We would like to thank Mr Degraeuwe for his interest about our study
[1]. He is correct in stating that the confidence intervals are useful in
interpreting the diagnostic value of procalcitonin. The sensitivity,
specificity, positive and negative predictive values expressed as
percentages (95% CI) were respectively 100 (88-100), 65 (54-76), 67 (56-
78) and 100 (88-100) for PCT at the 0.6 ng/mL cut-off value.
We would like to thank Mr Degraeuwe for his interest about our study
[1]. He is correct in stating that the confidence intervals are useful in
interpreting the diagnostic value of procalcitonin. The sensitivity,
specificity, positive and negative predictive values expressed as
percentages (95% CI) were respectively 100 (88-100), 65 (54-76), 67 (56-
78) and 100 (88-100) for PCT at the 0.6 ng/mL cut-off value.
Mr Degraeuwe also commented on our method of calculating the number
of subjects. Several methods are available, and our biostatistics
department chose the comparison of percentages with objectives of
difference, power and alpha risk, as detailed in the article.
Therefore, we confirm the validity of our prudent conclusion. It
seems that procalcitonin can help in eliminating late-onset sepsis in
newborns hospitalized in a neonatal intensive care unit. These results
need to be confirmed in larger studies.
Aurélien Jacquot
Reference:
[1] Jacquot A, Labaune JM, Baum TP, Putet G, Picaud JC. Rapid quantitative
procalcitonin measurement to diagnose nosocomial infections in newborn
infants. Arch Dis Child Fetal Neonatal Ed. 2009;94:F345-8.
Sir,
Alvarez and colleagues1 report a clinically useful metanalysis on the
diagnostic value of subependymal pseudocysts and choroid plexus cysts seen
on neonatal cerebral ultrasound. It appears that complex subependymal
cysts at the caudothalamic groove may be more important clinically than
simple cysts here or in the choroid plexus. Their analysis did not expose
two other important conditions causing multiple and/or bila...
Sir,
Alvarez and colleagues1 report a clinically useful metanalysis on the
diagnostic value of subependymal pseudocysts and choroid plexus cysts seen
on neonatal cerebral ultrasound. It appears that complex subependymal
cysts at the caudothalamic groove may be more important clinically than
simple cysts here or in the choroid plexus. Their analysis did not expose
two other important conditions causing multiple and/or bilateral
subependymal pseudocysts in the neonate. Firstly glutaric aciduria type
1(GA1) 2,3, although rare, is important, as it is a potentially treatable
autosomal recessive disorder and signs such as macrocephaly may not be
present in the neonatal period. In GA1 the subependymal cysts tend to be
complex. Screening for this disorder is easy by urine organic analysis,
blood spot glutarylcarnitine and plasma total and free carnitine
estimations; if abnormal confirmation is by fibroblast glutaryl CoA
dehydrogenase activity3 and mutation analysis. The second disorder to
consider is in utero exposure to cocaine. While there is debate in the
literature, many studies have shown an association with subpendymal
cysts4, and subepedymal hemorrhage5. The effect on the foetus may be dose
dependent 5 and is likely vascular in basis. In these cases a detailed
antenatal history may identify the diagnosis.
1. Fernandez Alvarez JR, Amess PN, Gandhi RS, Rabe H. Diagnostic
value of subependymal pseudocysts and choroid plexus cysts on neonatal
cerebral ultrasound: a meta-analysis. Arch Dis Child Fetal Neonatal Ed.
2009 ;94(6):F443-F446.
2. Twomey EL,Naughten ER, Donoghue VB ,Ryan S. Neuroimaging findings in
glutaric aciduria type 1 .Pediatr Radiol 2003 ;33: 823–830.
3. Hartley L.M, Khwaja O. S, Verity C.M, Glutaric Aciduria Type 1 and
Nonaccidental Head Injury. Pediatrics 2001;107(1):174-175 .
