Practice variation in initial management and transfer thresholds for infants with respiratory distress in Australian hospitals. Who should write the guidelines?

AIM: In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress; (ii) to identify factors important in deciding to transfer an infant; and (iii) to identify thresholds for transfer. METHODS: All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n=176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU. RESULTS: 15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO(2)) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard 'Medical Staff Experience' and 'Time to Nearest NICU' as important compared with SCUs (P<0.05). NICUs would 'Probably' and 'Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P<0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO(2) level. CONCLUSION: The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines.     

Nasal high flow therapy in very low birth weight infants with mild respiratory distress syndrome: a single center experience

Background

Pulmonary disorders and respiratory failure represent one of the most common morbidities of preterm newborns admitted to neonatal intensive care units (NICUs). The use of nasal high-flow therapy (nHFT) has been more recently introduced into the NICUs as a non-invasive respiratory (NIV) support.

Methods

We performed a retrospective study to evaluate safety and effectiveness of nHFT as primary support for infants born <?29 weeks of gestation and/or VLBW presenting with mild Respiratory Distress Syndrome (RDS).The main outcome was the percentage of patients that did not need mechanical ventilation. Secondary outcomes were rate of bronchopulmonary dysplasia (BDP), air leaks, nasal injury, late onset sepsis (LOS), intraventricular hemorrhage (IVH), retinopathy (ROP), necrotizing enterocolitis (NEC), hemodynamically-significant patent ductus arteriosus (PDA) and death.

Results

Sixty-four preterm newborns were enrolled. Overall, 93% of enrolled patients did not need mechanical ventilation. In a subgroup analysis, 88.5% of infants <?29 weeks and 86.7% of infants ELBW (<?1000 g BW) did not need mechanical ventilation.BPD was diagnosed in 26.6% of preterms enrolled (Mild 20%, Moderate 4.5%, Severe 1.5%). In subgroup analysis, BPD was diagnosed in 53.9% of newborns with GA <?29 weeks, in 53.3% of ELBW newborns and in 11.1% of small for gestational age (SGA) newborns.Neither air leaks nor nasal injury were recorded as well as no exitus occurred. LOS, IVH, ROP, NEC and PDA occurred respectively in 16.1%, 0%, 7.8%, and 1.6% of newborns.

Conclusions

According to our results, n-HFT seems to be effective as first respiratory support in preterm newborns with mild RDS. Further studies in a larger number of preterm newborns are required to confirm nHFT effectiveness in the acute phase of RDS.

     

Asistencia respiratoria en las unidades de cuidados intensivos neonatales en España: situación en 2005

AimTo learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain.Material and methodA structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005.ResultsA total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7–1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO.ConclusionsThe mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems.     

Factors associated with iatrogenesis in neonatal intensive care units: an observational multicenter study

The objective of our study was to assess factors associated with iatrogenic events in Neonatal Intensive Care Units (NICUs). This was a retrospective analysis based on a cohort of patients who participated in our previous prospective study (Pediatrics 122:550?C555, 2008), conducted in four tertiary university-affiliated NICUs in Israel, that included all consecutive infants (n?=?615) hospitalized during the study period. Ongoing monitoring of iatrogenic events was performed by designated ??iatrogenesis advocates.?? The main outcome measures were the association of individual infant characteristics and NICUs?? environmental characteristics with iatrogenic events assessed by univariate and multiple logistic regression analysis. We found that four infant characteristics were significantly (p?<?0.001) associated with iatrogenic events in a univariate analysis: gestational age, birth weight, severity of initial illness as assessed by the Score for Neonatal Acute Physiology and Perinatal Extension (SNAPPE II), and length of stay (LOS). All four factors demonstrated a significant (p?<?0.001) dose?Cresponse relationship with iatrogenic events. Univariate analysis for environmental characteristics showed that type of shift, but not nursing workload, was significantly associated with iatrogenic events (p?<?0.001). In a multiple logistic regression analysis, only LOS (adjusted OR 1.02 [95?% CI, 1.01?C1.03]) and type of shift, morning vs. evening (adjusted OR 3.44 [95?% CI, 2.33?C5.08]) and morning vs. night (adjusted OR 6.07 [95?% CI, 3.86?C9.56]), remained independently associated with iatrogenic events (p?<?0.001). Prolonged LOS and morning shifts were found to be significantly associated with iatrogenic events. Further prospective research is warranted to identify the specific causes for iatrogenic events in order to target active interventions to prevent them.     

