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0000-0003-2179-4367
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Publisher: S. Karger AG
Date: 22-09-2009
DOI: 10.1159/000239768
Abstract: i Background: /i Very preterm neonates can have severe lung disease and are prone to brain injury if cerebral blood flow fluctuates. Partial liquid ventilation (PLV) may benefit the lung disease, but it is unknown whether the administration of intratracheal perfluorocarbon when starting PLV affects haemodynamics or cerebral blood flow. i Objectives: /i To determine if haemodynamics or cerebral blood flow are affected in preterm lambs receiving a dose of perfluorocarbon when starting PLV. i Methods: /i Sixteen preterm lambs were randomised to either PLV or conventional mechanical ventilation. An intratracheal loading dose of 30 ml/kg of perfluorocarbon liquid (PLV group) or air (sham group) was instilled over 20 min. Data were collected continuously for 30 min from the start of dosing. i Results: /i Cortical cerebral blood flow velocity, measured continuously with laser Doppler, was increased in the PLV group during the administration of perfluorocarbon and immediately thereafter (p = 0.0026) the highest mean increase in the PLV group was 27%. There was no difference in cortical cerebral blood flow variability (p = 0.96). There was a slightly lower mean arterial blood pressure in the PLV group the heart rate did not differ between groups. The Pa i CO /i sub /sub was higher in the PLV group at 30 min – the difference between groups was not statistically significant (difference between means = 5.5 mm Hg, 95% confidence interval –2.7 to 13.7). i Conclusions: /i Preterm lambs receiving a dose of tracheal perfluorocarbon at the start of PLV have an increased cortical cerebral blood flow velocity, but no change in cortical cerebral blood flow variability.
Publisher: John Wiley & Sons, Ltd
Date: 19-07-2004
Publisher: Wiley
Date: 07-09-2011
Publisher: Wiley
Date: 14-03-2012
Publisher: Wiley
Date: 12-1998
DOI: 10.1046/J.1440-1754.1998.00306.X
Abstract: The aim of this study was to determine the incidence of toxic trough serum gentamicin levels in neonates in the first week of life, with different dosage intervals. This was a retrospective study of neonates born between 01.07.95 and 31.12.95, who received gentamicin. Data were collected on birth weight, gestation, gentamicin dose, the trough level of gentamicin, serum creatinine and urine output. A trough serum gentamicin level of > or =1.5 mg/L was considered toxic. One hundred and seventy infants met the study criteria. All 21 infants in group one (24-29 weeks) received gentamicin with a dosage interval of 24 h. Sixteen (76%) infants had toxic trough serum gentamicin levels. In group two (30-34 weeks) 8 infants had gentamicin q12hly and all (100%) had toxic trough serum gentamicin levels. Fourteen infants had gentamicin every 18 h and 13 (93%) had toxic trough serum gentamicin levels. Sixty-one infants had gentamicin q24hly and 25 (41%) had toxic trough serum gentamicin levels. The differences in proportions with toxic levels were statistically significant. In group three (> or =35 weeks) 29 infants had gentamicin q12hly and 25 (86%) had toxic trough serum gentamicin levels. Six infants had gentamicin every 18 h and 2 (33%) had toxic trough serum gentamicin levels. Thirty-one infants had gentamicin q24hly and 4 (13%) had toxic trough serum gentamicin levels. The differences in proportions comparing infants having gentamicin q12hly with those having it q24hly were statistically significant. A starting gentamicin dosage interval of 12 h in infants of any gestational age, or a starting dosage interval of 24 h for infants of less than 30 weeks gestational age, leads to most having toxic trough serum gentamicin levels. In infants of 30 weeks gestational age or greater, most have safe non-toxic trough serum gentamicin levels if started on a dosage interval of 24 h.
Publisher: Wiley
Date: 2004
DOI: 10.1002/PPUL.20036
Abstract: The warming and humidification of inspired gases for ventilated neonates are routine. There are no data on the temperature of the gas at the airway opening in ventilated neonates. Is the inspired gas temperature at the airway opening, as expected and set on the humidifier, around 37 degrees C? We aimed to measure temperature at the airway opening and compare this with the circuit temperature. This was an observational study in a neonatal intensive care unit. Twenty-five mechanically ventilated infants were studied. All had humidifiers with chamber temperature set at 36 degrees C and the circuit temperature set at 37 degrees C. Two temperature probes were inserted and rested at the circuit-exit and at the airway opening, and temperatures were measured for 2 min in each infant. At this time, the circuit temperature was also noted. The mean (SD) temperature at the airway opening in infants nursed in incubators was 34.9 (1.2) degrees C, compared with radiant warmers where the mean (SD) was 33.1 (0.5) degrees C. The mean (SD) difference in temperature from the circuit temperature probe to the airway opening was greater under radiant warmers, with a mean (SD) drop of 3.9 (0.6) degrees C compared with a mean (SD) drop of 2.0 (1.3) degrees C in the incubators. In conclusion, the temperature at the circuit temperature probe does not reflect the temperature at the airway opening. Inspired gas temperatures are lower than the expected 37 degrees C with the normal circuits and usual humidifier settings.
Publisher: Elsevier BV
Date: 2008
DOI: 10.1016/J.MEHY.2008.02.005
Abstract: Respiratory mortality and morbidity remain major consequences of extreme prematurity. Percutaneous transfer of oxygen and carbon dioxide is possible in the newborn human. Perfluorocarbon (PFC) liquids have excellent oxygen and carbon dioxide carrying capacity. Animals can breath immersed in perfluorocarbon liquids and maintain adequate gas exchange. Our hypothesis is that the combination of spontaneous tidal perfluorocarbon breathing and respiration through the skin immersed in perfluorocarbon will allow adequate gas exchange in the preterm newborn. In this pilot study we aimed to observe the effects of immersion in FC-77 perfluorocarbon liquid on the preterm lamb. PILOT DATA: Four preterm lambs at 100-115 days gestation were delivered using a modified EXIT procedure. Immediately after complete delivery, the catheterised lamb was immersed in warm, oxygenated FC-77 perfluorocarbon liquid. Physiological monitoring was done for up to 60 min. All lambs were warmed adequately and seemed to have centrally intact circulation initially. All had little or no respiratory effort and there was no appreciable lung expansion. All had severe respiratory acidosis. For the provision of immediate ex utero care to the 'fetus' there are three requirements: adequate gas exchange surfaces and sufficient oxygen and carbon dioxide gradients, a functioning circulation, and an environment capable of keeping the lamb warm (thus minimising metabolic demand, oxygen consumption and carbon dioxide production). In this pilot study the greatest initial problem was the severe and rapidly worsening respiratory acidosis. The major problem was a lack of respiratory drive. No lung expansion from the outset would yield zero contribution to gas exchange from the lungs. An intact central circulation does not necessarily mean that the pulmonary circulation, respiratory drive and/or the skin circulation are adequate. For adequate gas exchange to occur it will require a 'breathing' animal with expanded alveoli. If the transition from the normal in utero state to immersion in PFC was immediate, and lung expansion was achieved, it could still be possible to achieve adequate gas exchange through the skin and lungs of the extremely preterm newborn. Given the potential for gas exchange across the skin of the extremely preterm infant we hypothesise that the immersion of extremely preterm infants in PFC liquid will allow optimal percutaneous gas exchange to occur. Given some lung gas exchange with less injurious liquid ventilation (spontaneous or mechanical) we hypothesise that the combination of skin and lung gas exchange will provide sufficient gas exchange to support life.