4. Smith LM, Qureshi N, Renslo R, Sinow RM. Prenatal cocaine exposure and
cranial sonographic findings in preterm infants. J Clin Ultrasound.
2001;29(2):72-77.
5. Frank D.A, McCarten K.M, , Robson C.D, Mirochnick M, Cabral H, Park H,
Zuckerman B. Level of In Utero Cocaine Exposure and Neonatal Ultrasound
Findings. Pediatrics. 1999;104(5 Pt 1):1101–1105.
Verhagen et al describe the use of analgesics, sedatives and
neuromuscular blockers during reorientation of care to compassionate
measures in Groningen, the Netherlands (1). The authors draw attention to
the fact that in 16% of such events, neuromuscular blockers (NMBs) were
used. In cases, NMBs were used to eliminate gasping after the
endotracheal tube had been removed.
Diagnoses and reasons for administering NMBs afte...
Verhagen et al describe the use of analgesics, sedatives and
neuromuscular blockers during reorientation of care to compassionate
measures in Groningen, the Netherlands (1). The authors draw attention to
the fact that in 16% of such events, neuromuscular blockers (NMBs) were
used. In cases, NMBs were used to eliminate gasping after the
endotracheal tube had been removed.
Diagnoses and reasons for administering NMBs after the decision to
reorient care are described in 55 infants in the study. In two cases it
was to prevent gasping, in 14 to stop established gasping and in one case
the reason is stated as “to end life”. Futhermore, it was described as
requested by parents in 2 cases. Dr Ward Platt has written a thoughtful
editorial about this retrospective Dutch survey (2). He writes, “In the
UK and perhaps elsewhere I suspect that the administration of such agents
to a baby not already paralysed would be much less likely because it is
more difficult to justify the use of NMBs on the basis of “double effect”.
Because Archives of Diseases in Childhood is the Journal of the United
Kingdom’s RCPCH, we feel it is important to make clear that administration
of NMBs after extubation of a patient is currently illegal. Double effect
might be argued in the event of administering intravenous sedatives. The
used of NMBs after assisted ventilation has been withdrawn has the single
purpose of ending respirations, thus bringing about the patient’s death.
C Piyasena, IA Laing.
Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of
Edinburgh, EH16 4SA
Correspondence to: Dr I A Laing, Neonatal Unit, Simpson Centre for
Reproductive Health, Royal Infirmary of Edinburgh, EH16 4SA
Competing interests: None
REFERENCES
1) Verhaagen AAE, Dorscheidt JHHM, Engels B et al. Analgesics,
sedatives and neuromuscular blockers as part of end-of-life decisions in
Dutch NICUs. Arch Dis Child Fetal Neonatal Ed 2009;94:F434-F438
2) Ward Platt M. End of life care in Holland. Fantoms. Arch Dis Child
Fetal Neonatal Ed 2009;94:F391
I am writing this letter in reference to the article "Rapid
quantitative procalcitonin measurement to diagnose nosocomial infections
in newborn infants" by Jacquot et al. [1] The aim of this study was to
investigate the diagnostic accuracy of procalcitonin in neonatal
nosocomial infections. However, the flawed methodology and the incomplete
reporting preclude a reliable conclusion with respect to the d...
I am writing this letter in reference to the article "Rapid
quantitative procalcitonin measurement to diagnose nosocomial infections
in newborn infants" by Jacquot et al. [1] The aim of this study was to
investigate the diagnostic accuracy of procalcitonin in neonatal
nosocomial infections. However, the flawed methodology and the incomplete
reporting preclude a reliable conclusion with respect to the diagnostic
performance of procalcitonin for ruling out nosocomial sepsis.
With an eye to the study objective, the power calculation should have
been based on the expected sensitivity, specificity, predictive accuracy
and their minimal acceptable lower confidence limit. [2,3]
The authors omitted to report the 95% confidence interval for the
estimates of sensitivity and negative predictive value. This prevents the
reader of appreciating the range within which the true values are likely
to lie [4]. Therefore, I backward calculated the true positive (30), false
positive (15), false negative (0), and true negative (28) test results.
