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Asian Journal of Andrology
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Print) 1008-682X - ISSN (Online) 1745-7262
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Fantoms
- Authors: Stenson; B. J.
  Pages: 115 - 115
  Abstract: Haemodynamic assessment and management of hypotension in the preterm The haemodynamic management of preterm infants has evolved over time, supported by epidemiological data, physiologically reasoned and well intentioned, but with little sophistication in the physiological assessment and little evidence to guide drug treatment. Rachel Mullaly and Afif Faisal El Khuffash review the present state of knowledge, highlighting the flaws of using mean blood pressure to guide treatment and describing the range of haemodynamic inferences that can be drawn with more sophisticated echocardiographic investigation. Their article is nicely illustrated and includes a summary of the presently used drugs and their potential effects. They acknowledge the weakness of the evidence supporting the wider range of agents increasingly in use and call for trials that use detailed physiological assessment to determine treatment approaches to take us forward. See page F120 Staphylococcus Capitis Staphylococcus capitis has generated a...
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2024-326973
  Issue No: Vol. 109, No. 2 (2024)
Neurodevelopmental outcomes in early childhood for infants born very
preterm in countries outside the UK
- Authors: Doyle; L. W.
  Pages: 117 - 119
  Abstract: Knowledge of outcomes beyond the primary hospitalisation for infants born very preterm is vital to understanding the impact of interventions in the perinatal and newborn periods, particularly as more infants born
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-326400
  Issue No: Vol. 109, No. 2 (2024)
Haemodynamic assessment and management of hypotension in the preterm
- Authors: Mullaly, R; El-Khuffash, A. F.
  Pages: 120 - 127
  Abstract: The management of low blood flow states in premature neonates is fraught with many challenges. We remain over-reliant on regimented stepwise protocols that use mean blood pressure as a threshold for intervention to guide treatment, without giving due consideration to the underlying pathophysiology. The current available evidence does not reflect the need to concentrate on the unique pathophysiology of the preterm infant and thus leads to widespread misuse of vasoactive agents that often do not provide the desired clinical effect. Therefore, understanding the underlying pathophysiological underpinnings of haemodynamic compromise may better guide choice of agent and assess physiological response to the selected intervention.
  Keywords: Editor's choice
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2022-324935
  Issue No: Vol. 109, No. 2 (2024)
Clinical outcomes of Staphylococcus capitis isolation from neonates,
England, 2015-2021: a retrospective case-control study
- Authors: Yuan, J.-M; Nugent, C, Wilson, A, Verlander, N. Q, Alexander, E, Fleming, P, Modi, N, Oughham, K, Ratnaraja, N, Wan, Y, Thorn, L, Felgate, H, Webber, M. A, Ogundipe, E, Brown, C. S, Paranthaman, K, Demirjian, A.
  Pages: 128 - 134
  Abstract: Objective Staphylococcus capitis, a coagulase-negative staphylococci (CoNS) species, has been increasingly detected from UK sterile site samples and has caused neonatal unit outbreaks worldwide. We compared survival to discharge and 30-day mortality for the detection of S. capitis versus other CoNS species.MethodsIn this retrospective case–control study, we included hospitalised infants with any CoNS species detected from a normally sterile body site up to 90 days of age. We linked English laboratory reports from the Second Generation Surveillance System database, mortality data from the Personal Demographics Service, and neonatal unit admissions from the National Neonatal Research Database. In primary analysis, multivariable logistic regression was used, with two co-primary outcomes: survival to discharge and death within 30 days of positive specimen date. Sensitivity analyses using multiply imputed datasets followed.ResultsWe identified 16 636 CoNS episodes relating to 13 745 infants. CoNS episodes were highest among infants born extremely preterm (22–27 weeks) and with extremely low birth weight (400–999 g). In primary analysis, there were no differences in survival to discharge (p=0.71) or 30-day mortality (p=0.77) between CoNS species. In sensitivity analyses, there were no differences in outcomes between infection with four of the most common CoNS species (Staphylococcus epidermidis, S. capitis, Staphylococcus haemolyticus and Staphylococcus warneri) but the remaining CoNS species were at higher risk of adverse outcomes when treated in aggregate.ConclusionInfants with S. capitis detected from sterile site samples did not experience significant differences in either survival to discharge or 30-day mortality compared with infants with detection of other common CoNS species.
