recurrences were observed, with a median time to recurrence of 1.6 years (range, 0.2-10.3) and 7.1 years median follow-up. ALC during RT was associated with induction chemotherapy (P < .001), concurrent carboplatin (P = .009), age (P = .01), and high-risk status (P = .05). On univariable analysis, high-risk disease (hazard ratio = 2.0 [1.06-3.9]; P = .03) and M stage≥1 (hazard ratio = 2.2 [1.1-4.4]) were associated with recurrence risk, as was lower ALC early during RT (ALCwk1, hazard ratio = 0.28 [0.12-0.65]; P = .003; Lymphopeniawk2, hazard ratio = 2.27 [1.1-4.6]; P = .02). Neither baseline ALC nor nadir correlated with outcome. These associations persisted when excluding carboplatin and pre-RT chemotherapy patients, and in the multivariable analysis accounting for confounders lymphocyte counts remained significant (ALCwk1, hazard-ratio = 0.23 [0.09-0.57]; P = .002; Lymphopeniawk2, hazard-ratio = 2.3 [1.1-4.8]; P = .03).Conclusions: ALC during weeks 1 and 2 of RT was associated with recurrence, and low ALC is an independent prognostic factor in medulloblastoma. Strategies to mitigate the risk of radiation-induced lymphopenia should be considered. [ABSTRACT FROM AUTHOR]

Background and Objectives: In anaemic preterm infants who receive packed red blood cell (PRBC) transfusions, changes to mesenteric tissue oxygenation and perfusion have been reported using a restrictive haemoglobin (Hb)‐based threshold. We aimed to investigate changes to hepatic tissue oxygenation and abdominal blood flow after PRBC transfusion and its association with enteral feeding using a liberal Hb threshold (as shown inTable1). 1 Table: Haemoglobin threshold level (g/L) to trigger PRBC transfusion: If respiratory support is required If respiratory support is not required Postnatal age Capillary haemoglobin (g/L) Central haemoglobin (g/L) Capillary haemoglobin (g/L) Central haemoglobin (g/L) Days 1‐7 ≤ 135 ≤ 122 ≤ 120 ≤ 109 Days 8‐14 ≤ 120 ≤ 109 ≤ 100 ≤ 90 Days 15 until discharge ≤ 100 ≤ 90 ≤ 85 ≤ 77 Material and Methods: We prospectively studied a cohort of preterm infants born at < 32 weeks' gestation who received at least one PRBC transfusion and monitored them immediately before (Time 1), immediately after (Time 2) and 24 hours after transfusion (Time 3). Data obtained included physiological parameters, the hepatic tissue oxygenation index and pulsed Doppler ultrasound measurements in the abdominal arterial circulation. Additionally, the effects of withholding enteral feeds were investigated. Results: We monitored 50 PRBC transfusion episodes in 40 preterm infants, in whom the mean gestational age was 26.72 weeks (±1.6 weeks) and the mean birth weight was 855.25 g (±190.7 g). We observed significant changes to pulsed Doppler measurements in abdominal arterial circulation (coeliac artery mean peak systolic velocity Time 2 [75.08 cm/sec] versus Time 3 [71.13 cm/sec]; mean end‐diastolic velocity Time 2 [15.71 cm/sec] versus Time 3 [13.76 cm/sec]; mean resistive index Time 2 0.78 versus Time 3 0.80, right renal artery mean peak systolic velocity Time 1 58.28 cm/sec versus Time 2 50.97 cm/sec, left renal artery mean peak systolic velocity Time 1 49.20 cm/sec versus Time 2 45.40 cm/sec), but not to hepatic tissue oxygenation after PRBC transfusion (Time 1 mean 53.66 [SD, 13.34]; Time 2 mean 54.93 [SD, 9.3]; Time 3 mean 55.64 [SD, 12.86]). There were no changes to hepatic tissue oxygenation or mesenteric blood flow from withholding enteral feeds during PRBC transfusion. There were no local adverse effects from hepatic tissue oxygenation monitoring. Conclusion: In mildly anaemic preterm infants, when allowing a liberal Hb threshold‐based trigger for PRBC transfusion, changes in abdominal arterial circulation were present, but not in hepatic tissue oxygenation. Withholding enteral feeds during PRBC transfusion had no impact on hepatic tissue oxygenation or mesenteric flows. [ABSTRACT FROM AUTHOR]