Using a commercial statistical package (Prism 5.0 GraphPad software, San
Diego, CA, USA), the sensitivity (95% CI) can be calculated to be 1
(0.8843 to 1) whereas the accuracy of a negative test is 1 (0.8766 to 1).
As yet, given this (im)precision, procalcitonin cannot be used to
rule out nosocomial infection in the NICU at the moment of suspicion.
References:
1. Jacquot A, Labaune JM, Baum TP, Putet G, Picaud JC. Rapid
quantitative procalcitonin measurement to diagnose nosocomial infections
in newborn infants. Arch Dis Child Fetal Neonatal Ed 2009;94:F345-8.
2. Flahault A, Cadilhac M, Thomas G. Sample size calculation should
be performed for design accuracy in diagnostic test studies. J Clin
Epidemiol 2005;58:859-62.
3. Buderer NM. Statistical methodology: I. Incorporating the
prevalence of disease into the sample size calculation for sensitivity and
specificity. Acad Emerg Med 1996;3:895-900.
4. Harper R, Reeves B. Reporting of precision of estimates for
diagnostic accuracy: a review. BMJ 1999;318:1322-3.
Many procedural interventions remain a burden as they result in pain
or discomfort in neonates. Adequate management of pain necessitates an
integrated approach. Such an approach should also include the use of the
most effective methods to perform a given procedure. [1] We therefore
appreciate the paper on the randomized comparison between binocular
indirect ophthalmoscopy (BIO) and wide-field digit...
Many procedural interventions remain a burden as they result in pain
or discomfort in neonates. Adequate management of pain necessitates an
integrated approach. Such an approach should also include the use of the
most effective methods to perform a given procedure. [1] We therefore
appreciate the paper on the randomized comparison between binocular
indirect ophthalmoscopy (BIO) and wide-field digital retinal imaging
(WFDRI) recently published by Dhaliwal et al. in this journal. [2] Based
on observations collected in 76 infants, the authors concluded that both
techniques resulted in a similar pain response and speculated that the
pain during screening for retinopathy of prematurity was mainly due to the
introduction of the speculum.
We recently also reported on the clinical pain response during BIO and
compared these observations with the outcome variables as described by
Belda et al. [3,4] However, instead of the classic scleral indentation
technique as used by Belda et al. and by Dhaliwal et al., the eyelid was
kept open with a 20 diopter lens (Fabrilens). [5] A blunted clinical
stress response was observed with a faster return to baseline in neonates
in whom the Fabrilens was used since CRIES score returned to pre-
intervention values within 5 minutes while changes in cardiovascular
indicators were less prominent. We therefore confirm the hypothesis
formulated by Dhaliwal et al. that indeed the introduction of the eyelid
speculum results in the pain response.
In addition to the prospective validation of various (non)pharmacological
interventions for procedural pain relief, there is extensive field of
prospective evaluation of various procedural techniques waiting for
neonatal caregivers, nurses and doctors, to generate the data urgently
needed reduce the pain and stress associated with the medical and nursing
care in neonates.
References
1.Allegaert K, Veyckemans F, Tibboel D. Clinical practice: analgesia in
neonates. Eur J Pediatr 2009;168:765-770.
2.Dhaliwal CA, Wright E, McIntosh N, Dhalial K, Fleck BW. Pain in neonates
during screening for retinopathy of prematurity using binocular indirect
ophthalmoscopy and wide-filed digital retinal imaging: a randomised
comparison. Arch Dis Child Fetal Neonatal Ed 2009 (online available)
DOI:10.1136/adc.2009.168971
3.Belda S, Pallas CR, De la Cruz J, Tejada P. Screening for retinopathy of
prematurity: is it painful? Biol Neonate 2004;86:195-200.
4.Allegaert K, Tibboel D. Shouldn’t we reconsider procedural techniques to
prevent neonatal pain? Eur J Pain 2007;11:910-912.