Neonatal respiratory support strategies in the intensive care unit: an Italian survey

We carried out a survey of current practices of neonatal respiratory support in neonatal intensive care units (NICUs) in Italy with the aim of comparing the current reality with evidence from the literature. We sent a questionnaire by email to the 103 level III neonatal units in Italy. There was a 61 % (73/120) response rate to the questionnaire. We found that synchronized intermittent positive pressure ventilation is mostly used in infants in the acute phase of respiratory distress syndrome (RDS), while the majority of the units prefer volume-targeted ventilation for those in the weaning phase. Nasal continuous positive airway pressure is the most commonly used non-invasive mode of respiratory support, both in the acute and post-extubation phase of RDS. Surfactant is mainly given as rescue treatment. Infants receive caffeine before extubation and analgesia under mechanical ventilation, while post-natal steroids are given after the first week of life in the majority of the units. In conclusion, respiratory support strategies in Italian NICUs are frequently evidence-based. However, since there are areas where this does not occur, we suggest that focused interventions take place on these areas to help improve clinical practice and increase their adherence to evidence-based medical criteria.     

Respiratory outcome of prematurely born infants following human rhinovirus A and C infections

Human rhinoviruses (HRVs) are a common cause of lower respiratory tract infections (LRTIs) and are associated with chronic respiratory morbidity. Our aim was to determine whether HRV species A or C were associated with chronic respiratory morbidity and increased health care utilisation in prematurely born infants. A number of 153 infants with a median gestational age of 34 (range 23–35) weeks were prospectively followed. Nasopharyngeal aspirates were collected whenever the infants had LRTIs regardless of hospitalisation status. Parents completed a respiratory diary card and health questionnaire about their infant when they were 11 and 12 months corrected age, respectively. The health-related cost of care during infancy was calculated from the medical records using the National Health Service (NHS) reference costing scheme and the British National Formulary for children. There were 32 infants that developed 40 HRV LRTIs; samples were available from 23 of the 32 infants for subtyping. Nine infants had HRV-A LRTIs, 13 HRV-C LRTIs, and one infant had a HRV-B LRTI. Exclusion of infants who also had RSV LRTIs revealed that the infants who had a HRV-C LRTI were more likely to wheeze (p?<?0.0005) and use respiratory medications (p?<?0.0005) and had more days of wheeze (p?=?0.01) and used an inhaler (p?=?0.02) than the no LRTI group. In addition, the respiratory cost of care was greater for the HRV-C LRTI than the no LRTI group (p?<?0.0005). Conclusion: Our results suggest HRV-C is associated with chronic respiratory morbidity during infancy in prematurely born infants.     

Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia. International Neonatal Network, Scottish Neonatal Consultants, Nurses Collaborative Study Group

OBJECTIVES—To compare outcomes of care in selected neonatal intensive care units (NICUs) for very low birthweight (VLBW) or preterm infants in Scotland and Australia (study 1) and perinatal care for all VLBW infants in both countries (study 2).
DESIGN—Study 1: risk adjusted cohort study; study 2: population based cohort study.
SUBJECTS—Study 1: all 2621 infants of < 1500 g birth weight or < 31 weeks'' gestation admitted to a volunteer sample of hospitals comprising eight of all 17 Scottish NICUs and six of all 12 tertiary NICUs in New South Wales and Queensland in 1993-1994; study 2: all 5986infants of 500-1499 g birth weight registered as live born in Scotland and Australia in 1993-1994.
MAIN OUTCOMES—Study 1: (a) hospital death; (b) death or cerebral damage, each adjusted for gestation and CRIB (clinical risk index for babies); study 2: neonatal (28 day) mortality.
RESULTS—Study 1. Data were obtained for 1628 admissions in six Australian NICUs, 775 in five Scottish tertiary NICUs, and 148 in three Scottish non-tertiary NICUs. Crude hospital death rates were 13%, 22%, and 22% respectively. Risk adjusted hospital mortality was about 50% higher in Scottish than in Australian NICUs (adjusted mortality ratio 1.46, 95% confidence interval (CI) 1.29 to 1.63,p < 0.001). There was no difference in risk adjusted outcomes between Scottish tertiary and non-tertiary NICUs. After risk adjustment, death or cerebral damage was more common in Scottish than Australian NICUs (odds ratio 1.9, 95% CI 1.5 to 2.5). Both these risk adjusted adverse outcomes remained more common in Scottish than Australian NICUs after excluding all infants < 28 weeks'' gestation from the comparison. Study 2. Population based neonatal mortality in infants of 500-1499 g was higher in Scotland (20.3%) than Australia (16.6%) (relative risk 1.22, 95% CI 1.08 to 1.39, p = 0.002). In a post hoc analysis, neonatal mortality was also higher in England and Wales than in Australia.
CONCLUSIONS—Study 1: outcome was better in the Australian NICUs. Study 2: perinatal outcome was better in Australia. Both results may be consistent, at least in part, with differences in the organisation and implementation of neonatal care.

