JournalTOCs

Asian Journal of Andrology
Journal Prestige (SJR): 0.856

Citation Impact (citeScore): 2
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Print) 1008-682X - ISSN (Online) 1745-7262
Published by Medknow Publishers

[444 journals]

Fantoms
- Authors: Stenson; B. J.
  Pages: 551 - 551
  Abstract: Estimated neonatal survival for very preterm births in the UK Sarah Seaton et al have provided valuable new outcome information about extremely preterm babies born in the UK between 2016 and 2020. These data will be highly valuable in discussions with families. We have been relying on evidence from earlier years and from other health systems. They report neonatal survival figures. This means the proportion of babies who are still alive 28 days after birth. Outcomes of more than 43 000 pregnancies are reported. The data exclude babies whose deaths were considered to be caused by congenital anomalies. The data do not include deaths after 28 days. Around 75% of deaths have occurred by 28 days, so it is important to recognise that some later deaths occur during and after the initial birth hospitalisation. By combining datasets they were able to consider survival from three points in the patient...
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-326446
  Issue No: Vol. 108, No. 6 (2023)
Neonatal seizures. Treat! But when, with what and for how long'
- Authors: Hunt; R. W.
  Pages: 552 - 553
  Abstract: Neonatal seizures remain a complex challenge for those of us involved in these babies’ care. While relatively common, our approaches to these patients vary between clinicians, subspecialties and centres. Nearly every facet of detection, investigation, treatment and follow-up of these patients is subject to some variation in practice. Sewell et al, on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, provide more evidence on the enormous variation in practice that exists for these infants, with an observational study on antiseizure medication (ASM) use after discharge for infants with hypoxic-ischaemic encephalopathy (HIE).1 The data were collected on infants who had been enrolled into various cooling trials over the preceding 15 years. Despite recommendations about cessation of ASM for neonates with a normal neurological examination and normal electroencephalogram (EEG), continuation of ASM is still commonplace. Rates of ASM continuation at hospital discharge between...
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325324
  Issue No: Vol. 108, No. 6 (2023)
Can we balance early exogenous surfactant therapy and non-invasive
respiratory support to optimise outcomes in extremely preterm infants' A
nuanced review of the current literature
- Authors: Glaser, K; Bamat, N. A, Wright, C. J.
  Pages: 554 - 560
  Abstract: Therapeutic advances have significantly improved the survival of premature infants. However, a high burden of bronchopulmonary dysplasia (BPD) persists. Aiming at prevention of neonatal lung injury, continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) strategies have replaced mechanical ventilation for early respiratory support and treatment of respiratory distress syndrome. Multiple randomised controlled trials have demonstrated that broad application of CPAP/NIV decreases exposure to mechanical ventilation and reduces rates of BPD. Here, we explore why this treatment effect is not larger. We discuss that today’s neonatal intensive care unit population evolving from the premature to the extremely premature infant demands better targeted therapy, and indicate how early and accurate identification of preterm infants likely to fail CPAP/NIV could increase the treatment effect and minimise the potential harm of delaying exogenous surfactant therapy in these infants. Finally, we argue that less invasive modes of surfactant administration may represent both a pragmatic and beneficial approach in combining CPAP/NIV and early surfactant. Beneficial treatment effects might be higher than reported in the literature when targeting this approach to preterm infants suffering from respiratory failure primarily due to surfactant deficiency. Considering ongoing limitations of current approaches and focusing both on prospects and potential harm of modified strategies, this commentary ultimately addresses the need and the challenge to prove that pushing early CPAP/NIV and strategies of early and less invasive surfactant application prevents lung injury in the long term.
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-324530
  Issue No: Vol. 108, No. 6 (2023)
Subcortical bruising in the preterm infant
- Authors: Roychaudhuri, S; Benson, C, El-Dib, M.
