Prognostic model for predicting survival in very preterm infants:an external validation study

Objective: To perform a temporal and geographical validation of a prognostic model, considered of highest methodological quality in a recently published systematic review, for predicting survival in very preterm infants admitted to the neonatal intensive care unit. The original model was developed in the UK and included gestational age, birthweight and gender. Design: External validation study in a population-based cohort. Setting: Dutch neonatal wards. Population or sample: All admitted white, singleton infants born between 23+0 and 32+6 weeks of gestation between 1 January 2015 and 31 December 2019. Additionally, the model’s performance was assessed in four populations of admitted infants born between 24+0 and 31+6 weeks of gestation: white singletons, non-white singletons, all singletons and all multiples. Methods: The original model was applied in all five validation sets. Model performance was assessed in terms of calibration and discrimination and, if indicated, it was updated. Main outcome measures: Calibration (calibration-in-the-large and calibration slope) and discrimination (c statistic). Results: Out of 6092 infants, 5659 (92.9%) survived. The model showed good external validity as indicated by good discrimination (c statistic 0.82, 95% CI 0.79–0.84) and calibration (calibration-in-the-large 0.003, calibration slope 0.92, 95% CI 0.84–1.00). The model also showed good external validity in the other singleton populations, but required a small intercept update in the multiples population. Conclusions: A high-quality prognostic model predicting survival in very preterm infants had good external validity in an independent, nationwide cohort. The accurate performance of the model indicates that after impact assessment, implementation of the model in clinical practice in the neonatal intensive care unit could be considered. Tweetable abstract: A high-quality model predicting survival in very preterm infants is externally valid in an independent cohort.</p

Efficacy of feed forward and feedback signaling for inflations and chest compression pressure during cardiopulmonary resuscitation in a newborn mannequin

Background: The objective of the study was to evaluate a device that supports professionals during neonatal cardiopulmonary resuscitation (CPR). The device features a box that generates an audio-prompted rate guidance (feed forward) for inflations and compressions, and a transparent foil that is placed over the chest with marks for inter nipple line and sternum with LED’s incorporated in the foil indicating the exerted force (feedback). Methods: Ten pairs (nurse/doctor) performed CPR on a newborn resuscitation mannequin. All pairs initially performed two sessions. Thereafter two sessions were performed in similar way, after randomization in 5 pairs that used the device and 5 pairs that performed CPR without the device (controls). A rhythm score was calculated based on the number of CPR cycles that were performed correctly. Results: The rhythm score with the device improved from 85 ± 14 to 99 ± 2% (P &lt;0.05). In the control group no differences were observed. The recorded pressures with the device increased from 3.1 ± 1.6 to 4.9 ± 0.8 arbitrary units (P &lt;0.05). The second performance of the teams showed significant better results for the group with the CPR device compared to the controls. Conclusion: Feed forward and feedback signaling leads to a more constant rhythm and chest compression pressure during CPR

New constrains on the thickness of the Semail Ophiolite in the Northern Emirates

Near-critical angle and refraction studies were performed at IFP as piggyback studies during a wider programme of crustal imagery operated by WesternGeco on behalf of the Ministry of Energy of the United Arab Emirates. The main objective is to illuminate the base of the Semail Ophiolite along part of a regional transect (D1) crossing the Northern Emirates from the Gulf of Oman in the east up to the Arabian Gulf in the west. Results confirm that the sole thrust of the ophiolite has been folded during the Miocene stacking of the underlying Arabian Platform. The thickness of the ophiolite grades from zero in the core of the Masafi tectonic window, up to a maximum of 1.7 km below the axial part of a successor basin which has been preserved on top of the serpentinite west of the current exposure of the main ultramafic bodies. Apatite grains extracted from plagiogranites of the Semail ophiolite also provide evidences for an early unroofing of the gabbros and plagiogranites during the Late Cretaceous, with cooling ages of 72-76 Ma at the top of the ophiolite in the east (not far from the Fujairah coast line), which are coeval and also consistent with the occurrence of Late Cretaceous paleo-soils, rudists and paleo-reef deposits on top of serpentinized ultramafics in the west. Younger cooling ages of 20 Ma have been also found at the base of the ophiolite near Masafi, in the core of the nappe anticline, thus providing a Neogene age for the refolding of the allochthon and stacking of underlying parautochthonous platform carbonate units. These results, together with the occurrence of a thick sedimentary pile illuminated below the metamorphic sole along the north-trending, strike-profile D2 running parallel to the axis of the Masafi window, should stimulate a renewal of the exploration in the central part of the Emirate foothills, where the ophiolite thickness is currently limited, and was already drastically reduced by the end of its Late Cretaceous obduction. © 2010 Saudi Society for Geosciences