Publisher: Wiley
Date: 09-11-2006
DOI: 10.1111/J.1440-1754.2006.00980.X
Abstract: We aimed to determine the laboratory detection time of bacteraemia in neonatal blood cultures, and whether this differed by: organism s les deemed to represent true bacteraemia versus contaminants and blood cultures collected from an infant or=48 h of age (late). A retrospective audit of all positive blood cultures collected from neonates in the Grantley Stable Neonatal Unit, Royal Women's Hospital, Brisbane, between 1 January 2000 and 31 December 2004 was undertaken. The bacteraemia detection method used was the BacTAlert system with Peds bottles. Two hundred and three positive blood cultures were included in the analysis. One hundred and sixteen (57%) were deemed septicaemia, 87 (43%) were deemed contaminants. The median (interquartile range) time to positivity for positive blood cultures deemed septicaemia and contaminants were 15.9 (11.6, 22.2) and 30.2 (20.4, 43.9) h, respectively. Fifty-six (28%) positive blood cultures were collected when infants were or=48 h of age. Post hoc analysis revealed that the time to positivity for early septicaemia was 13.7 (11, 16.7) h early contaminant was 25.2 (19.2, 33.8) h late septicaemia was 17.2 (12.2, 23.4) h and late contaminant was 37.9 (21.7, 51.2) h. The time to positivity for: Group B streptococcus was 9.3 (8.2, 11.0) h Escherichia coli was 11.3 (10.0, 13.5) h and coagulase-negative staphylococci was 28.9 (20.5, 41.2) h. The incubation time for positive blood cultures significantly differs by organism type and whether they are considered early or late septicaemia versus contaminants. We recommend that: infants who are or=48 h of age at the time of collection should continue antibiotic treatment for at least 48 h before cessation is considered.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.IJNURSTU.2009.10.017
Abstract: The incubator environment is essential for optimal physiological functioning and development of the premature infant but the infant is ultimately required to make a successful transfer from incubator to open cot in order to be discharged from hospital. Criteria for transfer lack a systematic approach because no clear, specific guideline predominates in clinical practice. Practice variation exists between continents, regions and nurseries in the same countries, but there is no recent review of current practices utilised for transferring premature infants from incubators to open cots. To document current practice for transferring premature infants to open cots in neonatal nurseries. A descriptive, cross-sectional survey. Twenty-two neonatal intensive care units and fifty-six high dependency special care baby units located in public hospitals in Australia and New Zealand. A s le of 78 key clinical nursing leaders (nurse unit managers, clinical nurse consultants or clinical nurse specialists) within neonatal nurseries identified through email or telephone contact. Data were collected using a web-based survey on practice, decision-making and strategies utilised for transferring premature infants from incubators to open cots. Descriptive statistics (frequencies and crosstabs) were used to analyse data. Comparisons between groups were tested for statistical significance using Chi-squared or Fisher's exact test. Significant practice variation between countries was found for only one variable, nursing infants clothed (p=0.011). Processes and practices undertaken similarly in both countries include use of incubator air control mode, current weight criterion, thermal challenging, single-walled incubators and heated mattress systems. Practice variation was significant between neonatal intensive care units and special care baby units for weight range (p=0.005), evidence-based practice (p=0.004), historical nursery practice (p=0.029) and incubator air control mode (p=0.001). Differences in these variables were also found between nurseries in metropolitan and rural locations. Practice variation exists however many practices are uniformly performed throughout neonatal nurseries in Australian and New Zealand. Commonality was seen between countries and in nurseries with a neonatal intensive care unit. Variation was significant between neonatal intensive care units and special care baby units and nurseries in metropolitan and rural locations.
Publisher: IOP Publishing
Date: 08-2000
DOI: 10.1088/0967-3334/21/3/402
Abstract: During partial liquid ventilation perfluorocarbon vapour is present in the exhaled gases. The volumes of these gases are measured by pneumotachometers. Error in measuring tidal volumes will give erroneous measurement of lung compliance during partial liquid ventilation. We aim to compare measured tidal volumes with and without perfluorocarbon vapour using tidal volumes suitable for use in neonates. Tidal volumes were produced with a 100 ml calibration syringe from 20 to 100 ml and with a calibrated Harvard rodent ventilator from 2.5 to 20 ml. Control tidal volumes were drawn from a humidifier chamber containing water vapour and the PFC tidal volumes were drawn from a humidifier chamber containing water and perfluorocarbon (FC-77) vapour. Tidal volumes were measured by a fixed orifice, target, differential pressure flowmeter (VenTrak) or a hot-wire anenometer (Bear Cub) placed between the calibration syringe or ventilator and the humidifier chamber. All tidal volumes measured with perfluorocarbon vapour were increased compared with control (ANOVA p < 0.001 and post t-test p < 0.0001). Measured tidal volume increased from 7 to 16% with the fixed orifice type flow-meter, and from 35 to 41% with the hot-wire type. In conclusion, perfluorocarbon vapour flowing through pneumotachometers gives falsely high tidal volume measurements. Calculation of lung compliance must take into account the effect of perfluorocarbon vapour on the measurement of tidal volume.
Publisher: Wiley
Date: 22-07-2002
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Publisher: Wiley
Date: 04-10-2017
DOI: 10.1111/JPC.13353
Abstract: End-of-life care remains part of the scope of practice in all neonatal units. This study aimed to characterise the end-of-life care provided in an Australian tertiary neonatal centre, where paediatric palliative care was accessible via a consultative service. This retrospective cohort study examined indicators of quality palliative care provided to 46 infants born within a 30-month period. The cohort included four infants who received palliative care consultations additional to usual neonatal care. The care provided was characterised using descriptive statistics. The most common causes of death were congenital abnormality (37%) and complications of extreme prematurity (22%). Very high proportions of infants and families had family meetings (100%), social worker involvement (100%), memory-making opportunities (100%) and discussion of autopsy (91%). Opiates were prescribed to 76% in the last day of life most (89%) were administered intravenously. For those prescribed opiates, the median parenteral morphine daily equivalent was 290 mcg/kg/day (interquartile range = 317) in the last 24 h of life. Antenatal resuscitation planning for families of a fetus with a prenatal diagnosis (9%), discussion of preferred location of death (9%), verbal communication with general practitioners (15%) and access to specialised bereavement care (3%) were infrequently provided. At the time of this study, the neonatal unit was not meeting all of the end-of-life care needs of infants and their families. Care was generally more comprehensive when the palliative care service was consulted.
Publisher: Wiley
Date: 16-02-2011
Publisher: Wiley
Date: 09-2005
DOI: 10.1111/J.1440-1754.2005.00695.X
Abstract: Objectives: To review the arterial carbon dioxide tensions (PaCO 2 ) in newborn infants ventilated using synchronized intermittent mandatory ventilation (SIMV) in volume guarantee mode (using the Dräger Babylog 8000+) with a unit policy targeting tidal volumes of approximately 4 mL/kg. Methods: Data on ventilator settings and arterial PaCO 2 levels were collected on all arterial blood gases (ABG n = 288) from 50 neonates ( weeks gestational age) ventilated using the Dräger Babylog 8000+ ventilator (Dräger Medizintechnik GmbH, Lübeck, Germany) in SIMV plus volume guarantee mode. Data were analysed for all blood gases done on the entire cohort in the first 48 h of life and a subanalysis was done on the first gas for each infant ( n = 38) ventilated using volume guarantee from admission to the nursery. The number of ABG showing severe hypocapnoea (PaCO 2 25 mmHg) and/or severe hypercapnoea (PaCO 2 65 mmHg) were determined. Results: The mean (SD) PaCO 2 during the first 48 h was 46.6 (9.0) mmHg. The mean (SD) PaCO 2 on the first blood gas of those infants commenced on volume guarantee from admission was 45.1 (12.5) mmHg. Severe hypo‐ or hypercapnoea occurred in 8% of infants at the time of their first blood gas measurement, and in % of blood gas measurements in the first 48 h. Conclusions: Infants ventilated with volume guarantee ventilation targeting approximately 4 mL/kg (range: 2.9–5.1) have acceptable PaCO 2 levels at the first blood gas measurement and during the first 48 h of life and avoid severe hypo‐ or hypercapnoea over 90% of the time.
Publisher: Wiley
Date: 19-07-2006
Publisher: Wiley
Date: 16-06-2013
DOI: 10.1111/JPC.12304
Abstract: We aimed to determine, in full-term newborns born between 2000 and 2499 g, what proportion develop problems or the need for interventions that would likely require admission to a special care nursery (SCN) (i.e., needed an intravenous line (IV) or a nasogastric tube (NGT). A multicentre, retrospective audit of all babies born from 1 January to 30 June 2011 was used. Eligible babies were term, inborn at one of four centres in south-east Queensland, with a birthweight between 2000 and 2499 g. The cohort of 98 babies had a mean (SD) birthweight of 2340 (122.3) g and a mean (SD) gestational age of 38.3 (1.0) weeks. Forty-three had at least one low temperature, 55 had at least one low blood glucose, 35 had an NGT, 22 had an IV cannula. In the entire cohort, 48 babies (49%) required either an IV cannula or an NGT. Fifteen per cent had a second problem (either low blood glucose or low temperature) at a median (interquartile range) age of 11 (5.5-25.5) h: none required a second NGT or IV. The proportion of babies that required either an NGT or an IV was larger in the 2000-2199 g group (P = 0.026). About half of the babies born with a birthweight of 2000-2499 g will require some intervention that will require them to be admitted to a SCN. However, about half would be able to avoid an SCN admission if they are well and admitted to the post-natal ward.