  Pages: 561 - 561
  Abstract: A cranial ultrasound (CUS) was performed on day 2 of a 27-week, 3-day gestational age newborn, with no external clinical signs or history of trauma during delivery nor concerns of significant thrombocytopenia or coagulopathy, prompted by acute drop in haematocrit (from 17.5 to 11.4 g/dL). Perinatal history was significant for in vitro fertilisation pregnancy, cervical cerclage, pregestational diabetes mellitus, gestational hypertension and premature prolonged membrane rupture, followed by a course of betamethasone and magnesium sulfate, then delivery by stat section for prolapsed cord. Resuscitation was uneventful except for endotracheal intubation lasting 3 hours for surfactant administration, followed by continuous positive airway pressure (CPAP). Initial and subsequent CUS showed several echogenicities grouped in the left subcortical frontoparietal parenchyma (figure 1). Differential diagnoses included heterotopia, calcification or haemorrhage. MRI on day 18 confirmed small areas of parenchymal haemorrhage within left superior frontal subcortical white matter in the T1, T2 and...
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325414
  Issue No: Vol. 108, No. 6 (2023)
Estimated neonatal survival of very preterm births across the care
pathway: a UK cohort 2016-2020
- Authors: Seaton, S. E; Agarwal, R, Draper, E. S, Fenton, A. C, Kurinczuk, J. J, Manktelow, B. N, Smith, L. K.
  Pages: 562 - 568
  Abstract: ObjectiveCurrently used estimates of survival are nearly 10 years old and relate to only those babies admitted for neonatal care. Due to ongoing improvements in neonatal care, here we update estimates of survival for singleton and multiple births at 22+0 to 31+6 weeks gestational age across the perinatal care pathway by gestational age and birth weight.DesignRetrospective analysis of routinely collected data.SettingA national cohort from the UK and British Crown Dependencies.PatientsBabies born at 22+0 to 31+6 weeks gestational age from 1 January 2016 to 31 December 2020.InterventionsNone.Main outcome measuresSurvival to 28 days.ResultsEstimates of neonatal survival are provided for babies: (1) alive at the onset of care during the birthing process (n=43 763); (2) babies where survival-focused care was initiated (n=42 004); and (3) babies admitted for neonatal care (n=41 158). We have produced easy-to-use survival charts for singleton and multiple births. Generally, survival increased with increasing gestational age at birth and with increasing birth weight. For all births with a birthweight over 1000 g, survival was 90% or higher at all three stages of care.ConclusionsSurvival estimates are a vital tool to support and supplement clinical judgement within perinatal care. These up-to-date, national estimates of survival to 28 days are provided based on three stages of the perinatal care pathway to support ongoing clinical care. These novel results are a key resource for policy and practice including counselling parents and informing care provision.
  Keywords: Editor's choice
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-324987
  Issue No: Vol. 108, No. 6 (2023)
National priority setting partnership using a Delphi consensus process to
develop neonatal research questions suitable for practice-changing
randomised trials in the UK
- Authors: Evans, K; Battersby, C, Boardman, J. P, Boyle, E, Carroll, W, Dinwiddy, K, Dorling, J, Gallagher, K, Hardy, P, Johnston, E, Mactier, H, Marcroft, C, Webbe, J. W. H, Gale, C.
  Pages: 569 - 574
  Abstract: BackgroundThe provision of neonatal care is variable and commonly lacks adequate evidence base; strategic development of methodologically robust clinical trials is needed to improve outcomes and maximise research resources. Historically, neonatal research topics have been selected by researchers; prioritisation processes involving wider stakeholder groups have generally identified research themes rather than specific questions amenable to interventional trials.ObjectiveTo involve stakeholders including parents, healthcare professionals and researchers to identify and prioritise research questions suitable for answering in neonatal interventional trials in the UK.DesignResearch questions were submitted by stakeholders in population, intervention, comparison, outcome format through an online platform. Questions were reviewed by a representative steering group; duplicates and previously answered questions were removed. Eligible questions were entered into a three-round online Delphi survey for prioritisation by all stakeholder groups.ParticipantsOne hundred and eight respondents submitted research questions for consideration; 144 participants completed round one of the Delphi survey, 106 completed all three rounds.ResultsTwo hundred and sixty-five research questions were submitted and after steering group review, 186 entered into the Delphi survey. The top five ranked research questions related to breast milk fortification, intact cord resuscitation, timing of surgical intervention in necrotising enterocolitis, therapeutic hypothermia for mild hypoxic ischaemic encephalopathy and non-invasive respiratory support.ConclusionsWe have identified and prioritised research questions suitable for practice-changing interventional trials in neonatal medicine in the UK at the present time. Trials targeting these uncertainties have potential to reduce research waste and improve neonatal care.
