-
Mashup Score: 9Severe case of aplasia cutis congenita - 7 day(s) ago
A male infant was born at 35+6 weeks’ gestation to a 19-year-old woman by vaginal delivery after spontaneous onset of labour. There had been limited antenatal care within the UK with previous care in East Africa. Parents are non-consanguineous. The antenatal ultrasound at 34+5 weeks in the UK was normal. After birth, the infant was noted to have a large defect on the right temporo-parieto-occipital region of …
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 3Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study - 7 day(s) ago
Objective To (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH). Design Cohort study of the Children’s Hospitals Neonatal Database from 2010 to 2022. Setting 41 referral neonatal intensive care units (NICUs) in North America. Patients Infants born before 32 weeks’ gestation with PHH defined as acquired hydrocephalus with intraventricular haemorrhage. Interventions (1) No intervention, (2) temporising device (TD) only, (3) initial permanent shunt (PS) and (4) TD followed by PS (TD-PS). Main outcome measures Mortality and meningitis. Results Of 3883 infants with PHH from 41 centres, 36% had no surgical intervention, 16% had a TD only, 19% had a PS only and 30% had a TD-PS. Of the 46% of infants with TDs, 76% were reservoirs; 66% of infants with TDs required PS placement. The percent of infants with PHH receiving v
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 0Are toddlers with neurosensory impairment more difficult to follow up? A secondary analysis of the hPOD follow-up study - 8 day(s) ago
Objective To describe strategies used to maximise follow-up after a neonatal randomised trial, how these differed for families of different ethnicity, socioeconomic status and urban versus rural residence and investigate relationships between the difficulty of follow-up and rate of neurosensory impairment. Method hPOD was a multicentre randomised trial assessing oral dextrose gel prophylaxis for neonatal hypoglycaemia. Follow-up at 2 years was conducted from 2017 to 2021. We analysed all recorded contacts between the research team and participants’ families. Neurosensory impairment was defined as blindness, deafness, cerebral palsy, developmental delay or executive function impairment. Results Of 1321 eligible participants, 1197 were assessed (91%) and 236/1194 (19.8%) had neurosensory impairment. Participants received a median of five contacts from the research team (range 1–23). Those from more deprived areas and specific ethnicities received more contacts, particularly home tracking
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 13Development of a dedicated ‘drive-through’ pathway for neonates with bilious vomiting: a prospective cohort study - 10 day(s) ago
We report the findings of our multidisciplinary, polyperspective, collaborative quality improvement project. Infants with bile-stained vomit require an upper gastrointestinal (GI) contrast and review by a paediatric surgeon to exclude a midgut volvulus due to malrotation. Surgical and radiological findings of this potentially fatal condition1 are shown in figure 1. At our institution, a patient referred from a local neonatal unit (LNU) with bilious vomiting would be reviewed by the Southampton Oxford Neonatal Transport team (SONeT). SONeT would stabilise the baby and transfer to a surgical cot in the John Radcliffe Newborn Care Unit (NNU) where tertiary services are located. The baby would be prepared for contrast study; accompanied by two porters, a registrar and nurse to the …
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 16Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research - 10 day(s) ago
Objective Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. Design and intervention International online survey. Results Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%–98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had 5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome.