Publisher: Wiley
Date: 31-03-2023
DOI: 10.1111/APA.16773
Abstract: The aim of this study was to determine the pre‐discharge carbon dioxide (CO 2 ) levels of preterm neonates with bronchopulmonary dysplasia (BPD) requiring ongoing nasal cannulae oxygen therapy and who were ready for discharge home. We studied a retrospective cohort of infants born weeks gestational age (GA) at ≥36 weeks corrected GA who had established BPD requiring ongoing nasal cannulae oxygen therapy and were ready for discharge home. Neonates were born and admitted between May 2014 and December 2018. Demographic data at the time of birth and at the time of the last blood gas s led were collected. One hundred five neonates had median GA of 26.1 weeks and birth weight of 775 g. Median (IQR) CO 2 level was 54 (49–58) mmHg. Ninety‐nine (94%) neonates had CO 2 levels exceeding the normal range and 91 (87%) neonates had a CO 2 between 45 and 65 mmHg. Ninety‐four per cent of neonates weeks GA at ≥36 weeks corrected GA requiring ongoing nasal cannulae oxygen therapy for established BPD, who were ready for discharge home, have CO 2 levels outside of normocapnia (35–45 mmHg), with 87% having CO 2 levels between 45 and 65 mmHg.
Publisher: IOP Publishing
Date: 28-09-2007
DOI: 10.1088/0967-3334/28/10/012
Abstract: The objective of this paper is to establish a reference range of central venous pressure (CVP) values during the first 4 days of life in very low birth weight (VLBW) infants. A prospective observational study with continuous monitoring of CVP in VLBW newborns who had an umbilical venous catheter (UVC) positioned in or near the right atrium is conducted. All UVCs were inserted as part of normal care of the infants. The mean CVP (mCVP) was monitored for 72 h from recruitment, or until the UVC was removed. The mean mCVP was calculated for each infant. The median of the mean mCVPs was then calculated. Data were analysed in 17 infants. The median gestational age was 27 weeks and median birth weight was 940 g. Sixteen were mechanically ventilated and of these, six also received continuous positive airway pressure (CPAP) during the study period. One infant received no respiratory support. One infant died during the study period. The lowest mean mCVP was 2.8 mmHg and the highest was 13.9 mmHg. The median mean mCVP was 4.9 mmHg (interquartile range 4.4-6.1). The normal range of CVP in VLBW infants during the first 4 days of life is wider than previously suggested.
Publisher: KARGER
Date: 2010
DOI: 10.1159/000322746
Publisher: Wiley
Date: 23-09-2022
DOI: 10.1111/JPC.16226
Abstract: Noradrenaline (NA) has been used in preterm and term infants for circulatory support due to conditions including sepsis and pulmonary hypertension of the newborn. Treatment in neonates varies widely between institutions and respective neonatologists. The aim of this study is to determine the indications, use and effects of NA in preterm and term infants requiring circulatory support at the Royal Brisbane and Women's Hospital neonatal intensive care unit. We also aim to determine whether there were any differences between neonates who survived versus those who died after NA treatment. Data were collected from Royal Brisbane and Women's Hospital neonatal unit database including preterm and term infants between 1 January 2016 and 31 May 2021. Analysis included indication for use, blood pressure response, perfusion parameters, haemodynamic indicators and adverse effects. NA treatment was documented in 37 patients requiring treatment of cardiovascular compromise. In 11 (30%) of these infants the indication for use was due to sepsis, 19 (51%) infants had pulmonary hypertension of the newborn, and 7 (19%) infants were diagnosed with hypotension prior to NA administration. Infants who subsequently died (49%) represented a younger gestational age population and exhibited worse cardiac compromise prior to NA administration. Tachycardia occurred in 15 (31%) infants and 1 (2.7%) infant developed transient hypertension. Overall improvement in poor tissue perfusion was seen after NA use. NA use in treating neonates requiring circulatory support appears to be effective. Further prospective trials into NA use as a first‐ or second‐line inotropic agent would be valuable.
Publisher: Springer Science and Business Media LLC
Date: 26-02-2008
Publisher: Wiley
Date: 23-07-2013
Publisher: Springer Berlin Heidelberg
Date: 23-09-2011
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2004
Publisher: Springer Science and Business Media LLC
Date: 19-12-2003
DOI: 10.1007/S00134-003-2085-4
Abstract: To determine whether perfluorocarbon liquid can be condensed from gases containing perfluorocarbon vapour and whether the amount recovered varies with background flow rate. Bench-top experimental study in a neonatal laboratory. The expiratory limb of a standard ventilator circuit set-up was mimicked, with the addition of a chilled water jacket (Liebig) condenser. Perfluorocarbon vapour was passed through the circuit at a number of flow rates. Perfluorocarbon vapour was passed through the circuit and the percentage recovery of liquid measured. More than 60% of the perfluorocarbon vapour was recovered at all flow rates (1, 2, 5 and 10 l/min), with significantly higher recovery obtained (up to 74%) at low flow rates (1 l/min). Using a simple condenser, more than 60% of perfluorocarbon liquid can be recovered without altering the function of an expiratory limb of a ventilator circuit.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1440-1754.2009.01678.X
Abstract: To assess if neonatal endotracheal tube (ETT) position improved with introduction of the NeoBar. This retrospective study compared two cohorts of intubated neonates and their x-rays. During the first 2-month study period, ETTs were secured with tape only--the 'Tape-only' period during the second study period, they were secured with a NeoBar (or tape if the NeoBar was unsuitable)--the 'NeoBar' period. ETT tip position was assessed subjectively as very high, high, OK, low, or very low and objectively by vertebral body position and the ETT-tip-to-T1 distance. During the Tape-only period, 59 babies had 275 x-rays with an ETT visible. During the NeoBar period, 67 babies had 331 x-rays with an ETT visible. There were 160 (58.2%) and 193 (58.3%) assessed as OK during the Tape-only and NeoBar periods, respectively (Fisher's Exact Test, P= 1.0). There were more very high tubes during the NeoBar period, and more low and very low tubes during the Tape-only period (Chi-squared test, P= 0.011). A similar trend was observed with the distribution of the ETT-tip-to-T1 distance (difference not statistically significant, Mann-Whitney test, P= 0.079). During both time periods, less than two-thirds of ETTs were located in an acceptable position. For ETTs in unacceptable positions, there were more tubes in the higher positions during the NeoBar period, and more tubes in the lower positions during the Tape-only period. Further investigation is necessary to clarify if the differences in ETT position on x-ray correlate with relevant clinical outcomes.
Publisher: Wiley
Date: 08-2008
Publisher: Wiley
Date: 2013
DOI: 10.1002/EBCH.1899
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.JPEDSURG.2012.01.010
Abstract: A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected. Eighty-eight patients with gastroschisis were managed over an 11 year period. Forty-four of these patients received SWR, with 2 deaths in the neonatal period. In the 42 survivors, 35 patients were reviewed at a median age of 7 years and 10 months (range, 6-134 months interquartile range, 37-124 months). One patient experienced failure to thrive and developmental delay, and later died of a medical complication. Thirty-two patients (91.4%) developed an umbilical hernia, only 2 of whom required umbilical herniotomy. Four patients (11.4%) developed small bowel obstruction, all within the first year. Most patients with SWR exhibited normal growth with minimal bowel complications. Despite the high incidence of umbilical hernia, the majority resolved spontaneously and did not require subsequent herniotomy.
