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Introduction. Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in children, leading to an increase in morbidity and mortality. A previous study in 2013 showed that VAP rates decreased dramatically after implementation of a VAP bundle and appointing a VAP coordinator. As part of a ‘Plan, Do, Study, Act’ cycle, it was necessary to evaluate the efficacy of these interventions.Objective. To evaluate the VAP rate in the paediatric intensive care unit (PICU) over 2 years (2017 - 2018), and to describe the causative organisms and antibiotic sensitivity/resistance patterns during this period. Methods. This was a retrospective, descriptive study using the existing PICU VAP database as well as clinical folders.Results. Over the 2 years, 31 VAP cases were identified. The VAP rate for 2017 was 4.0/1 000 ventilator days and 5.4/1 000 ventilator days for 2018. Compliance with the VAP bundle was 68% in 2017 and 70% in 2018. The median (interquartile range (IQR)) duration of ventilation in 2017 was 9 (6 -12) days and 15 (11 - 28) days in 2018. The median (IQR) length of PICU stay in 2017 was 11 (8 - 22) days and 25 (17 - 37) days in 2018. The most common cultured organism was an extended-spectrum beta-lactamase (ESBL) Klebsiella pneumoniae sensitive to amikacin and carbapenems. Conclusion. Our VAP rate has not decreased since 2013. It is imperative that we improve compliance with the VAP bundle, in order to reduce VAP rates. K. pneumoniae and Pseudomonas aeruginosa were the most common organisms causing VAPs and empiric use of piptazobactam and amikacin is still appropriate.

BACKGROUND: Periviability, defined as a gestational age of 20 0/7 to 25 6/7 weeks, is considered the limit of foetal maturity where a reasonable chance of survival exists. The outcome of these neonates in sub-Saharan Africa is poorly describedOBJECTIVE: To describe the mortality and morbidities of periviable neonates admitted to a resource-limited public hospital in South Africa (SAMETHODS: This was a retrospective, descriptive study performed at Tygerberg Hospital, Cape Town, SA, between January 2017 and December 2018. Records of all periviable neonates (gestational age

Contains fulltext : 196096.pdf (Publisher’s version ) (Open Access) Advances in neonatal cardiac imaging permit a more comprehensive assessment of myocardial performance in neonates that could not be previously obtained with conventional imaging. Myocardial deformation analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in neonates. Cardiac strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. These measurements are obtained in neonates using tissue Doppler imaging (TDI) or two-dimensional speckle tracking echocardiography (STE). There is an expanding body of literature describing longitudinal reference ranges and maturational patterns of strain values in term and preterm infants. A thorough understanding of deformation principles, the technical aspects, and clinical applicability is a prerequisite for its routine clinical use in neonates. This review explains the fundamental concepts of deformation imaging in the term and preterm population, describes in a comparative manner the two major deformation imaging methods, provides a practical guide to the acquisition and interpretation of data, and discusses their recognized and developing clinical applications in neonates.

BACKGROUND. Neonatal hypotension remains one of the most controversial topics in neonatology. Various definitions are used but lack an evidence base. Owing to the variation in defining a low blood pressure (BP), significant differences in pharmacological manipulation of BP are evident. OBJECTIVES. The aim of the present research was to determine (1) the diagnostic criteria for neonatal hypotension and (2) management strategies for neonatal hypotension in South Africa. Methods. A 29-point questionnaire was designed to determine the criteria used by South African neonatologists and paediatricians to diagnose and manage neonatal hypotension. The survey was conducted at two different time points in 2017. RESULTS. The combination of the two surveys resulted in a 9.3% (47/507) response rate. A BP below the gestational age (in weeks) was the most common definition used for neonatal hypotension (75%). Most clinicians (86%) administered fluid prior to initiating inotrope therapy. Dopamine, dobutamine and adrenaline were the most common first-, second- and third-line anti-hypotensive drugs used. Most clinicians (77%) did not use a hypotension management guideline. CONCLUSION. Neonatal hypotension definition and management in South Africa are similar to international patterns, despite a lack of evidence to support the diagnosis and management strategies.

In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.

Contains fulltext : 196159.pdf (Publisher’s version ) (Open Access) One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinical assessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objective monitoring tools. An overview will be provided about the use of neonatologist-performed echocardiography (NPE) to assess cardiovascular compromise and guide hemodynamic management. Different techniques of central blood flow measurement, such as left and right ventricular output, superior vena cava flow, and descending aortic flow are reviewed focusing on methodology, validation, and available reference values. Recommendations are provided for individualized hemodynamic management guided by NPE.

Contains fulltext : 196161.pdf (Publisher’s version ) (Open Access) Neonatologists can use echocardiography for real-time assessment of the hemodynamic state of neonates to support clinical decision-making. There is a large body of evidence showing the shortcomings of conventional echocardiographic indices in neonates. Newer imaging modalities have evolved. Tissue Doppler imaging is a new technique that can provide measurements of myocardial movement and timing of myocardial events and may overcome some of the shortcomings of conventional techniques. The high time resolution and its ability to assess left and right cardiac function make tissue Doppler a favorable technique for assessing heart function in neonates. The aim of this review is to provide an up-to-date overview of tissue Doppler techniques for the assessment of cardiac function in the neonatal context, with focus on measurements from the atrioventricular (AV) plane. We discuss basic concepts, protocol for assessment, feasibility, and limitations, and we report reference values and give examples of its use in neonates.

Contains fulltext : 196081.pdf (Publisher’s version ) (Open Access) Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.

Item does not contain fulltext There is a growing interest worldwide in using echocardiography in the neonatal unit to act as a complement to the clinical assessment of the hemodynamic status of premature and term infants. However, there is a wide variation in how this tool is implemented across many jurisdictions, the level of expertise, including the oversight of this practice. Over the last 5 years, three major expert consensus statements have been published to provide guidance to neonatologists performing echocardiography, with all recommending a structured training program and clinical governance system for quality assurance. Neonatal practice in Europe is very heterogeneous and the proximity of neonatal units to pediatric cardiology centers varies significantly. Currently, there is no overarching governance structure for training and accreditation in Europe. In this paper, we provide a brief description of the current training recommendations across several jurisdictions including Europe, North America, and Australia and describe the steps required to achieve a sustainable governance structure with the responsibility to provide accreditation to neonatologist performed echocardiography in Europe.

Contains fulltext : 196118.pdf (Publisher’s version ) (Open Access) Cardiac ultrasound techniques are increasingly used in the neonatal intensive care unit to guide cardiorespiratory care of the sick newborn. This is the first in a series of eight review articles discussing the current status of "neonatologist-performed echocardiography" (NPE). The aim of this introductory review is to discuss four key elements of NPE. Indications for scanning are summarized to give the neonatologist with echocardiography skills a clear scope of practice. The fundamental physics of ultrasound are explained to allow for image optimization and avoid erroneous conclusions from artifacts. To ensure patient safety during echocardiography recommendations are given to prevent cardiorespiratory instability, hypothermia, infection, and skin lesions. A structured approach to echocardiography, with the same standard views acquired in the same sequence at each scan, is suggested in order to ensure that the neonatologist confirms normal structural anatomy or acquires the necessary images for a pediatric cardiologist to do so when reviewing the scan.