     

早产儿血清总胆汁酸升高的危险因素分析

目的 探讨早产儿血清总胆汁酸（TBA）升高的危险因素。方法 回顾性分析入住新生儿重症监护病房的216例早产儿的临床资料。以是否发生TBA升高（TBA > 24.8 μmol/L）,将早产儿分为TBA升高组（53例）和非TBA升高组（163例）。对可能导致TBA升高的影响因素进行单因素分析和非条件多因素logistic回归分析。结果 单因素分析显示,TBA升高和非TBA升高两组出生胎龄、出生体重、小于胎龄儿比例、呼吸机辅助通气比例、禁食时间、静脉营养时间以及新生儿呼吸衰竭、新生儿败血症的发生率的比较差异有统计学意义（P < 0.05）。非条件多因素logistic回归分析显示,低出生体重（OR=3.84,95% CI：1.53~9.64）、新生儿败血症（OR=2.56,95% CI：1.01~6.47）是早产儿TBA升高的独立危险因素。结论 低出生体重及新生儿败血症可导致TBA升高。     

Outcomes for high risk New Zealand newborn infants in 1998-1999: a population based,national study

OBJECTIVE: To determine short term morbidity and mortality outcomes, provision of care, and treatments for a national cohort of high risk infants born in 1998-1999 and admitted to New Zealand neonatal intensive care units (NICUs). SETTING: All level III (six) and level II (13) NICUs in New Zealand. METHODS: Prospective audit by the Australian and New Zealand Neonatal Network (ANZNN) of all infants defined as "high risk" (born at < 32 weeks gestation or < 1500 g birth weight, or received assisted ventilation for four hours or more, or had major surgery). Data were collected from birth until discharge home or death. RESULTS: There were 3368 high risk infants (3.0% of all live births), comprising 1241 (37%) < 32 weeks gestation, 1084 (32%) < 1500 g, 3156 (94%) who received assisted ventilation, and 243 (7%) who received major surgery (categories overlap). Most infants (87%) received some care in tertiary hospitals, and 13% were cared for entirely in non-tertiary hospitals. Survival was 91% for infants < 32 weeks gestation, 97% for infants > or = 32 weeks gestation who received assisted ventilation, and 92% for infants > or = 32 weeks gestation who had major surgery. The proportion of very preterm infants who survived free of early major morbidity was 11%, 28%, 53%, 81%, and 90% for infants born at < 24, 24-25, 26-27, 28-29, and 30-31 weeks gestation respectively. CONCLUSIONS: These unique population based national data provide contemporary information on the care and early morbidity and mortality outcomes for all high risk infants, whether cared for in hospitals with level III or level II NICUs.     