Publisher: Wiley
Date: 21-01-2002
Publisher: Wiley
Date: 09-2012
DOI: 10.1111/J.1440-1754.2012.02528.X
Abstract: Neonatal alloimmune thrombocytopenia (NAIT), with an incidence of one in 1000 live births, is the most common cause of severe thrombocytopenia and intra-cerebral haemorrhage in term neonates. NAIT results from trans-placental passage of maternal antibodies against a paternally derived fetal platelet alloantigen. Clinical presentation varies from unexpected thrombocytopenia on a blood film in a well newborn to intracranial haemorrhage (ICH). In contrast to haemolytic disease of the newborn, NAIT can present in a first pregnancy, and subsequent pregnancies are usually more severely affected. The role of antenatal screening for maternal alloantibodies instead of fetal blood s ling to identify at-risk fetuses remains uncertain, but there is a trend towards less invasive maternally directed treatment for at-risk pregnancies. Neonatal management is aimed at preventing or limiting thrombocytopenic bleeding with transfusion of antigen-matched platelets.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.IJNURSTU.2017.10.004
Abstract: The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on 'Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools. To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age. Systematic Review. Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary studies published between 1946 and 2017. Reference lists of retrieved articles were reviewed for potential studies. Primary studies published in English that reported physiological vital sign reference ranges pertaining to well newborns born from 34 weeks gestation were selected. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating heart or respiratory rate, temperature, blood pressure and oxygen saturations in well newborns greater than 34 weeks gestational age. Assessment of quality and grading of level of evidence were assessed using National Health and Medical Research Council level of Evidence Hierarchy Table and the Quality Assessment Tool for Quantitative Studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers. A total of 1497 primary studies were retrieved. Following screening and removal of duplicates and screening, 10 primary studies investigating heart rate (n=1), respiratory rate (n=1), temperature (n=1), blood pressure (n=4) and oxygen saturations (n=3) were eligible for inclusion in this review. The populations studied included term (n=6) or both preterm and term newborns (n=4). No reference ranges for any vital sign measurements could be identified from the included literature. In addition, inconsistencies between vital sign parameters of newborns were identified between the studies. There is paucity of normal vital sign data in the late preterm >34 weeks and post term gestational age cohorts despite literature suggesting differences in physiological maturity between these cohorts.
Publisher: Wiley
Date: 22-07-2002
Publisher: Elsevier BV
Date: 02-2022
Publisher: Wiley
Date: 17-10-2007
Publisher: Wiley
Date: 2007
DOI: 10.1111/J.1440-1754.2007.01000.X
Abstract: Aim: There are currently two dexamethasone regimes used in our nursery. We aimed to retrospectively compare the cumulative dose of dexamethasone that infants on each regime received and the requirement for further courses. Methods: Infants receiving dexamethasone between 1 January 2000 and 31 December 2004, with a gestational age of weeks or a birthweight of g, were identified and then a chart review of these infants was undertaken. Demographic data were obtained and compared as was the total dose of dexamethasone and number of courses that each infant received. Some clinical outcome measurements were also obtained. Results: A total of 119 infants were identified. The total dexamethasone dose received was 1.92 mg/kg less for infants commencing on the 2‐week course compared with the 6‐week course (difference between medians, Mann–Whitney test, P = 0.005). Infants having the 2‐week course had 17 days less steroid treatment (difference between medians, Mann–Whitney test, P = 0.0001). Seventeen (46%) subjects who started on a 2‐week course of steroids and 18 (22%) who started on a 6‐week course required at least one further course of steroids (Fisher’s exact test, P = 0.01). There were no significant differences in the short‐term outcome measures of neonatal chronic lung disease. Conclusion: Infants who received the 2‐week course of dexamethasone had a 27% reduction in total steroid dose compared with infants receiving a 6‐week course with similar short‐term outcomes. However, our study was limited by its retrospective nature and possible confounding factors.
Publisher: Wiley
Date: 06-01-2022
DOI: 10.1111/JPC.15860
Abstract: To determine if any cases of culture‐positive neonatal early‐onset sepsis (EOS) would be missed using the neonatal EOS calculator, when compared with current guidelines and practices. Retrospective audit of all neonates born at ≥35 weeks and admitted to Royal Brisbane and Women's Hospital with EOS from January 2014 to December 2020. A missed case was defined as antibiotic therapy not being recommended within 24 h of birth. Management recommendations according to the neonatal EOS calculator were compared with current guidelines and current practices. There were significantly more missed cases using the neonatal EOS calculator compared to the current guideline and current management groups. Using the neonatal EOS calculator, 11 neonates (35%, 95% confidence interval 19.2–54.6%) would not have received antibiotics by 24 h of age. In comparison, only one neonate (3%, 95% confidence interval 0.1–16.7%) would not have received antibiotics by 24 h of age using the current guidelines. In terms of the current practice in the cohort of patients, two neonates (6%) did not receive antibiotics by 24 h of age. The significantly higher rate of missed cases using the neonatal EOS calculator compared with current guidelines and practice supports the concerns many neonatologists have regarding safety of the neonatal EOS calculator.
Publisher: Scientific Foundation SPIROSKI
Date: 12-2009
Publisher: Wiley
Date: 10-2002
DOI: 10.1046/J.1440-1754.2002.00036.X
Abstract: To investigate the effects of inhaled nitric oxide (iNO) and partial liquid ventilation (PLV) on oxygenation and pulmonary haemodynamics in acute lung injury (ALI), and to assess their effects on lung function, systemic haemodynamics and lung injury. Using saline lung lavage, ALI was induced in 18 piglets. A control group was ventilated with conventional mechanical ventilation (CMV) for 2 h. An iNO-first group received iNO for the first hour and then iNO with PLV. A PLV-first group received PLV for the first hour and then PLV with iNO. Variables were measured at baseline, 5 min postlavage, and at 1 h and 2 h postlavage. During the first hour, both treatment groups showed improvement in oxygenation index (OI). At 2 h, the dif-ferences in OI were statistically significant (P = 0.037), with a mean +/- SD of 23.8 +/- 20.7 in the control group, 4.4 +/- 0.9 in the PLV-first group and 6.5 +/- 3.1 in the iNO-first group. The OI was similar in both treatment groups (P = 0.178). At 2 h, the pulmonary artery pressure (PAP) was significantly different (P = 0.04) between groups, with a mean +/- SD PAP of 36.3 +/- 7.2 mmHg in the control group, 27.4 +/- 4.0 mmHg in the PLV-first group and 30.0 +/- 4.1 mmHg in the iNO-first group. The PAP was similar in both treatment groups (P = 0.319). In ALI, oxygenation and pulmonary hypertension are improved with PLV and iNO given together, regardless of the order in which they are commenced.
Publisher: Wiley
Date: 23-12-2015
DOI: 10.1111/JPC.12798
Abstract: Neonatology, the care and study of newborn infants, is a 'young' specialty. Over the last 50 years, there have been many advances in the way that neonatologists care for newborn infants, particularly those born preterm, leading to dramatic improvements in mortality. To illustrate these advances, we describe four eras in neonatology from the point of view of the junior hospital doctor.
Publisher: Wiley
Date: 17-01-2022
DOI: 10.1002/PPUL.25821
Abstract: We aimed to identify factors present at the start of an initial course of systemic dexamethasone that would be associated with successful extubation in mechanically ventilated neonates <30 weeks gestational age (GA) with or at risk of developing bronchopulmonary dysplasia (BPD). We studied a retrospective cohort of neonates (23 A total of 287 neonates were included. Each additional week of GA at birth led to a 1.53 increase in the odds of successful extubation (95% CI: 1.122-2.096, p < 0.01). Higher average fraction of inspired oxygen (FiO Mechanically ventilated neonates with or at risk of developing BPD, born at <30 week GA and initiated on dexamethasone to facilitate extubation, had a lower likelihood of successful extubation by Day 14 if they had younger GA at birth, and at the time of commencing steroids had higher MAPs and had higher oxygen requirements.
Publisher: Wiley
Date: 31-08-2016
Publisher: Wiley
Date: 10-2002
DOI: 10.1046/J.1440-1754.2002.00038.X
Abstract: To examine the fate of research presented at the first annual Perinatal Society of Australia and New Zealand (PSANZ) Congress in 1997, by determining: the rate of publication in peer-reviewed biomedical journals publication rate by discipline journals in which work was published concordance for aims, conclusions, authors and number of study subjects and time from presentation to publication. A MEDLINE search was conducted for any publication in a peer-reviewed journal resulting from a publishable abstract from the proceedings of the first annual PSANZ Congress in 1997. Searching was completed 42 months post-congress. The concordance of aims, conclusions, authors and number of subjects between abstract and published paper was determined. There were 172 publishable abstracts in the proceedings of the PSANZ Congress in 1997, and 78 (45%) were published as 83 articles. Basic sciences had the highest publication rate (67%) and midwifery the lowest (20%). Articles were published in 41 journals, with one-third of the articles in three paediatric journals. There was a match with aims in 75%, and with conclusions in 65%. There were 47/77 with the same number of subjects, 20/77 with more and 10/77 with fewer. There were 22 articles with one author added, 12 had more than one author added, 11 had one author removed and five had more than one author removed. Median time-to-publication was 18 months (interquartile range 9-26 months). A publication rate of 45% is comparable to other conferences. Basic science and neonatology had the highest publication rates. There were considerable differences between abstract and published article in terms of aims, conclusions, number of subjects and authors.
