I read with interest the recommendation of Reece and colleagues
regarding the positioning of long lines in preterm neonates. [1]
In their methods the authors state that they aimed to place the tip of the
line up to 10 mm into the right atrium (upper limb insertions).
Manufacturer and standard text book of neonatology recommend that the line
tip should not be sited in the right atrium as there are potenti...
I read with interest the recommendation of Reece and colleagues
regarding the positioning of long lines in preterm neonates. [1]
In their methods the authors state that they aimed to place the tip of the
line up to 10 mm into the right atrium (upper limb insertions).
Manufacturer and standard text book of neonatology recommend that the line
tip should not be sited in the right atrium as there are potential serious
complications.[2] I am sure the authors are aware of the recent media
attention, and the enquiry into deaths in neonates due to cardiac
complications of long lines. [3]
The authors commented that almost 50% of the line tips could not be
visualised on plain x-ray examination. Some of the currently available
lines with guide wires (27 G CV Single lumen catheter Medex Medical Inc.
Haslingdon, Lancashire UK ) are particularly suited to the needs of
preterm infant. The radio opaque wire enables adequate visualisation on
plain x-ray. I would welcome the authors’ views on the use of these lines.
Although the study did not have the power to study the adverse effects of
contrast used, unless safety of the material is well established it seems
premature to recommend its routine use.
References:
(1) Reece A, Ubhi T, Craig AR, Newell SJ. Positioning long lines: contrast
versus plain radiography. Arch Dis Child Fetal Neonatal Ed 2001; 84: F129-
30
(2) Brain AJ, Roberton NRC, Rennie JM. Textbook of neonatology. London:
Churchill Livingstone 1999:1376
(3)Charter D. Baby heart deaths force inquiry. The Times 2000 Nov 25
We were interested to read the article of Vyas et al (1) on the
incidence of severe retinopathy of prematurity (ROP) in 11 neonatal units
(NUs) from five cities in England in 1994. We have published similar data
from 8 NUs in New South Wales (NSW) Australia in 1993 and 1994.(2)
These data were prospectively collected in the NSW Neonatal Intensive Care
Unit's data collection and is stored and maintai...
We were interested to read the article of Vyas et al (1) on the
incidence of severe retinopathy of prematurity (ROP) in 11 neonatal units
(NUs) from five cities in England in 1994. We have published similar data
from 8 NUs in New South Wales (NSW) Australia in 1993 and 1994.(2)
These data were prospectively collected in the NSW Neonatal Intensive Care
Unit's data collection and is stored and maintained in the NSW Centre for
Perinatal Health Services Research, University of Sydney, NSW.
For infants <_29 weeks="weeks" gestation="gestation" there="there" was="was" no="no" significant="significant" difference="difference" in="in" severe="severe" rop="rop" greater="greater" than="than" or="Stage" _3="_3" between="between" the="the" _5="_5" cities="cities" england="england" and="and" nsw="nsw" australia="australia" table.="table." p="p"/> Table: Incidence of severe ROP in the 5 cities in England and NSW,
Australia.
Gestation
5 cities in England
NSW, Australia
Significance
< 27 weeks
20/95 (21%)*
44/157 (28%)
ns
27-28 weeks
5/162 (2.6%)
15/269 (5.6%)
ns
*= Number with severe ROP/number examined and the percent in
parenthesis.
