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Archives of Disease in Childhood - Fetal and Neonatal Edition
Journal Prestige (SJR): 1.837
Citation Impact (citeScore): 3
Number of Followers: 76  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1359-2998 - ISSN (Online) 1468-2052
Published by BMJ Publishing Group Homepage  [64 journals]
  • Highlights from this issue

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      Authors: Stenson B. J.
      Pages: 457 - 457
      Abstract: Therapeutic creep in provision of hypothermia for hypoxic ischaemic encephalopathy Three articles relate to the changing practices of UK clinicians in the provision of therapeutic hypothermia for hypoxic ischaemic encephalopathy (HIE). Lori Hage and colleagues report the clinical characteristics of term born infants treated with therapeutic hypothermia for a diagnosis of HIE in the UK between 2010 and 2017. The data came from the National Neonatal Research Database and include infants who were treated for 3 days or who died during this period. There were 5201 infants who met this definition. The number of infants treated increased year on year until 2015 and then levelled out. Markers of condition at birth suggested inclusion over time of greater numbers of infants with less severe disease. The number of infants treated with a diagnosis of mild encephalopathy increased four-fold from 31 infants per year to 133 infants per year over the...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2021-322970
      Issue No: Vol. 106, No. 5 (2021)
       
  • Neonatal encephalopathy and potential lost opportunities: when the story
           fits, please cool

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      Authors: Tagin, M. A; Gunn, A. J.
      Pages: 458 - 459
      Abstract: Clinical scenario ‘Sarah is a baby girl born by an emergency caesarean section following a period of observation for non-reassuring cardiotocographic recordings. She was initially ‘flat’ and received positive pressure ventilation for 3 min before establishing spontaneous breathing. Her Apgar scores were 1, 6 and 8 at 1, 5 and 10 min, respectively; cord pH was 7.08 and standard base excess (sBE) was –12.1. Sarah stayed with her mother as she was breathing normally and centrally pink despite being mildly hypotonic with minimal activity. At 10 hours of age, she started to develop recurrent seizures. Cerebral MRI showed extensive diffusion restriction patterns compatible with acute hypoxic–ischaemic insult.’ Sarah is a composite case, developed to include real events that we and others have observed. Unfortunately, many neonatal units receive similar cases every year and they often end up not offering therapeutic hypothermia, the only available treatment with proven safety and efficacy...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2021-321696
      Issue No: Vol. 106, No. 5 (2021)
       
  • Neonatal hyperglycaemia is associated with worse neurodevelopmental
           outcomes in extremely preterm infants

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      Authors: Zamir, I; Stoltz Sjöström, E, Ahlsson, F, Hansen-Pupp, I, Serenius, F, Domellöf, M.
      Pages: 460 - 466
      Abstract: ObjectiveTo assess the associations between neonatal hyperglycaemia and insulin treatment, versus long-term neurodevelopmental outcomes in children born extremely preterm.Design and settingObservational national cohort study (Extremely Preterm Infants in Sweden Study) using prospectively and retrospectively collected data. Neurodevelopmental assessment was performed at 6.5 years of age.Patients533 infants born 8 mmol/L was associated with WISC-IV scores—for each day with hyperglycaemia there was a decrease of 0.33 points (95% CI 0.03 to 0.62) in FSIQ. Neonatal hyperglycaemia>8 mmol/L occurring on 3 consecutive days was associated with lower MABC-2 scores (adjusted mean difference: –4.90; 95% CI –8.90 to –0.89). For each day with hyperglycaemia>8 mmol/L, there was a decrease of 0.55 points (95% CI 0.17 to 0.93) in MABC-2 total score. Insulin treatment was not associated with any of the outcome measures.ConclusionNeonatal hyperglycaemia>8 mmol/L was associated with lower intelligence scores and worse motor outcomes at 6.5 years of age. Insulin treatment was not associated with either worsened or improved neurodevelopmental outcomes. Randomised controlled trials are needed to clarify the role of insulin in treating hyperglycaemia in extremely preterm infants.
      Keywords: Open access
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319926
      Issue No: Vol. 106, No. 5 (2021)
       
  • Neurodevelopmental outcomes following neonatal late-onset sepsis and blood
           culture-negative conditions