5.Missotten L, Afschrift L. Contact lenses for ophthalmoscopy in children
and premature. Bull Soc Belge Ophthalmol 1975;172:802-804.
Azzopardi et al (1) report the experience of introducing total body
cooling as a standard form of therapy for infants with moderate or severe
perinatal asphyxia. It is notable that this publication includes only one
level 2 neonatal intensive care unit of the 25 units providing data for
the TOBY register (Royal Cornwall Hospital, Truro). The Royal Devon and
Exeter Hospital (also a level 2 unit) has since joined the TOBY...
Azzopardi et al (1) report the experience of introducing total body
cooling as a standard form of therapy for infants with moderate or severe
perinatal asphyxia. It is notable that this publication includes only one
level 2 neonatal intensive care unit of the 25 units providing data for
the TOBY register (Royal Cornwall Hospital, Truro). The Royal Devon and
Exeter Hospital (also a level 2 unit) has since joined the TOBY register
having participated in the TOBY trial. Part of the success in
recruitment to the TOBY trial was due to the trial being rolled out to
many more units in the second phase of the trial (2). The Peninsula
Neonatal Network level 3 unit at Derriford Hospital in Plymouth
participated in this trial as did the two level 2 units in Exeter and
Truro. All the units were very well supported by training days set up at
the units by the TOBY trial investigators.
In the Peninsula Neonatal Network this system of care has continued
and total body cooling is provided at the three units that participated in
the TOBY trial. Since the trial 6 babies have been cooled in Exeter and 9
babies in Truro. The two level 2 units inform the level 3 unit of infants
that are being cooled. We believe that there are significant advantages
providing total body cooling on a locality basis when the skills are there
and the training is continually updated as long as the infant is stable
without evidence of multi-system problems. There is close liaison on these
issues with the level 3 centre. Early treatment is important and this is
best done as soon as possible in the unit in which the infant is born.
There are real benefits to not transferring the infant out to another unit
particularly when the delivery has been traumatic and there may be a
number of questions from parents and vital issues of communication about
obstetric management. These can be addressed quickly and locally in these
high risk situations. Providing thermal control for infants is part of
the everyday management of neonatal units and the level 2 units have had
no difficulty in the technical aspects of providing body cooling. This is
likely to be made easier with the advent of servo controlled cooling. We
all contribute to the TOBY register which provides feedback on our
temperature control and all those providing cooling in the units have
attended and presented at regional and national meetings on total body
cooling.
We believe that there is a strong case to be made for level 2 units
who have experience of cooling to continue to provide this. It is
important to remember that one of the central tenets of the NHS is to
provide appropriate care as close to home as possible for the family. The
case for cooling to be provided in level 2 units rests on the support
structures and a rigorous approach to case review and quality
control/audit both through the TOBY register and by local oversight. The
network approach establishes this by ensuring treatment is supported as a
network provision, not as a unit provision.
Yours sincerely
Dr Michael Quinn
Consultant Neonatal
Paediatrician,
Neonatal Unit,
Royal Devon and Exeter Hospital,
Barrack Rd,
Exeter EX2 5DW
Dr Paul Munyard
Consultant Neonatal
Paediatrician,
Neonatal Unit,
Royal Cornwall Hospital,
Treliske,
Truro TR1 3LJ.
Correspondence to Dr Michael Quinn.