This is an Australia New Zealand Neonatal Network (ANZNN) wide survey to identify current practice and guide future practice improvement for the use of laryngeal mask airway (LMA) during neonatal resuscitation. An online questionnaire containing 13 questions was sent out to all tertiary neonatal centres (n = 29 units) and neonatal transport units (n = 4) within ANZNN. The non-tertiary (level-II) centres were not included. Response from a senior neonatologist at each centre was received and evaluated. Twenty-two services (67%) had LMA available; of that only, 40% felt the competency of staff to be adequate; and 59% had routine training in LMA use. During neonatal resuscitation, 68% units reported using LMA if endotracheal intubation was unsuccessful after two or more failed intubation attempts and only 18% used it before intubation if face mask ventilation was inadequate. This survey highlighted variations in practice across the tertiary neonatal centres in ANZNN network. One-third of the units lack LMA availability and the units with LMA, face concerns of underutilisation and lack of skills for its use. [ABSTRACT FROM AUTHOR]

Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women’s depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to the neonatal intensive care unit, low birth weight infants, and artificial feeding. Objective: To determine if caseload midwifery or young women's clinic are associated with improved perinatal outcomes when compared to standard care. Design: A retrospective cohort study. Setting: A tertiary Australian hospital where routine maternity care is delivered alongside two community-based maternity care models specifically for young women aged 21 years or less: caseload midwifery (known midwife) and young women's clinic (rostered midwife). Participants: All pregnant women aged 21 years or less, with a singleton pregnancy, who attended a minimum of two antenatal visits, and who birthed a baby (without congenital abnormality) at the study hospital during May 2008 to December 2012. Methods: Caseload midwifery and young women's clinic were each compared to standard maternity care, but not with each other, for four primary outcomes: preterm birth (<37 weeks gestation), low birth weight infants (<2500g), neonatal intensive care unit admission, and breastfeeding initiation. Two analyses were performed on the primary outcomes to examine potential associations between maternity care type and perinatal outcomes: intention-to-treat (model of care at booking) and treatment-received (model of care on admission for labour/birth). Results: 1908 births were analysed by intention-to-treat and treatment-received analyses. Young women allocated to caseload care at booking, compared to standard care, were less likely to have a preterm birth (adjusted odds ratio 0.59 (0.38-0.90, p = 0.014)) or a neonatal intensive care unit admission adjusted odds ratio 0.42 (0.22-0.82, p = 0.010). Rates of low birth weight infants and breastfeeding initiation were similar between caseload and standard care participants. Participants allocated to young women's clinic at booking, compared to standard care, were less likely to have a low birth weight infant adjusted odds ratio 0.49 (0.24-1.00, p = 0.049), however when analysed by treatment-received, this finding was not significant. There was no difference in the other primary outcomes. Conclusions: Young women who were allocated to caseload midwifery at booking, and/or were receiving caseload midwifery at the time of admission for birth, were less likely to experience preterm birth and neonatal intensive care unit admission. [ABSTRACT FROM AUTHOR]

Background: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in “alongside hospital” birth centers in Australia during 1999 to 2002 using nationally collected data. Methods: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. Results: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. Conclusions: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother’s parity. (BIRTH 34:3 September 2007) [ABSTRACT FROM AUTHOR]

Objective To study the association between volume of hospital births per annum and birth outcome for low risk women. Design Population-based study using the National Perinatal Data Collection (NPDC). Setting Australia. Participants Of 750,491 women who gave birth during 1999–2001, there were 331,147 (47.14%) medically ‘low risk’ including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae. Methods The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point. Main outcome measures Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100–500, 501–1000, 1001–2000 and >2001 births per annum. Results Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14–0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54–0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28–0.42); instrumental birth (AOR 0.80; 99% CI 0.69–0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49–0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10–0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62–0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29–0.36); instrumental birth (AOR 0.52; 99% CI 0.41–0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33–0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07–0.12). Conclusions In Australia, lower hospital volume is not associated with adverse outcomes for low risk women. [ABSTRACT FROM AUTHOR]