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      Authors: Mukhopadhyay, S; Puopolo, K. M, Hansen, N. I, Lorch, S. A, DeMauro, S. B, Greenberg, R. G, Cotten, C. M, Sanchez, P. J, Bell, E. F, Eichenwald, E. C, Stoll, B. J, on behalf of the NICHD Neonatal Research Network
      Pages: 467 - 473
      Abstract: ObjectiveDetermine risk of death or neurodevelopmental impairment (NDI) in infants with late-onset sepsis (LOS) versus late-onset, antibiotic-treated, blood culture-negative conditions (LOCNC).DesignRetrospective cohort study.Setting24 neonatal centres.PatientsInfants born 1/1/2006–31/12/2014, at 22–26 weeks gestation, with birth weight 401–1000 g and surviving>7 days were included. Infants with early-onset sepsis, necrotising enterocolitis, intestinal perforation or both LOS and LOCNC were excluded.ExposuresLOS and LOCNC were defined as antibiotic administration for ≥5 days with and without a positive blood/cerebrospinal fluid culture, respectively. Infants with these diagnoses were also compared with infants with neither condition.OutcomesDeath or NDI was assessed at 18–26 months corrected age follow-up. Modified Poisson regression models were used to estimate relative risks adjusting for covariates occurring ≤7 days of age.ResultsOf 7354 eligible infants, 3940 met inclusion criteria: 786 (20%) with LOS, 1601 (41%) with LOCNC and 1553 (39%) with neither. Infants with LOS had higher adjusted relative risk (95% CI) for death/NDI (1.14 (1.05 to 1.25)) and death before follow-up (1.71 (1.44 to 2.03)) than those with LOCNC. Among survivors, risk for NDI did not differ between the two groups (0.99 (0.86 to 1.13)) but was higher for LOCNC infants (1.17 (1.04 to 1.31)) compared with unaffected infants.ConclusionsInfants with LOS had higher risk of death, but not NDI, compared with infants with LOCNC. Surviving infants with LOCNC had higher risk of NDI compared with unaffected infants. Improving outcomes for infants with LOCNC requires study of the underlying conditions and the potential impact of antibiotic exposure.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320664
      Issue No: Vol. 106, No. 5 (2021)
       
  • Comparative efficacy of methods for surfactant administration: a network
           meta-analysis

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      Authors: Bellos, I; Fitrou, G, Panza, R, Pandita, A.
      Pages: 474 - 487
      Abstract: ObjectivesTo compare surfactant administration via thin catheters, laryngeal mask, nebulisation, pharyngeal instillation, intubation and surfactant administration followed by immediate extubation (InSurE) and no surfactant administration.DesignNetwork meta-analysis.SettingMedline, Scopus, CENTRAL, Web of Science, Google-scholar and Clinicaltrials.gov databases were systematically searched from inception to 15 February 2020.PatientsPreterm neonates with respiratory distress syndrome.InterventionsLess invasive surfactant administration.Main outcome measuresThe primary outcomes were mortality, mechanical ventilation and bronchopulmonary dysplasia.ResultsOverall, 16 randomised controlled trials (RCTs) and 20 observational studies were included (N=13 234). For the InSurE group, the median risk of mortality, mechanical ventilation and bronchopulmonary dysplasia were 7.8%, 42.1% and 10%, respectively. Compared with InSurE, administration via thin catheter was associated with significantly lower rates of mortality (OR: 0.64, 95% CI: 0.54 to 0.76), mechanical ventilation (OR: 0.43, 95% CI: 0.29 to 0.63), bronchopulmonary dysplasia (OR: 0.57, 95% CI: 0.44 to 0.73), periventricular leukomalacia (OR: 0.66, 95% CI: 0.53 to 0.82) with moderate quality of evidence and necrotising enterocolitis (OR: 0.67, 95% CI: 0.41 to 0.9, low quality of evidence). No significant differences were observed by comparing InSurE with administration via laryngeal mask, nebulisation or pharyngeal instillation. In RCTs, thin catheter administration lowered the rates of mechanical ventilation (OR: 0.39, 95% CI: 0.26 to 0.60) but not the incidence of the remaining outcomes.ConclusionAmong preterm infants, surfactant administration via thin catheters was associated with lower likelihood of mortality, need for mechanical ventilation and bronchopulmonary dysplasia compared with InSurE. Further research is needed to reach firm conclusions about the efficacy of alternative minimally invasive techniques of surfactant administration.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319763
      Issue No: Vol. 106, No. 5 (2021)
       
