17 research outputs found
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Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data
BackgroundDeferred (also known as delayed) cord clamping can improve survival of infants born preterm (before 37 weeks of gestation), but the optimal duration of deferral remains unclear. We conducted a systematic review and individual participant data network meta-analysis with the aim of comparing the effectiveness of umbilical cord clamping strategies with different timings of clamping or with cord milking for preterm infants.MethodsWe searched medical databases and trial registries from inception until Feb 24, 2022 (updated June 6, 2023) for randomised controlled trials comparing cord clamping strategies for preterm infants. Individual participant data were harmonised and assessed for risk of bias and quality. Interventions were grouped into immediate clamping, short deferral (≥15 s to FindingsWe included individual participant data from 47 trials with 6094 participants. Of all interventions, long deferral reduced death before discharge the most (compared with immediate clamping; odds ratio 0·31 [95% credibility interval] 0·11–0·80; moderate certainty). The risk of bias was low for 10 (33%) of 30 trials, 14 (47%) had some concerns, and 6 (20%) were rated as having a high risk of bias. Heterogeneity was low, with no indication of inconsistency.InterpretationThis study found that long deferral of clamping leads to reduced odds of death before discharge in preterm infants. In infants assessed as requiring immediate resuscitation, this finding might only be generalisable if there are provisions for such care with the cord intact. These results are based on thoroughly cleaned and checked individual participant data and can inform future guidelines and practice.</p
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[Reply] Delayed cord clamping saves lives – why does it not affect major complications?
We thank Pettinger et al for their excellent editorial and for offering an intriguing question – why does delayed cord clamping (DCC) not appear to affect major complications? (Pettinger 2024) We offer three answers. First, many of the surviving infants may have died without DCC. Second, we don’t wait for the neonate to obtain enough of its own blood to survive and thrive. Third, during the 30-60 seconds, practices we use stress the infant which may impede the placental transfusion [...]</p
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Feasibility of cerebellar measurements with phased-array sonography through the anterior fontanelle in comparison to MRI
OBJECTIVE: Cerebral sonography through the anterior fontanelle is a neonatal brain imaging method that has become an integral part of modern neonatal bedside care for both screening and diagnostic purposes. Premature infants with cognitive delay have a reduction in cerebellar size at term corrected age on MRI. We aimed to determine the level of agreement between postnatal MRI and cerebral sonography for cerebellar biometry and to determine the level of agreement within one and between different examiners.Â
STUDY DESIGN: Cerebellar sonography and MRI measurements of the cerebellum from 30 term infants was assessed by Bland-Altman plots. Measurements between both modalities were compared using Wilcoxon Signed-Rank Test. A p-value
RESULTS: There was no statistically significant difference between cerebral sonography and MRI for linear measurements, but the measurements of perimeter and surface area differed significantly between the two techniques. There was a systematic bias between both modalities for most measurements except for anterior-posterior width and vermis height. For measurements that were not statistically different from MRI we found excellent intra-rater ICC for the anterior-posterior width, vermis height and cerebellar width. The inter-rater ICC was excellent for the anterior-posterior width and vermis height, but poor for the transverse cerebellar width.Â
CONCLUSIONS: With a strict imaging protocol cerebellar measurements of the anterior-posterior width and the vermis height can be used as an alternative to MRI for diagnostic-screening purposes in a neonatal department where multiple clinicians perform bedside cerebral sonography.</p
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Management of congenital cytomegalovirus infection: an evidence-based approach
Abstract Despite cytomegalovirus being the most common congenital infection leading to psychomotor impairment and sensori-neural hearing loss, little is known about early identification and management of congenitally infected neonates. This article reviews the literature and devises an algorithm for identification and management of these neonates. Conclusion: Application of the current knowledge in the management of congenital cytomegalovirus infected neonates could be beneficial, until further evidence is available
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Optiflow vs Vapotherm as extended weaning mode from nasal continuous positive airway pressure in preterm infants = 28 weeks gestational age
Introduction Current evidence supports nasal continuous positive airway pressure (NCPAP) weaning. Heated humidified high-flow nasal cannula (HHFNC) reduces NCPAP time in infants less than 28 weeks gestational age (GA) without increasing morbidity. The aim of the study was to compare the two most frequently used HHFNC devices in weaning from NCPAP. Methodology We performed a retrospective matched-pair case-control study of infants less than or equal to 28 GA born in a single tertiary neonatal center managed with Optiflow or Vapotherm after being weaned from NCPAP. Patients were matched for antenatal steroid doses, delivery mode, birth plurality, GA, birthweight, gender, surfactant doses, length of mechanical ventilation, and length of NCPAP. Outcome measures were duration of HHFNC, low-flow nasal cannula, nasal bridge lesions, pneumothorax, bronchopulmonary dysplasia, postnatal steroids, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, retinopathy of prematurity, length of stay, discharge weight, and mortality. Results were displayed as median (interquartile range) or ratio (percentage). Statistical analysis was performed using Mann-Whitney U and ? 2 tests. Results 70 patients were recruited retrospectively. Thirty-five infants were weaned from NCPAP to Optiflow and 35 infants to Vapotherm with gestational ages and birthweights of 27 GA (26-27) and 1010?g (835-1165) and 27 GA (26-28) and 960?g (788-1191), respectively. There was no statistically significant difference in any outcome measure. Infants managed with Vapotherm required a not statistically significant shorter length of time on HHFNC and low-flow nasal cannula. Conclusions Optiflow and Vapotherm seem to be equally effective and safe for weaning from NCPAP. However, infants weaned to Vapotherm appear to spend less time on non-invasive respiratory support
