Archives of Disease in Childhood - Fetal and Neonatal Edition最新文献

{"title":"Video analysis of neonatal intubations using video laryngoscopy: a prospective comparison of clinical practice with resuscitation guidelines.","authors":"Caitríona M Ní Chathasaigh, Emma A Dunne, Lucy E Geraghty, Colm P F O'Donnell, Eoin O'Currain, Anna E Curley","doi":"10.1136/archdischild-2024-327723","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327723","url":null,"abstract":"<p><strong>Background: </strong>The Neonatal Resuscitation Program recommends direct laryngoscopy (DL) as the primary method for neonatal intubation. Video laryngoscopy (VL) is suggested as an option, particularly for training novice operators or for intubating infants with difficult airways. The programme outlines specific steps for intubation, including managing the external environment and techniques for visualising key anatomical landmarks. It is unclear whether the DL method can be effectively applied to VL.</p><p><strong>Objectives: </strong>To determine the degree of adherence to resuscitation guidelines during intubation using VL, and to examine the relationship between guideline adherence and intubation success.</p><p><strong>Methods: </strong>In a cohort of newborn infants who were intubated with VL, we simultaneously recorded the view obtained with the video laryngoscope and an external view of the procedure with a GoPro video camera, and synchronised the recordings for analysis. In each set of recordings, we assessed infant and operator positions, interventions during the procedure, and the anatomical landmarks visualised.</p><p><strong>Results: </strong>We assessed 95 intubation attempts in 57 infants (median corrected gestational age: 28 weeks; median weight: 1160 g). Sixty-six of these attempts (69%) were successful. Operators spent more time attempting to insert the endotracheal tube through a visible glottis than locating it. Sixty-six (69%) attempts were performed with an appropriate lift manoeuvre. The vocal cords were visualised in only 58 (61%) attempts, while the glottis was seen in 85 (89%).</p><p><strong>Conclusions: </strong>Neonatal intubation using VL differed from the technique recommended in resuscitation guidelines. Revised guidelines considering the use of VL may be warranted.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of gestational day with antenatal management and the mortality and respiratory outcomes of extremely preterm infants.","authors":"T'ng Chang Kwok, Magdalena Fiolna, Nia Jones, Kate Walker, Don Sharkey","doi":"10.1136/archdischild-2024-328066","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328066","url":null,"abstract":"<p><strong>Objective: </strong>Perinatal epidemiological studies and outcomes are often reported on gestational week thresholds. This study aims to quantify and investigate the association of each gestational day at birth on antenatal management, mortality and respiratory outcomes of extremely preterm infants.</p><p><strong>Design: </strong>Retrospective cohort study using National Neonatal Research Database.</p><p><strong>Setting: </strong>England and Wales.</p><p><strong>Patients: </strong>26 098 infants born <28 weeks of gestational age (GA) and admitted to neonatal units from 2010 to 2020.</p><p><strong>Interventions: </strong>Antenatal care and outcome measures for each gestational day were described with 95% CI determined using Agresti-Coull method. χ² test for trend assessed the trends across gestational day. Analysis of means assessed if outcome on each gestational day differed from the overall outcome for that gestational week.</p><p><strong>Main outcome measures: </strong>Mortality and respiratory disease.</p><p><strong>Results: </strong>Neonatal admissions peaked at the start of each gestational week. Caesarean section was the most common birth mode from 26⁺¹ to 26⁺⁴ weeks GA. Mortality and severe respiratory morbidity decreased with each day of gestation within the gestational week threshold (p<0.01). Mortality at the beginning and end of each gestational week differed from the overall mortality for that gestational week (p=0.03 to <0.001) in infants <27⁺⁰ weeks GA. Mortality was higher in infants <26⁺⁰ weeks GA born to mothers without complete antenatal corticosteroid course or born in centres without neonatal intensive care units.