  • Bedside agitated saline test confirming diagnosis of anomalous right
           superior caval vein draining into the left atrium

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      Authors: Wijedasa, N. H. Y; Fortier, M. V, Zhang, D. Z, Aquino-Grino, S. A, Choo, J. T. L.
      Pages: 487 - 488
      Abstract: Cardiology was called to review a neonate with cyanosis at 6 hours of life. The oxygen saturations averaged 70% at baseline with no preductal and postductal difference. No cardiac murmurs were heard, but the chest X-ray showed an enlarged heart. Transthoracic echocardiography (TTE) demonstrated a small patent arterial duct and a patent oval foramen, both with left-to-right flow across. TTE also showed dilatation of the left atrium (LA) and left ventricle (LV) (figure 1A), suggesting increased flow to the left—heart (figure 1B). The atrioventricular and ventriculoarterial connections were normal. Agitated saline was administered via an intravenous cannula over the infant’s left hand, and microbubbles were seen to enter the LA and LV in the early phase1 (figure 1C) (video 1), through the right superior caval vein (RSCV) (figure 1D). There was no left superior caval vein. A diagnosis...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319737
      Issue No: Vol. 106, No. 5 (2021)
       
  • Heart rate during the first 24 hours in term-born infants

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      Authors: Tveiten, L; Diep, L. M, Halvorsen, T, Markestad, T.
      Pages: 489 - 493
      Abstract: ObjectiveHeart rate (HR) is an important clinical parameter in newborn infants, but normal ranges are poorly defined. Our aim was to establish normal reference ranges and individual variations in HR as obtained by auscultation in healthy term-born infants during the first 24 hours of life.DesignObservational study.SettingSingle hospital in Norway.MethodsHR was assessed by auscultation for 30 s at 2, 4, 8, 16 and 24 hours of age. Auscultation was validated against ECG recordings.SubjectsHealthy term-born infants who were asleep or awake in a quiet resting state.Main outcome measuresConstruction of percentile curves for resting HR.ResultsThe study included 953 infants. The 50th percentile was 126 beats per minute (bpm) at age 2 hours and thereafter 120–122 bpm. The respective 2nd and 98th percentiles were 102 (thereafter 96–100) bpm and 162 (thereafter 150–156) bpm. The mean HR was 5.6 bpm higher when awake than asleep, 4.9 bpm higher when on the mother’s chest than in the cot, 1.6 bpm higher in girls than in boys, and increased by 0.5 bpm per 0.1°C increase in rectal temperature. Mode of delivery, meconium staining, birth weight and maternal smoking during pregnancy were of no significance. For each infant, HR varied considerably during the first 24 hours (intraclass correlation 0.21 (95% CI 0.18 to 0.24), coefficient of variation 9.2%).ConclusionsThe HR percentiles allow for a scientifically based use of HR when assessing newborn infants born at term.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320761
      Issue No: Vol. 106, No. 5 (2021)
       
  • Cost of neonatal abstinence syndrome: an economic analysis of English
           national data held in the National Neonatal Research Database