  Keywords: Open access
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325504
  Issue No: Vol. 108, No. 6 (2023)
Fragility and resilience: parental and family perspectives on the impacts
of extreme prematurity
- Authors: Janvier, A; Bourque, C. J, Pearce, R, Thivierge, E, Duquette, L.-A, Jaworski, M, Barrington, K. J, Synnes, A. R, Church, P, Luu, T. M.
  Pages: 575 - 580
  Abstract: ObjectivesExtremely preterm babies have a significant risk of neurodevelopmental impairment (NDI). There has been little investigation regarding the impact of prematurity on families. The objective of this study was to explore parental perspectives regarding the impact of prematurity on themselves/their family.MethodsOver 1 year, parents of children born
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325011
  Issue No: Vol. 108, No. 6 (2023)
Health-related quality of life in adults born extremely preterm or with
extremely low birth weight in the postsurfactant era: a longitudinal
cohort study
- Authors: Selman, C; Mainzer, R, Lee, K, Anderson, P, Burnett, A, Garland, S. M, Patton, G. C, Pigdon, L, Roberts, G, Wark, J, Doyle, L. W, Cheong, J. L. Y, for the Victorian Infant Collaborative Study Group
  Pages: 581 - 587
  Abstract: ObjectivesTo compare health-related quality of life (HRQoL) at 25 and 18 years in individuals born extremely preterm (EP,
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325230
  Issue No: Vol. 108, No. 6 (2023)
Video laryngoscopy-assisted less-invasive surfactant administration
quality improvement initiative
- Authors: Kurepa, D; Boyar, V, Predtechenska, O, Gupta, V, Weinberger, B, Pulju, M, Zaytseva, A, Galanti, S. G, Kasniya, G, Perveen, S.
  Pages: 588 - 593
  Abstract: ObjectiveTo describe the use of quality improvement methodology in transitioning from delivery of surfactant by INSURE (INtubation–SURfactant administration–Extubation) to video laryngoscope-assisted LISA (less-invasive surfactant administration) for infants with respiratory distress syndrome (RDS) receiving non-invasive ventilatory support.SettingTwo large neonatal intensive care units (NICUs) at Northwell Health (New Hyde Park, New York, USA).Study populationInfants with RDS receiving continuous positive airway pressure in the NICU and eligible for surfactant administration.ResultsLISA was initiated in our NICUs in January 2021, after extensive guideline development, education programmes, hands-on training and provider credentialing. Our Specific, Measurable, Achievable, Relevant and Timely aim was to deliver surfactant by LISA for 65% of total doses by 31 December 2021. This goal was achieved within 1 month of go-live. In total, 115 infants received at least one dose of surfactant during the year. Of those, 79 (69%) received it via LISA and 36 (31%) via INSURE. Two Plan–Do–Study–Act cycles contributed to improved adherence to guidelines on timely surfactant administration and both written and video documentation.ConclusionsSafe and effective introduction of LISA with the use of video laryngoscopy is achievable with careful planning, clear clinical guidelines, adequate hands-on training and comprehensive safety and quality control.
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325357
  Issue No: Vol. 108, No. 6 (2023)
Effect of initial and subsequent mask applications on breathing and heart
rate in preterm infants at birth
- Authors: Kuypers, K. L. A. M; Hopman, A, Cramer, S. J. E, Dekker, J, Visser, R, Hooper, S. B, te Pas, A. B.
  Pages: 594 - 598
  Abstract: ObjectiveApplication of a face mask may provoke the trigeminocardiac reflex, leading to apnoea and bradycardia. This study investigates whether re-application of a face mask in preterm infants at birth alters the risk of apnoea compared with the initial application, and identify factors that influence this risk.MethodsResuscitation videos and respiratory function monitor data collected from preterm infants
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-324835
  Issue No: Vol. 108, No. 6 (2023)
Neonatal outcomes following early fetal growth restriction: a subgroup
analysis of the EVERREST study
- Authors: Lingam, I; Okell, J, Maksym, K, Spencer, R, Peebles, D, Buquis, G, Ambler, G, Morsing, E, Ley, D, Singer, D, Tenorio, V, Dyer, J, Ginsberg, Y, Weissbach, T, Huertas-Ceballos, A, Marlow, N, David, A, on behalf of the EVERREST consortium
  Pages: 599 - 606
  Abstract: ObjectiveTo quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).DesignThe EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction') prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW)
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325285
  Issue No: Vol. 108, No. 6 (2023)
Ultra-high frequency lung ultrasound in preterm neonates: a test
validation study on interpretation agreement and reliability
- Authors: Sartorius, V; Loi, B, Vivalda, L, Regiroli, G, de la Rubia Ortega, S, Centorrino, R, De Luca, D.