Background: Continuous positive airway pressure (CPAP) is a recommended first-line therapy for infants with respiratory distress at birth. Resuscitation devices incorporating CPAP delivery can have significantly different imposed resistances affecting airway pressure stability and work of breathing., Aim: To compare CPAP performance of two resuscitation devices (Neopuff T-piece resuscitator and rPAP) in a neonatal lung model simulating spontaneous breathing effort at birth., Methods: The parameters assessed were variation in delivered pressures (∆P), tidal volume (VT), inspiratory effort (model pressure respiratory muscle (PRM)) and work of breathing (WOB). Two data sequences were required with Neopuff and one with rPAP: (1) set PRM with changes in VT and (2) constant VT (preterm 6 mL, term 22 mL) with increased effort. Data were collected at CPAP settings of 5, 7 and 9 cmH 2 O using a 1 kg preterm (Compliance: 0.5 mL/cmH 2 O) and 3.5 kg term (1.0 mL/cmH 2 O) model., Results: 2298 breaths were analysed (760 rPAP, 795 Neopuff constant VT, 743 Neopuff constant PRM). With CPAP at 9 cmH 2 O and set VT the mean ∆P (cmH 2 O) rPAP vs Neopuff 1.1 vs 5.6 (preterm) and 1.9 vs 13.4 (term), WOB (mJ) 4.6 vs 6.1 (preterm) and 35.3 vs 44.5 (term), and with set PRM mean VT (ml) decreased to 6.2 vs 5.2 (preterm) and 22.3 vs 17.5 (term) p<0.001. Similar results were found at pressures of 5 and 7 cmH 2 O., Conclusion: rPAP had smaller pressure swings than Neopuff at all CPAP levels and was thus more pressure stable. WOB was higher with Neopuff when VT was held constant. VT reduced with Neopuff when respiratory effort was constant., Competing Interests: Competing interests: T Drevhammar is one of the inventors of rPAP., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Computational signal preprocessing is a prerequisite for developing data-driven predictive models for clinical decision support. Thus, identifying the best practices that adhere to clinical principles is critical to ensure transparency and reproducibility to drive clinical adoption. It further fosters reproducible, ethical, and reliable conduct of studies. This procedure is also crucial for setting up a software quality management system to ensure regulatory compliance in developing software as a medical device aimed at early preclinical detection of clinical deterioration., Objective: This scoping review focuses on the neonatal intensive care unit setting and summarizes the state-of-the-art computational methods used for preprocessing neonatal clinical physiological signals; these signals are used for the development of machine learning models to predict the risk of adverse outcomes., Methods: Five databases (PubMed, Web of Science, Scopus, IEEE, and ACM Digital Library) were searched using a combination of keywords and MeSH (Medical Subject Headings) terms. A total of 3585 papers from 2013 to January 2023 were identified based on the defined search terms and inclusion criteria. After removing duplicates, 2994 (83.51%) papers were screened by title and abstract, and 81 (0.03%) were selected for full-text review. Of these, 52 (64%) were eligible for inclusion in the detailed analysis., Results: Of the 52 articles reviewed, 24 (46%) studies focused on diagnostic models, while the remainder (n=28, 54%) focused on prognostic models. The analysis conducted in these studies involved various physiological signals, with electrocardiograms being the most prevalent. Different programming languages were used, with MATLAB and Python being notable. The monitoring and capturing of physiological data used diverse systems, impacting data quality and introducing study heterogeneity. Outcomes of interest included sepsis, apnea, bradycardia, mortality, necrotizing enterocolitis, and hypoxic-ischemic encephalopathy, with some studies analyzing combinations of adverse outcomes. We found a partial or complete lack of transparency in reporting the setting and the methods used for signal preprocessing. This includes reporting methods to handle missing data, segment size for considered analysis, and details regarding the modification of the state-of-the-art methods for physiological signal processing to align with the clinical principles for neonates. Only 7 (13%) of the 52 reviewed studies reported all the recommended preprocessing steps, which could have impacts on the downstream analysis., Conclusions: The review found heterogeneity in the techniques used and inconsistent reporting of parameters and procedures used for preprocessing neonatal physiological signals, which is necessary to confirm adherence to clinical and software quality management system practices, usefulness, and choice of best practices. Enhancing transparency in reporting and standardizing procedures will boost study interpretation and reproducibility and expedite clinical adoption, instilling confidence in the research findings and streamlining the translation of research outcomes into clinical practice, ultimately contributing to the advancement of neonatal care and patient outcomes., (©Jessica Rahman, Aida Brankovic, Mark Tracy, Sankalp Khanna. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 20.08.2024.)