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      Authors: Rees, P; Carter, B, Gale, C, Petrou, S, Botting, B, Sutcliffe, A. G.
      Pages: 494 - 500
      Abstract: ObjectiveTo determine the incidence of neonatal abstinence syndrome (NAS) across neonatal units, explore healthcare utilisation and estimate the direct cost to the NHS.DesignPopulation cohort study.SettingNHS neonatal units, using data held in the National Neonatal Research Database.ParticipantsInfants born between 2012 and 2017, admitted to a neonatal unit in England, receiving a diagnosis of NAS (n=6411).Main outcome measuresIncidence, direct annual cost of care (£, 2016–2017 prices), duration of neonatal unit stay (discharge HR), predicted additional cost of care, and odds of receiving pharmacotherapy.ResultsOf 524 334 infants admitted during the study period, 6411 had NAS. The incidence (1.6/1000 live births) increased between 2012 and 2017 (β=0.07, 95% CI (0 to 0.14)) accounting for 12/1000 admissions and 23/1000 cot days nationally. The direct cost of care was £62 646 661 over the study period. Almost half of infants received pharmacotherapy (n=2631; 49%) and their time-to-discharge was significantly longer (median 18.2 vs 5.1 days; adjusted HR (aHR) 0.16, 95% CI (0.15 to 0.17)). Time-to-discharge was longer for formula-fed infants (aHR 0.73 (0.66 to 0.81)) and those discharged to foster care (aHR 0.77 (0.72 to 0.82)). The greatest predictor of additional care costs was receipt of pharmacotherapy (additional mean adjusted cost of £8420 per infant).ConclusionsThis population study highlights the substantial cot usage and economic costs of caring for infants with NAS on neonatal units. A shift in how healthcare systems provide routine care for NAS could benefit infants and families while alleviating the burden on services.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319213
      Issue No: Vol. 106, No. 5 (2021)
       
  • Changing clinical characteristics of infants treated for hypoxic-ischaemic
           encephalopathy in England, Wales and Scotland: a population-based study
           using the National Neonatal Research Database

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      Authors: Hage, L; Jeyakumaran, D, Dorling, J, Ojha, S, Sharkey, D, Longford, N, Modi, N, Battersby, C, Gale, C.
      Pages: 501 - 508
      Abstract: BackgroundTherapeutic hypothermia is standard of care for babies with moderate/severe hypoxic-ischaemic encephalopathy and is increasingly used for mild encephalopathy.ObjectiveDescribe temporal trends in the clinical condition of babies diagnosed with hypoxic-ischaemic encephalopathy who received therapeutic hypothermia.DesignRetrospective cohort study using data held in the National Neonatal Research Database.SettingNational Health Service neonatal units in England, Wales and Scotland.PatientsInfants born from 1 January 2010 to 31 December 2017 with a recorded diagnosis of hypoxic-ischaemic encephalopathy who received therapeutic hypothermia for at least 3 days or died in this period.Main outcomesPrimary outcomes: recorded clinical characteristics including umbilical cord pH; Apgar score; newborn resuscitation; seizures and treatment on day 1. Secondary outcomes: recorded hypoxic-ischaemic encephalopathy grade.Results5201 babies with a diagnosis of hypoxic-ischaemic encephalopathy received therapeutic hypothermia or died; annual numbers increased over the study period. A decreasing proportion had clinical characteristics of severe hypoxia ischaemia or a diagnosis of moderate or severe hypoxic-ischaemic encephalopathy, trends were statistically significant and consistent across multiple clinical characteristics used as markers of severity.ConclusionsTreatment with therapeutic hypothermia for hypoxic-ischaemic encephalopathy has increased in England, Scotland and Wales. An increasing proportion of treated infants have a diagnosis of mild hypoxic-ischaemic encephalopathy or have less severe clinical markers of hypoxia. This highlights the importance of determining the role of hypothermia in mild hypoxic-ischaemic encephalopathy. Receipt of therapeutic hypothermia is unlikely to be a useful marker for assessing changes in the incidence of brain injury over time.
      Keywords: Editor's choice
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319685
      Issue No: Vol. 106, No. 5 (2021)
       
  • Comparison of rectal and axillary temperature measurements in preterm
           newborns

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      Authors: McCarthy, L. K; ODonnell, C. P. F.
      Pages: 509 - 513
      Abstract: ObjectiveTo compare rectal and axillary temperatures in preterm newborns on admission to the neonatal intensive care unit (NICU).DesignSecondary analysis of data collected in a randomised controlled trial (RCT).SettingMaternity hospital, level 3 NICU.PatientsSeventy-two newborns
      Keywords: Open access
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320627
      Issue No: Vol. 106, No. 5 (2021)
       
  • SARS-CoV-2 genome and antibodies in breastmilk: a systematic review and
           meta-analysis