  Pages: 607 - 611
  Abstract: ObjectiveTo verify if increasing frequency, through the use of ultra-high frequency transducers, has an impact on lung ultrasound pattern recognition.DesignTest validation study.SettingTertiary academic referral neonatal intensive care unit.PatientsNeonates admitted with respiratory distress signs.InterventionsLung ultrasound performed with four micro-linear probes (10, 15, 20 and 22 MHz), in random order. Anonymised images (600 dpi) were randomly included in a pictorial database: physicians with different lung ultrasound experience (beginners (n=7), competents (n=6), experts (n=5)) blindly assessed it. Conformity and reliability of interpretation were analysed using intraclass correlation coefficient (ICC), area under the curve (AUC) of the multi-class ROC analysis, correlation and multivariate linear regressions (adjusting for frequency, expertise and their interaction).Outcome measuresA (0–3) score based on classical lung ultrasound semiology was given to each image as done in the clinical routine.ResultsICC (0.902 (95% CI: 0.862 to 0.936), p
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325300
  Issue No: Vol. 108, No. 6 (2023)
Hyper high haemoglobin content in red blood cells and erythropoietic
transitions postnatally in infants of 22 to 26 weeks gestation: a
prospective cohort study
- Authors: Larsson, S. M; Ulinder, T, Rakow, A, Vanpee, M, Wackernagel, D, Sävman, K, Hansen-Pupp, I, Hellström, A, Ley, D, Andersson, O.
  Pages: 612 - 616
  Abstract: ObjectiveBlood cell populations, including red blood cells (RBC) unique to the extremely preterm (EPT) infant, are potentially lost due to frequent clinical blood sampling during neonatal intensive care. Currently, neonatal RBC population heterogeneity is not described by measurement of total haemoglobin or haematocrit. We therefore aimed to describe a subpopulation of large RBCs with hyper high haemoglobin content,>49 pg (Hyper-He) following EPT birth.DesignProspective observational cohort study.SettingTwo Swedish study centres.ParticipantsInfants (n=62) born between gestational weeks 22+0 to 26+6.MethodsProspective data (n=280) were collected from March 2020 to September 2022 as part of an ongoing randomised controlled trial. Blood was sampled from the umbilical cord, at postnatal day 1–14, 1 month, 40 weeks’ postmenstrual age and at 3 months’ corrected age.ResultsAt birth, there was a considerable inter-individual variation; Hyper-He ranging from 1.5% to 24.9% (median 7.0%). An inverse association with birth weight and gestational age was observed; Spearman’s rho (CI) –0.38 (–0.63 to –0.07) and –0.39 (–0.65 to –0.05), respectively. Overall, Hyper-He rapidly decreased, only 0.6%–5.0% (median 2.2%) remaining 2 weeks postnatally. Adult levels (
  Keywords: Open access
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325248
  Issue No: Vol. 108, No. 6 (2023)
Experiences of healthcare personnel with death in the neonatal intensive
care unit: a systematic review of qualitative studies
- Authors: Wong, J. Q. H; Charles, J. S, Mok, H. T, Tan, T. S. Z, Amin, Z, Ng, Y. P. M.
  Pages: 617 - 622
  Abstract: ObjectiveTo synthesise evidence from qualitative studies on the experiences of healthcare personnel (HCP) in the neonatal intensive care unit (NICU) caring for dying neonates.MethodsWe conducted a systematic search, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: CRD42021250015), of four databases (PubMed, Embase, PsycINFO and CINAHL) from date of inception of the databases to 31 December 2021 using MeSH terms and related keywords. Data were analysed using three-step inductive thematic synthesis. Quality assessment of included studies was performed.ResultsThirty-two articles were included. There were 775 participants, majority (92.6%) of whom were nurses and doctors. Quality of studies was variable. The narratives of HCP coalesced into three themes: sources of distress, coping methods and the way forward. Sources of distress encompassed HCP’s discomfort with neonatal deaths; poor communication among HCP and with patient’s family; lack of support (from organisations, peers and HCP’s family) and emotional responses (guilt, helplessness and compassion fatigue). Methods of coping included setting emotional boundaries, support from colleagues, clear communication and compassionate care and well-designed end-of-life workflows. Steps taken by HCP to move forward and overcome the emotionally turbulent effects of NICU deaths included finding meaning in death, building deeper relationship with patients’ families and the NICU team and embracing purpose and pride in work.ConclusionHCP face several challenges when a death occurs in the NICU. HCP can provide better end-of-life care if their undesirable experiences with death are mitigated by better understanding and overcoming factors causing distress.
