Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study

Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers a training certificate for fnECHO. In Europe, the use and indications of fnECHO and the extent of point-of-care fnECHO training and accreditation are unknown. We aimed to assess utilisation and training of fnECHO in Europe. For this, we conducted an email survey of 45 randomly chosen tertiary NICUs in 17 European countries. The recall rate was 89 % (n?=?40). Neonatologists with skills in fnECHO worked in 29 NICUs (74 %), but paediatric cardiologists would routinely perform most fnECHOs. Twenty-four-hour echocardiography service was available in 31 NICUs (78 %). Indications for fnECHO included assessment of haemodynamic volume status (53 %), presence or absence of pulmonary hypertension of the neonate (55 %), indication for and effect of volume replacement therapy (58 %), PDA assessment and monitoring of PDA treatment (80 %). Teaching of fnECHO was offered to trainees in 22 NICUs (55 %). Teaching of fnECHO was provided by paediatric cardiologists (55 %) or by neonatologists (45 %). Only six (15 %) national colleges accredited fnECHO teaching courses. Conclusion: fnECHO is widely practiced by neonatologists across Europe for a broad range of clinical questions. However, there is a lack of formal training and accreditation of fnECHO skills. This could be addressed by designing a dedicated European fnECHO training programme and by agreeing on a common European certificate of fnECHO.     

What is the rationale for the use of granulocyte and granulocyte-macrophage colony-stimulating factors in the neonatal intensive care unit?

Neonatal sepsis remains an unsolved major contributor to morbidity and mortality. In the 1980s the promise of augmenting immune function using pooled intravenous gammaglobulin to supplement the exceedingly low levels of immunoglobulin G in premature infants failed to demonstrate a clear advantage. Similarly, cytokine augmentation of cellular function in the 1990s largely appeared to be suffering the same fate. However, both results may arise from a problem in experimental design where the combination of both treatments may be necessary along with specific antibody. For example, in vitro, independently of an array of other humoral and cellular immature immune system issues, opsonization of bacteria is improved in the presence of antibody. The question is whether the same result can be achieved in vivo. No experiments have been reported that directly test this hypothesis. CONCLUSION: More investigation is needed in this challenging area of neonatal research.     

Perinatal factors related to the morbidity and mortality of newborns in nine neonatal care units in the city of São Paulo

This study was carried out in nine hospitals in the city of S?o Paulo, in 1991 (between July 1 and November 30), when 10,235 live children were born. The aim of this study was to analyze the characteristics of the 1975 pathologic newborn (PNB) who were put into those neonatal care units (NCU) of the hospitals; besides that, the most common morbidity conditions, breast feeding prevalent and therapies were studied. It was calculated the odds ratio, its confidence interval and the c(2) test in order to evaluate the association between the variables and the death of the PNB. The results have demonstrated that the low weight PNB lethality (especially those with weight <1500 g) was higher than those PNB whose weight was > or = 2500 g. The lethality for both premature PNB and small for gestational age PNB was higher than the other categories of babies. The PNB with hypoxia until the 5th minute had the worst prognostic: their lethality was 10 times higher than the other category. The PNB who had Apgar < or =7 until the 5th minute had twice as much lethality when compared with PNB who had Apgar < or =7 just until the 1st minute. Conventional therapies have been used and only 25.4% have received breast feeding. Several risk factors (maternal, delivery, newborn) were associated with the PNB mortality, as well as most of the morbidity conditions. Those factors reflect the perinatal assistance in our environment.     

Teaching ethics in neonatal and perinatal medicine: What is happening in Canada?

Ethically challenging clinical situations are frequently encountered in neonatal and perinatal medicine (NPM), resulting in a complex environment for trainees and a need for ethics training during NPM residency. In the present study, the authors conducted a brief environmental scan to investigate the ethics teaching strategies in Canadian NPM programs. Ten of 13 (77%) accredited Canadian NPM residency programs participated in a survey investigating teaching strategies, content and assessment mechanisms. Although informal ethics teaching was more frequently reported, there was significant variability among programs in terms of content and logistics, with the most common topics being ‘The medical decision making process: Ethical considerations’ and ‘Review of bioethics principles’ (88.9% each); lectures by staff or visiting staff was the most commonly reported formal strategy (100%); and evaluation was primarily considered to be part of their overall trainee rotation (89%). This variability indicates the need for agreement and standardization among program directors regarding these aspects, and warrants further investigation.     

Establishing national neonatal perinatal database and birth defects registry network — Need of the hour!

Early detection and prevention of birth defects is necessary to further reduce neonatal morbidity and mortality. A birth defect registry or surveillance system is necessary to assess the exact magnitude, profile and modifiable risk factors for birth defects. We review the existing efforts and suggest possible options for addressing this important issue. Connecting birth defects registry with the pre-existing programs such as National Neonatal Perinatal Database could be one of the option.     

Scope and feasibility of operating on the neonatal intensive care unit: 312 cases in 10?years

Purpose

To report the scope, feasibility and learning experience of operating on neonates on the neonatal intensive care unit (NICU).

Methods

(1) Review of all NICU operations performed by general neonatal surgeons over 10?years; (2) 6-month prospective comparison of procedures performed in NICU or operating room; (3) structured interviews with five surgeons with 1–13?years experience of operating on NICU.

Results

312 operations were performed in 249 infants. Median birth weight was 1,494?g (range 415–4,365), gestational age 29?weeks (22–42), and age at operation 25?days (0–163). Nearly half (147) were laparotomy for acute abdominal pathology in preterm, very low birth-weight infants There were no surgical adverse events related to location of surgery. Surgeon satisfaction with operating on NICU for this population was high (5/5). Several factors contribute to making this process a success.

