Highlights from the literature
Azithromycin in labour Two contrasting outcomes for a similar therapy. Tita et al (N Engl J Med 2016;375:1231–41) randomised 2,013 women to receive azithromycin 500 mg intravenously as prophylaxis for caesarean section during labour or after membrane rupture in a multicentre trial in the USA; there was definite benefit for women in terms of lower rates of endometritis and wound infection, but no evident benefit for their babies. On the other hand, Oluwalana et al (Pediatrics 2016;139, February:e20162281) randomised 829 Gambian women to 2 g oral azithromycin or placebo during labour, with a 98% vaginal deliv...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Tags: Hyperion Source Type: research

The roles of drug therapy given via the endotracheal tube to neonates
Many drugs are given to intubated neonates by the inhalation route. The optimum aerosol delivery system, however, has not been identified and there are many challenges in delivering drugs effectively to the lower airways of intubated neonates. The effectiveness of surfactant in prematurely born infants and nitric oxide has been robustly investigated. Other drugs are being used on very limited evidence. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Greenough, A., Papalexopoulou, N. Tags: Reviews Source Type: research

A systematic review of administrative and clinical databases of infants admitted to neonatal units
Conclusions A number of neonatal databases exist that have potential to contribute to evaluating neonatal care. The majority is created by entering data specifically for the database, duplicating information likely already captured in other administrative and clinical patient records. This repetitive data entry represents an unnecessary burden in an environment where electronic patient records are increasingly used. Standardisation of data items is necessary to facilitate linkage within and between countries. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Statnikov, Y., Ibrahim, B., Modi, N. Tags: Reviews Source Type: research

Lung haemangioma presenting with air-crescent-sign like image in an extreme premature baby
A preterm girl was delivered at 26 weeks by caesarean section because of suspected chorioamnionitis. The pregnancy had been complicated by prolonged rupture of the membranes since 19 weeks. She had a complicated respiratory course with need for invasive ventilation, recurrent pneumonia and two episodes of left-sided pneumothorax, with evolution to bronchopulmonary disease. As a right lower lobe mass was suspected (figure 1), a high-resolution CT chest scan was done which revealed a round homogeneous consolidation with an air crescent sign, typically seen in pulmonary aspergillosis (figure 2). Although there were no clinica...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: de Laat, M., Proesmans, M., Breysem, L., Debeer, A. Tags: Oncology, Journalology, Immunology (including allergy), Drugs: infectious diseases, Pneumonia (infectious disease), TB and other respiratory infections, Pregnancy, Reproductive medicine, Child health, Infant health, Neonatal health, Radiology, Pneumonia ( Source Type: research

Oxygen saturation ranges for healthy newborns within 24 hours at 1800 m
There are minimal data to define normal oxygen saturation (SpO2) levels for infants within the first 24 hours of life and even fewer data generalisable to the 7% of the global population that resides at an altitude of>1500 m. The aim of this study was to establish the reference range for SpO2 in healthy term and preterm neonates within 24 hours in Nairobi, Kenya, located at 1800 m. A random sample of clinically well infants had SpO2 measured once in the first 24 hours. A total of 555 infants were enrolled. The 5th–95th percentile range for preductal and postductal SpO2 was 89%–97% fo...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Morgan, M. C., Maina, B., Waiyego, M., Mutinda, C., Aluvaala, J., Maina, M., English, M. Tags: Open access Short research reports Source Type: research

Outcome of babies with no detectable heart rate before 10 minutes of age, and the effect of gestation
Conclusions Our results add to the body of evidence suggesting that having no heart rate before 10 min of age, in term babies, may not be an appropriate prompt to discontinue resuscitation. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Sproat, T., Hearn, R., Harigopal, S. Tags: Epidemiologic studies, Physiotherapy, Guidelines Original articles Source Type: research