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325566
  Issue No: Vol. 108, No. 6 (2023)
Early initiation of antibiotic therapy and short-term outcomes in preterm
infants: a single-centre retrospective cohort analysis
- Authors: Köstlin-Gille, N; Serna-Higuita, L. M, Bubser, C, Arand, J, Haag, L, Schwarz, C. E, Heideking, M, Poets, C. F, Gille, C.
  Pages: 623 - 630
  Abstract: BackgroundSepsis is one of the most important complications in preterm infants. For this reason, many such infants receive antibiotics during their hospital stay. However, early antibiotic therapy has also been associated with adverse outcome. It is yet largely unclear if the time of onset of antibiotic therapy influences the outcome. We here investigated whether the timing of initiation of antibiotic therapy plays a role in the association between antibiotic exposure and short-term outcome.MethodsRetrospective analysis of data from 1762 very low birthweight infants born in a German neonatal intensive care unit (NICU) between January 2004 and December 2021.ResultsAntibiotics were administered to 1214 of the 1762 (68.9%) infants. In 973 (55.2%) of the 1762 of infants, antibiotic therapy was initiated within the first two postnatal days. Only 548 (31.1%) infants did not have any antibiotic prescription during their stay in the NICU. Antibiotic exposure at every timepoint was associated with an increased risk of all short-term outcomes analysed in univariable analyses. In multivariable analyses, initiation of antibiotic therapy within the first two postnatal days and initiation between postnatal days 3 and 6 was independently associated with an increased risk of developing bronchopulmonary dysplasia (BPD) (OR 3.1 and 2.8), while later initiation of antibiotic therapy was not.ConclusionVery early initiation of antibiotic therapy was associated with an increased risk of BPD. Due to the study design, no conclusions on causality can be drawn. If confirmed, our data suggest that an improved identification of infants at low risk of early-onset sepsis is needed to reduce antibiotic exposure.
  Keywords: Open access
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325113
  Issue No: Vol. 108, No. 6 (2023)
Prognostic value of echocardiographic parameters in congenital
diaphragmatic hernia: a systematic review and meta-analysis
- Authors: Pammi, M; Kelagere, Y, Koh, S, Sisson, A, Hagan, J, Kailin, J, Fernandes, C. J.
  Pages: 631 - 637
  Abstract: BackgroundPrognostication of mortality and decision to offer extracorporeal membrane oxygenation (ECMO) treatment in infants with congenital diaphragmatic hernia (CDH) can inform clinical management.ObjectiveTo summarise the prognostic value of echocardiography in infants with CDH.MethodsElectronic databases Ovid MEDLINE, Embase, Scopus, CINAHL, the Cochrane Library and conference proceedings up to July 2022 were searched. Studies evaluating the prognostic performance of echocardiographic parameters in newborn infants were included. Risk of bias and applicability were assessed using the Quality Assessment of Prognostic Studies tool. We used a random-effect model for meta-analysis to compute mean differences (MDs) for continuous outcomes and relative risk (RR) for binary outcomes with 95% CIs. Our primary outcome was mortality; secondary outcomes were need for ECMO, duration of ventilation, length of stay, and need for oxygen and/or inhaled nitric oxide.ResultsTwenty-six studies were included that were of acceptable methodological quality. Increased diameters of the right and left pulmonary arteries at birth (mm), MD 0.95 (95% CI 0.45 and 1.46) and MD 0.79 (95% CI 0.58 to 0.99), respectively) were associated with survival. Left ventricular (LV) dysfunction, RR 2.40, (95% CI 1.98 to 2.91), right ventricular (RV) dysfunction, RR 1.83 (95% CI 1.29 to 2.60) and severe pulmonary hypertension (PH), RR 1.69, (95% CI 1.53 to 1.86) were associated with mortality. Left and RV dysfunctions, RR 3.30 (95% CI 2.19 to 4.98) and RR 2.16 (95% CI 1.85 to 2.52), respectively, significantly predicted decision to offer ECMO treatment. Limitations are lack of consensus on what parameter is optimal and standardisation of echo assessments.ConclusionsLV and RV dysfunctions, PH and pulmonary artery diameter are useful prognostic factors among patients with CDH.
