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Objective. Textbooks recognize the controversy of concomitant enteral nutrition (EN) during umbilical catheter usage in high-risk newborns, but support for the practice varies. There is only one clinical trial examining these practices in a small but randomized, controlled trial of enterally fed newborns with umbilical arterial catheters (UACs) in situ, and that trial did not demonstrate any adverse consequences. We speculate that concomitant EN with umbilical catheter usage is more common than some textbooks suggest--practiced by at least 20% of all US neonatal intensive care units (NICUs). The objective of this study is to determine the prevalence of NICUs where high-risk newborns with UAC or umbilical venous catheter (UVC) placement receive concomitant EN. Methods. Medical Directors listed in the American Academy of Pediatrics United States Neonatologist and Perinatologist Directory were surveyed by mail. On return of surveys, responses to multiple choice questions were recorded by electronic scanning and validated by manually conducted quality control checks. NICU identities were recorded by code to maintain anonymity. Results. Following 2 requests for survey participation, 70% (549/785) of surveys were returned. Respectively, 82% and 62% of NICUs with and without training programs were represented. On average, surveyed medical directors had practiced neonatal medicine 18.1 [+ or -] 0.3 years. Of surveyed NICUs, 99% reported placement of UVCs and UACs. Of the 92% believing that it is safe to provide trophic EN to newborns with UVCs in place, 51% practiced this some of the time, and 37% practiced it most of the time. By comparison, it was reported that newborns with UACs in place receive trophic EN most of the time (30%), some of the time (49%), or none of the time (22%). Of the 80% believing that it is safe to provide more complete EN to newborns with UVCs in place, 44% practiced this some of the time, and 24% practiced it most of the time. For newborns with UACs in place, more complete EN was provided most of the time (15%), some of the time (36%), or none of the time (49%). Conclusions. Concurrent UVC and UAC usage with EN is more commonly practiced than suggested in textbooks or published articles. The relative risk-benefit profiles of these practices remain uncertain secondary to the limited number of controlled clinical observations and to the infrequent occurrence of adverse events. A prospective, multicenter, controlled trial would address the continued advisability of these unexpectedly common practices., ABBREVIATIONS. EN, enteral nutrition; NEC, necrotizing enterocolitis; NICU, neonatal intensive care unit; UAC, umbilical arterial catheter; UVC, umbilical venous catheter. Cannulation of the umbilical vein was initially described in 1947 [...]

Background. Annual lung cancer screening using low-dose computed tomography (LDCT) scans is associated with a survival benefit, but it is also associated with potential harm. Unlike descriptive probability formats, experienced tasks have been shown to decrease perceptions of rare events. The objective of this study was to compare descriptive versus experienced probability formats on patients’ knowledge, beliefs, endorsement of screening for heavy smokers, and preference (choice predisposition) to undergo screening. Methods. A total of 276 patients attending an outpatient pulmonary practice were randomized to learn about screening using 1 of 3 formats: numbers only, numbers + icon arrays, numbers + a set of slides illustrating LDCT scans of 250 people in random order that displayed the number of normal scans, false-positive lung nodules, cancers found leading to a life saved, and cancers found leading to death despite treatment. Results. Knowledge differed between the 3 formats (P = 0.001), with participants randomized to the numbers + icon array format having the highest knowledge score. Beliefs were more favorable among participants randomized to the numbers + experienced format compared with the numbers + icon array format (difference between means [95% confidence interval]= 1.6 [0.4–2.8]). Differences in participants’ endorsement of screening (P = 0.4) and choice predisposition (P = 0.6) across probability format mirrored those of beliefs but were not statistically significant. Discussion. Contrary to what we expected, the experienced format increased propensity toward screening compared with the numbers + icon array format, as indicated by more favorable beliefs and nonsignificant trends toward stronger choice predisposition and endorsement. Experienced risk formats may not be a practical approach to improve risk communication for patients deciding whether or not to undergo annual lung cancer screening. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the relationship between umbilical vein catheter (UVC) placement and death in extremely premature newborns (<29 weeks gestation). STUDY DESIGN: Utilizing a retrospective, case-control study design, results for newborns that received UVC placements and died were compared with those who received UVC placements and survived (n = 719) by univariate and multiple logistic regression analyses. RESULT: Death rate was 30% in infants with low lines versus 16% in those without (p = 0.012). High UVC tip placement significantly and independently increased severe periventricular hemorrhages (p = 0.014). Severe periventricular hemorrhage increased death rates by 3-fold independent of gestational age (p < 0.001). Proper line placement significantly reduced severe periventricular hemorrhage by 2.5-fold independent of gestational age (p = 0.019). CONCLUSION: In extremely premature newborns, incorrect UVC placement is significantly associated with death through its relation to severe periventricular hemorrhage. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Investigate the benefit of umbilical catheterization upon survival and selected morbidities in extremely premature newborns (<28 weeks gestation). Outcomes of successfully catheterized extremely premature newborns are compared with others who cannot be successfully catheterized, and we hypothesize that umbilical catheterization promotes survival and reduces morbidities. STUDY DESIGN: Utilizing a retrospective, cohort study design, survival and outcomes of catheterized and non-catheterized newborns (n = 722) were compared by univariate and multiple logistic regression analyses. RESULTS: Of all newborns, 66.8% had both umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) placements, 15.0% had only UAC, 13.7% had only UVC, and 4.6% had neither. Overall survival was 82.5%. Survivals with and without UAC were 82.5% and 82.6% (NS), but survival with UVC was 80.7% versus 90.1% without UVC (p = 0.012). Analysis of risk factors associated with death during umbilical catheterization reaffirmed that death remained significantly dependent upon UVC placement (OR = 35.7; 95% CI: 3.7-347.3, p = 0.002). CONCLUSION: Successful umbilical catheterization of extremely premature newborns does not provide benefit through promotion of survival or reduction of morbidities when compared to others who are not successfully catheterized at the umbilicus. [ABSTRACT FROM AUTHOR]