</p><p><strong>Conclusions: </strong>Each day of gestation is important for extremely preterm infant outcomes. Perinatal decision-making, counselling and reporting should avoid broad gestational weeks and include day of gestation.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red blood cell transfusions in neonatal intensive care units: a nationwide observational cohort study.","authors":"Lisanne Elise Heeger, Camila Caram-Deelder, Suzanne Gunnink, F Cassel, Esther J d'Haens, Christian V Hulzebos, Ellen de Kort, Wes Onland, S Prins, Daniel C Vijlbrief, Sabine L Vrancken, Elke van Westering-Kroon, Johanna G van der Bom, Enrico Lopriore","doi":"10.1136/archdischild-2024-327441","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327441","url":null,"abstract":"<p><strong>Objective: </strong>To describe the use and nationwide variation of red blood cell (RBC) transfusions in neonatal intensive care units (NICUs) following the introduction of the revised national transfusion guideline in 2019.</p><p><strong>Design and patients: </strong>We randomly selected neonates born below 32 weeks' gestation admitted to any NICU in the Netherlands in 2020 to include in our retrospective observational cohort study.</p><p><strong>Main outcome measures: </strong>Main outcome measures were the number of neonates receiving at least one transfusion, and the number of transfusions per transfused neonate.</p><p><strong>Results: </strong>Of 762 neonates included, 34% (257/762) received at least one RBC transfusion, varying between centres from 20% (12/61) to 50% (39/77). Median phlebotomy loss during admission was 8.2 mL/kg (IQR 4.5-17.3 mL/kg), equating to 54.3% of the median transfusion volume. Of 770 transfusions, 358 (47%) were administered above the recommended threshold, and the proportion of transfusions given above the threshold varied between centres from 15% to 719%. Median transfusion dosage and mean infusion duration were 15.1 mL/kg (IQR 15.0-16.7 mL/kg) and 3.9 hours (SD 1.1 hour) and varied from 14.8 mL/kg to 18.9 mL/kg and from 2.5 hours to 5.5 hours between centres. Blood transfusion volume was positively correlated with cumulative volume of blood draws (Pearson correlation coefficient 0.84, 95% CI 0.82 to 0.86) and lower gestation.</p><p><strong>Conclusions: </strong>Large variation in transfusion practice remains between Dutch NICUs despite a national guideline. Extreme prematurity and cumulative blood draws were associated with increased use of RBC transfusions. Benchmarking will yield leverage points to understand and potentially prevent unwarranted variation.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing precision and affordability in assessing infant development in large-scale mortality trials: secondary analysis of a randomised controlled trial.","authors":"Kristy P Robledo, Ingrid Rieger, Sarah Finlayson, William Tarnow-Mordi, Andrew J Martin","doi":"10.1136/archdischild-2024-327762","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327762","url":null,"abstract":"<p><strong>Objective: </strong>Large-scale mortality trials require reliable secondary assessments of impairment. We compared the Ages and Stages Questionnaire (ASQ-3), a screening tool self-administered by parents, in classifying impairment using the 'gold standard' Bayley Scales of Infant Development (Bayley-III), a diagnostic tool administered by trained assessors.</p><p><strong>Design: </strong>Analysis of 405 children around 2 years corrected age from the Australian Placental Transfusion Study, a trial conducted over 8 years.</p><p><strong>Setting: </strong>Secondary analysis of international, open-label, multicentre randomised trial.</p><p><strong>Patients: </strong>Children born <30 weeks gestation.</p><p><strong>Interventions: </strong>Immediate (<10 s) versus delayed (60 s+) cord clamping.</p><p><strong>Main outcomes: </strong>ASQ-3 and Bayley-III assessments around 2 years corrected age. Impairment (or developmental delay) was defined as <2 SD below the mean (<70) for Bayley-III domains.</p><p><strong>Results: </strong>The area under the receiver operating curve for ASQ-3 domains predicting delay was 0.75-0.99. Sensitivity for predicting delay was 57%-100%, while specificity was 88%-90%.We modelled the cost and sample size using a less expensive, though less precise, screening assessment for impairment compared with a more costly diagnostic assessment. For detecting a 25% reduction in the relative risk of delay, using ASQ-3 rather than Bayley-III could require double the sample size (15 000 to 30 000), but outcome assessment cost savings would be US$13M (EUR$12M). However, assessment cost savings may be outweighed by upscaling.