Fifteen minute consultation: stabilisaton of the high risk newborn infant beside the mother

Paediatric and adult resuscitation is often performed with family present. Current guidelines recommend deferred umbilical cord clamping as part of immediate neonatal care, requiring neonatal assessment next to the mother. This paper describes strategies for providing care beside the mother using both standard resuscitation equipment and a trolley designed for this purpose

Bronchopulmonary dysplasia prediction models: a systematic review and meta-analysis with validation

IntroductionPrediction models could identify infants at the greatest risk of bronchopulmonary dysplasia (BPD) and allow targeted preventative strategies. We performed a systematic review and meta-analysis with external validation of identified models. Methods Studies using predictors available before day 14 of life to predict BPD in very preterm infants were included. Two reviewers assessed 7,628 studies for eligibility. Meta-analysis of externally validated models was followed by validation using 62,864 very preterm infants in England and Wales.Results64 studies using 53 prediction models were included totalling 274,407 infants (range 32–156,587/study). 35 (55%) studies predated 2010; 39 (61%) were single-centre studies. 97% of studies had a high risk of bias, especially in the analysis domain. Following meta-analysis of 22 BPD and 11 BPD/death composite externally validated models, Laughon’s day one model was the most promising in predicting BPD and death (C-statistic 0.76 (95% CI 0.70–0.81) and good calibration). Six models were externally validated in our cohort with C-statistics between 0.70–0.90 but with poor calibration.ConclusionFew BPD prediction models were developed with contemporary populations, underwent external validation, or had calibration and impact analyses. Contemporary, validated, and dynamic prediction models are needed for targeted preventative strategies

Impact of a protocol-driven unified service for neonates with bronchopulmonary dysplasia

Aim: a new specialised service for preterm infants with bronchopulmonary dysplasia requiring long-term oxygen therapy (LTOT) was established in 2007, led by the paediatric respiratory team, transitioning from neonatal-led follow-up. The new service included the utilisation of a clear protocol. Our objective was to review whether this service initiation led to a reduction of time in LTOT and hospital readmissions. Methods: we performed a retrospective cohort study of infants born at lt;32 weeks’ gestation requiring LTOT in a single tertiary neonatal service. Cases were identified from hospital records, BadgerNet and a local database for two cohorts, 2004-2006 and 2008-2010. Data collected for infants requiring LTOT included demographic details, length of neonatal stay, time in oxygen and hospital attendance rates. Results: the initiation of the service led to an increase in the number of discharges in LTOT: 13.1% of infants born alive before 32 weeks’ gestation in comparison to 3.5% (p&lt;0.001). However, the length of time in LTOT reduced from 15 to 5 months (p=0.01). There was no difference in hospital readmission rates (p=0.365). Conclusions: in our experience the increase in neonates requiring LTOT is likely to be due to enhanced provision of overnight oximetry studies prior to discharge. Structured monitoring and weaning led to a shorter duration of home oxygen therapy.</p