Feasibility of a fetal measurement electrode system

Findings of the study are summarized and conclude that all monitoring requirements are not currently satisfied. An approach is presented to provide a multiparametric monitoring system through combinations of existing transducers. This monitoring system would be appropriate, not only for intrapartum monitoring, but also for neonatal and adult blood gas evaluations. A literature search was conducted to provide an insight into current state-of-the-art in fetal monitoring

Early prediction of hypoxic ischaemic encephalopathy in newborn infants in a resource-limited setting

Includes bibliographical references.Hypoxic ischaemic encephalopathy (HIE) after birth is an important cause of neonatal morbidity and mortality, particularly in resource-limited regions. Therapeutic hypothermia initiated within the first 6 hours of life, in settings that can offer neonatal intensive care, is a therapy that can reduce death or severe disability in newborn infants with moderate or severe HIE. Therapeutic hypothermia has not been shown to be safe or effective in low-resource settings where neonatal intensive care is not available; however, there are situations such as in some centres in South Africa, where limited neonatal intensive care (NICU) is available against a background of moderate neonatal mortality rates, relatively low socio-economic conditions and limited capacity for long-term follow-up. In such settings, accurate case definition and early prediction of HIE and outcome may assist with the appropriate allocation of resources. The amplitude-integrated electro-encephalogram (aEEG) is an ideal tool to use for prediction of outcome and the need for cooling, but it’s availability is limited, particularly at primary and secondary hospitals

Determining the best method for first-line assessment of neonatal blood glucose levels

Objective: To evaluate and compare the accuracy and performance of two electrochemical glucose meters. To determine the user acceptability of these glucose meters and the ABL 620 Blood Gas Analyser (Radiometer, Copenhagen, Denmark) with an electrochemical glucose oxidase electrode for use in a Level 2 special care baby unit

Origins of neonatal intensive care in the UK

Chaired by Professor Robert Boyd, this seminar reviewed the development and changes in care of the newborn in the UK over the past 50 years. Advances in techniques were described, such as mechanical ventilation, total parenteral nutrition and continuous monitoring of vital signs, to care for ill or vulnerable newborn infants. Diagnostic techniques that were developed and introduced in the 1970s and early 1980s were discussed, such as ultrasound imaging, magnetic resonance spectroscopy and imaging and near infrared spectroscopy, for the non-invasive investigation of the brain, as well as the setting up of neonatal intensive care units. Witnesses include: Professor Eva Alberman, Dr Herbert Barrie, Professor Richard Cooke, Dr Beryl Corner, Dr Pamela Davies, Professor John Davis, Professor David Delpy, Professor Victor and Dr Lilly Dubowitz, the late Professor Harold Gamsu, Professor David Harvey, Professor Colin Normand, Professor Tom Oppé, Professor Osmund Reynolds, Dr Jean Smellie, Professor Maureen Young and nurses, including Miss Anthea Blake, Miss Caroline Dux and Miss Mae Nugent. Introduction by Professor Peter Dunn, viii, 84pp, 1 chart, glossary, subject and name index

Survival prediction of high-risk outborn neonates with congenital diaphragmatic hernia from capillary blood gases

BACKGROUND: The extent of lung hypoplasia in neonates with congenital diaphragmatic hernia (CDH) can be assessed from gas exchange. We examined the role of preductal capillary blood gases in prognosticating outcome in patients with CDH. ----- METHODS: We retrospectively reviewed demographic data, disease characteristics, and preductal capillary blood gases on admission and within 24 h following admission for 44 high-risk outborn neonates. All neonates were intubated after delivery due to acute respiratory distress, and were emergently transferred via ground ambulance to our unit between 1/2000 and 12/2014. The main outcome measure was survival to hospital discharge and explanatory variables of interest were preductal capillary blood gases obtained on admission and during the first 24 h following admission. ----- RESULTS: Higher ratio of preductal partial pressure of oxygen to fraction of inspired oxygen (PcO2/FIO2) on admission predicted survival (AUC = 0.69, P = 0.04). However, some neonates substantially improve PcO2/FIO2 following initiation of treatment. Among neonates who survived at least 24 h, the highest preductal PcO2/FIO2 achieved in the initial 24 h was the strongest predictor of survival (AUC = 0.87, P = 0.002). Nonsurvivors had a mean admission preductal PcCO2 higher than survivors (91 ± 31 vs. 70 ± 25 mmHg, P = 0.02), and their PcCO2 remained high during the first 24 h of treatment. ----- CONCLUSION: The inability to achieve adequate gas exchange within 24 h of initiation of intensive care treatment is an ominous sign in high-risk outborn neonates with CDH. We suggest that improvement of oxygenation during the first 24 h, along with other relevant clinical signs, should be used when making decisions regarding treatment options in these critically ill neonates

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: A review of current concepts

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, th