Publisher: Wiley
Date: 08-2000
DOI: 10.1046/J.1440-1754.2000.00510.X
Abstract: To evaluate and compare the accuracy and performance of two electrochemical glucose meters. To determine the user acceptability of these glucose meters and the ABL 620 Blood Gas Analyser (Radiometer, Copenhagen, Denmark) with an electrochemical glucose oxidase electrode for use in a Level 2 special care baby unit. A total of 108 blood s les were collected from 47 babies at risk for hypoglycaemia. The blood glucose level was measured with two glucose meters, the Advantage Glucose Meter (Roche Diagnostics, Castle Hill, Australia) and the Precision-G Blood Glucose Testing System (Medisense, Melbourne, Australia), and the true blood glucose (TBG) measured with the ABL 620 blood gas analyser. Results from the glucose meters were compared with the TBG (as a percentage of the TBG). The mean (SD) percentage difference between the Advantage Glucose Meter and TBG was 4.5% (12. 5), and Precision-G Glucose Meter and TBG was 15.4% (12.4). The s le haematocrit did not significantly influence the glucose meter/TBG differences. There was an overall preference by the nursing staff for the Advantage Glucose Meter. The Advantage Glucose Meter was significantly more accurate than the Precision-G with similar precision. It was the preferred method of screening for neonatal hypoglycaemia.
Publisher: John Wiley & Sons, Ltd
Date: 18-04-2007
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/325919
Abstract: Objectives . To determine, in women transferred antenatally for acute admission with high risk pregnancies, the numbers who deliver, the average time from transfer to delivery, and whether the reason for transfer influences the time-to-delivery. Methods . A retrospective analysis of time-to-delivery was performed in a population of women transferred to the Royal Brisbane and Women’s Hospital, QLD. Data were obtained from the hospital obstetric, neonatal, and admission databases. Results . A total of 941 women were transferred antenatally with high risk pregnancies where delivery was deemed potentially imminent. Of these 821 (87%) delivered at RBWH. The remaining 120 women (13%) were discharged prior to delivery and then delivered elsewhere. Of the 821 maternal transfers that delivered, the median time to delivery was 24.4 hrs. There were 43% who delivered within 24 hours of admission and 29% who either delivered after 7 days or delivered elsewhere. Most transfers for fetal abnormality delivered in the first 24 hours while most transfers for antepartum haemorrhage and preterm prelabour membrane rupture delivered beyond 24 hours. Conclusion . There are significant differences in time-to-delivery following transfer depending on the reason for transfer and many infants transferred in utero will not deliver imminently.
Publisher: Wiley
Date: 2007
DOI: 10.1002/PPUL.20731
Abstract: To determine the inspired gas temperature at points from the endo-tracheal tube (ETT) circuit manifold to the tip of the ETT in a model neonatal lung. A model lung attached to standard ventilator circuit, autofeed chamber and humidifier was ventilated using typical pressure-limited, time cycled settings. Temperatures were measured at various distances along the ETT using a K-type thermocouple temperature probe. The inspired gas temperature dropped from the circuit temperature probe site (40 degrees C) to the proximal end of the ETT (37 degrees C). The temperature dropped further as it passed through the exposed part of the ETT (34 degrees C) but then warmed again on entering the lung model so that the inspired gas at the distal end of the ETT was 37 degrees C. Statistically significant differences were found with a one-way ANOVA P-value of <0.0001. The differences between each pair of mean temperatures were statistically significant (all P 0.05). Inspired gas temperature drops as it passes through the circuit temperature probe site, the proximal end of the ETT and the exposed part of the ETT. The inspired gas rewarms on entering the model lung and exits the ETT at the desired temperature. The effect of measuring temperature closer to the patient, setting the circuit temperature higher and/or increasing the ambient temperature through which the circuit passes, need to be evaluated.
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1440-1754.2008.01455.X
Abstract: To determine if: time from blood culture inoculation to positive growth (total time to positive) and time from blood culture machine entry to positive growth (machine time to positive) is altered by delayed entry into the automated blood culture machine, and if the total time to positive differs by the concentration of organisms inoculated into blood culture bottles. Staphylococcus epidermidis, Escherichia coli and group B beta-haemolytic streptococci were chosen as clinically significant representative organisms. Two concentrations (> or =10 colony-forming units per millilitre and <1 colony-forming units per millilitre) were inoculated into PEDS BacT/Alert blood culture bottles and randomly allocated to one of three delayed automated blood culture machine entry times (30 min/8.5 h/15.5 h). For all organisms at all concentrations, except the Staphylococcus epidermidis, the machine time to positive was significantly decreased by delayed entry. For all organisms at all concentrations, the mean total time to positive significantly increased with increasing delayed entry into the blood culture machine. Higher concentrations of group B beta-haemolytic streptococci and Escherichia coli grew significantly faster than lower concentrations. Bacterial growth in inoculated bottles, stored at room temperature, continues although at a slower rate than in those blood culture bottles immediately entered into the machine. If a blood culture specimen has been stored at room temperature for greater than 15.5 h, the currently allowed safety margin of 36 h (before declaring a result negative) may be insufficient.
Publisher: Wiley
Date: 19-07-2004
Publisher: Wiley
Date: 21-01-2002
Publisher: Springer Science and Business Media LLC
Date: 2007
Publisher: John Wiley & Sons, Ltd
Date: 23-01-2008
Publisher: John Wiley & Sons, Ltd
Date: 28-03-2016
DOI: 10.1002/CCA.1193
Publisher: Cold Spring Harbor Laboratory
Date: 04-04-2021
DOI: 10.1101/2021.03.27.21254449
Abstract: Gentamicin is recommended as first-line treatment of neonatal sepsis. The use of gentamicin is associated with toxicity which complicates neonatal dosing and necessitates therapeutic drug monitoring (TDM). In a proof-of-concept investigation, we sought to compare (1) gentamicin concentrations obtained using volumetric absorptive micros ling (VAMS) to standard TDM plasma s les, and (2) the time taken to report results obtained using VAMS compared to standard TDM by the local hospital chemical pathology service. The difference between gentamicin concentrations obtained from plasma collected for routine clinical care and calculated plasma concentrations, based on s les collected in whole blood using VAMS, was −18.0% and −0.4% for two patients. The research laboratory reported results within the time taken for the routine chemical pathology laboratory to report results. This proof-of-concept study demonstrates that the use of micros ling for TDM by pathology services can fulfil the requirements of providing an accurate gentamicin concentration in a timely manner.
Publisher: Wiley
Date: 23-01-2008
Publisher: Wiley
Date: 18-07-2007
Publisher: Wiley
Date: 18-01-2013
DOI: 10.1111/JPC.12088
Abstract: This study aims to document methods of blood culture collection used in our neonatal unit and to determine whether or not the proportion of contaminated cultures varied according to method of collection. Two specific comparisons of interest were the proportion of contaminated cultures in s les collected via (i) preferred versus non-preferred methods, and (ii) peripheral cannulae at the time of insertion versus separate arterial or venous puncture. Data were collected on every blood culture taken in the Grantley Stable Neonatal Unit of the Royal Brisbane and Women's Hospital over a 12-month period. The method used to collect blood for culture was recorded, and the proportion of contaminated cultures taken by each method was calculated. Blood was collected via peripheral cannulae at the time of insertion in 63.1% of cultures, umbilical catheters at the time of insertion in 18.1%, peripheral arterial or venous puncture in 7.7%, and indwelling lines in 2.1%, and the method was unknown in 9.0%. The proportion of contaminated blood cultures was 11.5% with collection via peripheral vascular puncture, 11.1% via indwelling lines, 2.1% via peripheral cannulae at the time of insertion and 1.1% via umbilical catheters at the time of insertion. There was no significant difference in the proportion of contaminated cultures taken via preferred and non-preferred methods. The proportion of contaminated cultures taken via peripheral cannulae at the time of insertion was significantly less than when s les were taken via a separate arterial or venous puncture. In our unit, blood cultures are frequently collected via peripheral cannulae at the time of insertion. Blood cultures taken in this manner are less likely to be contaminated than cultures collected via separate vascular puncture.