Influence of own mother's milk on bronchopulmonary dysplasia and costs
Conclusions Increased dose of OMM feedings from birth to 36 weeks PMA was associated with a reduction in the odds of BPD in VLBW infants. Thus, high-dose OMM feeding may be an inexpensive, effective strategy to help reduce the risk of this costly multifactorial morbidity. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Patel, A. L., Johnson, T. J., Robin, B., Bigger, H. R., Buchanan, A., Christian, E., Nandhan, V., Shroff, A., Schoeny, M., Engstrom, J. L., Meier, P. P. Tags: Bronchopulmonary dysplasia, Epidemiologic studies, Neonatal and paediatric intensive care, Neonatal intensive care Original articles Source Type: research

Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study
Conclusion UVC tip localisation by standard radiography is very imprecise, and catheter tip migration occurs in a significant proportion of infants during first weeks of age. We suggest ultrasound as the best modality to assist localisation and follow-up of UVC tip in preterm infants. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Franta, J., Harabor, A., Soraisham, A. S. Tags: Child health, Infant health, Neonatal health, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Original articles Source Type: research

Effect of antibiotic use on antimicrobial antibiotic resistance and late-onset neonatal infections over 25 years in an Australian tertiary neonatal unit
We describe 25 years of responsible antibiotic use in a tertiary neonatal unit. Methods Data on neonatal infections and antibiotic use were collected prospectively from 1990 to 2014 at a single tertiary Sydney neonatal intensive care unit attached to a maternity unit. There are approximately 5500 deliveries and 900 nursery admissions per year. Results The mean annual rate of late-onset sepsis was 1.64 episodes per 100 admissions. The mean number of late-onset sepsis episodes per admission to the neonatal unit decreased by 4.0% per year (95% CI 2.6% to 5.4%; p
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Carr, D., Barnes, E. H., Gordon, A., Isaacs, D. Tags: Epidemiologic studies, Drugs: infectious diseases, Child health, Neonatal and paediatric intensive care, Neonatal health Original articles Source Type: research

Determinants of developmental outcomes in a very preterm Canadian cohort
Objectives Identify determinants of neurodevelopmental outcome in preterm children. Methods Prospective national cohort study of children born between 2009 and 2011 at
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Synnes, A., Luu, T. M., Moddemann, D., Church, P., Lee, D., Vincer, M., Ballantyne, M., Majnemer, A., Creighton, D., Yang, J., Sauve, R., Saigal, S., Shah, P., Lee, S. K., on behalf of the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Netw Tags: Eye Diseases, Bronchopulmonary dysplasia, Epidemiologic studies, Cerebral palsy, Ophthalmology, Child health, Disability, Ear, nose and throat/otolaryngology Original articles Source Type: research

Enterostomy-related complications and growth following reversal in infants
Conclusions Around 40% of infants with an enterostomy will have an enterostomy-related complication. Whatever their weight, gestation or underlying pathology, most infants thrive after enterostomy closure and this should be considered when planning the optimal timing for this procedure. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Bethell, G., Kenny, S., Corbett, H. Tags: Childhood nutrition, Childhood nutrition (paediatrics), Child health, Infant health, Infant nutrition (including breastfeeding) Original articles Source Type: research

Two-hourly versus 3-hourly feeding for very low birthweight infants: a randomised controlled trial
Conclusion 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events. Trial registration number ACTRN12611000676910, pre-result. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Ibrahim, N. R., Kheng, T. H., Nasir, A., Ramli, N., Foo, J. L. K., Syed Alwi, S. H., Van Rostenberghe, H. Tags: Oesophagus, Clinical trials (epidemiology), Child health, Infant health, Neonatal health, Physiotherapy Original articles Source Type: research

Staphylococcal scalded skin syndrome in an extremely preterm newborn: management in a neonatal intensive care unit
A preterm newborn (24 weeks gestational age, birth weight 710 g) was admitted to the neonatal intensive care unit. On day 30 of life, he was receiving respiratory support with nasal continuous positive airway pressure (CPAP), full breast milk feeds and no medication except vitamin supplements. He developed an exudative erythematous skin lesion where the CPAP mask made contact. In a few hours, perioral blisters appeared, as well as epidermolytic lesions in pressure zones, with a positive Nikolsky sign and palmoplantar exfoliative erythema (figure 1). There was no mucosal involvement or systemic manifestations. Sta...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Valero-Portero, S., Quesada-Dorigne, L., Quesada Lopez, J. J., Brea-Lamas, A. B., Cidras-Pidre, M. Tags: Images in neonatal medicine Source Type: research