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      Authors: Zhu, F; Zozaya, C, Zhou, Q, De Castro, C, Shah, P. S.
      Pages: 514 - 521
      Abstract: ObjectiveTo systematically review and meta-analyse the rate of SARS-CoV-2 genome identification and the presence of SARS-CoV-2 antibodies in breastmilk of mothers with COVID-19.DesignA systematic review of studies published between January 2019 and October 2020 without study design or language restrictions.SettingData sourced from Ovid Embase Classic+Embase, PubMed, Web of Science, Scopus, relevant bibliographies and the John Hopkins University COVID-19 database.PatientsMothers with confirmed COVID-19 and breastmilk tested for SARS-CoV-2 by RT-PCR or for anti-SARS-CoV-2 antibodies.Main outcome measuresPresence of SARS-CoV-2 genome and antibodies in breastmilk.ResultsWe included 50 articles. Twelve out of 183 women from 48 studies were positive for SARS-CoV-2 genome in their breastmilk (pooled proportion 5% (95% CI 2% to 15%; I2=48%)). Six infants (50%) of these 12 mothers tested positive for SARS-CoV-2, with one requiring respiratory support. Sixty-one out of 89 women from 10 studies had anti-SARS-CoV-2 antibody in their breastmilk (pooled proportion 83% (95% CI 32% to 98%; I2=88%)). The predominant antibody detected was IgA.ConclusionsSARS-CoV-2 genome presence in breastmilk is uncommon and is associated with mild symptoms in infants. Anti-SARS-CoV-2 antibodies may be a more common finding. Considering the low proportion of SARS-CoV-2 genome detected in breastmilk and its lower virulence, mothers with COVID-19 should be supported to breastfeed.
      Keywords: COVID-19
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-321074
      Issue No: Vol. 106, No. 5 (2021)
       
  • Usefulness of video recordings for validating neonatal encephalopathy
           exams: a population-based cohort study

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      Authors: Arnaez, J; Vega-Del-Val, C, Hortigüela, M, Benavente-Fernandez, I, Martinez-Biarge, M, Ochoa Sangrador, C, Garcia-Alix, A, IC-HIE Study Group
      Pages: 522 - 528
      Abstract: ObjectiveTo determine the usefulness of video recordings for validating neonatal encephalopathy (NE) exams.DesignPopulation-based prospective cohort study. NE was assessed and recorded at 1, 3 and 5 hours after birth by the attending physician. Recordings were reviewed blindly after the recruitment period by two specialists. Outcome was assessed at 36 months of age.SettingTwelve intensive care units in Spain.PatientsInfants of ≥35 weeks’ gestational age with perinatal asphyxia.Main outcomes measuresWeighted kappa to measure disagreement between the two specialists and between the attending physician and the specialists’ classification agreed on by consensus. Regression models to test the association of disagreement on NE assessment and outcome.ResultsOf the 32 325 liveborn infants, 217 met the inclusion criteria. Video-recordings were not available for 43 infants (20%). Weighted kappa statistic was 0.74 (95% CI 0.67 to 0.81) between the specialists and the attending physicians. Disagreement occurred in 93 of the 417 (22%) videos, specifically in 39 (14%), 43 (47%), 11 (34%) and 0 exams categorised as no, mild, moderate and severe NE, respectively. According to the specialist consensus assessment, there was disagreement on the therapeutic hypothermia decision in 10 infants.When there was consensus among the specialists assessing a more severe NE degree compared with the attending physicians in 170 infants, those infants had lower cognitive scores with a median of –5.33 points (95% CI –9.85 to –8.16; p=0.02).ConclusionsThis study supports the feasibility and benefit of using video recordings to identify NE in infants with perinatal asphyxia.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320791
      Issue No: Vol. 106, No. 5 (2021)
       
  • Trends in the incidence and management of hypoxic-ischaemic encephalopathy
           in the therapeutic hypothermia era: a national population study