Failed resuscitation of a newborn due to congenital tracheal agenesis: a case report

Tracheal agenesis is a rare congenital condition. It usually presents as an unexpected emergency during resuscitation of a newborn in the delivery room. The condition is almost always fatal in the resuscitation phase, but also when the neonate survives the long term prognosis remains poor. We present a case of tracheal agenesis, discuss its presenting symptoms and possibilities for antenatal diagnosis and review the therapeutic options

QRS classification and spatial combination for robust heart rate detection in low-quality fetal ECG recordings

Non-invasive fetal electrocardiography (ECG) can be used for prolonged monitoring of the fetal heart rate (FHR). However, the signal-to-noise-ratio (SNR) of non-invasive ECG recordings is often insufficient for reliable detection of the FHR. To overcome this problem, source separation techniques can be used to enhance the fetal ECG. This study uses a physiology-based source separation (PBSS) technique that has already been demonstrated to outperform widely used blind source separation techniques. Despite the relatively good performance of PBSS in enhancing the fetal ECG, PBSS is still susceptible to artifacts. In this study an augmented PBSS technique is developed to reduce the influence of artifacts. The performance of the developed method is compared to PBSS on multi-channel non-invasive fetal ECG recordings. Based on this comparison, the developed method is shown to outperform PBSS for the enhancement of the fetal ECG

Recurring staphylococcal scalded skin syndrome in a very low birth weight infant: A case report

Introduction. Staphylococcal scalded skin syndrome is an extensive desquamative erythematous condition caused by exfoliative toxins of Staphylococcus aureus. This disease usually affects neonates and generally responds rapidly to antibiotic therapy. Case presentation. We describe the case of a premature baby boy, weighing 1030 g, born after 26 6/7 weeks gestation, who developed two episodes of Staphylococcal scalded skin syndrome on days 19 and 48 of life. Cultures obtained during the first period did not reveal Staphylococcus aureus, but diagnosis was based on typical clinical grounds. Although the initial diagnosis was irritation by the fixation material of a nasal continuous positive airway pressure tube, the infant showed rapidly progressing skin blistering and exfoliation, characteristic of Staphylococcal scalded skin syndrome. After administration of antibiotic treatment, complete recovery was seen. In the second period, diagnosis of Staphylococcal scalded skin syndrome was made clinically and confirmed by results of microbiologic investigations. Staphylococcus aureus was cultured from the nose, skin lesions and the pharynx. The strain appeared to produce exfoliative toxin A. The clinical response to similar antibiotic treatment was identical to the first period of Staphylococcal scalded skin syndrome. Conclusion. This case report discusses an unusual presentation of recurring Staphylococcal scalded skin syndrome in a baby with a very low birth weight

Evaluation of an Intubation Readiness Score to Assess Neonatal Sedation before Intubation