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115 Blood Sugar Monitoring in Preterm Infants < 31 Weeks and < 1000 G
No description supplie
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Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates
Objective To evaluate whether changing dopamine infusions every 12?hours and preparing these infusions 30?min before administration reduces blood pressure fluctuations in preterm and term neonates. Design This was a retrospective study using data from live patients on the neonatal unit and prospective study exploring stability of infusions in a laboratory-based neonatal ward simulation. Setting Single-centre study in a tertiary neonatal surgical unit in a university teaching hospital. Patients Neonates who received more than one subsequent dopamine infusion and had invasive arterial blood pressure monitoring, during their admission in the neonatal unit, were included. Interventions As part of the Quality Improvement project, the standard operating procedure (SOP) was changed, and dopamine infusions were prepared by nursing staff and left to rest for 30?min before administering to the neonate. Additionally, infusions were replaced every 12?hours. Main outcome measures The percentage change in mean arterial pressure (MAP) and the percentage loss in the drug concentration during infusion during changeover. Results Our findings indicate that up to 15% of the initial dopamine concentration is lost after 24?hours. This results in a sharp variation in the dopamine concentration during infusion changeover that correlates with observed rapid fluctuations in MAP. In changing the SOP, no significant difference in the concentration of dopamine and MAP were observed over 12?hours. Conclusions Delaying administration of dopamine infusions by 30?min after preparation combined with changing infusions 12 hourly has reduced MAP fluctuations. Therefore, the risks associated with MAP fluctuations, including intraventricular haemorrhages, are reduced
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Intra- and inter-rater agreement of superior vena cava flow and right ventricular outflow measurements in late preterm and term neonates
OBJECTIVES: To explore the intra- and inter-rater agreement of superior vena cava (SVC) flow and right ventricular (RV) outflow in healthy and unwell late preterm neonates (33-37 weeks' gestational age), term neonates (=37 weeks' gestational age), and neonates receiving total-body cooling. METHODS: The intra- and inter-rater agreement (n?=?25 and 41 neonates, respectively) rates for SVC flow and RV outflow were determined by echocardiography in healthy and unwell late preterm and term neonates with the use of Bland-Altman plots, the repeatability coefficient, the repeatability index, and intraclass correlation coefficients. RESULTS: The intra-rater repeatability index values were 41% for SVC flow and 31% for RV outflow, with intraclass correlation coefficients indicating good agreement for both measures. The inter-rater repeatability index values for SVC flow and RV outflow were 63% and 51%, respectively, with intraclass correlation coefficients indicating moderate agreement for both measures. CONCLUSIONS: If SVC flow or RV outflow is used in the hemodynamic treatment of neonates, sequential measurements should ideally be performed by the same clinician to reduce potential variability
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A prospective cohort study using non-invasive methods of cardiovascular assessment to compare postnatal adaptation in well late preterm and term infants
Echocardiography was combined with pulse oximetry plethysmography to investigate postnatal cardiovascular adaptation in late preterm and term infants. Median (IQR) pleth variability decreased over three days and similar, day2 15%(12–18%) preterm versus 16%(15–18%) term infants. Median (IQR) pulse transit time heart rate normalised was lower in term babies, day2 0.55(0.51–0.63) versus 0.64(0.62–0.68)
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Visible damp in a child’s bedroom is associated with increased respiratory morbidity in early life: a multicentre cohort study
ObjectiveHousehold damp exposure is an important public health issue. We aimed to assess the impact of the location of household damp on respiratory outcomes during early life.MethodsHousehold damp exposure was ascertained in children recruited to the GO-CHILD multicentre birth cohort study. The frequency of respiratory symptoms, infections, healthcare utilisation and medication prescription for wheezing were collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.ResultsFollow-up was obtained in 1344 children between August 2010 and January 2016. Visible damp was present in a quarter of households (25.3%) with 1 in 12 children’s bedrooms affected (8.3%). Damp in the bathroom, kitchen or living room was not associated with any respiratory or infection-related outcomes. Damp in the child’s bedroom was associated with an increased risk of dry cough (8.7% vs 5.7%) (adjusted relative risk 1.56, 95% CI 1.07 to 2.27; p=0.021) and odds of primary care attendance for cough and wheeze (7.6% vs 4.4%) (adjusted OR 1.37, 95% CI 1.07 to 1.76; p=0.009). There were also increased risk of inhaled corticosteroid (13.3% vs 5.9%) (adjusted RR 2.22, 95% CI 1.04 to 4.74; p=0.038) and reliever inhaler (8.3% vs 5.8%) (adjusted RR 2.01, 95% CI 1.21 to 2.79; p=0.018) prescription.ConclusionDamp in the child’s bedroom was associated with increased respiratory morbidity. In children presenting with recurrent respiratory symptoms, clinicians should enquire about both the existence and location of damp, the presence of which can help prioritise those families requiring urgent household damp assessment and remediation works.</p