Publisher: Springer Science and Business Media LLC
Date: 02-06-2016
DOI: 10.1038/JP.2016.88
Abstract: Premature infants often receive pasteurized donor human milk when mothers are unable to provide their own milk. This study aims to establish the effect of the pasteurization process on a range of trace elements in donor milk. Breast milk was collected from 16 mothers donating to the milk bank at the Royal Brisbane and Women's Hospital. S les were ided into pre- and post-pasteurization aliquots and were Holder pasteurized. Inductively coupled plasma mass spectrometry was used to analyze the trace elements zinc (Zn), copper (Cu), selenium (Se), manganese (Mn), iodine (I), iron (Fe), molybdenum (Mo) and bromine (Br). Differences in trace elements pre- and post-pasteurization were analyzed. No significant differences were found between the trace elements tested pre- and post-pasteurization, except for Fe (P<0.05). The median (interquartile range, 25 to 75% μg l(-1)) of trace elements for pre- and post- pasteurization aliquots were-Zn: 1639 (888-4508), 1743 (878-4143), Cu: 360 (258-571), 367 (253-531), Se: 12.34 (11.73-17.60), 12.62 (11.94-16.64), Mn: (1.48 (1.01-1.75), 1.49 (1.11-1.75), I (153 (94-189), 158 (93-183), Fe (211 (171-277), 194 (153-253), Mo (1.46 (0.37-2.99), 1.42 (0.29-3.73) and Br (1066 (834-1443), 989 (902-1396). Pasteurization had minimal effect on several trace elements in donor breast milk but high levels of inter-donor variability of trace elements were observed. The observed decrease in the iron content of pasteurized donor milk is, however, unlikely to be clinically relevant.
Publisher: Wiley
Date: 31-05-2018
DOI: 10.1111/JPC.14064
Abstract: The risk of mortality and morbidity is increased in outborn, extremely premature infants. We aim to determine whether earlier arrival of the retrieval team after the birth of infants less than 29 weeks gestation improves short-term mortality and morbidity. This is a retrospective analysis of a cohort of infants less than 29 weeks gestation who were retrieved to the Royal Brisbane and Women's Hospital (RBWH) over a 5-year period. Demographic information regarding the infant and mother, retrieval team arrival time and outcome data was collected. Primary outcomes investigated were mortality prior to discharge from hospital or a composite of mortality or severe intraventricular haemorrhage (IVH). Data on 105 infants were analysed 88 infants (83.8%) survived to discharge home, and 79 (75.2%) survived to discharge without severe IVH. On univariate analysis, there was no significant association between age at arrival of the retrieval team and death prior to discharge (P = 0.94) or death prior to discharge or severe IVH (P = 0.83). On logistic regression analysis, age at arrival of retrieval team remained non-significant for a reduction in death prior to discharge and composite of death or severe IVH (P = 0.70 and P = 0.99, respectively). The earlier arrival of the retrieval team is not associated with improved short-term outcomes in outborn, extremely preterm infants who are retrieved and admitted to a tertiary neonatal intensive care unit - for infants where the retrieval team arrived within about 8 h of birth.
Publisher: John Wiley & Sons, Ltd
Date: 26-01-2004
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2006
Publisher: Wiley
Date: 28-05-2018
DOI: 10.1111/JPC.14062
Abstract: To determine the proportion of very preterm infants who were exclusively fed breast milk at the time of discharge home, before and after the availability of pasteurised donor human milk (PDHM). This was an observational retrospective cohort study with historical comparison, comparing two cohorts (<32 weeks gestational age or very low birthweight) before and after the availability of donor human milk. The main explanatory variable was the PDHM cohort: pre-PDHM or post-PDHM. The primary dichotomous outcome variable was defined as whether the baby was being fed with breast milk only at the time of discharge home, compared with those fed with artificial formula alone or mixed feeding (artificial formula and breast milk). There were 1088 babies in the pre-PDHM cohort and 330 in the post-PDHM cohort (total n = 1418). Following the introduction of PDHM, 56% (185/330) were exclusively fed breast milk at the time of hospital discharge and 57% (620/1088) in the pre-PDHM cohort. The availability of PDHM is not a significant predictor of feeding outcome upon discharge (P = 0.45) when adjusted for maternal age, log-transformed post-natal age at discharge home and any congenital abnormality. The availability of donor human milk in our unit is not associated with a decrease in the number of very preterm infants receiving mother's own breast milk at time of discharge home. Other factors that positively impact the successful establishment of breastfeeding in preterm babies were older maternal age, the absence of any congenital abnormality and a shorter duration of hospital stay.
Publisher: Springer Science and Business Media LLC
Date: 09-08-2021
DOI: 10.1007/S13318-021-00708-X
Abstract: BACKGROUND AND OBJECTIVE: Gentamicin is commonly used in neonates, and it requires drug concentration monitoring. The objective of this study was to determine the extent of high trough (≥ 2 mg/l) and therapeutic peak serum gentamicin concentrations (5-12 mg/l) using our current gentamicin regimen and to adjust the dosing regimen accordingly and reassess. This was a prospective cohort study of neonates, with normal renal function, who were prescribed gentamicin. Group 1: March 2014-July 2017-gentamicin intravenous (IV) 2.5 mg/kg given every 36 h if < 30 weeks gestational age (GA) and every 24 h if ≥ 30 weeks GA Group 2: August 2019-February 2020-gentamicin IV 3.5 mg/kg given every 36 h if < 30 weeks GA and every 24 h if ≥ 30 weeks GA. We assessed the number of neonates with aberrant trough and peak serum gentamicin concentrations. Forty-eight neonates < 30 weeks GA and 34 ≥ 30 weeks GA were given 2.5 mg/kg gentamicin. Eleven (23%) neonates < 30 weeks GA and four (13%) ≥ 30 weeks GA had subtherapeutic peak concentrations ( 12 mg/l) or toxic trough concentrations (≥ 2 mg/l). Forty-four neonates < 30 weeks GA and 54 ≥ 30 weeks GA were given 3.5 mg/kg gentamicin. Eighty-four (86%) had non-toxic trough concentrations (< 2 mg/l). One (1%) < 30 weeks GA neonate had subtherapeutic ( 12 mg/l) peak concentrations. Gentamicin regimen of 2.5 mg/kg given every 36 h for neonates < 30 weeks GA and every 24 h for neonates ≥ 30 weeks GA was suboptimal at achieving therapeutic gentamicin peak. Increasing the dosage to 3.5 mg/kg achieved therapeutic peak concentrations in 98% and non-toxic trough concentrations in 86% of all neonates (prior to dose interval adjustment).
Publisher: BMJ
Date: 03-08-2012
Abstract: To determine the effects on weight gain and temperature control of transferring preterm infants from incubators to open cots at a weight of 1600 g versus a weight of 1800 g. Randomised controlled trial. One tertiary and two regional neonatal units in public hospitals in Queensland, Australia. 182 preterm infants born with a birth weight less than 1600 g, who were at least 48 h old had not required ventilation or continuous positive airways pressure within the last 48 h were medically stable with no oxygen requirement, or significant apnoea or bradycardia did not require phototherapy and were enterally fed with an intake (breast milk/formula) of at least 60 ml/kg/day. Transfer into an open cot at 1600 or 1800 g. The primary outcomes were temperature stability and average daily weight gain over the first 14 days following transfer to an open cot. 90 infants in the 1600 g group and 92 infants in the 1800 g group were included in the analysis. Over the first 72 h, more infants in the 1800 g group had temperatures 37.1°C (p=0.02). Average daily weight gain in the 1600 g group was 17.07 (SD±4.5) g/kg/day and in the 1800 g group, 13.97 (SD±4.7) g/kg/day (p=<0.001). Medically stable, preterm infants can be transferred to open cots at a birth weight of 1600 g without any significant adverse effects on temperature stability or weight gain. ACTRN12606000518561 (www.anzctr.org.au).