Unlike Vyas et al (1) we could not find an association between
improved survival and the development of severe ROP. In 6 of the NUs in
our study survival
in infants <_27 weeks="weeks" gestation="gestation" ranged="ranged" from="from" _51.3="_51.3" to="to" _68.8="_68.8" two="two" nus="nus" have="have" been="been" excluded="excluded" this="this" analysis="analysis" as="as" they="they" are="are" childrens="childrens" hospitals="hospitals" and="and" very="very" few="few" small="small" premature="premature" infants.="infants." the="the" percent="percent" with="with" severe="severe" rop="rop" for="for" lowest="lowest" highest="highest" survival="survival" was="was" _15.1="_15.1" _3="_3" _20="_20" _23.8="_23.8" _5="_5" _21="_21" respectively="respectively" while="while" range="range" of="of" in="in" _6="_6" _36.0="_36.0" _9="_9" _25.="_25." infants="infants" _27-28="_27-28" _85.1="_85.1" _96.7="_96.7" _7.1="_7.1" _4="_4" _56="_56" _3.4="_3.4" _2="_2" _58="_58" respectively.="respectively." group="group" _2.01="_2.01" _50="_50" unpublished="unpublished" observations.="observations." we="we" also="also" shown="shown" that="that" despite="despite" an="an" increase="increase" preterm="preterm" following="following" introduction="introduction" surfactant="surfactant" there="there" no="no" significant="significant" impact="impact" on="on" incidence="incidence" or="or" severity="severity" rop.3="rop.3" p="p"/> In infants 29-31 weeks' gestation, 6 of 443 (1.4%)
developed severe ROP and one infant required Cryo/Laser therapy.(2)
This infant was 30 weeks' gestation with a birth weight of 1305 grams. We
therefore agree with Vyas et al (1) that there should be no reduction in
the upper limit of gestation or birth weight for screening for ROP.
David A Todd
Neonatal Unit
The Princess Anne Hospital
Coxford Road
Southampton, Hants, UK
John Kennedy
Ophthalmology Department
Westmead Hospital
Sydney, NSW
Australia
1. Vyas J, Field D, Draper ES, Woodruff G, Fielder AR, Thompson J, Shaw NJ, Clark D, Gregson R, Burke J, Durbin G. Severe retinopathy of prematurity and its association with different rates of survival in infants less than 1251 g birth weight. Arch Dis Child Fetal Neonatal Ed 2000;82:F145-F149.
2. Todd DA, Cassell C, Kennedy J, John E and the NSW Neonatal
Intensive Care Unit's study group. Retinopathy of prematurity in infants
<_32 weeks="weeks" gestation="gestation" at="at" birth="birth" in="in" new="new" south="south" wales="wales" _1993="_1993" and="and" _1994.="_1994." j="j" paediatr="paediatr" child="child" health="health" _199935355-357.="_199935355-357." p="p"/> 3. Kennedy J, Todd DA, Watts J, John E. Retinopathy of prematurity
in infants less than 29 weeks' gestation: 3 1/2 years pre- and
postsurfactant. J Pediatr Ophthalmol Strabismus 1997;34:289-292.
I read with interest the paper by McHaffie [1] et al on the follow up of
bereaved parents after treatment withdrawal from newborns. They comment
how they could find no evidence in the literature to support the
recommendations for timing of follow up given by the Stillbirth and
Neonatal Death Society and how bereavement care is largely an "intuitive
response". I wish to offer the following comments:...
I read with interest the paper by McHaffie [1] et al on the follow up of
bereaved parents after treatment withdrawal from newborns. They comment
how they could find no evidence in the literature to support the
recommendations for timing of follow up given by the Stillbirth and
Neonatal Death Society and how bereavement care is largely an "intuitive
response". I wish to offer the following comments:
In a study by Benfield [2] in 1978 of parental grief following
neonatal death 50 mother/father pairs were asked to schedule a follow up
appointment at the time of their choosing. The average time of this was 40
days (range 11 to 97 days). The same study found no significant
differences in parental grief score if treatment had been withdrawn after
discussion with the parents compared with those parents whose baby had
died on a ventilator.
In a Glasgow study in 1984 [3] the parents of 12 babies who had died
were interviewed at a mean of 6.3 months after death to establish how
death had been handled and what the wishes of bereaved parents were. 10
(83%) wanted a review with a paediatrician and 9 (75%) of the families
suggested 5 weeks after death as optimum timing. All parents wished to
have a discussion on the risk of recurrence and 10 (83%) wanted a
memento. Half of the group would have liked bereavement counselling in
their home. Parents stressed the importance of the postmortem result in
alleviating questioning and guilt.
