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Background: Pneumothoraces in newborn infants are associated with significant mortality and morbidity (e.g. intraventricular haemorrhage, IVH and chronic lung disease, CLD). Registry data such as from the ANZNN often report only cases of pneumothoraces that were drained using thoracentesis. We aimed to investigate cases of pneumothoraces (both treated using thoracentesis and conservatively managed) from our centre over a 10-year period in order to ascertain rates and outcomes. Method(s): We interrogated our database for cases of pneumothoraces in infants admitted from Jan 2003 to Dec 2012, prior to widespread use of pigtail catheters. A case control study with control infant matched to each baby with pneumothorax by gestational age (GA) +/- 3 days and birth weight (BW) +/- 15%. We performed statistical analyses (univariate and multivariate) using Stata 14. Result(s): 218 cases of pneumothorax (121 drained and 97 conservatively managed) were identified from 2003 to 2012 with median(IQR) GA 35.5(31-38) weeks, BW of 2599(1461-3271) grams with a median (range) of 22 (15-31) cases per annum. No significant difference in rate per annum was detected (p = 0.9). Rate of CLD (OR 1.5; 0.67-3.33,p = 0.11), discharged with home oxygen (OR1.63;0.67-3.92,p = 0.179) and IVH (OR1.14:0.41-3.15, p = 0. 078) were not significantly different. Antenatal use was similar for both group (p = 0.136) with no difference between gender (p = 0.136). In logistic regression analysis, the odds ratio for dying in infants with pneumothoraces was 4.0 (95% CI 1.8-8.9). Conclusion(s): The 10-year trend did not show change in the rate of conservatively managed or treated pneumothoraces in our NICU. Mortality was higher for infants with pneumothoraces although significant morbidity was not noted.

Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method(s): Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Result(s): VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and >=32 weeks, AUC 0.50-0.65; >=1500 g and <32 weeks, AUC 0.60-0.62). Conclusion(s): There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.Copyright © 2017 The Author(s).

© 2017 The Author(s). Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.

Introduction: Chorioamnionitis is a risk factor for preterm delivery. Intrauterine infection leads to the fetal inflammatory response which is characterised by elevated cytokine levels. Chorioamnionitis is reported to cause accelerated but abnormal lung maturation, resulting in decreased incidence of respiratory distress syndrome (RDS) but increased chronic lung disease (CLD), and predisposes the infant to cerebral injury. Objective(s): To investigate the relation between chorioamnionitis and RDS, CLD, cerebral lesions, neurodevelopmental outcome and mortality in a cohort of extremely premature infants. Material(s) and Method(s): Infants born between 1997 and 2001 with a gestational age of less than 28 weeks or a birth weight of less than 1000 g were divided into two groups: Group 1 with evidence of chorioamnionitis and Group 2 without. Outcomes of these two groups of infants were compared. Result(s): A total of 388 infants were included (105 in Group 1 and 283 in Group 2). Chorioamnionitis was significantly associated with an increased risk of extreme preterm delivery. Group 1 showed a trend towards an increased incidence of CLD and mortality, while the incidence of periventricular leukomalacia, retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC) were similar between the two groups. Subgroup analysis of 2-year neurodevelopmental outcome showed an increased trend towards cerebral palsy and visual impairment, while the incidence of developmental delay and hearing impairment are similar between the two groups. Conclusion(s): Extremely preterm infants with chorioamnionitis showed a trend towards an increased incidence of CLD, mortality, cerebral palsy and visual impairement, but a decreased risk of RDS.

Background: The Neonatal Intensive Care Unit (NICU) at Monash Newborn is part of an integrated perinatal centre, where infants requiring surgery can be treated in-house. Emergency surgery can be performed within our NICU itself, if necessary. Preterm infants who require laparotomy for either spontaneous intestinal perforations (SIP) or perforated necrotising enterocolitis (pNEC) represent a group of infants with high mortality (ranging from 20 to 50%). The aim is to study the outcome of infants with SIP and pNEC from our centre (over a 5-year period). Method(s): Preterm infants (2004 to mid-2009) <32 weeks gestation who had diagnoses of either SIP or pNEC were identified from our NICU database. X-Ray images and reports were re-assessed. A proforma was used to extract data for these infants. Result(s): A total of 21 infants were identified. Eleven infants had SIP while 10 had pNEC. The average age (+/-SD) when laparotomy occurred was 6.9 (+/-5.9) days for SIP and 33.1 (+/-19.6) days for pNEC (t-test; P = 0.002) with overall age of 19.2 (+/-19.3) days. Overall mortality rate was 23.8% (18.2% for SIP and 30% for pNEC). Median (IQR) length of stay (LOS) for all survivors was 109 (64 to 199) days, while SIP infants' LOS was 70 (38 to 199) days and pNEC infants' LOS was 143 (123 to 183) days. Three infants from the SIP group had grade III/IV IVH while 1 infant with pNEC had PVL. Conclusion(s): The mortality rate from our centre is comparable to published outcomes. SIP presented with perforation at a significantly earlier age compared to pNEC.

Background: Necrotizing enterocolitis (NEC) is an acute abdominal emergency of unknown etiology predominantly affecting preterm infants. We describe a cluster of NEC in a level III NICU involving 15 infants over a 6-month period. Cohorting and stringent infection control measures were associated with termination of the cluster. A case-control study was used to investigate potential risk factors associated with development of NEC. Method(s): Stool samples were collected from 55 infants (10 of 15 NEC and 45 non-NEC controls). Enteric pathogens were identified by culture and/or molecular diagnostic techniques. For the case-control study, controls were selected from admitted neonates during the same time and in the preceding 6-month period, matched for gestation and birthweight. Result(s): Forty percent (4/10) of NEC infants had norovirus RNA detected compared with 9% (4/45) of non-NEC infants (OR: 6.83, 95% CI: 1.3-34.9, P = 0.021). A lower rate of prolonged rupture of membranes and a higher rate of maternal smoking was also observed in NEC infants than in controls. No significant differences in incidences of chorioamnionitis, intrapartum antibiotics, volume of feedings, time of first formula feeding, and rates of patent ductus arteriosus or intrauterine growth retardation were detected. Conclusion(s): Infants who developed NEC had an increased incidence of norovirus detection in their stool following diagnosis. This further strengthens the case for an etiologic role of norovirus in the pathogenesis of NEC. © 2010 by Lippincott Williams & Wilkins.