Competing Interests: None
REFERENCES
1. Azzopardi D, Strohm B, Edwards AD, Halliday H, Juszczak E, Levene
M, Thoresen M, Whitelaw A, Brocklehurst P on behalf of the Steering Group
and TOBY Cooling Register participants. Treatment of asphyxiated newborns
with moderate hypothermia in routine clinical practice: how cooling is
managed in the UK outside a clinical trial. Arch Dis Child (Fetal and
Neonatal Edition) 2009; 94 (4):F260-F264
2. Azzopardi D, Strohm B, Edwards AD, Dyet L, Halliday H, Juszczak E,
Kapellou O, Levene M, Marlow N, Porter E, Thoresen M, Whitelaw A,
Brocklehurst P for the TOBY Study Group. Moderate hypothermia to treat
perinatal asphyxial encephalopathy. N Eng J Med 2009; 361 (14): 1349-1358
Dear editor, the article by Keren et al 'Visual assessment of
jaundice in term and late preterm infants' justifies the limitations of
visual assessment of jaundice in newborns. The authors have advised to do
serum bilirubin levels in case of visible jaundice. The problem with total
serum bilirubin level is that it is dependent on the serum albumin level.
Therefore a healthy newborn with a good serum albumin will bind bili...
Dear editor, the article by Keren et al 'Visual assessment of
jaundice in term and late preterm infants' justifies the limitations of
visual assessment of jaundice in newborns. The authors have advised to do
serum bilirubin levels in case of visible jaundice. The problem with total
serum bilirubin level is that it is dependent on the serum albumin level.
Therefore a healthy newborn with a good serum albumin will bind bilirubin
which will appear in the circulation showing a high serum bilirubin level
despite having low levels in the tissues as compared to a preterm or sick
neonate with low albumin levels where despite low serum bilirubin level
due to poor binding to albumin and more tissue bound bilirubin, there is
an increased risk of damage to the tissues including the brain. Also, the
laboratory estimations of bilirubin are quite variable. Till free
bilirubin measurements are available we are forced to use these surrogate
markers of bilirubin which are far from being perfect in predicting the
brain damage.
Dear Sir,
Dr Hawkes is right, if a gas flow meter that will deliver
very high flows when turned
up to its maximum flow, which may be over 80 L/min, is used
with the Neopuff then if
the flow is increased about the set level dangerously high
levels of PIP and PEEP
will be delivered.
What is not commonly known is that some flow meters that are
marked to deliver a
flow from 0 to 15 L/min can deliver these very high flows
whi...
Dear Sir,
Dr Hawkes is right, if a gas flow meter that will deliver
very high flows when turned
up to its maximum flow, which may be over 80 L/min, is used
with the Neopuff then if
the flow is increased about the set level dangerously high
levels of PIP and PEEP
will be delivered.
What is not commonly known is that some flow meters that are
marked to deliver a
flow from 0 to 15 L/min can deliver these very high flows
which will overwhelm the
pressure control valves in the Neopuff. A flow meter should
never be used with the
Neopuff that can deliver a maximum gas flow above 15 L/min.
The practical message for all who use the Neopuff is that it
should be used
according to the manufacturer’s instructions.
• The recommended operating gas flow range is 5 to 15 L/min.
It specifically
says, “Do not attempt to use a flow higher than 15 L/min".
• Adjust the gas supply to the desired flow rate between 5
and 15 L/min then
set the PIP and PEEP.
• If the flow rate increases from 5 to 15L/min, peak
pressure typically increases
approximately 8 cm H2O/mbar.
• The Neopuff should only be used on a baby after checking
that correct
pressures will be delivered to the baby.
If the Neopuff PIP and PEEP are set with a flow of 5 L/min
then if the flow is
increased to 10 L/min the PEEP will rise to about 15 cm H2O
and the PIP will be
similar to, or just above the set PIP even when max PIP is
set very high. If the flow is
increased to 15 L/min the PEEP rises to about 24 cm H2O and
PIP is similar to, or
just above the set PIP even when max PIP is set very high.
The effect of increasing
the flow to 15 L/min will be much less if the PIP and PEEP
were set at a flow of 10
l/min at the start.
The practical clinical messages are simple
1) Pick a flow you are going to use, we suggest 8 L/min
should be more than
adequate, set the PEEP and PIP and then don’t alter the
flow.
2) If the PEEP and PIP are not being delivered this is due
to a large leak
between the mask and face and that should be remedied by
altering mask
position and hold and not by increasing the flow.