Asking bereaved parents about their needs is important so that
guidelines for follow up can be made. McHaffie et al are to be
congratulated on their important study.
Madeleine White
Consultant Paediatrician
References
(1) McHaffie H E, Laing I A, Lloyd D J. Follow up care of bereaved
parents after treatment withdrawal from newborns. Arch Dis Child Fetal
Neonatal Ed.2001;
84:F125-128
(2) Benfield D G, Leib S A, Vollman J H. Grief response of parents to
neonatal death and parent participation in deciding care. Pediatrics
1978;62:171-177.
(3) White M P, Reynolds B, Evans T J. Handling of death on special care
nurseries and parental grief. Br Med J 1984;289:167-169.
Long lines are commonplace but putting them in the appropriate place is not so common. The article [1] advocates the use of contrast to position long lines. In a e-letter, Dr Yadav [2] argues against the use of contrast medium until safety is validated. We, at Glan Clwyd Hospital, have found that using the picture archiving and communication system (PACS), line tips are simpler to identify. We use software MedVi...
Long lines are commonplace but putting them in the appropriate place is not so common. The article [1] advocates the use of contrast to position long lines. In a e-letter, Dr Yadav [2] argues against the use of contrast medium until safety is validated. We, at Glan Clwyd Hospital, have found that using the picture archiving and communication system (PACS), line tips are simpler to identify. We use software MedView RV 2.1 in our neonatal unit, which allows for image inversion. Changing a positive image to negative does not offer any additional information but makes it easier to see lines without the use of contrast. This applies for the smaller long lines such as the 27G Medex long line. Filmless radiology is being increasingly implemented [3,4] and visualising long lines adds on to its benefits [4]. We feel that image inversion using a digital system should do away with the debate of contrast versus plain radiography.
Ian Barnard
Consultant Paediatrician
Glan Clwyd Hospital
I Banerjee
Specialist Registrar
Glan Clwyd Hospital
References:
(1) Reece A, Ubhi T, Craig A R, Newell S J. Positioning long lines: contrast versus plain radiography. Arch Dis Child Fetal Neonatal Ed 2001 ; 84:F129-30.
(2) Yadav M. E-letter, Arch Dis Child, May 14, 2001.
(3) Bryan S, Weatherburn G C, Watkins J R, Buxton M J.
The benefits of hospital-wide picture acchiving and communication systems: a survey of clinical user of radiology services. Br J Radiol 1999 May;72(857):469-78.
(4) Strickland NH.PACS ( picture archiving and communication systems ): filmless radiology. Arch Dis Child 2000; 83:82-86.
Dear Editor,
We read the article by Reece et al [1] and followed the subsequent
correspondence with interest. In light of the recent review commissioned
by The Chief Medical Officer for England, physicians must be aware of
potential complications of peripherally inserted central catheters (PICC).[2] While the true incidence of such events will only be known with
prospective data collection, retrospective studies s...
Dear Editor,
We read the article by Reece et al [1] and followed the subsequent
correspondence with interest. In light of the recent review commissioned
by The Chief Medical Officer for England, physicians must be aware of
potential complications of peripherally inserted central catheters (PICC).[2] While the true incidence of such events will only be known with
prospective data collection, retrospective studies suggest a complication
rate (pleural/pericardial effusions) of 0.5% per line insertion.[3] The
Department of Health (DoH) paper in response to this review recommends
placement of central venous lines outwith the cardiac chambers.[4]
However, complications related to central lines are not only confined to
the thorax. We report 3 cases of delayed detection of peritoneal
extravasation related to central venous catheters.