Publisher: Springer Science and Business Media LLC
Date: 06-01-2016
Publisher: Wiley
Date: 09-2012
DOI: 10.1111/J.1440-1754.2010.01781.X
Abstract: The questions that must be asked about any health-care intervention, including the use of immersion in the second stage of labour with birth into the water, are: is it useful?, does it do any harm? and do any benefits outweigh any harms? There is little subjective evidence (and no reliable, objective evidence) of any benefit to the mother or baby from water birth. There are reports of uncommon, yet significant, adverse outcomes for babies including deaths and significant morbidity directly attributed to water birth. There are also sound physiological mechanisms that can readily explain the significant adverse outcomes reported. It remains unknown whether any benefits from water birth outweigh any harms given the small number of underpowered studies available. An appropriately sized randomised controlled trial of good quality remains the only reliable way to assess both the efficacy and the safety of water births. Babies should not be born into water unless enrolled in such trials.
Publisher: Wiley
Date: 05-10-1999
DOI: 10.1046/J.1440-1754.1999.355404.X
Abstract: Research on using liquid ventilation to provide artificial respiration in mammals has been ongoing since the 1960s. The development of inert perfluorocarbon (PFC) liquids with high oxygen and carbon dioxide solubility has made gas exchange with liquid ventilation possible. In 1991 the technique of partial liquid ventilation was introduced where PFC are instilled into the lungs whilst continuing with conventional mechanical ventilation. Partial liquid ventilation has been shown to improve gas exchange and lung function with decreased secondary lung injury, in animal models of acute lung injury and surfactant deficiency. It has been used in uncontrolled trials in preterm neonates, and preliminary results are available from a randomized controlled trial of partial liquid ventilation in paediatric acute respiratory distress syndrome. Perfluorocarbons can also be used to deliver drugs to the lungs, to lavage inflammatory exudate and debris from the lungs, and as an intrapulmonary X-ray contrast medium. Many questions about partial liquid ventilation remain unanswered particularly with regard to the dose of PFC required, its ideal method of administration and the long-term effects. Partial liquid ventilation promises to be an exciting new therapy for infants and children with a variety of respiratory problems. The technique requires ongoing research and experimentation.
Publisher: Wiley
Date: 03-09-2010
DOI: 10.1111/J.1440-1754.2010.01828.X
Abstract: Very preterm neonates are prone to brain injury if cerebral blood flow fluctuates. Partial liquid ventilation (PLV) may benefit any lung disease but giving 30 mL/kg of perfluorocarbon when starting PLV increases cortical cerebral blood flow velocity. We aimed to determine if varying the initial dose of perfluorocarbon alters the effect on cerebral blood flow velocity when starting PLV. In this randomised, controlled trial with historical comparison 24 preterm lambs received one of three loading doses of intratracheal perfluorocarbon liquid over 20 min when starting PLV: 20, 30 or 40 mL/kg. Data on respiratory mechanics, haemodynamics and cerebral blood flow velocity, measured with laser Doppler, were collected continuously for 30 min from the start of dosing. Cortical cerebral blood flow velocity increased over time in all three groups (two-way ANOVA, P= 0.007). There was no difference between groups (two-way ANOVA, P= 0.26). There was no difference between groups in cortical cerebral blood flow velocity variability (P= 0.68), blood pressure (P= 0.96) or heart rate (P= 0.46). The was no statistically significant difference in PaCO(2) between groups measured at baseline and at 30 min after starting PLV (P= 0.51). Cortical cerebral blood flow velocity and its variability are not affected by varying doses of tracheal perfluorocarbon (20, 30 or 40 mL/kg) at the start of PLV in preterm lambs.
Publisher: Wiley
Date: 16-07-2003
DOI: 10.1046/J.0004-8666.2003.00092.X
Abstract: The present paper reports a retrospective cohort of preterm infants admitted to our hospital who delivered outside the normal geographical catchment area of the mother's local level three neonatal nursery. Nineteen mothers had 21 preterm infants (23.1-34.9 weeks, 500-2330 g born) where 14 infants required ventilation (median 57 h, range 3-428). Eighteen survivors had a median length of stay of 41 days (range 3-91). Twelve of 19 mothers were interviewed: all described isolation, loneliness, poor social support and significant financial hardship related to getting their infants back to a local hospital or home. To avoid these problems, we recommend confining travel to within a short distance from home or local maternity unit after 22 weeks.
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.JPEDSURG.2004.11.030
Abstract: In gastroschisis it is proposed that gut reduction may be achieved without intubation or general anesthesia (GA) through ward reduction. The authors aimed to determine if ward reduction decreased morbidity and duration of treatment. Infants born from January 1, 1995, to December 31, 2001, with gastroschisis were managed with either reduction under GA in the operating theatre (OT group)--up to September 1999, or ward reduction (when eligible) in the neonatal unit without GA/ventilation (ward reduction [WR] group)--from September 1999. Of the 37 infants, 31 were eligible for ward reduction-15 from the OT group, 16 from the WR group. All infants in the OT group had at least 1 episode of ventilation and 1 GA: 62% of infants in the WR group avoided ventilation (P = .0002) and 81% avoided GA (P < .0001). Infants who had ward reduction had significantly shorter durations of ventilation and oxygen therapy. Septicemia occurred in 31% of the WR group and 7% of the OT group (P = .17). Infants who had ward reduction left intensive care 16 days earlier (P = .02) and tended to reach full enteral feeds 8 days sooner (P = .06) and be discharged from hospital 15 days earlier (P = .05). Infants who had ward reduction do better in terms of avoiding GA/ventilation, establishing feeds, and going home earlier. A randomized, controlled trial comparing the 2 approaches is feasible, safe, and worthwhile.
Publisher: S. Karger AG
Date: 2002
DOI: 10.1159/000065892
Abstract: There are limited data on the volumes used to ventilate infants with respiratory distress syndrome (RDS). There are no data on the volumes to aim for to avoid hypocapnia or unacceptable levels of hypercapnia. In this pilot study we measured minute volumes (MV) in ventilated infants to determine whether MV can predict arterial carbon dioxide (PaCO sub /sub ) within acceptable parameters. Low birth weight infants (n = 14) mechanically ventilated for RDS had lung function recorded (n = 53) as an arterial blood gas was taken. MVs were plotted against PaCO sub /sub giving the regression equation for prediction of PaCO sub /sub (mm Hg) with MV (ml/kg/min): PaCO sub /sub = 58.3 – 0.075 × MV, r = 0.62, r sup /sup = 0.38, p 0.001, residual variance (s sup /sup ) of 52.7 (s = 7.26). 95% CI give a predicted PaCO sub /sub ± 15 mm Hg for a given MV. A MV of 200 ml/kg/min predicts a PaCO sub /sub of 43 mm Hg (95% Cl 29–58). PaCO sub /sub correlates reasonably well with MV. Setting appropriate MVs may allow closer targeting of PaCO sub /sub , and prevent over- or under-ventilation.
Publisher: Wiley
Date: 09-2012
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 15-05-2018
DOI: 10.1111/JPC.13935
Abstract: There is much debate between neonatologists and paediatricians about appropriate oxygen saturation targets for babies with chronic neonatal lung disease (CNLD). Overnight oximetry is used to guide the fraction of inspired oxygen to use. We did this literature review to examine the current literature on the use of overnight oximetry in term infants, preterm infants and babies with CNLD (especially relevant to ex-preterm babies with CNLD going home on oxygen). We reviewed the literature from January 1990 to October 2017 by searching the following databases: Cochrane Central Register of Controlled Trials, The Joanna Briggs Institute, CINAHL, MEDLINE, Scopus, EMBASE, ProQuest and Science Direct. Sixteen articles were included in the review. The literature available on overnight oximetry in neonates is limited, it is not contemporary, and it reports studies that did not use oximeters with modern software for data collection and analysis. It is imperative that reference ranges be defined for overnight oximetry parameters so that babies are not inadvertently administered inappropriate amounts of oxygen.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2006
Abstract: The loss of perfluorocarbon (PFC) vapour in the expired gases during partial liquid ventilation should be minimized both to prevent perfluorocarbon vapour entering the atmosphere and to re-use the recovered PFC liquid. Using a substantially modified design of our previously described condenser, we aimed to determine how much perfluorocarbon liquid could be recovered from gases containing PFC and water vapour, at concentrations found during partial liquid ventilation, and to determine if the amount recovered differed with background flow rate (at flow rates suitable for use in neonates). The expiratory line of a standard ventilator circuit set-up was mimicked, with the addition of two condensers. Perfluorocarbon (30 mL of FC-77) and water vapour, at concentrations found during partial liquid ventilation, were passed through the circuit at a number of flow rates and the percentage recovery of the liquids measured. From 14.2 mL (47%) to 27.3 mL (91%) of the infused 30 mL of FC-77 was recovered at the flow rates studied. Significantly higher FC-77 recovery was obtained at lower flow rates (ANOVA with Bonferroni's multiple comparison test, p 0.0001). As a percentage of the theoretical maximum recovery, 64 to 95% of the FC-77 was recovered. Statistically significantly less FC-77 was recovered at 5 Lmin -1 (ANOVA with Bonferroni's multiple comparison test, p 0.0001). Amounts of perfluorocarbon vapour recovered were 47%, 50%, 81% and 91% at flow rates of 10, 5, 2 and 1 Lmin -1 , respectively. Using two condensers in series 47% to 91% of perfluorocarbon liquid can be recovered, from gases containing perfluorocarbon and water vapour, at concentrations found during partial liquid ventilation.