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325887
  Issue No: Vol. 109, No. 2 (2024)
Advance care planning in perinatal settings: national survey of
implementation using Normalisation Process Theory
- Authors: Shaw, K. L; Spry, J, Cummins, C, Ewer, A. K, Kilby, M. D, Mancini, A.
  Pages: 135 - 142
  Abstract: BackgroundPerinatal advance care planning (PnACP) is a process of formal decision-making to help families plan for their baby’s care when recognised that they may have a life-limiting condition. While PnACP is recommended in policy, there is a lack of evidence to support implementation and development in the perinatal setting.ObjectiveTo conduct an online survey of UK and Ireland perinatal providers to examine how PnACP is operationalised in current practice.MethodsA secure online questionnaire was developed to collect data on (1) ‘what’ is being implemented, (2) the ‘processes’ being used, (3) perceived impact and (4) unmet support needs. Data were analysed using basic descriptive statistics, thematic analysis and through a conceptual lens of Normalisation Process Theory.ResultsQuestionnaires were completed by 108 health professionals working in 108 maternity and neonatal services, representing 90 organisations across the UK and Ireland. This revealed many resources and examples of good practice to support PnACP. However, there was wide variation in how PnACP was conceptualised and implemented. Existing frameworks, pathways and planning tools are not routinely embedded into care, and respondents identified many barriers that negatively impact the quality of care. They called for better integration of palliative care principles into acute settings and more investment in staff training to support families at existentially difficult times.ConclusionsPriorities for additional perinatal service development include greater sharing of best practice and effective strategies to target the unique challenges of PnACP, such as time-sensitive collaborative working and decision-making in the face of high uncertainty.
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325649
  Issue No: Vol. 109, No. 2 (2024)
Two-year neurodevelopmental data for preterm infants born over an 11-year
period in England and Wales, 2008-2018: a retrospective study using the
National Neonatal Research Database
- Authors: van Blankenstein, E; Sodiwala, T, Lanoue, J, Modi, N, Uthaya, S. N, Battersby, C, on behalf of the UK Neonatal Collaborative
  Pages: 143 - 150
  Abstract: ObjectiveUnited Kingdom guidelines recommend all infants born
  Keywords: Open access
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325746
  Issue No: Vol. 109, No. 2 (2024)
Neuroimaging in infants with congenital cytomegalovirus infection and its
correlation with outcome: emphasis on white matter abnormalities
- Authors: Alarcon, A; de Vries, L. S, Parodi, A, Arnaez, J, Cabanas, F, Steggerda, S. J, Rebollo, M, Ramenghi, L, Dorronsoro, I, Lopez-Azorin, M, Schneider, J, Noguera-Julian, A, Rios-Barnes, M, Recio, M, Bickle-Graz, M, Martinez-Biarge, M, Fortuny, C, Garcia-Alix, A, Truttmann, A. C.
  Pages: 151 - 158
  Abstract: ObjectiveTo evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs).MethodsMulticentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability.ResultsNeuroimaging scoring was associated with outcome (p
  Keywords: Open access
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325790
  Issue No: Vol. 109, No. 2 (2024)
Identifying effect modifiers of systemic hydrocortisone treatment
initiated 7-14 days after birth in ventilated very preterm infants on
long-term outcome: secondary analysis of a randomised controlled trial
- Authors: Halbmeijer, N. M; Sonnaert, M, Swarte, R. M, Koopman-Esseboom, C, van Stuijvenberg, M, Mulder-de Tollenaer, S, Tan, R. N. G. B, Mohns, T, Bruneel, E, Steiner, K, Kramer, B. W, Debeer, A, van Weissenbruch, M. M, Marechal, Y, Blom, H, Plaskie, K, Offringa, M, Merkus, M. P, Onland, W, Leemhuis, A. G, van Kaam, A. H, SToP-BPD Study group
  Pages: 159 - 165
  Abstract: ObjectiveTo explore clinical effect modifiers of systemic hydrocortisone in ventilated very preterm infants for survival and neurodevelopmental outcome at 2 years’ corrected age (CA).DesignSecondary analysis of a randomised placebo-controlled trial.SettingDutch and Belgian neonatal intensive care units.PatientsInfants born
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325558
  Issue No: Vol. 109, No. 2 (2024)
First-year growth trajectory and early nutritional requirements for
optimal growth in infants with congenital diaphragmatic hernia: a
retrospective cohort study
- Authors: Coignard, M; Mellul, K, Stirnemann, J, Khen-Dunlop, N, Lapillonne, A, Kermorvant-Duchemin, E.
