Three-Dimensional Digital Capture of Head Size in Neonates – A Method Evaluation

Introduction: The quality of neonatal care is mainly determined by long-term neurodevelopmental outcome. The neurodevelopment of preterm infants is related to postnatal head growth and depends on medical interventions such as nutritional support. Head circumference (HC) is currently used as a two-dimensional measure of head growth. Since head deformities are frequently found in preterm infants, HC may not always adequately reflect head growth. Laser aided head shape digitizers offer semiautomatic acquisition of HC and cranial volume (CrV) and could thus be useful in describing head size more precisely. Aims: 1) To evaluate reproducibility of a 3D digital capture system in newborns. 2) To compare manual and digital HC measurements in a neonatal cohort. 3) To determine correlation of HC and CrV and predictive value of HC. Methods: Within a twelve-month period data of head scans with a laser shape digitizer were analysed. Repeated measures were used for method evaluation. Manually and digitally acquired HC was compared. Regression analysis of HC and CrV was performed. Results: Interobserver reliability was excellent for HC (bias-0.005%, 95% Limits of Agreement (LoA) −0.39–0.39%) and CrV (bias1.5%, 95%LoA-0.8–3.6%). Method comparison data was acquired from 282 infants. It revealed interchangeability of the methods (bias-0.45%; 95%LoA-4.55–3.65%) and no significant systematic or proportional differences. HC and CrV correlated (r2 = 0.859, p<0.001), performance of HC predicting CrV was poor (RSD ±24 ml). Correlation was worse in infants with lower postmenstrual age (r2 = 0.745) compared to older infants (r2 = 0.843). Discussion: The current practice of measuring HC for describing head growth in preterm infants could be misleading since it does not represent a 3D approach. CrV can vary substantially in infants of equal HC. The 3D laser scanner represents a new and promising method to provide reproducible data of CrV and HC. Since it does not provide data on cerebral structures, additional imaging is required

Analyzing support of postnatal transition in term infants after c-section

Background: Whereas good data are available on the resuscitation of infants, little is known regarding support of postnatal transition in low-risk term infants after c-section. The present study was performed to describe current delivery room (DR) management of term infants born by c-section in our institution by analyzing videos that were recorded within a quality assurance program. Methods: DR- management is routinely recorded within a quality assurance program. Cross-sectional study of videos of term infants born by c-section. Videos were analyzed with respect to time point, duration and number of all medical interventions. Study period was between January and December 2012. Results: 186 videos were analyzed. The majority of infants (73%) were without support of postnatal transition. In infants with support of transition, majority of infants received respiratory support, starting in median after 3.4 minutes (range 0.4-14.2) and lasting for 8.8 (1.5-28.5) minutes. Only 33% of infants with support had to be admitted to the NICU, the remaining infants were returned to the mother after a median of 13.5 (8-42) minutes. A great inter- and intra-individual variation with respect to the sequence of interventions was found. Conclusions: The study provides data for an internal quality improvement program and supports the benefit of using routine video recording of DR-management. Furthermore, data can be used for benchmarking with current practice in other centers

Positioning of term infants during delivery room routine handling – analysis of videos

Background: Delivery room management (DR) of the newly born infant should be performed according to international guidelines, but no recommendations are available for an infant’s position immediately after birth. The present study was performed to answer the following questions: 1. How often is DR-management performed in term infants in side position? 2. Is routine DR-management possible in side position? 3. Is there any benefit of side position with respect to agitation or vital parameters? Methods: Cross-sectional study of video-recorded DR-management in term newborns delivered by C-section in 2012. Videos were analysed for infant’s position, administered interventions, vital parameters and agitation. Results: 187 videos were analysed. The Main Position (defined as position spent more than 70% of the time) was “supine” in 91, “side” in 63 and “not determinable” in 33 infants. “Supine” infants received significantly (p 90% earlier than “supine” positioned infants (p = 0.16). Conclusions: DR-management is feasible in the side position in term infants. Side position seems to be associated with reduced agitation and improved oxygenation. However, it remains unclear whether this represents a causal relationship or an association. The study supports the need for a randomized controlled trial

Correlation and prediction intervals of HC and CrV at different Postmenstrual Ages (PMA).

<p>CrV plotted against HC for infants A) below 37 weeks PMA and B) greater/equal 37 weeks PMA. Grey continuous line is indicating regression line. Dashed lines and light grey filling define the 95% prediction intervals.</p

Correlation and prediction intervals of HC and CrV.

<p>Data points indicate CrV plotted against HC. Grey continuous line is indicating regression line. Dashed lines and light grey filling define the 95% prediction interval.</p

Additional file 2: Figures S1, S2. of Analyzing video recorded support of postnatal transition in preterm infants following a c-section

The time point of first occurrence of an intervention for every LGA, VLGA and ELGA that the specific intervention was given. (XLSX 78 kb

Clinical characteristics.

<p>Clinical characteristics at birth and at the time of head scan. GA = gestational age, HC = head circumference,PMA = postmenstrual age, PNA = postnatal age, HCman. = manually measured HC, HCdig. = digitally measured HC, CrV = cranial volume.</p

Physalis alkekengi L. var. franchetii Makino f. bunyardii Makino subf. monstrifera Makino

原著和名: ヤウラクホホヅキ科名: ナス科 = Solanaceae採集地: 千葉県 船橋市三山2-2-1 東邦大学 (下総 東邦大学)採集日: 1965/9/7採集者: 萩庭丈壽整理番号: JH900170国立科学博物館整理番号: TNS-VS-99406

Distribution of differences between manual and digital HC measurements.

<p>Folded empirical cumulative distribution plot (Mountain-Plot). Percentiles of each ranked difference between the methods are plotted against the relative differences. The orange dashed line indicates bias.</p