Newborn infants with bilious vomiting: a national audit of neonatal transport services

Objective: The precautionary approach to urgently investigate infants with bilious vomiting has increased the numbers referred to transport teams and tertiary surgical centres. The aim of this national UK audit was to quantify referrals, determine the frequency of surgical diagnoses, with the purpose to inform the consequent inclusion of these referals in the national 'time critical' dataset. Method: A prospective, multi-centre UK-wide audit was conducted (01 August 2015 to 31 October 2015). Term infants, ≤ 7 days of age, referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at seven days after transfer were collected by the local teams and tranferred anonymously for analysis. Results: Sixteen teams contributed data on 165 cases. Teams that consider such transfers as “time-critical” responded significantly faster than those that do not classify bilious vomiting as time-critical. There was a surgical diagnosis in 22% cases and 7% had a condition where delayed treatment may have caused bowel loss. Most surgical problems could be predicted by clinical and/or X-ray findings but two infants with normal X-ray features were found to have a surgical problem. Conclusion: The results of this study support the need for infants with bilious vomiting to be investigated for potential surgical pathologies, but the data do not provide evidence for the default designation of such referrals as “time critical.” Decisions should be made by clinical collaboration between the teams and, where appropriate, swift transfer provided

Blood pressure intervention levels in preterm infants : pilot randomised trial

OBJECTIVE: To examine the feasibility of a trial allocating different blood pressure (BP) intervention levels for treatment in extremely preterm infants. DESIGN: Three-arm open randomised controlled trial performed between February 2013 and April 2015. SETTING: Single tertiary level neonatal intensive care unit. PATIENTS: Infants born <29 weeks' gestation were eligible to participate, if parents consented and they did not have a major congenital malformation. INTERVENTIONS: Infants were randomised to different levels of mean arterial BP at which they received cardiovascular support: active (<30 mm Hg), moderate (<gestational age mm Hg) or permissive (signs of poor perfusion or <19 mm Hg). Once this threshold was breached, all were managed using the same treatment guideline. BP profiles were downloaded continuously; cardiac output and carotid blood flow were measured at 1 day and 3 days, and amplitude integrated EEG was recorded during the first week. Cranial ultrasound scans were reviewed blind to study allocation. MAIN OUTCOME MEASURE: Inotrope usage and achieved BP. RESULTS: Of 134 cases screened, 60 were enrolled, with mean gestation 25.8 weeks (SD 1.5) and birth weight 817 g (SD 190). Invasively measured BP on the first day and inotrope usage were highest in the active and lowest in the permissive arms. There were no differences in haemodynamic or EEG variables or in clinical complications. Predefined cranial ultrasound findings did not differ significantly; no infants in the active arm had parenchymal brain lesions. CONCLUSION: The BP threshold used to trigger treatment affects the achieved BP and inotrope usage, and it was possible to explore these effects using this study design. TRIAL REGISTRATION NUMBER: ISRCTN83507686

Identification and rejection of scattered neutrons in AGATA

Gamma rays and neutrons, emitted following spontaneous fission of 252Cf, were measured in an AGATA experiment performed at INFN Laboratori Nazionali di Legnaro in Italy. The setup consisted of four AGATA triple cluster detectors (12 36-fold segmented high-purity germanium crystals), placed at a distance of 50 cm from the source, and 16 HELENA BaF2 detectors. The aim of the experiment was to study the interaction of neutrons in the segmented high-purity germanium detectors of AGATA and to investigate the possibility to discriminate neutrons and gamma rays with the gamma-ray tracking technique. The BaF2 detectors were used for a time-of-flight measurement, which gave an independent discrimination of neutrons and gamma rays and which was used to optimise the gamma-ray tracking-based neutron rejection methods. It was found that standard gamma-ray tracking, without any additional neutron rejection features, eliminates effectively most of the interaction points due to recoiling Ge nuclei after elastic scattering of neutrons. Standard tracking rejects also a significant amount of the events due to inelastic scattering of neutrons in the germanium crystals. Further enhancements of the neutron rejection was obtained by setting conditions on the following quantities, which were evaluated for each event by the tracking algorithm: energy of the first and second interaction point, difference in the calculated incoming direction of the gamma ray, figure-of-merit value. The experimental results of tracking with neutron rejection agree rather well with Geant4 simulations

Octupole transitions in the 208Pb region

The 208Pb region is characterised by the existence of collective octupole states. Here we populated such states in 208Pb + 208Pb deep-inelastic reactions. γ-ray angular distribution measurements were used to infer the octupole character of several E3 transitions. The octupole character of the 2318 keV 17− → 14+ in 208Pb, 2485 keV 19/2 − → 13/2 + in 207Pb, 2419 keV 15/2 − → 9/2 + in 209Pb and 2465 keV 17/2 + → 11/2 − in 207Tl transitions was demonstrated for the first time. In addition, shell model calculations were performed using two different sets of two-body matrix elements. Their predictions were compared with emphasis on collective octupole states.This work is supported by the Science and Technology Facilities Council (STFC), UK, US Department of Energy, Office of Nuclear Physics, under Contract No. DEAC02-06CH11357 and DE-FG02-94ER40834, NSF grant PHY-1404442