Case 1: An eight-week old malnourished infant was intubated and
ventilated for acute onset severe respiratory distress following a brief
flu-like illness. His endotracheal secretions were positive for RSV and a
previously undetected myopathy was suspected and investigated. He required
prolonged ventilation and received blood transfusions through a triple-lumen right femoral venous catheter for anaemia. On the fifth day after
admission he developed abdominal distension and a diagnostic tap under
ultrasound guidance revealed haemorrhagic ascites. A contrast radiograph
of the femoral catheter showed extravascular spillage of dye, in this case
in the extraperitoneal space. In retrospect, the infant showed no rise in
haemoglobin following 2 packed cell transfusions. Extravascular migration
of the catheter tip was diagnosed and the catheter was promptly removed.
Case 2: A 24-week preterm female infant was admitted to the neonatal
intensive care unit where she was ventilated and treated with surfactant.
Severe respiratory distress of prematurity, patent ductus arteriosus and
sepsis complicated the initial course. The PDA did not respond to 2
courses of indomethacin and surgical ligation was scheduled on day 13 of
life. A PICC was removed due to suspected catheter sepsis and she was
treated with intravenous antibiotics. She had a right femoral venous
central single-lumen catheter through which she received parenteral
nutrition and blood transfusions on the unit. Her anaemia failed to
respond to the three packed cell transfusions and when she developed
abdominal distension with bluish discolouration in the groin, the femoral
line was radiographically reviewed after injecting contrast material.
Extravascular spillage of the dye was noted in the extraperitoneal space
and the subcutaneous tissue of the lower abdominal wall.
Case 3: A – week preterm infant with PICC in the leg developed a skin
abscess at the xyphisternum. Abdominal radiograph with contrast injected
through the catheter, revealed retroperitoneal extravasation of contrast.
The PICC was removed and the infant made a full recovery.
In each of these case reports, femoral catheter tip migration was
detected following extravascular extravasation of blood or parental
nutrition fluid. Haemoperitoneum has been reported in the past as a
complication of central catheters but may not be widely recognised. In
comparison with PICC, these catheters are shorter and more rigid, hence
more likely to perforate through vessel wall. Femoral venous access is
readily obtained in infants and is commonly used in intensive care
settings for parenteral nutrition, maintenance fluids, blood transfusions
and other parenteral therapy. Whilst malpositioning of femoral catheter is
readily detected in most instances during placement, a spontaneous
extravascular migration of a previously well-placed catheter tip is
possible in some cases. As opposed to frank rupture of the blood vessel
and haemorrhage into the retroperitoneum, slow extravascular infusion of
blood in the low resistance extraperitoneal space may not be promptly
detected in the absence of a high index of suspicion. In preterm newborns
and malnourished infants the vessel wall integrity may be compromised and
migration of a previously normally positioned catheter tip may be more
likely. Femoral venous catheter tip positions must be reviewed in all
cases of unexplained ascites and abdominal distension. Contrast
radiography, digitalized image inversion and ultasonography have a role in
determining catheter tip position and diagnosing malpositioned
intravascular catheters.[5]
We agree with the DoH recommendation that there should be a
prospective National Audit of such cases.
References
(1) Reece A, Ubhi T, Craig AR and Newell SJ. Positioning long lines:
contrast versus plain radiography. Arch. Dis. Child 2001; 84: F129-130.
(2) Nadroo AM, Lin J, Green RS, Magid MS, Holzman IR. Death as a
complication of peripherally inserted central catheters in neonates. J.
Pediatr 2001 Apr; 138(4): 599-601.
(3) Keeney SE, Richardson CJ. Extravascular extravasation of fluid as
a complication of central venous lines in the neonate. J Perinatology
1995: 15;No 4, p284-288.
(4) Review of four neonatal deaths due to cardiac tamponade associated
with the presence of a Central Venous Catheter. Recommendations and
Department of Health response.
[http://www.doh.gov.uk/manchesterbabies/manchestersummary/]
(5) Bernard I, Banerjee I. E-letter. Arch. Dis. Child, 14th May 2001.