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      Authors: Shipley, L; Gale, C, Sharkey, D.
      Pages: 529 - 534
      Abstract: ObjectiveHypoxic-ischaemic encephalopathy (HIE) remains a leading cause of neonatal mortality and neurodisability. We aimed to determine the incidence of HIE and management patterns against national guidelines.DesignRetrospective cohort study using the National Neonatal Research Database.SettingNeonatal units in England and Wales.PatientsInfants 34–42 weeks gestational age (GA) with a recorded diagnosis of HIE.Main outcomesIncidence of HIE, mortality and treatment with therapeutic hypothermia (TH) were the main outcomes. Temporal changes were compared across two epochs (2011–2013 and 2014–2016).ResultsAmong 407 462 infants admitted for neonatal care, 12 195 were diagnosed with HIE. 8166 infants ≥36 weeks GA had moderate/severe HIE, 62.1% (n=5069) underwent TH and mortality was 9.3% (n=762). Of infants with mild HIE (n=3394), 30.3% (n=1027) underwent TH and 6 died. In late preterm infants (34–35 weeks GA) with HIE (n=635, 5.2%), 33.1% (n=210) received TH and 13.1% (n=83) died. Between epochs (2011–2013 vs 2014–2016), mortality decreased for infants ≥36 weeks GA with moderate/severe HIE (17.5% vs 12.3%; OR 0.69, 95% CI 0.59 to 0.81, p
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320902
      Issue No: Vol. 106, No. 5 (2021)
       
  • Can EEG accurately predict 2-year neurodevelopmental outcome for preterm
           infants'

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      Authors: Lloyd, R. O; O'Toole, J. M, Livingstone, V, Filan, P. M, Boylan, G. B.
      Pages: 535 - 541
      Abstract: ObjectiveEstablish if serial, multichannel video electroencephalography (EEG) in preterm infants can accurately predict 2-year neurodevelopmental outcome.Design and patientsEEGs were recorded at three time points over the neonatal course for infants
      Keywords: Open access
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319825
      Issue No: Vol. 106, No. 5 (2021)
       
  • Total body water in full-term and preterm newborns: systematic review and
           meta-analysis

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      Authors: Young, A; Brown, L. K, Ennis, S, Beattie, R. M, Johnson, M. J.
      Pages: 542 - 548
      Abstract: BackgroundTotal body water (TBW) is one component of fat-free mass and changes in TBW are influenced by fluid shifts (especially during transition to postnatal life), electrolyte balance and nutritional status. Normal values for term-born neonates and preterm infants at birth have not been defined in large cohorts, limiting investigation into its monitoring and use in clinical practice.ObjectiveTo systematically review the evidence base for percentage of TBW in term-born infants, quantify the effect of prematurity on TBW at birth, and describe normal progression of TBW over time in preterm infants.MethodsSystematic review of Medline, Web of Science Core Collection and EBSCO-CINAHL (January 1946 to January 2020). Included articles used dilutional methods to assess TBW.ResultsSearches identified 2349 articles of which 22 included data suitable for analysis. Mean TBW in term-born newborns was 73.8% (95% CI 72.47% to 75.06%, 15 studies, 433 infants). Meta-regression showed that TBW was higher in preterm infants (up to 90% at 26 weeks gestation, dropping to 75% at 36 weeks corrected gestation) and was negatively correlated with gestation at birth, falling 1.44% per week (95% CI 0.63% to 2.24%, 9 studies, 179 infants). Analysis of TBW over time during the ex utero growth of preterm infants was not possible due to paucity of data.ConclusionThis review defines the normal TBW percentage in term-born infants and confirms and quantifies previous findings that preterm infants have a higher TBW percentage.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-321112
      Issue No: Vol. 106, No. 5 (2021)
       
  • Umbilical venous catheter extravasation diagnosed by point-of-care
           ultrasound

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      Authors: Rajendran, G; Sinha, A. K.
      Pages: 549 - 549
      Abstract: A 24-week gestational age neonate with severe respiratory distress syndrome was managed with high-frequency oscillatory ventilation and inotropes. Umbilical artery catheter and umbilical venous catheter (UVC) were inserted on day 1. UVC aspirated blood freely at the time of insertion and followed a straight course on abdominal X-ray (AXR). UVC was initially at the eighth thoracic vertebral (T8) level and was pulled back to T10. On day 4, the baby developed progressively increasing abdominal distension and high lactate, and AXR showed little bowel gas. There was no associated generalised oedema. Point-of-care ultrasound (POCUS) of the abdomen showed massive ascites with no floating particulate matter or fibrinous adhesion (figure 1). The UVC tip was seen in the umbilical vein but not in the inferior vena cava (figure 2). At this stage UVC was at T11 on AXR on day 5. UVC pressure reading was zero. Blood...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320008
      Issue No: Vol. 106, No. 5 (2021)
       