Background: Premedication for neonatal intubation facilitates the procedure and reduces stress and physiological disturbances. However, no validated scoring system to assess the effect of premedication prior to intubation is available. Objective: To evaluate the usefulness of an Intubation Readiness Score (IRS) to assess the effect of premedication prior to intubation in newborn infants. Methods: Two-center prospective study in neonates who needed endotracheal intubation. Intubation was performed using a standardized procedure with propofol 1-2 mg/kg as premedication. The level of sedation was assessed with the IRS by evaluating the motor response to a firm stimulus (1 = spontaneous movement; 2 = movement on slight touch; 3 = movement on firm stimulus; 4 = no movement). Intubation was proceeded if an adequate effect, defined as an IRS of 3 or 4, was reached. IRS was compared to the quality of intubation measured with the Viby-Mogensen intubation score. Results: A total of 115 patients, with a median gestational age of 27.7 weeks (interquartile range 5.3) and a median birth weight of 1,005 g (interquartile range 940), were included. An adequate IRS was achieved in 105 patients, 89 (85%) of whom also had a good Viby-Mogensen intubation score and 16 (15%) had an inadequate Viby-Mogensen intubation score. The positive predictive value of the IRS was 85%. Conclusions: Preintubation sedation assessment using the IRS can adequately predict optimal conditions during intubation in the majority of neonates. We suggest using the IRS in routine clinical care. Further research combining the IRS with other parameters could further improve the predictability of adequate sedation during intubation

Conservative Management of Patent Ductus Arteriosus in Preterm Infants-A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies

Objective: This study aims to evaluate outcome after conservative management (no pharmacological/surgical intervention other than fluid restriction, diuretics, or ventilator adjustments) compared with active (pharmacological and/or surgical) treatment for patent ductus arteriosus (PDA) in preterm infants and analyze differences in outcome between randomized controlled trials (RCTs) and cohort studies. Study Design: This is a systematic literature review using PubMed, EMBASE, and Cochrane library. RCTs and cohort studies comparing conservative management with active treatment were included. Meta-analysis was used to compare conservative management with any active (pharmacological and/or surgical), any pharmacological (non-prophylactic and prophylactic), and/or surgical treatment for mortality as primary and major neonatal morbidity as secondary outcome measure. Fixed-effect analysis was used, unless heterogeneity (I2) was >50%. Outcome is presented as relative risk (RR) with 95% confidence interval. Results: Twelve cohort studies and four RCTs were included, encompassing 41,804 and 720 patients, respectively. In cohort studies, conservative management for PDA was associated with a significantly higher risk for mortality (RR, 1.34 [1.12-1.62]) but a significantly lower risk for bronchopulmonary dysplasia (RR, 0.55 [0.46-0.65]), necrotizing enterocolitis (RR, 0.85 [0.77-0.93]), intraventricular hemorrhage (RR, 0.88 [0.83-0.95]), and retinopathy of prematurity (RR, 0.47 [0.28-0.79]) compared with any active PDA treatment. Meta-analysis of the RCTs revealed no significant differences in outcome between conservative management and active treatment. Conclusion: No differences in mortality or morbidity for conservative management compared with active treatment regimens were observed in RCTs. Findings from cohort studies mainly highlight the lack of high-quality evidence for conservative management for PDA in preterm infants

Propofol for endotracheal intubation in neonates: A dose-finding trial

Objective: To find propofol doses providing effective sedation without side effects in neonates of different gestational ages (GA) and postnatal ages (PNA). Design and setting: Prospective multicentere dose-finding study in 3 neonatal intensive care units. Patients: Neonates with a PNA <28 days requiring non-emergency endotracheal intubation. Interventions: Neonates were stratified into 8 groups based on GA and PNA. The first 5 neonates in every group received a dose of 1.0 mg/kg propofol. Based on sedative effect and side effects, the dose was increased or decreased in the next 5 patients until the optimal dose was found. Main outcome measures: The primary outcome was the optimal single propofol starting dose that provides effective sedation without side effects in each age group. Results: After inclusion of 91 patients, the study was prematurely terminated because the primary outcome was only reached in 13% of patients. Dose-finding was completed in 2 groups, but no optimal propofol dose was found. Effective sedation without side effects was achieved more often after a starting dose of 2.0 mg/kg (28%) than after 1.0 mg/kg (3%) and 1.5 mg/kg (9%). Propofol-induced hypotens