Relation Between Red Cell Distribution Width and Clinical Outcome After Surgery for Congenital Heart Disease in Children

Recent studies have reported a strong association between increased red cell distribution width (RDW) and the risk of adverse outcomes for adults with heart failure. This study investigated the association between preoperative RDW and postoperative clinical outcomes for children with cardiac disease. The relation between preoperative RDW and the length of postoperative stay was tested with 688 consecutive children undergoing surgery for congenital heart disease (CHD). The RDW was significantly higher in patients who died during the postoperative hospital stay (mean, 18.34?±?4.69 vs 16.12?±?2.84; p?=?0.004). The risk of postoperative death was five times higher for patients with an RDW of 16% or more. In the general study population, RDW correlated with the intensive care unit (ICU) stay (p?<?0.0001) and with the total hospital stay in the local population (p?<?0.0001). The correlation between RDW and ICU stay was stronger for patients with acyanotic CHD (p?<?0.0001) than for those with cyanotic CHD (p?=?0.0007), and for the subpopulation of patients with acyanotic CHD and normal hemoglobin level (p?<?0.0001) than for anemic patients with acyanotic CHD (p?=?0.025). Preoperative RDW is a strong predictor of an adverse outcome in children undergoing surgery for CHD, especially in nonanemic patients, for whom it reflects an underlying inflammatory stress.     

超早产儿出生时间与复苏结局的关系

目的 探讨非工作时间(工作日夜间6 pm～8 am、周末和国家法定节假日)出生的与正常工作时间出生的超早产儿复苏过程和早期结局有无差异.方法 回顾性收集2010年1月1日至2020年12月31日于北京大学第三医院出生并转入新生儿重症监护病房的超早产儿病例.根据出生时间的不同分为工作时间出生组(n=77)和非工作时间出生...     

Impact of Behavior Change Communication Among Pregnant Women Regarding Neonatal Care

Objectives

To assess the behavior of pregnant women regarding neonatal care. Also to implement and assess impact of Behaviour Change Communication (BCC) package among pregnant women regarding neonatal care.

Methods

This community based intervention study was conducted in field practice area of Urban Health Training Centre (UHTC), Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (A.M.U), Aligarh (UP), India. Two hundred pregnant women were included. Epi Info version 3.5.1. Percentages, and Chi square test were used for statistical analysis.

Results

Due to implementation of BCC package, institutional deliveries improved (RR?=?2.47, P?<?0.05), delivery practices significantly increased (RR?=?2.47, P?<?0.05). There was significant difference regarding breastfeeding practices on 7th and 28th d of delivery. More (80 %) deliveries were conducted in warm room (RR?=?1.87, p?<?0.05), bathing to the baby was delayed (RR?=?0.81, p?<?0.05) and decreased, vigorous removal of vernix caseosa was observed (RR?=?0.45, p?<?0.05). Correct knowledge about danger signs and physiological conditions in newborns were increased (RR?=?2.5.0, p?<?0.05 for cold to touch, RR?=?1.22, p?<?0.05 for peeling of skin).

Conclusions

There was a significant impact of BCC package on the behavior of pregnant women regarding neonatal care.     

Survey of sleeping position recommendations for prematurely born infants on neonatal intensive care unit discharge

Introduction Prematurely born infants are at an increased risk of sudden infant death syndrome (SIDS), particularly when sleeping prone. Parents are strongly influenced in their choice of sleeping position for their infant by practitioners. The aim of this study was to determine the neonatal units’ recommendations regarding the sleeping position for premature infants prior to and after discharge and ascertain whether there had been changes from those recorded in a survey performed in 2001–2002. Materials and methods A questionnaire survey was sent to all 229 neonatal units in the United Kingdom; 80% responded. Results and discussion The majority (83%) of units utilized the supine sleep position for infants at least 1–2 weeks prior to discharge, but after discharge, only 38% of the units actively discouraged prone sleeping and 17% additionally recommended side sleeping. Compared to the previous survey, significantly more units started infants with supine sleeping 1–2 weeks prior to discharge (p < 0.0001) and fewer recommended side sleeping after discharge (p = 0.0015). However, disappointingly, less actively discouraged prone sleeping after discharge (p = 0.0001). Conclusion Recommendations regarding sleeping position for prematurely born infants after neonatal discharge by some practitioners remain inappropriate. Evidence-based guidelines are required as these would hopefully inform all neonatal units’ recommendations.     