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325257
  Issue No: Vol. 108, No. 6 (2023)
Measuring Oxygenation in Newborn Infants with Targeted Oxygen Ranges
(MONITOR): a randomised crossover pilot study
- Authors: Christie, F. G; Kelly, R, Boardman, J. P, Stenson, B. J.
  Pages: 638 - 642
  Abstract: ObjectiveThe Neonatal Oxygenation Prospective Meta-analysis (NeOProM) Collaboration showed that high (91–95%) versus low (85–89%) SpO2 targets reduced mortality. Trials of higher targets are needed to determine whether any more survival advantage may be gained. This pilot study explored the achieved oxygenation patterns observed when targeting SpO2 92–97% to facilitate the design of future trials.DesignSingle-centre prospective randomised crossover pilot study. Manual FiO2 adjustment. Study time 12 hours per infant. 6 hours targeting SpO2 90–95% and 6 hours targeting SpO2 92–97%.PatientsTwenty preterm infants born
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-324833
  Issue No: Vol. 108, No. 6 (2023)
Clinical usefulness of reintubation criteria in extremely preterm infants:
a cohort study
- Authors: Alarcon-Martinez, T; Latremouille, S, Kovacs, L, Kearney, R. E, SantAnna, G. M, Shalish, W.
  Pages: 643 - 648
  Abstract: ObjectiveTo describe the thresholds of instability used by clinicians at reintubation and evaluate the accuracy of different combinations of criteria in predicting reintubation decisions.DesignSecondary analysis using data obtained from the prospective observational Automated Prediction of Extubation Readiness study (NCT01909947) between 2013 and 2018.SettingMulticentre (three neonatal intensive care units).PatientsInfants with birth weight ≤1250 g, mechanically ventilated and undergoing their first planned extubation were included.InterventionsAfter extubation, hourly O2 requirements, blood gas values and occurrence of cardiorespiratory events requiring intervention were recorded for 14 days or until reintubation, whichever came first.Main outcome measuresThresholds at reintubation were described and grouped into four categories: increased O2, respiratory acidosis, frequent cardiorespiratory events and severe cardiorespiratory events (requiring positive pressure ventilation). An automated algorithm was used to generate multiple combinations of criteria from the four categories and compute their accuracies in capturing reintubated infants (sensitivity) without including non-reintubated infants (specificity).Results55 infants were reintubated (median gestational age 25.2 weeks (IQR 24.5–26.1 weeks), birth weight 750 g (IQR 640–880 g)), with highly variable thresholds at reintubation. After extubation, reintubated infants had significantly greater O2 needs, lower pH, higher pCO2 and more frequent and severe cardiorespiratory events compared with non-reintubated infants. After evaluating 123 374 combinations of reintubation criteria, Youden indices ranged from 0 to 0.46, suggesting low accuracy. This was primarily attributable to the poor agreement between clinicians on the number of cardiorespiratory events at which to reintubate.ConclusionsCriteria used for reintubation in clinical practice are highly variable, with no combination accurately predicting the decision to reintubate.
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325245
  Issue No: Vol. 108, No. 6 (2023)
Diagnostic accuracy of small-for-gestational-age status for infant
mortality and school-age outcomes of live births
- Authors: Doyle, L. W; Chen, J, Boland, R. A, Kane, S. C, Mainzer, R, Roberts, G, Josev, E. K, Clark, M, Anderson, P. J, Cheong, J. L. Y.