Yours sincerely,
Colin Morley, Georg Schmoelzer, Peter Davis
We read with interest Laing’s article on controlling an outbreak of
MRSA in a neonatal unit. We have also learnt from outbreaks on our
neonatal unit. Laing et al talk about cohort nursing for those babies
found to be colonised. In our experience it is important to isolate/cohort
not just those babies that are MRSA colonised, but also to cohort those
babies whom are known contacts, with MRSA swabs repeated weekly. It is
i...
We read with interest Laing’s article on controlling an outbreak of
MRSA in a neonatal unit. We have also learnt from outbreaks on our
neonatal unit. Laing et al talk about cohort nursing for those babies
found to be colonised. In our experience it is important to isolate/cohort
not just those babies that are MRSA colonised, but also to cohort those
babies whom are known contacts, with MRSA swabs repeated weekly. It is
important that both staff and parents realise that a single negative MRSA
screen does not outrule low level colonisation in the baby. For this
reason, we continue to isolate or cohort nurse both MRSA positive babies
and their contacts until discharge from the neonatal unit. We ask that all
staff; including pharmacists and radiographers visit these rooms last when
visiting the neonatal unit. We ensure people maintain scrupulous hand
hygiene practices.
We acknowledge that the treatment of staff is contentious. Laing et
al mention anonymised staff screening. We have used a screen and treat
approach i.e, all staff are screened and immediately started on a
decolonisation protocol. The advantage of this approach is that positive
individuals do not usually have to be subsequently removed from duty.
Good communication is vital during such an outbreak. Regular meetings
briefing neonatal staff and also key individuals in affiliated departments
(e.g. obstetrics and midwifery), supported by circulated minutes ensure
that everyone is receiving the same information. We keep daily cot
position maps detailing where each baby is, so as to see how spread might
have occurred. If the neonatal unit closes, it is important to notify all
other hospitals within the perinatal network to ensure that they know that
they may be receiving a higher workload and will not be able to repatriate
babies back to the affected unit.
Dr Geraldine Ng, Consultant Neonatologist, St Mary’s Hospital,
Imperial College Healthcare NHS Trust, London
Dr Marianne Nolan, Consultant Microbiologist, St Mary’s Hospital,
Imperial College Healthcare NHS Trust, London
References
1. Laing IA, Gibb AP, McCallum A. Controlling an outbreak of MRSA in
the neonatal unit: a steep learning curve. Arch Dis Child 2009;94:F307-310
2. Deurenberg RH, Stobberingh EE. The molecular evolution of hospital
- and community-associated methicillin-resistant Staphylococcus aureus.
Curr Mol Med. 2009;9(2):100-15
We read with interest the article by K Ganesan et al 1 about using
prophylactic oral Nystatin to prevent fungal colonisation and invasive
fungaemia. We strongly support this practice especially in preterm babies
who are on broad spectrum antibiotics.
It is interesting to know if the authors discovered any other
bacterial organisms apart from candida in there routine surveillance
swabs. We in our unit in Royal O...
We read with interest the article by K Ganesan et al 1 about using
prophylactic oral Nystatin to prevent fungal colonisation and invasive
fungaemia. We strongly support this practice especially in preterm babies
who are on broad spectrum antibiotics.
It is interesting to know if the authors discovered any other
bacterial organisms apart from candida in there routine surveillance
swabs. We in our unit in Royal Oldham hospital (large District Hospital 16
neonatal level 2 Cots) not only swab babies but also there
microenvironment, toys and religious items left in incubators and cots. In
a recent random safety study we found 16 items in 10 cots, surveillance
swabs taken form them revealed scanty growth of skin organisms in 7,
scanty to moderate growth of coliforms in 3 and scanty growth of
staphylococci in 1. It is interesting to note that none of these
environmental swabs demonstrated any fungal colonisation. In view of the
above study findings we follow a ‘No soft toys or religious items in
cots/incubators policy’ along with the enforcement of strict hand washing
policy.