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., Competing Interests: Competing interests: The ResusRight is a startup company founded by MBT, MH, MCrott and M B to commercialise the prototype Juno monitor studied. MT is an unpaid medical consultant for the ResusRight and a minor share holder. MH is an unpaid engineering consultant for the ResusRight and a minor share holder. MCrott is a director and chief technical officer for ResusRight and is a shareholder. MB is a director chief executive officer for ResusRight and is a shareholder., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although not universal, active care is being offered to infants weighing < 500 g at birth, referred to as ultra-low birth weight (ULBW) infants appropriate for gestational age. These infants have the greatest risk of dying or developing major morbidities. ULBW infants face challenges related to fluid and heat loss as well as skin injury in the initial days of life from extreme anatomical and physiological immaturity of the skin. Although there is an emerging literature on the outcomes of ULBW infants, there is a paucity of evidence to inform practice guidelines for delivering optimal care to this cohort of infants., Data Sources: A comprehensive review of the literature was performed using the PubMed and Embase databases. Searched keywords included "thermoregulation or body temperature regulation", "incubator humidity", "skin care", "infant, extremely low birth weight" and "ultra-low birth weight infants"., Results: Evidences for thermoregulation, incubator humidity, and skincare practices are available for preterm infants weighing < 1500 g at birth but not specifically for ULBW infants. Studies on thermoregulation, incubator humidity, or skincare practices had a small sample size and did not include a sub-group analysis for ULBW infants. Current practice recommendations in ULBW infants are adopted from research in very and/or extremely low birth weight infants., Conclusions: This narrative review focuses on challenges in thermoregulation, incubator humidity, and skincare practices in ULBW infants, highlights current research gaps and suggests potential developments for informing practices for improving health outcomes in ULBW infants. Video abstract (MP4 1,49,115 kb)., (© 2024. The Author(s).)

Accurate identification of the QRS complex is critical to analyse heart rate variability (HRV), which is linked to various adverse outcomes in premature infants. Reliable and accurate extraction of HRV characteristics at a large scale in the neonatal context remains a challenge. In this paper, we investigate the capabilities of 15 state-of-the-art QRS complex detection implementations using two real-world preterm neonatal datasets. As an attempt to improve the accuracy and reliability, we introduce a weighted ensemble-based method as an alternative. Obtained results indicate the superiority of the proposed method over the state of the art on both datasets with an F1-score of 0.966 (95% CI 0.962-0.97) and 0.893 (95% CI 0.892-0.894). This motivates the deployment of ensemble-based methods for any HRV-based analysis to ensure robust and accurate QRS complex detection.