  Pages: 649 - 654
  Abstract: ObjectivesTo determine the diagnostic accuracy of small-for-gestational-age (SGA;
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325515
  Issue No: Vol. 108, No. 6 (2023)
Herpes simplex virus infection among neonates suspected of invasive
bacterial infection: a population-based cohort study
- Authors: Dungu, K. H. S; Lund, S, Malchau Carlsen, E. L, Hartling, U. B, Matthesen, A. T, Franck, K. T, Thomsen, M. K, Justesen, U. S, Nielsen, H. L, Nielsen, A. C. Y, Henriksen, T. B, Nygaard, U.
  Pages: 655 - 660
  Abstract: ObjectiveTo estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections.DesignA nationwide population-based cohort study.SettingAll neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019.PatientsNeonates aged 0–28 days with HSV infection.Main outcome measuresThe main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI.ResultsFifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0–3, 4–7 and 8–14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively.ConclusionsThe incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325583
  Issue No: Vol. 108, No. 6 (2023)
Cutaneous mucormycosis in an extremely premature infant
- Authors: Chmelova, K; Tinnion, R, Zalewski, S.
  Pages: 661 - 661
  Abstract: This case concerns a female infant born at 23+4/40 weighing 460 g. She was referred to us on day 6 with focal intestinal perforation, requiring small bowel resection and ileostomy. On day 7, skin necrosis was seen extending bilaterally from under the endotracheal tube (ETT) fixation (figure 1). Removing the device revealed extensive soft tissue damage. Honey dressings were applied and a non-adhesive method (bonnet & ties) used to resecure ETT. Antifungal prophylaxis was continued and antibiotics (tazocin, clindamycin, vancomycin) commenced as swabs from area grew Escherichia coli. Necrosis progressed to full thickness injury by day 11 (figure 2). Debridement of wounds was not felt to be a viable option due to anatomical position. Providing ongoing intensive care was impossible with progression of necrosis and no ways to secure respiratory support long term due to her size (ie, tracheostomy). Intensive care was stopped on day 12....
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2022-325022
  Issue No: Vol. 108, No. 6 (2023)
Vertical transmission of SARS-CoV-2 - are there differences in rates of
neonatal SARS-CoV-2 infection in two classification systems'
- Authors: Mand, N; Hutten, M, Maier, R. F, Mense, L, Pecks, U, Rüdiger, M, on behalf of the CRONOS Network
  Pages: 662 - 664
  Abstract: Neonatal SARS-CoV-2 infection due to vertical transmission has been summarised in recent reviews.1 2 However, the comparability of the underlying case reports and case series might be limited because of the often inconsistent use of different classification systems.1 COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS) was a prospective German registry enrolling pregnant women with confirmed SARS-CoV-2 infection during their pregnancy.3 4 The registry collected data between 3 April 2020 and 10 February 2023 with 130 of 686 (18.9%) German obstetric hospitals actively participating.4 To classify the timing and the probability of mother-to-child transmission of SARS-CoV-2-positive newborns in the CRONOS cohort we used the classification systems of the Nordic Federation of Societies of Obstetrics and Gynecology (NFSOG)5 and WHO.6 Within the study period, 8540 women had been registered in CRONOS, with 8032 final cases...
  Keywords: COVID-19
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325835
  Issue No: Vol. 108, No. 6 (2023)
Thermal care for preterm infants in the delivery room has not been
compromised since the routine adoption of delayed cord clamping in our
unit
- Authors: Clarke, R; Burgess-Shannon, J, Howarth, C, Rowell, V, Aladangady, N.
  Pages: 662 - 662
  Abstract: It was with great interest that we read the work of Dunne et al describing higher rates of admission hypothermia in preterm infants following the introduction of delayed cord clamping (DCC) (6% to 54%).1 We share their concerns given the association between admission hypothermia and increased mortality.2 The 2021 National Neonatal Audit Programme (NNAP) data highlighted our tertiary, medical neonatal intensive care unit as a negative outlier—only 12.1% of preterm infants received DCC compared with the national average of 43.0%. A quality improvement project (QIP) followed, led by a multidisciplinary team (MDT) consisting of neonatal, obstetric, anaesthetic and midwifery staff. Exploration of barriers and change ideas informed the development of a new guideline, education sessions and poster resources to embed DCC into routine practice. Subsequently, we demonstrated a statistically significant improvement in DCC rates for infants
  PubDate: 2023-10-19T00:45:33-07:00
  DOI: 10.1136/archdischild-2023-325861
  Issue No: Vol. 108, No. 6 (2023)