In their article, ‘Red blood cell transfusions in neonatal intensive care units: a nationwide observational cohort study’, authors Heeger et al 1 highlight the critical topic of variation in neonatal red blood cell (RBC) transfusion practices and adherence to guidelines. Heeger and colleagues demonstrate that despite introducing a national RBC transfusion guideline in the Netherlands in 2019, 46.5% of transfusions for neonates <32 weeks gestation occurred above the recommended thresholds at that time. They found significant variation among neonatal intensive care units, with transfusions above thresholds ranging from 15% to 71% and increasing with postnatal age, with most transfusions above recommended thresholds occurring after the third postnatal week. When the authors adjusted for case-mix using sample weights, including gestational age, variation in transfusion rates between centres persisted. Introducing a guideline alone does not mean it will be strictly adhered to, and this stud

Objective To describe early management of infants born to a parent with gene-positive long QT syndrome (LQTS) referred for specialist review. Review the diagnostic utility of the early neonatal and first clinic ECG. Design Retrospective cohort study, including a review of the first neonatal and first clinic ECG. Setting Quaternary paediatric-only referral hospital with specialised unit for the management of paediatric inherited cardiovascular diseases. Patients Infants born 2015–2022 referred in the setting of parental LQTS who subsequently underwent predictive genetic testing for a parental LQTS-causative genetic variant. Main outcome measures Age (at first early neonatal ECG, referral, first clinic attendance), genetic testing data, clinical course, exposure to QT-prolonging medications, neonatal hypoxia-ischaemia and cardiac events (cardiac arrest or death) in the infant’s first year. The first neonatal and first clinic ECGs were evaluated for QTc and T-wave morphology, by two obser

Objective To evaluate the effect of low-dose postnatal dexamethasone therapy for bronchopulmonary dysplasia (BPD) prevention/treatment on MRI-derived regional brain volumes at term-equivalent age (TEA) and neurodevelopmental outcomes in a regional cohort of preterm infants. Study design We prospectively recruited 392 preterm infants (≤32 weeks gestational age (GA)), who underwent structural MRI (3T Philips Ingenia) at TEA. We automatically segmented T2-weighted MRI scans using the Developing Human Connectome Project pipeline to derive a priori selected, two primary outcomes of interest: volumes of the cerebellum and subcortical grey matter. We estimated propensity scores for subjects with a logistic regression model and used weighted linear regression to determine the independent effects of dexamethasone on primary and two secondary outcomes: cortical surface area at TEA and motor scores at 2 years corrected age. Results Of 392 infants, 41 were treated with low cumulative dose dexameth

Objective Assess the feasibility and safety of a purpose-built automated tactile stimulation device (ATSD) responding to cardiorespiratory events in preterm infants. Design Randomised cross-over study. Setting Level-III neonatal intensive care unit in the Netherlands. Patients Infants born between 24 and 30 weeks gestational age, receiving non-invasive respiratory support and experiencing apnoea, bradycardia and/or hypoxia for>10 s. Interventions Infants underwent two study periods of 24 hours. In the control period, the ATSD was attached but inactive. In the intervention period, ATSD was activated and used in addition to standard care, providing direct vibratory stimulation in response to clinical alarms. Main outcome measure Feasibility of using ATSD, expressed by the number of infants completing the study, the ability to provide stimulation on the skin and the perceived feasibility by the nurses. Results 16 infants were included, of which 14 (88%) completed both study periods. Two i

Objective Assess the relationship between applied face mask force and leak during simulated ventilation using different ventilating devices and mask holds. Design Randomised cross-over simulation study. Setting Quiet, non-clinical room in children’s hospital. Participants Twenty-four experienced neonatal healthcare providers. Interventions Ventilate a manikin for 2 min per trial, each with three trial conditions: self-inflating bag (SIB) with one-hand hold, T-piece with one-hand hold, T-piece with two-hand hold. Main outcome measures Applied force (newtons (N)) measured under the head and at four locations on the manikin’s face (nasal bridge, mentum, left and right zygomatic arches), force asymmetry applied to the mask rim, and mask leak. Results Under-head force was greatest using the SIB with one-hand hold (mean (SD) 20.53 (5.87) N) and least using the T-piece with one-hand hold (mean (SD) 17.58 (6.11) N). While mask leak was reduced with increasing force, leak-free ventilation was a