Authors:
1] Nilesh M Mehta
Specialist Registrar
2] Richard M Nicholl
Consultant Neonatologist, Hon. Senior Clinical Lecturer
Northwick Park Hospital
NorthWest London Hospitals NHS Trust
Harrow HA1 3UJ, UK
I read with interest the article by D Hacking et al.
In their article they stress the significantly increased risk of RDS in the second twin. Our experience presented in the study 'Comparative outcome study between triplet and singleton preterm newborns' [1], differ from their findings. Birth order of the triplets did not influence the incidence or severity of Respiratory distress syndrome(RDS), Tr...
I read with interest the article by D Hacking et al.
In their article they stress the significantly increased risk of RDS in the second twin. Our experience presented in the study 'Comparative outcome study between triplet and singleton preterm newborns' [1], differ from their findings. Birth order of the triplets did not influence the incidence or severity of Respiratory distress syndrome(RDS), Transient tachypnoea of the newborn, Oxygen therapy at 36 weeks corrected age, Continuous positive airway pressure, Intermittent mandatory ventilation and High frequency ventilation and the Apgar score at one and five minutes. Nielson et al [2] found no significant difference in the incidence of RDS between the first and second born twin.
The literature is controversial. Hacking et al found that the risk of RDS is greater for twins above 29 weeks gestation. Our analysis by three gestational age groups, namely >28weeks, 29–30 weeks and 31–34 weeks yielded no differences for the incidence and severity of RDS or any of the other parameters tested. This relationship held true even when the youngest babies (gestational age >28weeks) were analyzed separately.
In conclusion the outcome of the second twin is still controversial in the literature and a prospective multifactorial study is recommended.
References
(1) Comparative outcome study between triplet and singleton preterm newborns. Maayan-Metzger A, Naor N, and Sirota L (in press)
(2) Neonatal outcome of very premature infants from multiple and singleton gestations. Nielsen H C,
Harvey-Wilkes K, MacKinnon B, et al. Am J Obstet Gynecol 1997;177:653-9.
We noted with interest Noar et al's letter of 20th July 2001
describing their as yet unpublished work on outcomes of infants from
multiple gestation pregnancies. We look forward to seeing the data and
methods of analysis on which their conclusions were based.
We discussed Nielsen et al's work in our paper where we noted that
'the sample size and analytical approach may explain discrepancies...
We noted with interest Noar et al's letter of 20th July 2001
describing their as yet unpublished work on outcomes of infants from
multiple gestation pregnancies. We look forward to seeing the data and
methods of analysis on which their conclusions were based.
We discussed Nielsen et al's work in our paper where we noted that
'the sample size and analytical approach may explain discrepancies with
our results'. Nielsen and colleagues investigated 203 infants from
multiple gestations and did not take into account the sibling relationship
between twin pairs, perhaps explaining their inability to find the
significant difference between sibling pairs observed in our series of 602
infants.
Yours sincerely
Doug Hacking
Andrew Watkins
Simon Fraser
Rory Wolfe
Terry Nolan
We were interested to read Embleton et al's study in which they
presented a well researched argument for using foot length as a predictor
of nasotracheal tube length in neonates [1]. While we do not doubt the
accuracy of this method we question some of the
intubation techniques described, particularly in an emergency situation.
It is generally recommended that emergency intubation should be or...
We were interested to read Embleton et al's study in which they
presented a well researched argument for using foot length as a predictor
of nasotracheal tube length in neonates [1]. While we do not doubt the
accuracy of this method we question some of the
intubation techniques described, particularly in an emergency situation.
It is generally recommended that emergency intubation should be oral
because it can be performed more rapidly than nasotracheal intubation and
is more reliable [2]. Once the patients condition is stabilised the
endotracheal tube can be changed electively to one via the nasal route
under direct vision. We note that in this study 13/72 (18%) of infants
could not be successfully intubated nasally and are concerned at the
possible morbidity associated with this failed intubation rate.