Neopuff T-piece resuscitator: does device design affect delivered ventilation?
Background The T-piece resuscitator (TPR) is in common use worldwide to deliver positive pressure ventilation during resuscitation of infants
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Hinder, M., Jani, P., Priyadarshi, A., McEwan, A., Tracy, M. Tags: Child health, Infant health, Neonatal health, Resuscitation Original articles Source Type: research

Developmental problems in patients with oesophageal atresia: a longitudinal follow-up study
Objective To longitudinally evaluate motor development and predictive factors in school-age children with oesophageal atresia. Design Cohort study with prospective longitudinal follow-up. Setting Outpatient clinic of a tertiary university paediatric hospital. Patients Children with oesophageal atresia born between January 1999 and May 2006 were assessed at 5 and 8 years of age. Interventions None. Main outcome Motor performance was evaluated at 5 and 8 years using the Movement Assessment Battery for Children (M-ABC). Additionally, we evaluated perinatal characteristics, duration of anaesthesia within the first 24...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Harmsen, W. J., Aarsen, F. J., van der Cammen-van Zijp, M. H. M., van Rosmalen, J. M., Wijnen, R. M. H., Tibboel, D., IJsselstijn, H. Tags: Oesophagus, Epidemiologic studies, Child health, Neonatal health Original articles Source Type: research

Neonatal ventilation with a manikin model and two novel PEEP valves without an external gas source
Objective Positive end expiratory pressure (PEEP) is beneficial when ventilating preterm newborns. The aim was to study whether inexperienced providers were able to generate PEEP during simulated neonatal ventilation, using two novel prototype PEEP valves, on a self-inflating bag without an external gas source. Design Forty-six nursing students in Tanzania were trained in ventilation with a new Laerdal Upright resuscitator and mask on a NeoNatalie manikin with a newborn resuscitation monitor. Ventilation was studied with and without PEEP valve 1 (anticipated level 4–5 cm H2O) and with and without PEEP valve 2 (...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Thallinger, M., Ersdal, H. L., Morley, C., Purington, C., Gomo, O., Mduma, E., Eilevstjonn, J., Stordal, K. Tags: Resuscitation Original articles Source Type: research

Initial stabilisation of preterm infants: a new resuscitation system with low imposed work of breathing for use with face mask or nasal prongs
Objective T-piece resuscitation systems are pressure unstable and have high imposed work of breathing (iWOB). Pressure stable respiratory support with low iWOB might improve outcome. We have developed a new resuscitation system that can be used with nasal prongs or face mask. The aim of the study was to describe the in vitro performance of the new system and to perform a clinical feasibility trial of initial stabilisation of preterm infants. Method A mechanical lung model was used to determine iWOB at increasing levels of continuous positive airway pressure (CPAP). The feasibility trial included 36 infants (27–34&nb...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Donaldsson, S., Drevhammar, T., Taittonen, L., Klemming, S., Jonsson, B. Tags: Child health, Infant health, Neonatal health, Airway biology, Informed consent, Resuscitation, Legal and forensic medicine Original articles Source Type: research

Thin-for-gestational age infants are at increased risk of neurodevelopmental delay at 2 years
We examined the effect of neonatal body composition and customised birthweight centiles on neurocognitive and behavioural outcomes at age 2. Study design Prospective cohort study of term infants from the Cork BASELINE Birth Cohort Study classified into the following exposure groups: a birth weight
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: O'Neill, S. M., Hannon, G., Khashan, A. S., Hourihane, J. O., Kenny, L. C., Kiely, M., Murray, D. M. Tags: Epidemiologic studies, Editor's choice, Developmental paediatrics Original articles Source Type: research