  • NeoBeat offers rapid newborn heart rate assessment

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      Authors: Bush, J. B; Cooley, V, Perlman, J, Chang, C.
      Pages: 550 - 552
      Abstract: BackgroundHeart rate (HR) is used to guide interventions during delivery room (DR) neonatal resuscitation. Dry electrode ECG (NeoBeat) may detect HR more rapidly than pulse oximetry (PO) and portable ECG, but real-time comparisons of these devices are lacking.Design/methodsPO, ECG and NeoBeat were placed sequentially on newborns in the DR. Time for device placement and time to accurate HR acquisition were noted.ResultsDR resuscitations of 28 preterm/term infants were observed. The NeoBeat was placed faster (ie, 3 s) than PO (20 s, p=
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320901
      Issue No: Vol. 106, No. 5 (2021)
       
  • Effects of varying chest compression depths on carotid blood flow and
           blood pressure in asphyxiated piglets

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      Authors: Bruckner, M; OReilly, M, Lee, T.-F, Neset, M, Cheung, P.-Y, Schmölzer, G. M.
      Pages: 553 - 556
      Abstract: BackgroundCurrent neonatal resuscitation guidelines recommend chest compressions (CCs) should be delivered to a depth of approximately 1/3 of the anterior–posterior (AP) chest diameter. The aim of the study was to investigate the haemodynamic effects of different CC depths in a neonatal piglet model.MethodsCCs were performed with an automated CC machine with 33%, 40% and 25% AP chest diameter in all piglets in the same order for a duration of 3 min each.ResultsEight newborn piglets (age 1–3 days, weight 1.7–2.3 kg) were included in the study. Carotid blood flow (CBF) and systolic blood pressure were the highest using a CC depth of 40% AP chest diameter (19.3±7.5 mL/min/kg and 58±32 mm Hg).ConclusionCC depth influences haemodynamic parameters in asphyxiated newborn piglets during cardiopulmonary resuscitation. The highest CBF and systolic blood pressure were achieved using a CC depth of 40% AP chest diameter.Trial registration numberPCTE0000148.
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319473
      Issue No: Vol. 106, No. 5 (2021)
       
  • Prematurity and postnatal alterations in intermittent hypoxaemia

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      Authors: Di Fiore, J. M; Shah, V, Patwardhan, A, Sattar, A, Wang, S, Raffay, T, Martin, R. J, Abu Jawdeh, E. G.
      Pages: 557 - 559
      Abstract: Intermittent hypoxaemia (IH) events are well described in extremely preterm infants, but the occurrence of IH patterns in more mature preterm infants remains unclear. The objective of this study was to characterise the effect of gestational age on early postnatal patterns of IH in extremely (
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320961
      Issue No: Vol. 106, No. 5 (2021)
       
  • Giant cranial pseudomeningocele after vacuum extraction

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      Authors: Favier, V; Werner, O, Roujeau, T.
      Pages: 560 - 560
      Abstract: A female newborn was presented to the neurosurgery department at 3 weeks of age with a subcutaneous scalp bulge (figure 1A). She was born at 40 weeks of gestation by vacuum extraction in another hospital. A frontal caput succedaneum was present at birth, and a cephalhaematoma developed next to the sagittal suture during the following hours. Clinical examination—including neurological examination and head circumference—was unremarkable. She was discharged on the fourth day of life. A cranial ultrasound on the ninth day of life confirmed the presence of a subaponeurotic collection with hyperechogenicity of the left frontal lobe suspect of intraparenchymal haemorrhage. A cranial CT scan revealed, the same day, a frontal subdural collection in the left frontal lobe associated with a frontal haemorrhagic suffusion. There was no skull fracture. The newborn was referred to our institution. Medical history revealed a slowly growing swelling of the cranial vault next...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319344
      Issue No: Vol. 106, No. 5 (2021)
       