Prophylactic nystatin could be the way forward to prevent fungal
colonisation but what about colonisation from other bacterial organisms?.
The age old saying ‘Prevention is better than cure’ stands true in our
fight against infection and hence the need to maintain a clean
microenvironment in the neonatal unit.
We would like to thank Mr Degraeuwe for his interest about our study [1]. He is correct in stating that the confidence intervals are useful in interpreting the diagnostic value of procalcitonin. The sensitivity, specificity, positive and negative predictive values expressed as percentages (95% CI) were respectively 100 (88-100), 65 (54-76), 67 (56- 78) and 100 (88-100) for PCT at the 0.6 ng/mL cut-off value.
Mr...
Sir, Alvarez and colleagues1 report a clinically useful metanalysis on the diagnostic value of subependymal pseudocysts and choroid plexus cysts seen on neonatal cerebral ultrasound. It appears that complex subependymal cysts at the caudothalamic groove may be more important clinically than simple cysts here or in the choroid plexus. Their analysis did not expose two other important conditions causing multiple and/or bila...
Verhagen et al describe the use of analgesics, sedatives and neuromuscular blockers during reorientation of care to compassionate measures in Groningen, the Netherlands (1). The authors draw attention to the fact that in 16% of such events, neuromuscular blockers (NMBs) were used. In cases, NMBs were used to eliminate gasping after the endotracheal tube had been removed. Diagnoses and reasons for administering NMBs afte...
Dear Sir
I am writing this letter in reference to the article "Rapid quantitative procalcitonin measurement to diagnose nosocomial infections in newborn infants" by Jacquot et al. [1] The aim of this study was to investigate the diagnostic accuracy of procalcitonin in neonatal nosocomial infections. However, the flawed methodology and the incomplete reporting preclude a reliable conclusion with respect to the d...
dear editor,
Many procedural interventions remain a burden as they result in pain or discomfort in neonates. Adequate management of pain necessitates an integrated approach. Such an approach should also include the use of the most effective methods to perform a given procedure. [1] We therefore appreciate the paper on the randomized comparison between binocular indirect ophthalmoscopy (BIO) and wide-field digit...
Azzopardi et al (1) report the experience of introducing total body cooling as a standard form of therapy for infants with moderate or severe perinatal asphyxia. It is notable that this publication includes only one level 2 neonatal intensive care unit of the 25 units providing data for the TOBY register (Royal Cornwall Hospital, Truro). The Royal Devon and Exeter Hospital (also a level 2 unit) has since joined the TOBY...
Dear editor, the article by Keren et al 'Visual assessment of jaundice in term and late preterm infants' justifies the limitations of visual assessment of jaundice in newborns. The authors have advised to do serum bilirubin levels in case of visible jaundice. The problem with total serum bilirubin level is that it is dependent on the serum albumin level. Therefore a healthy newborn with a good serum albumin will bind bili...
Dear Sir, Dr Hawkes is right, if a gas flow meter that will deliver very high flows when turned up to its maximum flow, which may be over 80 L/min, is used with the Neopuff then if the flow is increased about the set level dangerously high levels of PIP and PEEP will be delivered. What is not commonly known is that some flow meters that are marked to deliver a flow from 0 to 15 L/min can deliver these very high flows whi...
We read with interest Laing’s article on controlling an outbreak of MRSA in a neonatal unit. We have also learnt from outbreaks on our neonatal unit. Laing et al talk about cohort nursing for those babies found to be colonised. In our experience it is important to isolate/cohort not just those babies that are MRSA colonised, but also to cohort those babies whom are known contacts, with MRSA swabs repeated weekly. It is i...
We read with interest the article by K Ganesan et al 1 about using prophylactic oral Nystatin to prevent fungal colonisation and invasive fungaemia. We strongly support this practice especially in preterm babies who are on broad spectrum antibiotics.
It is interesting to know if the authors discovered any other bacterial organisms apart from candida in there routine surveillance swabs. We in our unit in Royal O...
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