Nasal CPAP for neonatal respiratory support in low and middle-income countries
The use of nasal continuous positive airway pressure (NCPAP) for neonatal respiratory support is increasing in low and middle-income countries (LMICs). WHO recommends its use in preterm infants with respiratory distress syndrome.1 Although the development of low-cost delivery systems has increased the availability of CPAP, it is not a simple intervention. Our experience of introducing NCPAP into LMICs including Rwanda, Malawi, Armenia, Papua New Guinea and other countries indicates that many issues need addressing for its successful introduction and use. The role of CPAP in helping reduce neonatal mortality Globally, neona...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Lissauer, T., Duke, T., Mellor, K., Molyneux, L. Tags: Leading articles Source Type: research

The direct and indirect influence of own mothers milk on bronchopulmonary dysplasia and costs
Human milk is indisputably the preferred source of nutrition for premature infants given the numerous short-term and long-term benefits. Indeed, one important quality measure for neonatal intensive care units (NICU) is the percentage of infants receiving mother’s own milk both in the hospital and at the time of discharge. When mother’s own milk is not available, donor human milk is increasingly being recommended as a surrogate1–3 with the assumption that donor milk is equal in efficacy to a diet of mother’s own milk. Patel and colleagues4 report the results of a prospective observational cohort stud...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Poindexter, B. Tags: Editorials Source Type: research

What does it mean to be a skinny baby?
The full impact of the intrauterine environment on the long-term health and well-being of the growing child remains incompletely understood. However, it is increasingly clear that poor fetal growth has critical effects on both long-term medical and developmental outcomes. Infants born after intrauterine growth restriction (IUGR) have increased risk for several adult-onset diseases including hypertension, heart disease and diabetes.1 In multiple studies, infants with IUGR have subtle but likely important deficits in cognitive, motor, language and neuropsychiatric outcomes. Importantly, interpretation of the literature on th...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: DeMauro, S. B. Tags: Editorials Source Type: research

Highlights from this issue
Canadian developmental outcomes
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - April 19, 2017 Category: Perinatology & Neonatology Authors: Ward Platt, M. Tags: Fantoms Source Type: research

Highlights from the literature
Oxygen saturation targets: outcome at 18 to 24 months Between them, the BOOST-II, COT and SUPPORT trials have improved our understanding of appropriate oxygen saturation targets, or so we like to believe. In the latest meta-analytic offering (Pediatrics doi:10.1542/peds.2016-1609), Manja et al have evaluated the composite outcome of death or disability at 18 to 24 months in 4751 subjects; the difference between this and other meta-analyses being the use of a standardised cut-off for defining disability. Intriguingly, using this standardised definition there was no difference in the composite outcome between the higher and ...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Tags: Hyperion Source Type: research

The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care
As the prescription opioid epidemic grew in the USA, its impact extended to pregnant women and their infants. This review summarises how increasing rates of neonatal abstinence syndrome resulted in a need to improve care to pregnant women and opioid-exposed infants. We discuss the variations in care delivery with particular emphasis on screening at-risk mothers, scoring systems for neonatal drug withdrawal, type and duration of pharmacotherapy, and discharge safety. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Pryor, J. R., Maalouf, F. I., Krans, E. E., Schumacher, R. E., Cooper, W. O., Patrick, S. W. Tags: Reviews Source Type: research

Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm infants
Improving neurodevelopmental outcome for preterm infants is an important challenge for neonatal medicine. The disruption of normal brain growth and neurological development is a significant consequence of preterm birth and can result in physical and cognitive impairments. While advances in neonatal medicine have led to progressively better survival rates for preterm infants, there has only been a modest improvement in the proportion of surviving infants without neurological impairment, and no change in the proportion with severe disability. The overall number of children with neurodisability due to prematurity is increasin...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Lea, C. L., Smith-Collins, A., Luyt, K. Tags: Reviews Source Type: research

Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate
This report reinforces the need to be aware of this rare but possible complication during HFNC therapy, as timely diagnosis and treatment can prevent neurological sequelae. We also stress the importance of paying close attention to flow rate, nasal cannula size and insertion, and mouth position, and of regularly checking insertion depth. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Iglesias-Deus, A., Perez-Munuzuri, A., Lopez-Suarez, O., Crespo, P., Couce, M.-L. Tags: Drugs: CNS (not psychiatric), Neurological injury, Child health, Infant health, Neonatal health, Trauma, Injury Case reports Source Type: research