Regionalization of neonatal intensive care in Korea

In the current era of low-birth rate in Korea, it is important to improve our neonatal intensive care and to establish an integrative system including a regional care network adequate for both high-risk pregnancies and high-risk newborn infants. Therefore, official discussion for nation-wide augmentation, proper leveling, networking, and regionalization of neonatal and perinatal care is urgently needed. In this report, I describe the status of neonatal intensive care in Korea, as well as nationwide flow of transfer of high-risk newborn infants and pregnant women, and present a short review of the regionalization of neonatal and perinatal care in the Unites States and Japan. It is necessary not only to increase the number of neonatal intensive care unit (NICU) beds, medical resources and manpower, but also to create a strong network system with appropriate leveling of NICUs and regionalization. A systematic approach toward perinatal care, that includes both high-risk pregnancies and newborns with continuous support from the government, is also needed, which can be spearheaded through the establishment of an integrative advisory board to propel systematic care forward

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants.

BACKGROUND: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. METHOD: This is a retrospective medical records review of 23 +0-28 +6 weeks' gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. RESULTS: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (pgrade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 - 2.16)) or IVH (1.38 (0.96 - 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 - 2.50)). CONCLUSIONS: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies

A retrospective evaluation of the impact of a dedicated obstetric and neonatal transport service on transport times within an urban setting

OBJECTIVE:To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area.DESIGN AND SETTING:The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times relating to the obstetric and neonatal incidents was analysed for 2005 and 2008. RESULTS: There was a significant improvement between 2005 and 2008 in all incidents evaluated. Flying Squad dispatch performance improved from 11.7% to 46.6% of all incidents dispatched within 4 min (p < 0.0001). Response time performance at the 15-min threshold did not demonstrate a statistically significant improvement (p = 0.4), although the improvement in the 30-min performance category was statistically significant in both maternity and neonatal incidents. Maternity incidents displayed the greatest improvement with the 30-min performance increasing from 30.3% to 72.9%. The analysis of the mean transit times demonstrated that neonatal transfers displayed the longest status time in all but one of the categories. Even so, the introduction of the Flying Squad programme resulted in a reduction in a total pre-hospital time from 177 to 128 min. CONCLUSION: The introduction of the Flying Squad programme has resulted in significant improvement in the transit times of both neonatal and obstetric patients. In spite of the severe resource constraints facing developing nations, the model employed offers significant gains

Schottky mass measurements of heavy neutron-rich nuclides in the element range 70\leZ \le79 at the ESR

Storage-ring mass spectrometry was applied to neutron-rich $^{197}$Au projectile fragments. Masses of $^{181,183}$Lu, $^{185,186}$Hf, $^{187,188}$Ta, $^{191}$W, and $^{192,193}$Re nuclei were measured for the first time. The uncertainty of previously known masses of $^{189,190}$W and $^{195}$Os nuclei was improved. Observed irregularities on the smooth two-neutron separation energies for Hf and W isotopes are linked to the collectivity phenomena in the corresponding nuclei.Comment: 10 pages, 9 figures, 2 table

"It's something you have to put up with' - service users' experiences of in utero transfer: a qualitative study

Objective The purpose of this study was to gain in-depth insight and enhance understanding of service users’ experiences of the in utero transfer (IUT) process, in order to inform policy and improve the current service provision of maternal care. Design Qualitative descriptive study using semi-structured interviews. Setting Participant's home or hospital in the Midlands, UK. Population Fifteen women transferred in utero to a tertiary level maternity hospital; five male partners and two grandmothers. Methods Audio-recorded individual or paired semi-structured interviews transcribed verbatum and analysed thematically using nvivo 9. Main outcome measures Facilitators and barriers of the IUT experience. Results Findings suggest that IUT is an emotional experience that financially disadvantages patients and their families. Male partners were perceived to be most negatively affected by the experience. The quality of the IUT experience was influenced by a range of factors, including the lack of proximity to home and the lack of information. Patients had little knowledge or awareness of IUT, and most felt unprepared for displacement. Despite this, there was resigned acceptance that IUT was a necessary rather than adverse experience. Conclusions The experience of IUT for service users could be enhanced by ensuring that they are better informed about the process and the circumstances that necessitate displacement, that they are better informed about the hospital to which they are being transferred, and that they are transferred as close to home as possible. Efforts to minimise the emotional and socio-economic impact of IUT on women and their families also need to be considered