Whichever method is used to estimate the length of the endotracheal
tube at the lip or nares the most important check for the intubator to
make is the length of the tube at the cords. This is often forgotten,
particularly by inexperienced personnel, but is a reliable way of ensuring
a tube is neither too long nor too short.
Finally we would argue strongly against pre-cutting endotracheal
tubes to within 0.5cm of estimated length as described as it leaves little
room for error. We note that 9/55 infants intubated nasally in the study
had high endotracheal tube placements on chest radiographs. With tubes cut
so short this means re-intubation and unnecessary instrumentation of the
larynx in 16% of infants.
References
(1) Embleton ND, Deshpande SA, Scott D et al. Foot length, an accurate
predictor of nasotracheal tube length in neonates. Arch Dis Child Fetal
Neonatal Ed 2001;85:F60-F64.
(2) American Heart Association. Pediatric Advanced Life Support. Texas:
American Heart Association, 1997:4-16.
Lee et al compare routine neonatal examinations by SHOs and ANNPs.
They claim that ANNPs were more sensitive and equally specific at
detecting all three conditions examined. The study proves this however
only for hip abnormalities, referred directly by the ANNPs and SHOs for
specialist assessment.
Referrals for eye and heart abnormalities were routed through senior
paediatricians in both hospi...
Lee et al compare routine neonatal examinations by SHOs and ANNPs.
They claim that ANNPs were more sensitive and equally specific at
detecting all three conditions examined. The study proves this however
only for hip abnormalities, referred directly by the ANNPs and SHOs for
specialist assessment.
Referrals for eye and heart abnormalities were routed through senior
paediatricians in both hospitals. The sensitivity and specificity
measured for these conditions therefore reflects those of the senior
paediatricians, not the ANNPs and SHOs. Differences in referral practices
between the paediatricians at the two hospital sites and different rates
of non-attendance from the two hospitals could also have affected the
numbers seen at the specialist clinics, particularly for the smaller arms
of the study, and should have been acknowledged in the report.
The study therefore encourages the role of ANNPs in neonatal checks
but has not yet proved their competence compared to the existing system.
Harding et al state that the problem of hypernatraemic dehydration in
breastfed babies is attributable to: "the reluctance of midwives to weigh
breastfed infants". They imply that weighing between 72 and 96 hours would
be an effective intervention, but provide no evidence to support this
claim.
It does not surprise me that the views of midwives and consultant
neonatologists differ on this point. Whe...
Harding et al state that the problem of hypernatraemic dehydration in
breastfed babies is attributable to: "the reluctance of midwives to weigh
breastfed infants". They imply that weighing between 72 and 96 hours would
be an effective intervention, but provide no evidence to support this
claim.
It does not surprise me that the views of midwives and consultant
neonatologists differ on this point. Whereas midwives in this country
receive specific training in the management of breastfeeding, most
paediatricians do not. Indeed most are (to coin a political aphorism) "one
club golfers" where the assessment of breastfeeding is concerned: weighing
might be one indicator of a baby’s fluid balance but there are other ways
of assessing the adequacy of breastfeeding, including feed observation.
Given these differences in expertise one might reasonably ask which group
of professionals gave the correct answer!
As Harding et al point out "normal weight loss is at its maximum"
between 72-96 hours after birth. In many midwives’ view (and mine) this
constitutes the strongest argument against weighing a baby who has been
observed to feed well. Demonstrating this weight loss frequently
undermines breastfeeding no matter how carefully the physiology of the
phenomenon is explained. Additionally (particularly in primiparous
mothers) lactogenesis is only just becoming established between 48 and 72
hours. Thus the volume of milk transferred to the infant is still rising
sharply between 72 and 96 hours of age.