Estimating discharge dates using routinely collected data: improving the preparedness of parents of preterm infants for discharge home
We report the use of routinely collected neonatal data to develop and implement a simple centile chart for date of discharge from hospital, which allows staff and parents to predict the likely discharge date more accurately for preterm infants, most of whom now go home more than 3 weeks before their EDD. This information allows better and timelier planning for discharge of such infants, by parents and staff. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Fleming, P. J., Ingram, J., Johnson, D., Blair, P. S. Tags: Open access, Child health, Infant health, Neonatal health Short research reports Source Type: research

Waiting 2 minutes after sucrose administration--unnecessary?
This study aims to determine if time interval between sucrose administration and heelstick correlates with pain scores. Methods Neonates were prospectively studied with variable time intervals and assessed with the Premature Infant Pain Profile-Revised (PIPP-R). Results 150 neonates were included with a median gestational age of 30+6 (IQR 27+6–33+2) weeks and a median time interval of 72 (IQR 39–115) seconds between sucrose administration and heelstick. In multiple regression analysis, this time interval was not significantly related to the PIPP-R (B=0.004, 95% CI –0.005 to 0.013, p=0.37). Providing non...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Meesters, N., Simons, S., van Rosmalen, J., Reiss, I., van den Anker, J., van Dijk, M. Tags: Open access, Pain (neurology), Child health, Infant health, Neonatal and paediatric intensive care, Neonatal health Short research reports Source Type: research

Insulin resistance, glucagon-like peptide-1 and factors influencing glucose homeostasis in neonates
Objectives To explore the relationships between postmenstrual age (PMA), insulin, C-peptide, glucagon and blood glucose concentrations (BGCs) in preterm and term neonates. To compare glucagon-like peptide-1 (GLP-1) concentrations in fed versus never-fed neonates. Design Observational. Setting Dunedin Hospital Neonatal Intensive Care Unit, New Zealand. Patients Term or preterm euglycaemic neonates (102) receiving routine blood tests (343 samples). Interventions None: plasma was obtained from surplus samples from routine clinical care. Main outcome measures Insulin, C-peptide, GLP-1 and glucagon concentrations were meas...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Salis, E. R., Reith, D. M., Wheeler, B. J., Broadbent, R. S., Medlicott, N. J. Tags: Drugs: CNS (not psychiatric), Child health, Infant health, Neonatal and paediatric intensive care, Neonatal health, Diabetes, Metabolic disorders Original articles Source Type: research

Spontaneous ping-pong parietal fracture in a newborn
Clinical case A female infant was delivered by caesarean section at 38 weeks of gestation with a depressed calvarial fracture (DCF) (figures 1–3). No trauma was described during the pregnancy. No instrumental extraction was used during C-section. The newborn examination was normal. DCF are skull distortion similar to a ‘ping pong ball’ because of the cranial vault flexibility.1 DCF are secondary to instrumental extraction, but may also occur in utero. Fetal head pressure against the maternal bony structures can result in fracture.2 Trauma to the mother’s abdomen and traumatic delivery are also ...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Loire, M., Barat, M., Mangyanda Kinkembo, L., Lenhardt, F., M'buila, C. Tags: Obstetrics and gynaecology, Oncology, Journalology, Neurological injury, Pregnancy, Reproductive medicine, Child and adolescent psychiatry (paedatrics), Competing interests (ethics), Trauma, Injury Images in neonatal medicine Source Type: research

Outcomes of infants born at 22-27 weeks' gestation in Victoria according to outborn/inborn birth status
Conclusions Mortality rates remained higher for outborn livebirths at 22–27 weeks' gestation compared with inborn peers in 2010–2011. Outborn infants admitted to NICU did not have substantially different rates of mortality or serious morbidity compared with inborns, with the exception of cPVL. Longer-term health consequences of outborn birth before 28 weeks' gestation need to be determined. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Boland, R. A., Davis, P. G., Dawson, J. A., Doyle, L. W. Tags: Eye Diseases, Bronchopulmonary dysplasia, Epidemiologic studies, Ophthalmology, Neonatal and paediatric intensive care, Neonatal intensive care Original articles Source Type: research