Survey of sleeping position recommendations for prematurely born infants

The risk of sudden infant death syndrome is increased in prematurely born infants compared to those born at term, particularly if they are either slept prone or on their side. The aim of this study was to determine whether a national campaign “Time to get back to sleep” had influenced the recommendations made by neonatal practitioners regarding the sleeping position for prematurely born babies prior to and after neonatal unit discharge. A questionnaire survey was sent to all UK neonatal units, of which 90% responded. The results were compared to those of a survey carried out prior to the national campaign. Analysis of the responses demonstrated that there was no significant difference in the proportion of units which recommended supine sleeping at least 1–2 weeks before discharge (78% versus 83%). Still, a minority of units provided written information for staff (26% versus 33%), but a greater proportion of units provided written information for parents (95% versus 90%, p = 0.047). All units recommended supine sleeping following discharge, and compared to the results of the previous survey, a smaller proportion of units additionally recommended side sleeping after discharge (8% versus 17%, p = 0.01) and a greater proportion actively discouraged prone sleeping (62% versus 38%, p < 0.0001). Conclusions: The majority but, importantly, not all neonatal units are giving appropriate recommendations regarding sleeping position following neonatal unit discharge. These results highlight that further education of neonatal staff regarding appropriate sleeping position for prematurely born babies remains imperative.     

A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy

Background/aimsPost-asphyxia neonatal encephalopathy (NE) is one of the main causes of disabilities in term-born infants. This review attempted to investigate the developmental outcomes of term-born infants with post-asphyxia NE.MethodAn electronic search on various databases identified 13 empirical studies against the selection criteria modified from the consensus statement from the International Cerebral Palsy Task Force.ResultsThe overall quality of methodology of these studies was average. The random effect meta-estimate of the proportion of infants having adverse developmental outcomes such as death, cognitive impairment, sensory-motor impairments was 47% (95% CI 36–57%). Significant heterogeneity (I² = 87.7%, p < 0.00001) between studies indicated variations in number of subjects in studies and their characteristics. For those studies using the Sarnat grading of NE, the proportion of infants with adverse outcomes was nil in stage 1 (mild) NE, 32% in stage 2 (moderate) and almost 100% in stage 3 (severe) NE.ConclusionsAt present, researchers are using very loose diagnostic criteria of perinatal asphyxia and post-asphyxia NE, making the study samples heterogeneous. Clinicians and researchers are urged to make use of the recent consensus statement regarding diagnostic criteria for intrapartum asphyxia and to identify these high-risk infants for early intervention.     

The use of mechanical ventilation protocols in Canadian neonatal intensive care units

OBJECTIVES:To identify the proportion of Canadian neonatal intensive care units with existing mechanical ventilation protocols and to determine the characteristics and respiratory care practices of units that have adopted such protocols.METHODS:A structured survey including 36 questions about mechanical ventilation protocols and respiratory care practices was mailed to the medical directors of all tertiary care neonatal units in Canada and circulated between December 2012 and March 2013.RESULTS:Twenty-four of 32 units responded to the survey (75%). Of the respondents, 91% were medical directors and 71% worked in university hospitals. Nine units (38%) had at least one type of mechanical ventilation protocol, most commonly for the acute and weaning phases. Units with pre-existing protocols were more commonly university-affiliated and had higher ratios of ventilated patients to physicians or respiratory therapists, although this did not reach statistical significance. The presence of a mechanical ventilation protocol was highly correlated with the coexistence of a protocol for noninvasive ventilation (P<0.001, OR 4.5 [95% CI 1.3 to 15.3]). There were overall wide variations in ventilation practices across units. However, units with mechanical ventilation protocols were significantly more likely to extubate neonates from the assist control mode (P=0.039, OR 8.25 [95% CI 1.2 to 59]).CONCLUSION:Despite the lack of compelling evidence to support their use in neonates, a considerable number of Canadian neonatal intensive care units have adopted mechanical ventilation protocols. More research is needed to better understand their role in reducing unnecessary variations in practice and improving short- and long-term outcomes.     

A Comparative Study on Reliability of Point of Care Sodium and Potassium Estimation in a Pediatric Intensive Care Unit

Objective

To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer.

Methods

This prospective method comparison study was done from February to April 2012 in Pediatric ICU of tertiary care hospital at Delhi. Sixty consecutive patients were tested during the period. Paired blood samples for venous blood gas to be tested on BGA and serum electrolytes to be tested on auto-analyzers (AA) were taken as per standard technique. Data was collected and 59 paired samples were analyzed for sodium and potassium levels. They were analyzed according to CLSI document EP15-A2 using ACB method comparison software.