  • Face mask versus nasal prong or nasopharyngeal tube for neonatal
           

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      Authors: Mangat, A; Bruckner, M, Schmölzer, G. M.
      Pages: 561 - 567
      Abstract: ImportanceThe current neonatal resuscitation guidelines recommend positive pressure ventilation via face mask or nasal prongs at birth. Using a nasal interface may have the potential to improve outcomes for newborn infants.ObjectiveTo determine whether nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-319460
      Issue No: Vol. 106, No. 5 (2021)
       
  • Impact of neonatal sepsis calculator in West Midlands (UK)

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      Authors: van Hasselt, T. J; McDermott, H, Surana, P, Eltahir, R, Macaskill, L, Jain, R, McMullan, N, Slee, S, Jagga, M, Naseem, M, Alake, O, Cherry, C, Miguras, B, Ewer, A. K, Paediatric Research Across the Midlands (PRAM) Network
      Pages: 568 - 569
      Abstract: The Kaiser Permanente Sepsis Risk Calculator (KP-SRC) was developed to predict early-onset neonatal sepsis (EOS), using continuous variables (local EOS incidence rates, maternal factors, infant well-being) to guide decision making.1 KP-SRC has been adopted in Plymouth and Wales, reducing antibiotic use by up to 84%2 3 compared with using National Institute for Health and Care Excellence (NICE) guidelines. This may reduce antibiotic resistance, dysbiosis,2 invasive procedures and mother–baby separation, although some safety concerns have been raised.4 We performed a virtual application of the KP-SRC versus NICE guidance on postnatal antibiotic usage and length of stay, using anonymised clinical data collected prospectively across 11 neonatal units in the West Midlands, UK. The Health Research Authority confirmed ethical approval was not required. All infants born ≥34 weeks’ gestation between 1 January 2020 and 29 February 2020 who were commenced on antibiotics...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-320862
      Issue No: Vol. 106, No. 5 (2021)
       
  • Intact cord stabilisation and delivery room strategies: current practice
           in the UK

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      Authors: Bean, A. E; Myers, L, Smith, C, Williams, T.
      Pages: 569 - 570
      Abstract: Previous studies have shown that there is wide variation in resuscitation and stabilisation practices for both term and preterm neonates across the UK.1 The latest International Liaison Committee on Resuscitation guidance is clear on the benefits of providing Positive end expiratory pressure (PEEP) for the initial ventilation of preterm infants.2 The benefits of delayed cord clamping (DCC) during initial stabilisation of preterm infants are also well documented3 and are recommended by the Resuscitation Council UK.4 The awaited National Neonatal Audit Programme report on data collected in 2019 will include national data on DCC rates across England, Scotland and Wales. However, there remains uncertainty as to whether to provide respiratory support and resuscitation as required to preterm infants while DCC is ongoing, otherwise known as intact cord stabilisation. Notably, intact cord stabilisation is not yet a recommended standard of practice in the...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-321153
      Issue No: Vol. 106, No. 5 (2021)
       
  • Learning intubation with neonatal videolaryngoscopy: education theory in
           practice

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      Authors: Ng, G. Y. T; Somerville, S.
      Pages: 570 - 570
      Abstract: We read with interest the study by O’Shea et al,1 which provides useful trainee perspectives on videolaryngoscopy as a teaching aid and highlights the need for standardised training packages. We agree that the use of non-invasive respiratory support has lessened the opportunities for intubation training. In addition, European Working Time Directive regulations have significantly reduced training times, making the acquisition of all procedural skills more challenging for junior doctors.2 Most UK neonatal units use direct laryngoscopy to teach intubation. However, videolaryngoscopy use is gradually increasing. We performed a qualitative study using semistructured interviews of 22 consultants and trainees in a UK tertiary neonatal unit where videolaryngoscopy is commonly used. We aimed to see how videolaryngoscopy contributes to teaching and learning. Interviews were recorded and transcribed verbatim. Data were analysed using attribute and descriptive coding methods. Framework analysis was used to interpret the data obtained from...
      PubDate: 2021-08-19T04:11:23-07:00
      DOI: 10.1136/archdischild-2020-321218
      Issue No: Vol. 106, No. 5 (2021)
       
 
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