MRI and spectroscopy in (near) term neonates with perinatal asphyxia and therapeutic hypothermia
Conclusions During and after therapeutic hypothermia, low ADC values and high Lac/NAA ratios of the basal ganglia and thalamus are associated with an adverse outcome in infants with perinatal asphyxia. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Alderliesten, T., de Vries, L. S., Staats, L., van Haastert, I. C., Weeke, L., Benders, M. J. N. L., Koopman-Esseboom, C., Groenendaal, F. Tags: Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma, Injury Original articles Source Type: research

Functional treatment of airway obstruction and feeding problems in infants with Robin sequence
Background Robin sequence (RS), characterised by micrognathia/retrognathia and glossoptosis with or without cleft palate, presents with intermittent upper airway obstruction and feeding difficulties. Active intervention is required to reduce the risk of brain damage or sudden death. Most treatment options are poorly studied and/or invasive. Our group developed a functional approach including early feeding training and the pre-epiglottic baton plate (PEBP), an orthodontic appliance with a velar extension shifting the base of the tongue forward. Patients and methods We evaluated the effect of this approach on sleep study re...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Buchenau, W., Wenzel, S., Bacher, M., Müller-Hagedorn, S., Arand, J., Poets, C. F. Tags: Original articles Source Type: research

Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle
Background and objective The American Academy of Pediatrics recommends that preterm infants complete a predischarge ‘car seat challenge’ observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants. Methods A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 ...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Arya, R., Williams, G., Kilonback, A., Toward, M., Griffin, M., Blair, P. S., Fleming, P. Tags: Open access, Child health, Infant health, Neonatal health Original articles Source Type: research

The ORACLE Children Study: educational outcomes at 11 years of age following antenatal prescription of erythromycin or co-amoxiclav
Conclusions Despite evidence that antibiotics are associated with increased functional impairment at 7 years, educational test scores and special needs at 11 years of age show no differences between trial groups. Trial registration number ISCRT Number 52995660 (original ORACLE trial number). (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Marlow, N., Bower, H., Jones, D., Brocklehurst, P., Kenyon, S., Pike, K., Taylor, D., Salt, A. Tags: Open access Original articles Source Type: research

Effect of inspiratory flow rate on the efficiency of carbon dioxide removal at tidal volumes below instrumental dead space
Conclusions Inflation flow rate affects the efficiency of CO2 removal with low VT. Our results are relevant for providers using volume-controlled ventilation or other modes that use low inflation flow rates because the VT required for normocapnia will be higher than published values that were generated using pressure-limited ventilation modes with high inflation flows. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Hurley, E. H., Keszler, M. Tags: Original articles Source Type: research

Presentation of acute suppurative parotitis in a newborn with incessant crying
A male infant born at 37 weeks of gestation by caesarean delivery presented to the emergency room at 17 days of age with incessant crying mostly during breast feeding which had started a few hours ago. His birth weight was 2545 g and he was gaining weight appropriately. On examination, the infant was very irritable and crying. He had a temperature of 37.5°C. The physical examination was otherwise unremarkable. Laboratory findings showed neutrophilic leucocytosis (white blood cell count of 14 750/mm3 with 10 000/mm3 neutrophils) and slightly increased C reactive protein (1.87 mg/dL, normal value
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Velkoski, A., Amoroso, S., Brovedani, P., Cont, G., Trappan, A., Travan, L. Tags: Images in neonatal medicine Source Type: research

A state-wide assessment of the association between epidural analgesia, maternal fever and neonatal antibiotics in Colorado, 2007-2012
Conclusions Colorado providers treat neonates born to mothers with maternal fever without respect to whether the mother had an epidural. Further research into improved criteria for neonatal sepsis evaluation that accounts for the contribution of maternal epidural fever should be developed to decrease unnecessary neonatal antibiotic exposure. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: White, A., Olson, D., Messacar, K. Tags: Epidemiologic studies, Drugs: infectious diseases, Pain (neurology), Pain (palliative care), Pain (anaesthesia) Original articles Source Type: research