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/JPC.14947
Publisher: Wiley
Date: 08-1999
DOI: 10.1046/J.1440-1754.1999.00365.X
Abstract: Fetal measurement of transverse cerebellar diameter (TCD) has been shown to correlate well with gestational age (GA), even in the presence of growth retardation. The aim of this study was to define the normal range of TCD in preterm neonates in an Australian population between 23 and 32 weeks GA. Infants admitted to the Royal Women's Hospital, Melbourne, having routine cranial ultrasound scans (< 1500 g and/or of gestational age ≤ 32 weeks at birth) had their TCD measured on a cranial scan performed during the first 3 days of life. The posterior fossa was examined through the asterion using a General Electric LOGIQ 500 scanner (GE Medical Systems, Waukesha, USA) and TCD measurement was taken in the coronal plane. 106 infants < 1500 g and/or of GA ≤ 32 weeks at birth had their TCD measured between 1 January 1997 and 30 November 1997. Transverse cerebellar diameter and associated 95% confidence intervals are described for infants between 23 and 32 weeks GA. The linear regression equation relating TCD and GA was: TCD (mm) = -12.9 + 1.61 × GA (weeks). R This is the only study of TCD measurement using cranial ultrasound in a group of preterm newborns, and forms the basis for nomograms of TCD which can be used as a tool to assist in the assessment of GA, even in growth-retarded preterm newborns, and in the diagnosis of cerebellar hypoplasia.
Publisher: Wiley
Date: 31-07-2014
Publisher: Wiley
Date: 28-02-2013
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2004
Publisher: BMJ
Date: 09-06-2013
DOI: 10.1136/ARCHDISCHILD-2011-301252
Abstract: To evaluate the hypotheses that a blended learning approach would improve the newborn examination skills of medical students and yield a higher level of satisfaction with learning newborn examination. Undergraduate medical students at a tertiary teaching hospital were in idually randomised to receive either a standard neonatology teaching programme (control group), or additional online access to the PENSKE Baby Check Learning Module (blended learning group). The primary outcome was performance of newborn examination on standardised assessment by blinded investigators. The secondary outcomes were performance of all 'essential' items of the examination, and participant satisfaction. The recruitment rate was 88% (71/81). The blended learning group achieved a significantly higher mean score than the control group (p=0.02) for newborn examination. There was no difference for performance of essential items, or satisfaction with learning newborn examination. The blended learning group rated the module highly for effective use of learning time and ability to meet specific learning needs. A blended learning approach resulted in a higher level of performance of newborn examination on standardised assessment. This is consistent with published literature on blended learning and has implications for all neonatal clinicians including junior doctors, midwifes and nurse practitioners.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: John Wiley & Sons, Ltd
Date: 23-01-2008
Publisher: John Wiley & Sons, Ltd
Date: 19-04-2004
Publisher: Wiley
Date: 07-04-2011
DOI: 10.1111/J.1440-1754.2011.02070.X
Abstract: Humidified High Flow Nasal Cannula (HHFNC) has been increasingly adopted as a new means of respiratory support throughout the world. However, evidence to support its safety and efficacy is limited. The aim of the present survey was to determine current practices regarding the usage of HHFNC by neonatologists in Australia and New Zealand. Surveys were sent to all 167 neonatologists identified by the list of centres in the Australia and New Zealand Neonatal Network. A total of 157 surveys were sent to valid email addresses: 111 (71%) responded of which 105 (67%) had completed the questionnaire. HHFNC is used in 17 (63%) of neonatal intensive care units in Australia and New Zealand. It is most commonly used to reduce nasal trauma (91%) and provide continuous positive airways pressure (62%). The main perceived benefits of HHFNC were the easier application and care of the infant (86%), and improved tolerance by the baby (84%). Rain out leading to fluid instillation into the upper airway (59%) was the most common problem. This survey has provided a snapshot of the practice of HHFNC usage in Australia and New Zealand in 2010 and has revealed that HHFNC use is widespread and that clinical practices are erse. The majority of neonatologists acknowledge that there is limited evidence to support its efficacy and safety, and would be happy to participate in clinical trials to address how best to deliver HHFNC.
Publisher: Wiley
Date: 19-06-2013
DOI: 10.1111/JPC.12297
Abstract: Perfluorocarbon administration increases cerebral blood flow. This can be mitigated by preventing a rise in carbon dioxide by adjusting pressure-controlled ventilation. Volume-controlled ventilation should prevent increases in arterial carbon dioxide and cerebral blood flow. This study aims to determine if cerebral blood flow is increased during administration of 10 mL/kg of perfluorocarbon while using volume-controlled ventilation. Two New Zealand white rabbits, ventilated with volume-control, were each allocated to six dosing events where each dosing event was randomly allocated to one of two dosing strategies: a control group - given a sham dose of air (10 mL/kg) over 20 min or a partial liquid ventilation group - given 10 mL/kg FC-77 slowly over 20 min. Data were recorded for 1 min before and 30 min after the start of each dosing event. No adjustment of ventilation (except fraction of inspired oxygen) was allowed during each dosing event. There were no significant changes over time and no differences between groups for carotid blood flow (P = 0.48 at the end of the dose). There were slight increases in cortical cerebral blood flow in both groups there was no statistically significant difference between groups (P = 0.56 at end dose and P = 0.49 at time of maximum difference). There was no difference between groups for the variability in carotid blood flow or cortical cerebral blood flow. Cerebral blood flow was not significantly increased during administration of a dose of 10 mL/kg of perfluorocarbon during commencement of partial liquid ventilation when using volume-controlled ventilation.
Publisher: Wiley
Date: 17-08-2020
DOI: 10.1111/JPC.15046
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/JPC.14350
Publisher: IOP Publishing
Date: 17-02-2004
DOI: 10.1088/0967-3334/25/2/N01
Abstract: A simple mount capable of securely holding a variety of intracranial probes to the skull was constructed from commonly available clinical consumables. Using this device the cerebral cortical blood flow of preterm lambs was measured using a laser Doppler flow probe, and cerebral pH and cortical electrical impedance were measured in newborn piglets using pH electrodes and Ag/AgCl wire electrodes. In both studies, the mount held the various probes for periods up to 6 h with no dislodgement or probe failure. The simple mount presented here can be adapted to a wide variety of intracranial probes and will hold them securely to the skull.
Publisher: Wiley
Date: 28-05-2018
DOI: 10.1111/JPC.14073
Abstract: To quantify, in well-positioned umbilical venous catheters (UVC), the direction and magnitude of catheter tip migration. In this prospective, single-centre, observational, cohort study, infants with a UVC inserted that reached the target zone - inferior vena cava, from ductus venosus to cavoatrial junction (CAJ) - were included. Ultrasound was used to position the catheter tip as near to the CAJ as possible at insertion and to guide any subsequent withdrawals of the catheter. Radiographs and ultrasound were repeated the day following the insertion of the UVC and on any day following adjustment. A final scan was performed on the day of catheter removal. The anatomical position of the catheter and its distance from the CAJ was recorded with each scan. The study ran from May 2015 to August 2016 in the neonatal unit at the Royal Brisbane and Women's Hospital. Thirty-eight patients were recruited, but 18 failed to negotiate the ductus venosus. For the remaining 20, the initial UVC position was within 3 mm of the CAJ on ultrasound. Subsequently, on day 2, 25% of catheters were well positioned, 65% were high and 10% were below the target zone. On the late scan prior to UVC removal, 90% of catheters had migrated from their position on the preceding scan: outward migration in 80% of cases ranging from 2 to 23 mm (median 8.5 mm). Only 35% of catheters remained well positioned. The majority of UVCs migrate over time, usually inwards initially and then outwards to a low position.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Mark Davies.