Introduction: Due to concerns of oxidative stress and injury, most clinicians currently use lower levels of fractional inspired oxygen (FiO2, 0.21-0.3) to initiate respiratory support for moderate to late preterm (MLPT, 32-36 weeks gestation) infants at birth. Whether this practice achieves recommended oxygen saturation (SpO2) targets is unknown., Methods: We aimed to determine SpO2 trajectories of MLPT infants requiring respiratory support at birth. We conducted a prospective, opportunistic, observational study with consent waiver. Preductal SpO2 readings were obtained during the first 10 min of life from infants between 32 and 36 weeks gestation requiring respiratory support in the delivery room. Primary outcome was reaching a minimum SpO2 80% at 5 min of life. The study was prospectively registered (ACTRN12620001252909)., Results: A total of 76 eligible infants were recruited between February 2021 and March 2022 from 5 hospitals in Australia. Most (n = 58, 76%) had respiratory support initiated with FiO2 0.21 (range 0.21-1.0) using CPAP (92%). Median SpO2 at 5 min was 81% (interquartile range [IQR] 67-90) and 93% (IQR 86-96) at 10 min. At 5 min, 18/43 (42%) infants had SpO2 below 80% and only 8/43 (19%) reached SpO2 80-85%., Conclusions: Many MLPT infants requiring respiratory support do not achieve recommended SpO2 targets. In very preterm infants, SpO2 <80% at 5 min of life increases risk of death, intraventricular haemorrhage, and neurodevelopmental impairment. The implications on this practice on the health outcomes of MLPT infants are unclear and require further research., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Introduction: Assessment of bowel health in ill preterm infants is essential to prevent and diagnose early potentially life-threatening intestinal conditions such as necrotizing enterocolitis. Auscultation of bowel sounds helps assess peristalsis and is an essential component of this assessment., Aim: We aim to compare conventional bowel sound auscultation using acoustic recordings from an electronic stethoscope to real-time bowel motility visualized on point-of-care bowel ultrasound (US) in neonates with no known bowel disease., Methods: This is a prospective observational cohort study in neonates on full enteral feeds with no known bowel disease. A 3M™ Littmann® Model 3200 electronic stethoscope was used to obtain a continuous 60-s recording of bowel sounds at a set region over the abdomen, with a concurrent recording of US using a 12l high-frequency Linear probe. The bowel sounds heard by the first investigator using the stethoscope were contemporaneously transferred for a computerized assessment of their electronic waveforms. The second investigator, blinded to the auscultation findings, obtained bowel US images using a 12l Linear US probe. All recordings were analyzed for bowel peristalsis (duration in seconds) by each of the two methods., Results: We recruited 30 neonates (gestational age range 27-43 weeks) on full enteral feeds with no known bowel disease. The detection of bowel peristalsis (duration in seconds) by both methods (acoustic and US) was reported as a percentage of the total recording time for each participant. Comparing the time segments of bowel sound detection by digital stethoscope recording to that of the visual detection of bowel movements in US revealed a median time of peristalsis with US of 58%, compared to 88.3% with acoustic assessment ( p  < 0.002). The median regression difference was 26.7% [95% confidence interval (CI) 5%-48%], demonstrating no correlation between the two methods., Conclusion: Our study demonstrates disconcordance between the detection of bowel sounds by auscultation and the detection of bowel motility in real time using US in neonates on full enteral feeds and with no known bowel disease. Better innovative methods using artificial intelligence to characterize bowel sounds, integrating acoustic mapping with sonographic detection of bowel peristalsis, will allow us to develop continuous neonatal bowel sound monitoring devices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Priyadarshi, Tracy, Kothari, Sitaula, Hinder, Marzbanrad, Morakeas, Trivedi, Badawi and Rogerson.)

Premature babies and those born with a medical condition are cared for within the neonatal intensive care unit (NICU) in hospitals. Monitoring physiological signals and subsequent analysis and interpretation can reveal acute and chronic conditions for these neonates. Several advanced algorithms using physiological signals have been built into existing monitoring systems to allow clinicians to analyse signals in real time and anticipate patient deterioration. However, limited enhancements have been made to interactively visualise and adapt them to neonatal monitoring systems. To bridge this gap, we describe the development of a user-friendly and interactive dashboard for neonatal vital signs analysis written in the Python programming language where the analysis can be performed without prior computing knowledge. To ensure practicality, the dashboard was designed in consultation with a neonatologist to visualise electrocardiogram, heart rate, respiratory rate and oxygen saturation data in a time-series format. The resulting dashboard included interactive visualisations, advanced electrocardiogram analysis and statistical analysis which can be used to extract important information on patients' conditions.Clinical Relevance- This will support the care of preterm infants by allowing clinicians to visualise and interpret physiological data in greater granularity, aiding in patient monitoring and detection of adverse conditions. The detection of adverse conditions could allow timely and potentially life-saving interventions for conditions such as sepsis and brain injury.