Measurement of neonatal heart rate using handheld Doppler ultrasound
Objective This pilot study aimed to determine whether handheld Doppler ultrasound is feasible and reliable for measuring neonatal heart rate (HR) when compared with ECG. Setting Stable newborns were recruited from the neonatal intensive care unit and postnatal ward between July 2014 and January 2015 at Royal North Shore Hospital, Sydney, Australia. Interventions Each newborn had their HR recorded every 15 s over 145 s using four different modalities: ECG, counted audible Doppler (AD) over 10 s, pulse oximetry (PO) and the Doppler display (DD). Outcome measures The correlation and variation between each mo...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Dyson, A., Jeffrey, M., Kluckow, M. Tags: Radiology, Clinical diagnostic tests, Radiology (diagnostics) Original articles Source Type: research

A four-vessel umbilical cord
Physical examination of a healthy newborn revealed a four-vessel umbilical cord (figure 1). At the placental cord insertion site only three vessels were seen. The routine prenatal ultrasonography did not show any abnormalities. The newborn had no dysmorphic features. During the early embryogenesis, the umbilical cord exists of four blood vessels (two veins, two arteries) as well as the vitelline duct and the allantois. By the eighth gestational week, the vitelline duct and allantois as well as the right umbilical vein become obliterated.1 It is extremely rare that they persist. A persistent vitelline duct or allantois can ...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Quaak, M. S., Draaisma, J. M. Tags: Journalology, Reproductive medicine, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Competing interests (ethics) Images in neonatal medicine Source Type: research

Neonatal hypoglycaemia: learning from claims
Conclusions Acknowledging that these are likely to be the most rare but most seriously affected cases, the clinical themes arising from these cases should be used for further development of training and guidance to reduce harm and redivert NHS funds from litigation to direct care. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Hawdon, J. M., Beer, J., Sharp, D., Upton, M., On behalf of NHS Improvement Patient Safety Programme 'Reducing Term Admissions to Neonatal Units Tags: Patients, Epidemiologic studies, Open access, Editor's choice, Medical error/ patient safety, Metabolic disorders Original articles Source Type: research

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study
Conclusions A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Aladangady, N., Shaw, C., Gallagher, K., Stokoe, E., Marlow, N., for Collaborators Group Tags: Epidemiologic studies, Child health, Neonatal and paediatric intensive care, Neonatal health Original articles Source Type: research

Delivery room deaths of extremely preterm babies: an observational study
Conclusions Non-pharmacological comfort care and parental support were routinely given. Comfort medication was given much more frequently than previously reported in other DRs. These data should encourage work on the indications for comfort medication and the interpretation of gasping. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Durrmeyer, X., Scholer-Lascourreges, C., Boujenah, L., Betremieux, P., Claris, O., Garel, M., Kaminski, M., Foix-L'Helias, L., Caeymaex, L., the EPIPAGE-2 Extreme Prematurity Writing Group Tags: Original articles Source Type: research

End-of-life decisions for fragile neonates: navigating between opinion and evidence-based medicine
The majority of neonatal deaths occur after a decision to limit life-sustaining interventions (LSIs).1 Decisions on when to withhold/withdraw LSIs in fragile neonates are among the most difficult decisions in paediatric practice. Two rigorous investigations shed some light on this topic. Durrmeyer et al2 systematically described the management of 73 delivery room deaths in the EPIPAGE-2 cohort. The vast majority of neonates had LSI withheld, at a median gestational age of 24 weeks. Pain was usually assessed: 50% of infants received comfort medication, the administration of which was not associated with the evaluation ...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Janvier, A., Farlow, B., Verhagen, E., Barrington, K. Tags: Editorials Source Type: research

Highlights from this issue
Learning from hypoglycamia claims Neonatal hypoglycaemia defined by blood glucose level alone is common, usually asymptomatic and in most cases results in no harm. Cases of neonatal hypoglycemia of sufficient severity to cause brain damage usually involve prolonged symptomatic hypoglycaemia, offering opportunities for intervention to prevent them. In this issue Jane Hawdon and colleagues describe the findings of an analysis of cases of brain damaging hypoglycemia that involved the NHS litigation authority between 2002 and 2011. Key themes emerge, the emphasis of which may help to protect future infants. When hypoglycemia i...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2017 Category: Perinatology & Neonatology Authors: Stenson, B. Tags: Fantoms Source Type: research