Conclusions

This is the largest reported series of general neonatal surgical procedures performed on NICU. Operating on NICU is feasible and safe, and a full range of neonatal operations can be performed. It removes risks associated with neonatal transfer and is likely to reduce physiological instability. We recommend this approach for all ventilated neonates and urge neonatal surgeons to operate at the cotside of unstable infants.     

Septicaemia and meningitis in neonates and during early infancy in the Göteborg area of Sweden

In a retrospective study of neonatal septicaemia and meningitis carried out in 1987–1996 in the Göteborg area of Sweden, 305 cases during the first 28 d of life were found. The incidence was 3.7/1000 live births, which was higher than that found in a study from 1975 to 1986 in the same area, 2.8/1000 live births. The most common pathogens were group B streptococci, aerobic Gram‐negative rods, Staphylococcus aureus and enterococci. The cases were approximately equally divided between very early, early and late onset infections. The case‐fatality rate was lower in the present study (9%) than that in the previous study (15%). The case‐fatality rate varied between 23% in neonates with a gestational age of ≤29 wk and 3% in full‐term neonates. Eighty‐three very late onset infections occurred between days 28 and 120 after birth, corresponding to an incidence of 1.0/1000 live births. Of those, 47 occurred in preterm neonates. The most common organisms were aerobic Gram‐negative rods. Coagulase‐negative staphylococci (CoNS) were studied separately. This organism was isolated in 60 and 32 cases during the first 28 d of life and between days 28 and 120, respectively, in neonates fulfilling the criteria of the Yale‐New Haven Hospital for infections caused by commensal species. The incidence rates of CoNS infections were 0.7 and 0.4/1000 live births, respectively. Conclusion: The incidence of neonatal infections increased and the case‐fatality rate decreased in the Göteborg area compared to the findings of a previous study. Very late onset infections should be added to the total burden of neonatal infections. CoNS are important pathogens but their role is difficult to determine since they are both pathogens and contaminants of cultures from blood and cerebrospinal fluid.     

Common problems and counterplans of extracorporeal membrane oxygenation implementation in neonatal intensive care unit北大核心CSCD

Extracorporeal membrane oxygenation (ECMO) is by far one of the most advanced life support technology,which provides temporary cardiopulmonary support and earns precious time for patients waiting for the recovery of organ function. However,due to various factors and constraints,this technology is still at the initial stage of application in neonatal field in China. In the meantime, there are many problems to deal with. This article will mainly discuss about several aspects in ECMO management,including choice of patients,timing to start,choice of ECMO mode,management of running ECMO,complications and ethic issues. © 2019 Authors. All rights reserved.     

Main diagnosis and cause of death in a neonatal intensive care unit: do clinicians and pathologists agree?

AIM: To determine the agreement rates between clinical and autopsy diagnoses in a neonatal intensive care unit (NICU), distinguishing between the main diagnosis and cause of death. METHODS: Clinical and autopsy records of 75 infants who died in two consecutive years in the NICU (autopsy rate 42.6%) of a pediatric hospital in Mexico City were reviewed. RESULTS: Ninety-two percent of main clinical diagnoses were confirmed by autopsy. Four conditions (congenital cardiopathy, prematurity, specific congenital syndromes and hyaline membrane disease) accounted for more than two-thirds of diagnoses. However, for cause of death, the global agreement was only 50%. The most common conditions considered by clinicians (77%) and pathologists (56%) to be the causes of death were cardiogenic, septic or mixed shocks. Additionally, clinicians omitted 34 relevant conditions in 30 (40.0%) patients, and 21 of these conditions possibly played a role in the deaths of 17 (22.7%) patients. The most frequently omitted diagnosis was pneumonia, in 9 (26.5%) patients. Omissions were not related to gestational age, age at death, days as an inpatient, or gender. CONCLUSION: Despite a high agreement rate in the main diagnoses, notable imprecisions were present regarding cause of death and antemortem overlooking of potentially fatal conditions, confirming the useful role of autopsy to verify clinical diagnoses and suggesting that differentiation between the main diagnosis and cause of death should be carried out in future studies.     

Restriction of cephalosporins and control of extended spectrum β-lactamase producing gram negative bacteria in a neonatal intensive care unit

This interventional study with historical controls was conducted to study the effect of cephalosporin restriction on the incidence of extended spectrum betalactamase (ESBL) gram negative infections in neonates admitted to intensive care unit. All gram negative isolates from the blood were evaluated for beta lactamase production. The incidence of ESBL production was compared before (year 2007) and after cephalosporin restriction (year 2008). Thirty two neonates (3% of NICU admissions) in the year 2007 and fifty six (5.2%) in the year 2008, had gram negative septicemia. The incidence of ESBL gram negatives decreased by 22% (47% to 25%, P=0.03). Restriction of all class of cephalosporins significantly decreased the incidence of ESBL gram negative infections.     

Palliative care delivery in the NICU: what barriers do neonatal nurses face?

Despite the existence of a universal protocol in palliative care for dying babies and their families, provision of this type of care remains ad hoc in contemporary neonatal settings. Influential bodies such as the American Academy of Pediatrics and the World Health Organization support palliative care to this patient population, so why are such measures not universally adopted? Are there barriers that prevent neonatal nurses from delivering this type of care? A search of the literature reveals that such barriers may be significant and that they have the potential to prevent dying babies from receiving the care they deserve. The goal of this literature review is to identify these barriers to providing palliative care in neonatal nursing. Results of the research have been used to determine item content for a survey to conceptualize and address these barriers.