</p><p><strong>Conclusions: </strong>When measuring developmental outcomes in a large-scale clinical trial, using a more precise diagnostic tool may be financially prohibitive, so increasing the sample size and using a less precise but appropriately calibrated tool may be more affordable.</p><p><strong>Trial registration number: </strong>ACTRN12610000633088.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the survival of very preterm infants between 2011 and 2020 in France.","authors":"Victoria Butler, Luc Gaulard, Victor Sartorius, Pierre Yves Ancel, François Goffinet, Jeanne Fresson, Jennifer Zeitlin, Héloïse Torchin","doi":"10.1136/archdischild-2024-327814","DOIUrl":"10.1136/archdischild-2024-327814","url":null,"abstract":"<p><strong>Objective: </strong>The objective is to evaluate changes in survival to discharge of liveborn infants less than 32 weeks' gestational age (GA) in France, where the latest available data on very preterm survival at a national-level are from the EPIPAGE-2 <i>(Etude épidémiologique sur les petits âges gestationnels)</i> cohort in 2011.</p><p><strong>Design: </strong>Population-based cohort study.</p><p><strong>Setting: </strong>Metropolitan France in 2011, 2015 and 2020.</p><p><strong>Patients: </strong>All births between 22 and 31 weeks' GA using the EPIPAGE-2 cohort study for the year 2011 and hospital discharge data linked to death certificates from the <i>Système National des Données de Santé</i> for the years 2015 and 2020.</p><p><strong>Main outcome measures: </strong>The primary outcome was survival to hospital discharge among liveborn infants. Survival rates were compared using modified Poisson regression and adjusted for population characteristics (maternal age, multiple birth, sex, small for GA). Data on all births were examined to assess changes to the live birth rate.</p><p><strong>Results: </strong>Survival to discharge among live births increased at 23 and 24 weeks' GA from 1% and 31% in 2011 to 8% and 37% in 2015 and to 31% and 47% in 2020, respectively. From 25 to 28 weeks' GA, survival rates tended to increase, but differences were not significant, and survival rates were stable from 29 to 31 weeks GA. Results were similar after adjustment. The proportion of live births versus stillbirths increased from 22 to 24 weeks' GA.</p><p><strong>Conclusion: </strong>Survival rates among live births improved between 2011 and 2020 from 23 to 28 weeks' GA, with marked changes at 23 and 24 weeks' GA.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between bronchopulmonary dysplasia severity and its risk factors and long-term outcomes in three definitions: a historical cohort study.","authors":"Trixie A Katz, Anton H van Kaam, Nicolaas P A Zuithoff, S M Mugie, Sabine Beuger, Geert Jan Blok, Anne A M W van Kempen, Henriëtte van Laerhoven, Claire A M Lutterman, Maarten Rijpert, Irene A Schiering, Nicolien C Ran, Fenna Visser, Els van Straaten, Cornelieke S H Aarnoudse-Moens, Aleid G van Wassenaer-Leemhuis, Wes Onland","doi":"10.1136/archdischild-2024-326931","DOIUrl":"10.1136/archdischild-2024-326931","url":null,"abstract":"<p><strong>Objective: </strong>To compare the association of the severity categories of the 2001-National Institutes of Health (NIH), the 2018-NIH and the 2019-Jensen bronchopulmonary dysplasia (BPD) definitions with neurodevelopmental and respiratory outcomes at 2 and 5 years' corrected age (CA), and several BPD risk factors.</p><p><strong>Design: </strong>Single-centre historical cohort study with retrospective data collection.</p><p><strong>Setting: </strong>Infants born between 2009 and 2015 at the Amsterdam University Medical Centers, location Amsterdam Medical Center.</p><p><strong>Patients: </strong>Preterm infants born at gestational age (GA) <30 weeks and surviving up to 36 weeks' postmenstrual age.</p><p><strong>Interventions: </strong>Perinatal characteristics, (social) demographics and comorbidities were collected from the electronic patient records.</p><p><strong>Main outcome measures: </strong>The primary outcomes were neurodevelopmental impairment (NDI) or late death, and respiratory morbidity at 2 and 5 years' CA. Using logistic regression and Brier scores, we investigated if the ordinal grade severity is associated with incremental increase of adverse long-term outcomes.