  Pages: 166 - 172
  Abstract: ObjectiveTo describe the growth trajectory of children with congenital diaphragmatic hernia (CDH) during the first year, to assess the risk factors for growth failure (GF) at 1 year and to determine nutritional intakes at discharge required for early optimal growth.DesignSingle-centre retrospective cohort study based on data from a structured follow-up programme.Setting and patientsAll neonates with CDH (2013–2019) alive at discharge and followed up to age 1.InterventionsNone.Main outcome measuresWeight-for-age z-score (WAZ) at birth, 3, 6 and 12 months of age; risk factors for GF at age 1; energy and protein intake of infants achieving early optimal growth.ResultsSixty-three of 65 neonates who were alive at discharge were included. Seven (11%) had GF at 1 year and 3 (4.8%) had a gastrostomy tube. The mean WAZ decreased in the first 3 months before catching up at 1 year (–0.6±0.78). Children with a severe form or born preterm experienced a deeper loss (from –1.5 to –2 z-scores) with late and limited catch-up. The median energy intake required to achieve positive or null weight growth velocity differed significantly according to CDH severity, ranging from 100 kcal/kg/day (postnatal forms) to 139 kcal/kg/day (severe prenatal forms) (p=0.009).ConclusionsGrowth patterns of CDH infants suggest that nutritional risk stratification and feeding practices may influence growth outcomes. Our results support individualised and active nutritional management based on CDH severity, with energy requirements as high as 140% of recommended intakes for healthy term infants.
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325713
  Issue No: Vol. 109, No. 2 (2024)
Preliminary results on validity and reliability from two prospective
cohort studies on a new Neonatal Coma Score
- Authors: Hart, A. R; Kieran, M, Matthews, E, Mandefield, L, Williams, T, Johnson, K, English, S, Evans, D, Cutsey, L, Goodden, J.
  Pages: 173 - 181
  Abstract: ObjectiveTo collect data on content/face validity and interobserver agreement for a Neonatal Coma Score (NCS) in well full-term neonates and on construct validity in unwell and preterm babies, specifically how the NCS changed with gestational age and illness.DesignProspective cohort studies.SettingTwo UK tertiary neonatal units (Sheffield and Leeds).Patients151 well full-term (≥37 weeks gestational age) newborn babies recruited between January and February 2020 in Sheffield and April and May 2021 in Leeds; 101 sick preterm and full-term babies admitted to Sheffield neonatal unit between January 2021 and May 2022.InterventionA new NCS.Main outcome measuresDetermination of normal values in well babies born ≥37 weeks gestational age; data on how the NCS changes with gestational age and illness.ResultsFace validity was demonstrated during development of the NCS. The median NCS of well, full-term newborn babies was 15 and the intraclass correlation coefficient was 0.78 (95% CI 0.70 to 0.84). In the ‘well’ preterm population, 95%
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325765
  Issue No: Vol. 109, No. 2 (2024)
Congenital duodenal obstruction repair with and without transanastomotic
tube feeding: a systematic review and meta-analysis
- Authors: Bethell, G. S; Neville, J. J, Johnson, M. J, Turnbull, J, Hall, N. J.
  Pages: 182 - 188
  Abstract: ObjectiveTo determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO).DesignSystematic review with meta-analysis.PatientsInfants with CDO requiring surgical repair.InterventionsTAT feeding following CDO repair versus no TAT feeding.Main outcome measuresThe main outcome was time to full enteral feeds. Additional outcomes included use of parenteral nutrition (PN), cost and complications from either TAT or central venous catheter. Meta-analyses were undertaken using random-effects models (mean difference (MD) and risk difference (RD)), and risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool.ResultsTwelve out of 373 articles screened met the inclusion criteria. All studies were observational and two were prospective. Nine studies, containing 469 infants, were available for meta-analysis; however, four were excluded due to serious or critical risk of bias. TAT feeding was associated with reduced time to full enteral feeds (–3.34; 95% CI –4.48 to –2.20 days), reduced duration of PN (–6.32; 95% CI –7.93 to –4.71 days) and reduction in nutrition cost of £867.36 (95% CI £304.72 to £1430.00). Other outcomes were similar between those with and without a TAT including inpatient length of stay (MD –0.97 (–5.03 to 3.09) days), mortality (RD –0.01 (–0.04 to 0.01)) and requirement for repeat surgery (RD 0.01 (–0.03 to 0.05)).ConclusionTAT feeding following CDO repair appears beneficial, without increased risk of adverse events; however, certainty of available evidence is low. Earlier enteral feeding and reduced PN use are known to decrease central venous catheter-associated risks while significantly reducing cost of care.PROSPERO registration numberCRD42022328381.