Highlights from the literature
What you want or what you're given One of the disadvantages of guidelines is that where there is a list of bullet points, people tend to follow them, especially if they come from NICE. So it is with Preterm Labour and Birth (NG25) and its recommendations for information and support for mothers at high risk of preterm labour or delivery. Unsurprisingly, a one-size-fits-all approach is not actually what women want. Gaucher et al (J Pediatr 2016;178:130–134.e7) surveyed 229 Canadian women, mostly white, mostly francophone, but all at high risk of preterm labour or delivery, in Montreal. They reported that what these wom...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - December 13, 2016 Category: Perinatology & Neonatology Tags: Pregnancy, Reproductive medicine Hyperion Source Type: research

Definition and monitoring of neonatal hypoglycaemia: a nationwide survey of NHS England Neonatal Units
Neonatal hypoglycaemia is common; however, there is an ongoing controversy regarding its operational definition, with recent guidance from the Paediatric Endocrine Society (PES) recommending using significantly higher blood glucose thresholds and longer periods of monitoring than existing guidance.1 A 2014 survey of Australasian neonatal units identified that the most common clinical threshold for the treatment of hypoglycaemia was 2.6 mmol/L, and some units used potentially unreliable nearside blood glucose monitoring devices.2 The most recent published survey of British neonatologists showed wide variation in defini...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - December 13, 2016 Category: Perinatology & Neonatology Authors: Dixon, K. C., Ferris, R. L., Marikar, D., Chong, M., Mittal, A., Manikam, L., Rose, P. J. Tags: PostScript Source Type: research

Implementation of the NICE prevention and treatment of early onset neonatal infection guideline: the Glasgow experience
The 2012 National Institute for Health and Care Excellence (NICE) guideline for prevention and treatment of neonatal early onset sepsis (EOS)1 has been subject to much debate since its publication. We have read with interest the experiences from other maternity units2–5 that have adopted this guideline. In contrast to these negative experiences, in Glasgow we have observed a positive impact following implementation in two large perinatal centres. The recommended changes aim to prioritise antibiotic treatment for infants most likely to develop EOS, while minimising antibiotic exposure and reducing hospital stay for th...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - December 13, 2016 Category: Perinatology & Neonatology Authors: Mitchell, J., Kirolos, S., Jackson, L., Powls, A. Tags: PostScript Source Type: research

Obtaining informed consent for delivery room research: the investigators' perspective
Research on delivery room (DR) resuscitation poses unique challenges. Because prospective informed consent is obtained before birth, many parents consent for studies for which their infants never become eligible.1 Conversely, many infants who require resuscitation are not enrolled, due to insufficient opportunity for parents to provide antenatal consent.2 One alternative is a waiver of prospective informed consent (or ‘retrospective’ or ‘deferred’ consent), in which eligible infants are enrolled after birth, and parents are approached for consent as soon as possible after enrolment. We sought to und...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - December 13, 2016 Category: Perinatology & Neonatology Authors: Foglia, E. E., Owen, L. S., Keszler, M., Davis, P. G., Kirpalani, H. Tags: PostScript Source Type: research

Tidal volume delivery during continuous chest compressions and sustained inflation
Objective To determine the distending pressure needed to achieve sufficient tidal volume (VT) delivery during continuous chest compressions (CC) superimposed by sustained inflation (SI) (CC+SI). Design Randomised animal/manikin trial. Setting University laboratory. Subjects Cadaver piglets/manikin. Interventions SI distending pressures of 5, 10, 15, 20, 25 and 30 cm H2O were delivered in random order during CC+SI for 2 min each. Main outcome measures VT, gas flow and airway pressure. Spearman's r for distending pressure and VT. Results Distending pressure and VT correlated in cadaver piglets (r=0.83, p
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - December 13, 2016 Category: Perinatology & Neonatology Authors: Solevag, A. L., Lee, T.-F., Lu, M., Schmölzer, G. M., Cheung, P.-Y. Tags: Short research reports Source Type: research