Results

Mean sodium measured on the BGA was 132.8?±?12.2 mmol/L where as measured by AA was 141.5?±?11.1 mmol/L. The mean difference between the two was ?8.76 mmol/L (p?<?0.001). The difference was statistically significant in all three subgroups of hypernatremia, isonatremia and hyponatremia (p?<?0.001). Potassium level in BGA was 3.53?±?0.81 mmol/L and AA was 4.28?±?1.05 mmol/L. The mean difference between the BGA and AA was ?0.75 mmol/L (p?<?0.0001). The difference was statistically significant in patients with normokalemia and hyperkalemia (p?<?0.0001). The difference was non significant in patients with hypokalemia (p?=?0.051).

Conclusions

Blood gas analyzers underestimates Na?+?and K?+?values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman’s analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.     

Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related

Background  

Nosocomial infection (NI), particularly with positive blood or cerebrospinal fluid bacterial cultures, is a major cause of morbidity in neonatal intensive care units (NICUs). Rates of NI appear to vary substantially between NICUs. The aim of this study was to determine risk factors for NI, as well as the risk-adjusted variations in NI rates among Canadian NICUs.     

Hyperbilirubinemia in Healthy Newborns Born to Immigrant Mothers from Southeastern Asia Compared to Italian Ones

Objective

To compare the characteristics of jaundice and hyperbilirubinemia in the newborn population of both immigrant and Italian mothers.

Methods

The authors studied a group of 1,680 infants born at “A. Gemelli” hospital during 1 y. All were with appropriate weight for gestational age, weighting more than 2,500 g, born to low-risk pregnancy. Maternal ethnicity, clinically evident jaundice (that is total serum bilirubin (TSB)?>?7 mg/dL), hyperbilirubinemia (TSB?>?12 mg/dL), the duration of hospital stay and their need of phototherapy were evaluated.

Results

In infants born to Asian mothers, hyperbilirubinemia was significantly more frequent (48.8 % vs. 26.5 %, p?=?0.003) and they reached mean TSB peak significantly later (86.5?±?38.5 vs. 74.5?±?20.6 h, P?=?0.0001) compared with Italian infants. The average length of hospitalization of infants of Asian and Latin American mothers is significantly longer compared to Italian newborns (4.5?±?1.9 vs. 3.6?±?1.1, p <0.0001 and 4.2?±?1.6 vs. 3.6?±?1.1, p?=?0.0004). With regard to the use of phototherapy, and to its duration, there are no significant differences between the populations studied.

Conclusions

Having studied all infants at low risk, the greater length of hospitalization is due to later peak and the higher frequency of jaundice in newborns of immigrant mother, especially in Asia. Therefore, as it happens to the Italian newborns, it would be desirable to build forecasting nomograms in these populations, to reduce the length of hospitalization and facilitate protected discharge.     

Randomised controlled double blind study of role of recombinant erythropoietin in the prevention of chronic lung disease

AIM—To evaluate the role of recombinant human erythropoietin (R-HuEpo) in reducing iron infusion, which may exacerbate free radical damage, leading to chronic lung disease.METHODS—A multicentre, randomised, placebo controlled, double blind study was carried out in four neonatal intensive care units in Yorkshire. Infants were randomly allocated and received either R-HuEpo (480 U/kg/wk) or placebo by twice weekly subcutaneous injection. The primary outcome measure was the number of days on respiratory support and a secondary outcome the number of blood transfusions required.RESULTS—Forty two very low birthweight (VLBW) infants were randomly allocated. There was little difference in the need for respiratory support one month after randomisation, but subsequently there was a trend towards a reduction in the proportion requiring respiratory support in the R-HuEpo group (difference at three months ?0.50, 95% confidence interval ?1.00, 0.17). During stay in hospital, the median number of blood transfusions was lower for infants in the R-HuEpo group (difference in medians ?2, 95% CI ?4, 0). The study was stopped early because of failure to recruit babies at the expected rate.CONCLUSIONS—R-HuEpo seems to reduce the number of days in oxygen for ill VLBW infants. These data could be used to construct a larger multicentre study to evaluate this effect further.