</p><p><strong>Results: </strong>584 preterm infants (median GA: 28.1 weeks) were included and classified according to the three BPD definitions. None of the definitions showed a clear ordinal incremental increase of risk for any of the outcomes with increasing severity classification. No significant differences were found between the three BPD definitions (Brier scores 0.169-0.230). Respiratory interventions, but not GA, birth weight or small for GA, showed an ordinal relationship with BPD severity in all three BPD definitions.</p><p><strong>Conclusion: </strong>The severity classification of three BPD definitions showed low accuracy of the probability forecast on NDI or late death and respiratory morbidity at 2 and 5 years' CA, with no differences between the definitions.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"51-56"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fantoms.","authors":"Ben J Stenson","doi":"10.1136/archdischild-2024-328334","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328334","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":"110 1","pages":"1"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of endotracheal intubation and supraglottic airway insertion by consultant paediatricians in non-tertiary neonatal units: a Scotland-wide survey.","authors":"Gemma Edwards, Philine Van Der Heide, Joyce E O'Shea","doi":"10.1136/archdischild-2024-327257","DOIUrl":"10.1136/archdischild-2024-327257","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"111-112"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedation and analgesia practices for less invasive surfactant administration, elective endotracheal intubation, and mechanical ventilation: a national UK survey.","authors":"Liam Willgress, Dina Sava, Robert Daniels, Julie Mullett, Sarah Keen, Lynn Jones, Sarah Cole, Alexandra Holgate, Jacqueline Jones, Adam Przychodzko, Fatima Altaf, Thuvaraka Thambiah, Zina Wells, Paul Clarke","doi":"10.1136/archdischild-2024-327458","DOIUrl":"10.1136/archdischild-2024-327458","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"113-114"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying neonatal transport research priorities: a modified Delphi consensus.","authors":"Aarti Mistry, Andrew Leslie, Shalini Ojha, Don Sharkey","doi":"10.1136/archdischild-2024-327213","DOIUrl":"10.1136/archdischild-2024-327213","url":null,"abstract":"<p><strong>Objectives: </strong>With increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport research questions as prioritised by parents and healthcare professionals (HCPs).</p><p><strong>Design: </strong>Key stakeholders participated in a modified three-stage Delphi consensus process. Research questions were identified and submitted through two survey stages before the final priority setting workshop.</p><p><strong>Participants: </strong>Parents of babies who received neonatal care, neonatal HCPs and stakeholders.</p><p><strong>Outcome: </strong>Identify the top 10 research priorities for neonatal transport.</p><p><strong>Results: </strong>Overall, 269 survey responses from HCPs/stakeholders (n=161) and parents (n=108) were analysed from two survey rounds. Consensus was reached on 22 of 43 research priorities for the final priority setting workshop. The agreed top research priorities covered the domains of: (1) Pain assessment and management, (2) Long-term neurological outcomes, (3) Impact of transfer on birth-related brain injury, (4) Investigating risk of transport, (5) Safety restraints for infants, (6) Optimal temperature management, (7) Respiratory management and outcomes, (8) Benchmarking of important of transport measures, (9) Understanding transport environmental exposures, (10) Mental health and burden of transfer on families.</p><p><strong>Conclusion: </strong>We have identified the top research questions for neonatal transport through an extensive process actively engaging parents, HCPs and key stakeholders. Targeted funding and research resources, directed towards addressing these prioritised research areas, will inform evidence-based practices and international frameworks specific to neonatal transport, helping minimise research waste and ultimately improve outcomes for these high-risk infants and their families.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"43-50"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141299862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}