  Keywords: Open access
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325988
  Issue No: Vol. 109, No. 2 (2024)
Neurodevelopmental outcomes at age 3 years after moderate preterm, late
preterm and early term birth: the Japan Environment and Childrens Study
- Authors: Hirata; K., Ueda, K., Wada, K., Ikehara, S., Tanigawa, K., Kimura, T., Ozono, K., Sobue, T., Iso, H., the Japan Environment Childrens Study Group
  Pages: 189 - 195
  Abstract: ObjectiveTo assess the association between gestational age classification at birth and the risk of neurodevelopmental impairments at age 3 years.DesignCohort study using the Japan Environment and Children’s Study database.PatientsA total of 86 138 singleton children born without physical abnormalities at 32–41 weeks of gestation enrolled between January 2011 and March 2014.Main outcome measuresNeurodevelopmental impairment, evaluated using the Ages and Stages Questionnaire (third edition).MethodsLogistic regression analysis was used to evaluate the risk of neurodevelopmental impairment in moderate preterm, late preterm and early term children compared with term children after adjusting for socioeconomic and perinatal factors.ResultsThe respective adjusted ORs (95% CIs) of incidence of scores below the cut-off value (
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325600
  Issue No: Vol. 109, No. 2 (2024)
Perspectives of extremely prematurely born adults on what to consider in
prenatal decision-making: a qualitative focus group study
- Authors: de Boer, A; De Proost, L, de Vries, M, Hogeveen, M, Verweij, E. J. T, Geurtzen, R.
  Pages: 196 - 201
  Abstract: ObjectiveA shared decision-making (SDM) approach is recommended for prenatal decisions at the limit of viability, with a guiding role for parental values. People born extremely premature experience the consequences of the decision made, but information about their perspectives on prenatal decisions is lacking. Therefore, this study aims to describe their perspectives on what is important in decision-making at the limit of viability.DesignSemi-structured focus group discussions were conducted, recorded and transcribed verbatim. The data were independently analysed by two researchers in Atlas.ti.ResultsFour focus groups were conducted in the Netherlands, with five to six participants each, born between 240/7 and 300/7 weeks gestation in the period between 1965 and 2002. Considering their personal life experiences and how their extremely premature birth affected their families, the participants reflected on decision-making at the limit of viability. Various considerations were discussed and summarised into the following themes: anticipated parental regret, the wish to look at the baby directly after birth, to give the infant a chance at survival, quality of life, long-term outcomes for the infant and the family, and religious or spiritual considerations.ConclusionsInsights into the perspectives of adults born extremely premature deepened our understanding of values considered in decision-making at the limit of viability. Results point out the need for a more individualised prediction of the prognosis and more extensive information on the lifelong impact of an extremely premature birth on both the infant and the family. This could help future parents and healthcare professionals in value-laden decision-making.
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325997
  Issue No: Vol. 109, No. 2 (2024)
2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in
70% isopropyl alcohol for skin disinfection prior to percutaneous central
venous catheterisation: the ARCTIC randomised controlled feasibility trial
- Authors: Clarke, P; Soe, A, Nichols, A, Harizaj, H, Webber, M. A, Linsell, L, Bell, J. L, Tremlett, C, Muthukumar, P, Pattnayak, S, Partlett, C, King, A, Juszczak, E, Heath, P. T.
  Pages: 202 - 210
  Abstract: ObjectiveCatheter-related sepsis (CRS) is a major complication with significant morbidity and mortality. Evidence is lacking regarding the most appropriate antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion in preterm neonates. To inform the feasibility and design of a definitive randomised controlled trial (RCT) of two antiseptic formulations, we conducted the Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) feasibility study to assess catheter colonisation, sepsis, and skin morbidity.DesignFeasibility RCT.SettingTwo UK tertiary-level neonatal intensive care units.PatientsPreterm infants born
  Keywords: Open access
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325871
  Issue No: Vol. 109, No. 2 (2024)
Neurodevelopmental outcomes of preterm neonates receiving rescue inhaled
nitric oxide in the first week of age: a cohort study
- Authors: Gurram Venkata; S. K. R., Lodha, A., Hicks, M., Jain, A., Lapointe, A., Makary, H., Kanungo, J., Lee, K.-S., Ye, X., Shah, P. S., Soraisham, A. S., the Canadian Neonatal Network Canadian Neonatal Follow Up Network
  Pages: 211 - 216
  Abstract: ObjectiveTo assess the neurodevelopmental outcomes of preterm neonates who received inhaled nitric oxide (iNO) in the first week of age for hypoxaemic respiratory failure (HRF).MethodsIn this retrospective cohort study, we included neonates born at
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325418
  Issue No: Vol. 109, No. 2 (2024)
Volume-targeted mask ventilation during simulated neonatal resuscitation
- Authors: Law, B. H. Y; Schmölzer, G. M.