Before early weighing can be recommended as a screening test for
hypernatraemic dehydration more information is required. Firstly the
precision of weighing in practice and the accuracy of measured differences
need clarification. In relation to this the predictive value of a weight
change on day 3–4 needs to be ascertained. Secondly the comparative
merits of other methods of assessing breastfeeding need more emphasis (the
American Academy of Pediatrics consensus statement cited by the authors
views weighing as only one aspect of the assessment). Thirdly the nature,
effectiveness and cost of resulting interventions need to be considered
(more than "encouragement to continue" may be needed). Finally the
potential adverse consequences of weighing (alluded to above) need to be
set against any diagnostic benefit.
In summary I fully agree that the prevention of hypernatraemic
dehydration is important but am not persuaded that early weighing is the
answer. In my view better training of health professionals, including
paediatricians, in the management of breastfeeding would go further.
Dear Editor,
I read with interest the recommendation of Reece and colleagues regarding the positioning of long lines in preterm neonates. [1] In their methods the authors state that they aimed to place the tip of the line up to 10 mm into the right atrium (upper limb insertions). Manufacturer and standard text book of neonatology recommend that the line tip should not be sited in the right atrium as there are potenti...
Dear Editor,
We were interested to read the article of Vyas et al (1) on the incidence of severe retinopathy of prematurity (ROP) in 11 neonatal units (NUs) from five cities in England in 1994. We have published similar data from 8 NUs in New South Wales (NSW) Australia in 1993 and 1994.(2) These data were prospectively collected in the NSW Neonatal Intensive Care Unit's data collection and is stored and maintai...
Dear Editor,
I read with interest the paper by McHaffie [1] et al on the follow up of bereaved parents after treatment withdrawal from newborns. They comment how they could find no evidence in the literature to support the recommendations for timing of follow up given by the Stillbirth and Neonatal Death Society and how bereavement care is largely an "intuitive response". I wish to offer the following comments:...
Long lines are commonplace but putting them in the appropriate place is not so common. The article [1] advocates the use of contrast to position long lines. In a e-letter, Dr Yadav [2] argues against the use of contrast medium until safety is validated. We, at Glan Clwyd Hospital, have found that using the picture archiving and communication system (PACS), line tips are simpler to identify. We use software MedVi...
Dear Editor, We read the article by Reece et al [1] and followed the subsequent correspondence with interest. In light of the recent review commissioned by The Chief Medical Officer for England, physicians must be aware of potential complications of peripherally inserted central catheters (PICC).[2] While the true incidence of such events will only be known with prospective data collection, retrospective studies s...
I read with interest the article by D Hacking et al.
In their article they stress the significantly increased risk of RDS in the second twin. Our experience presented in the study 'Comparative outcome study between triplet and singleton preterm newborns' [1], differ from their findings. Birth order of the triplets did not influence the incidence or severity of Respiratory distress syndrome(RDS), Tr...
Dear Sir,
We noted with interest Noar et al's letter of 20th July 2001 describing their as yet unpublished work on outcomes of infants from multiple gestation pregnancies. We look forward to seeing the data and methods of analysis on which their conclusions were based.
We discussed Nielsen et al's work in our paper where we noted that 'the sample size and analytical approach may explain discrepancies...
Dear Editor
We were interested to read Embleton et al's study in which they presented a well researched argument for using foot length as a predictor of nasotracheal tube length in neonates [1]. While we do not doubt the accuracy of this method we question some of the intubation techniques described, particularly in an emergency situation.
It is generally recommended that emergency intubation should be or...
Lee et al compare routine neonatal examinations by SHOs and ANNPs. They claim that ANNPs were more sensitive and equally specific at detecting all three conditions examined. The study proves this however only for hip abnormalities, referred directly by the ANNPs and SHOs for specialist assessment.
Referrals for eye and heart abnormalities were routed through senior paediatricians in both hospi...
Harding et al state that the problem of hypernatraemic dehydration in breastfed babies is attributable to: "the reluctance of midwives to weigh breastfed infants". They imply that weighing between 72 and 96 hours would be an effective intervention, but provide no evidence to support this claim.
It does not surprise me that the views of midwives and consultant neonatologists differ on this point. Whe...
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