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 2Retinopathy of prematurity comes full circle - 11 day(s) ago
In the 70 years since the first description, retinopathy of prematurity (ROP) has been the focus of intensive basic and clinical research. Over time, worldwide, there have been several phenotypes of ROP described. Here, we explore whether these are part of a single spectrum or are separate and distinct entities. First described in 1942 by Terry, clinical1 and experimental studies2 3 provided compelling evidence that ‘retrolental fibroplasia’—as ROP was then known—was related to uncontrolled oxygen exposure, although some acknowledged that the mechanism was likely complex. This led clinicians to the restriction of supplemental oxygen concentrations to less than 40%, with predictions that this would eliminate an important cause of infant blindness. Sadly, such forecasts were not fulfilled, and ROP-induced blindness still occurred. Subsequently with increasing preterm survival, the population developing ROP had ever decreasing gestational age. Other risk factors for ROP were recognised, l
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 6
Introduction There is insufficient evidence to determine if non-invasive transcutaneous bilirubin (TcB) measurement can replace serum bilirubin (SBR) in assessing rebound hyperbilirubinaemia after phototherapy. Objective To investigate if TcB can safely guide management of neonates after phototherapy. Subjects 100 well neonates ≥35 weeks’ gestation who had received inpatient phototherapy. Method Measurement of both helix (manufacturer’s recommendation) and earlobe TcB coincidentally with routine SBR 12 hours after cessation of phototherapy. All mothers gave written informed consent. Results Gestation ranged from 35+0 to 41+5 (median 37+6) weeks; birth weight 2018–4566 (median 3230) g; age 55–222 (median 109) hours at testing. 86% neonates were Caucasian. Outcomes determined by SBR included restarting phototherapy (n=0), repeat SBR next day (n=29), no further routine follow-up (n=71). TcB and SBR measurements were unpredictably inconsistent. Helix TcB tended to underestimate SBR (mean d
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 6
Objective To determine the accuracy of two developmental screening questionnaires to detect cognitive or language delay, defined using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), in children born extremely preterm (EP: <28 weeks’ gestation) or extremely low birth weight (ELBW: <1000 g). Design Prospective cohort study. Setting State of Victoria, Australia. Patients 211 infants born EP/ELBW assessed at 2 years’ corrected age (mean 2.2, SD 0.2). Main outcome measures Cognitive and language delay (<−1 SD) on the Bayley-III. The screening questionnaires were the Parent Report of Children’s Abilities-Revised (PARCA-R) and the Ages & Stages Questionnaires Third Edition (ASQ-3). Results The PARCA-R performed better than the ASQ-3, but neither questionnaire had substantial agreement with the Bayley-III to detect cognitive delay; kappa (95% CI): PARCA-R 0.43 (0.23, 0.63); ASQ-3 0.15 (−0.05, 0.35); sensitivity (95% CI): PARCA-R 70% (53%, 84%) ASQ-3 62% (47%, 7
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 12Gastrointestinal effects of caffeine in preterm infants: a systematic review and Bayesian meta-analysis - 14 day(s) ago
Objective Caffeine is widely used in preterm infants to prevent or treat apnoea of prematurity. Adverse gastrointestinal effects of caffeine have not been thoroughly researched in preterm infants. With this systematic review and meta-analysis, we aim to summarise the results of trials on the gastrointestinal effects of caffeine in preterm infants. Design We searched MEDLINE, Web of Science, Scopus and ClinicalTrials.gov up to 21 April 2023. We included randomised controlled trials assessing caffeine versus placebo in preterm neonates and reporting gastrointestinal side effects. Risk of bias was assessed using the Cochrane Risk of Bias tool. A Bayesian meta-analysis was performed to estimate the pooled OR of gastrointestinal side effects. Results Nine trials involving 2746 preterm infants were analysed. Seven trials assessing necrotising enterocolitis and four trials assessing feeding intolerance in our meta-analysis found no differences between caffeine and placebo (OR=1.007 (95% credi
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 2Deferred cord clamping and polythene bags at delivery: measuring and improving quality - 15 day(s) ago
Deferring cord clamping (DCC) at birth reduces mortality in preterm infants by around a third.1 This extraordinary reduction in mortality occurs in babies of all gestations, meaning the biggest reductions in mortality could be seen in the least mature infants, who have the highest baseline risk of death. While mortality is reduced, is it almost as striking that DCC does not appear to affect major complications of prematurity such as brain injury, bronchopulmonary dysplasia, necrotising enterocolitis or late onset infection,1 leaving the intriguing question of how the benefit is mediated. Since the publication of a systematic review in 2018,2 there has been a rapid increase in the proportion of very preterm infants (VPIs: born <32 weeks) who receive DCC. In the UK, the proportion increased from 28.9% in 2020 to 55.4% in 2022, an increase we expect to continue. Some centres exceed the 75% adherence that was managed in the trials without the use of cord intact stabilisation. However, in 2
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
Images in neonatal medicine Severe case of aplasia cutis congenita Can involve deeper structures (Parent/guardian consent obtained) https://t.co/eZ9yM3BqPM https://t.co/QLJMiPJ8NU