  Pages: 217 - 220
  Abstract: ObjectiveMask positive pressure ventilation (PPV) in the delivery room is routinely delivered with set peak inflation pressures. To aid mask PPV, stand-alone respiratory function monitors (RFMs) have been used in the delivery room, while ventilator-based, volume-targeted ventilation (VTV) is routinely used in the neonatal intensive care unit (NICU).DesignThis is a prospective, randomised, crossover simulation study. Participants were briefly trained to use a neonatal ventilator for volume-targeted mask ventilation (VTV-PPV), then performed mask ventilation on a manikin in a randomised order using VTV-PPV, T-piece PPV or T-piece PPV with RFM visible.SettingIn situ in a neonatal resuscitation room within a level 3 NICU.ParticipantsHealthcare professionals (HCPs) trained in neonatal resuscitation with experience as team leaders.InterventionsSemiautomated, ventilator-based VTV-PPV using two-hand hold versus manual PPV via a T-piece device (T-piece, RFM masked) versus manual PPV with RFM visible using one-hand hold.Main outcome measuresRespiratory characteristics including % mask leak, tidal volume (VT) and peak inflation pressure (PIP).ResultsThirty-two HCPs (23 (72%) female and 9 (28%) male) participated. The median mask leak was significantly lower with ‘VTV-PPV’ (11%, IQR 0%–14%) compared with both ‘T-piece, RFM visible’ (82%, IQR 30%–91%) and ‘T-piece, RFM masked’ (81%, IQR 47%–91%) (p
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325902
  Issue No: Vol. 109, No. 2 (2024)
Prolonged use of closed-loop inspired oxygen support in preterm infants: a
randomised controlled trial
- Authors: Schouten, T. M. R; Abu-Hanna, A, van Kaam, A. H, van den Heuvel, M. E. N, Bachman, T. E, van Leuteren, R. W, Hutten, G. J, Onland, W.
  Pages: 221 - 226
  Abstract: ObjectiveThis randomised study in preterm infants on non-invasive respiratory support investigated the effectiveness of automated oxygen control (A-FiO2) in keeping the oxygen saturation (SpO2) within a target range (TR) during a 28-day period compared with manual titration (M-FiO2).DesignA single-centre randomised control trial.SettingA level III neonatal intensive care unit.PatientsPreterm infants (
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325831
  Issue No: Vol. 109, No. 2 (2024)
Impact of adopting a neonatal sepsis risk calculator in a diverse
population in Birmingham, UK
- Authors: Yew, R; Macaskill, L, Brown, S, Dixie, M, Dogar, D, Checketts, E, Surana, P.
  Pages: 227 - 228
  Abstract: Background Kaiser-Permanente Sepsis Risk Calculator (KP-SRC) has safely reduced antibiotic use in the management of early-onset neonatal sepsis (EONS) in the USA and has been endorsed by the American Academy of Pediatrics.1 However, the updated UK National Institute for Health and Care Excellence (NICE) guidance 2021 (NG195) is risk factor based. It does permit the use of KP-SRC, but only with prospective audit, due to reservations regarding its applicability and safety in the UK setting.2 A recent Welsh study demonstrated the effectiveness of KP-SRC; however, Birmingham has significant inherent population differences (higher socioeconomic deprivation, ethnic diversity, EONS incidence and perinatal mortality).3 We aimed to implement KP-SRC in our diverse high-risk population to evaluate its safety following our pre-implementation study.4 Methods KP-SRC was applied to all babies born ≥34 weeks’ gestation, who would have received antibiotics as per the...
  PubDate: 2024-02-19T00:45:33-08:00
  DOI: 10.1136/archdischild-2023-325883
  Issue No: Vol. 109, No. 2 (2024)

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