Background: Newborn resuscitation guidelines recommend positive pressure ventilation (PPV) for newborns who do not establish effective spontaneous breathing after birth. T-piece resuscitator systems are commonly used in high-resource settings and can additionally provide positive end-expiratory pressure (PEEP). Short expiratory time, high resistance, rapid dynamic changes in lung compliance and large tidal volumes increase the possibility of incomplete exhalation. Previous publications indicate that this may occur during newborn resuscitation. Our aim was to study examples of incomplete exhalations in term newborn resuscitation and discuss these against the theoretical background., Methods: Examples of flow and pressure data from respiratory function monitors (RFM) were selected from 129 term newborns who received PPV using a T-piece resuscitator. RFM data were not presented to the user during resuscitation., Results: Examples of incomplete exhalation with higher-than-set PEEP-levels were present in the recordings with visual correlation to factors affecting time needed to complete exhalation., Conclusions: Incomplete exhalation and the relationship to expiratory time constants have been well described theoretically. We documented examples of incomplete exhalations with increased PEEP-levels during resuscitation of term newborns. We conclude that RFM data from resuscitations can be reviewed for this purpose and that incomplete exhalations should be further explored, as the clinical benefit or risk of harm are not known.

For the care of neonatal infants, abdominal auscultation is considered a safe, convenient, and inexpensive method to monitor bowel conditions. With the help of early automated detection of bowel dysfunction, neonatologists could create a diagnosis plan for early intervention. In this article, a novel technique is proposed for automated peristalsis sound detection from neonatal abdominal sound recordings and compared to various other machine learning approaches. It adopts an ensemble approach that utilises handcrafted as well as one and two dimensional deep features obtained from Mel Frequency Cepstral Coefficients (MFCCs). The results are then refined with the help of a hierarchical Hidden Semi-Markov Models (HSMM) strategy. We evaluate our method on abdominal sounds collected from 49 newborn infants admitted to our tertiary Neonatal Intensive Care Unit (NICU). The results of leave-one-patient-out cross validation show that our method provides an accuracy of 95.1% and an Area Under Curve (AUC) of 85.6%, outperforming both the baselines and the recent works significantly. These encouraging results show that our proposed Ensemble-based Deep Learning model is helpful for neonatologists to facilitate tele-health applications.

This review describes the sonographic appearances of the neonatal bowel in Necrotising enterocolitis. It compares these findings to those seen in midgut-Volvulus, obstructive intestinal conditions such as milk-curd obstruction, and slow gut motility in preterm infants on continuous positive airway pressure (CPAP)-CPAP belly syndrome. Point-of-care bowel ultrasound is also helpful in ruling out severe and active intestinal conditions, reassuring clinicians when the diagnosis is unclear in a non-specific clinical presentation where NEC cannot be excluded. As NEC is a severe disease, it is often over-diagnosed, mainly due to a lack of reliable biomarkers and clinical presentation similar to sepsis in neonates. Thus, the assessment of the bowel in real-time would allow clinicians to determine the timing of re-initiation of feeds and would also be reassuring based on specific typical bowel characteristics visualised on the ultrasound., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Priyadarshi, Rogerson, Cruzado, Crow, Hinder, Popat, Soundappan, Badawi and Tracy.)

Aim: Estimation of end-tidal carbon dioxide (EtCO 2 ) with capnography can guide mask ventilation in infants born at less than 30 weeks of gestation. Chemical-sensitive colorimetric devices to detect CO 2 are widely used at resuscitation. We aimed to quantify EtCO 2 in the first breaths following initiation of mask ventilation at birth and correlated need for endotracheal intubation., Methods: Infants <30 weeks gestation receiving mask ventilation were randomised into two groups of mask-hold technique (one-person vs. two-person). Data on EtCO 2 in the first 30 breaths, time to achieve 5 mmHg, 10 mmHg and 15 mmHg CO 2 using a respiratory function monitor was determined., Results: Twenty-five infants with a mean gestation of 27.3 (±3 weeks) and mean birth weight 920.4 (±188.3 g) were analysed. The median EtCO 2 was 5.6 mmHg in the first 10 breaths, whereas it was 12.6 mmHg for 11-20 breaths and 18 mmHg for 21-30 breaths. There was no significant difference in maximum median EtCO 2 for the first 20 breaths, although EtCO 2 was significantly lower in infants who were intubated (32.0 vs. 15.0, p = 0.018)., Conclusion: EtCO 2 monitoring in infants <30 weeks gestation at birth is feasible and reflective of alveolar ventilation. EtCO 2 may help guide ventilation of preterm infants at birth., (© 2022 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)