Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography

Objective: To determine whether the duration of indomethacin administration could be shortened in infants with good early constrictive response of patent ductus arteriosus (PDA). Study design: Infants born at< 30 weeks' gestational age were assessed with echocardiography in the first 12 hours of life and treated with indomethacin (0.1 mg/kg) if the PDA was >2 mm in diameter. Randomization occurred before the second dose to either standard treatment (2 more doses of indomethacin at 0.1 mg/kg irrespective of echocardiographic findings) or to echocardiographically directed duration of indomethacin treatment (ECHO; further doses only if the PDA was>1.6 mm). Serial echocardiography was performed to day 28 of age. The primary outcome was failure of PDA closure. Results: The infants were randomized to either the ECHO arm (n=3D34) or the standard treatment arm (n=3D40). No differences between the arms were seen in terms of failure of PDA closure, PDA reopening, need for further doses of indomethacin, or need for surgical ligation. More doses of indomethacin were given in the standard treatment arm (median, 3 doses [range, 1 to 12] vs 1 dose [range, 1 to 15]; P < .0001). Conclusion: Echocardiographically directed duration of indomethacin treatment is effective in achieving PDA closure and offers the potential for dose minimization

Characteristics and outcomes of respiratory distress among term infants born in a regional setting

Introduction: Respiratory distress is the leading cause of admission to neonatal units and is a common indication for medical retrieval. Whilst approximately 25% of births in NSW occur in regional centres, there is a paucity of neonatal research in these settings. Objective: To describe the characteristics and outcomes of term neonates admitted with respiratory distress to two regional special care nurseries (SCNs) and identify variables associated with the need for medical retrieval. Design: We describe a cohort of 629 term infants admitted to the SCN in two regional hospitals, 2015–2019. We describe the admission characteristics, level of respiratory support, biochemical investigations, diagnosis and outcomes. Findings: During the study period, 629 eligible term infants were admitted, retrieval occurred in 29 (4.6%). Those admitted were more often male (66.5%), with a mean gestational age of 39 + 1 weeks (±9 days) and birth weight of 3470 g (±500 g). Infants requiring medical retrieval had higher PaCO2 on blood gas analysis (59.8 mmHg vs. 53.3 mmHg, OR 1.03, p = 0.02). There was no association between maternal GBS status, meconium-stained liquor, gestational age, or raised inflammatory markers and medical retrieval. Transient tachypnoea of the newborn was the most common diagnosis of neonates admitted to SCN with respiratory distress. Discussion: Among term infants admitted to a SCN for respiratory distress most were male, of a normal birthweight and born in good condition. Within our cohort there was no association between retrieval and maternal GBS colonisation, meconium-stained liquor or raised infectious biomarkers. Medical retrieval was infrequent and was associated with higher PaCO2 on initial blood gas analysis. Conclusion: We present a large cohort of term newborn infants managed for respiratory distress in a regional setting over a five-year period. Retrieval was infrequent, and outcomes for the cohort were excellent with no deaths during the study period

Congenital candidiasis presenting as septic shock without rash

Congenital candidiasis is rare and often benign. This report describes the case of twins born at 32 weeks of gestation with different manifestations of congenital candidiasis. One twin was born well though neutropenic, and died from overwhelming sepsis with septic shock at 22 h. The other twin presented with a delayed onset of rash at 2 days, remained well and survived

Sail sign in neonatal pneumomediastinum: a case report

Abstract Background Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory distress. Chest x-ray can be diagnostic of pneumomediastinum however is often difficult to interpret. Case presentation A 36 week gestation newborn was delivered by emergency caesarean section, intubated and given intermittent positive pressure ventilation via Neopuff™ for apnoea before being extubated to CPAP. Chest radiography initially showed bilateral upper zone opacities, presenting a diagnostic dilemma; however subsequent films demonstrated a pneumomediastinum which was managed conservatively and resolved. Conclusions The “sail sign” describes an uncommon radiological appearance of a pneumomediastinum in neonates and infants. With careful conservative management, a spontaneous resolution without longterm sequelae can be expected

A quality audit of the service delivered by the NSW Neonatal and Paediatric Transport Service

Aim: To discover areas of NSW Neonatal and Paediatric Transport Service's (NETS) work with which the parents, referring and receiving doctors are dissatisfied and respond to them.Methods: An anonymous survey of referring doctors, parents of patients transported by NETS and receiving hospital doctors between July and December 2005.Results: Referring doctors: Fifty-seven per cent of the 288 (30% response rate) doctors who responded were paediatricians and 43% worked in rural settings. Over 90% responded positively about communication with the NETS team at referral and retrieval. Useful feedback included the need to be more time efficient in phone communication and during stabilisation of the child and to improve feedback about management and patient outcomes. Parents: Forty-seven per cent of 152 responses (15% response rate) came from rural families. The majority (>98%) of parents felt that the NETS team were helpful and supportive of them. Parents reported being able to travel with their child 60% of the time and of those who could not, 95% could explain why. Receiving doctors: Ninety-three per cent of 218 responses (42% response rate) thought that the referral was appropriate, that the NETS teams carried out their advice correctly (98%) and that the child's needs were reported accurately by the team (90%). In a minority of retrievals important concerns were raised about ventilation, sedation, patient assessment and management.Conclusion: Most retrievals happen in a way that referring consultants, parents and receiving consultants find appropriate. Important suggestions for improvement in service delivery and some areas of risk to patient safety have been identified. Processes for overcoming these situations are being developed and implemented