711 e-Letters

  • Placement of neonatal central venous catheter tips - is the right atrium so dangerous?
    David W Cartwright

    Dear Editor,

    The debate regarding placement of central venous catheter tips in neonates leaves me puzzled. We have been using percutaneously placed central venous catheters in our unit since 1978, with the aim of tip placement to be in the right atrium achieved in approximately 70% of catheters. I have prospectively maintained records of every baby, their diagnoses, managements (including central venous cathete...

    Show More
  • The "holding back" of intensive care.
    Indranil Bagchi

    Dear Editor

    I note with deep interest the article by Dr. Chiswick on the dilemma surrounding the issues of withdrawal of intensive care from a sick newborn infant. I would like to highlight one aspect of 'withdrawal' which I felt was missing in this thought provoking article.

    Although the most common scenario entailing withdrawal of intensive care is either surrounding an 'end of life decision' or 'quality...

    Show More
  • Triggered ventilation in neonates
    Margarita Burmester


    Baumer reports the results of large multi-centre study comparing the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV)1. There appears to be no benefit from PTV compared to IMV in death rate, development of chronic lung disease, pneumothorax rates and cerebral ultrasound abnormality. In addition, because of an increased trend toward a higher pneumothorax rate, Baumer conc...

    Show More
  • Case for ANNPs is now proven!
    Cliona Ni Bhrolchain

    Dear Editor

    I am reassured by Dr Lee et al’s response indicating that the same secondary screeners worked in both hospitals in their study. I am not so convinced that their interpretation of sensitivity is correct but this does not affect their conclusions, as there is no reason to suspect that the secondary screeners acted differently at the two hospitals. With that information I accept that they have indeed prove...

    Show More
  • Re: Need for prospective studies
    W H Ouwehand

    The letter from Dr Mantadakis addresses the important issue of the absence of randomised studies on the clinical effectiveness of the interventions used to prevent the possible severe sequelae of fetal alloimmune thrombocytopenia. Studies in small series are suggestive of some benificial effect of the current interventions like high dose intravenous immunoglobulin to the mother or intrauterine transfusion of HPA compat...

    Show More
  • Suprasternal palpation-a simple method for emergency placement of endotracheal tube in neonates
    Sanjay Patole

    Dear Editor,

    We read the recent article by Embleton et al with interest.[1] We accept their conclusion that foot length is an accurate predictor of nasotracheal tube length in neonates, and is at least as accurate as the conventional weight based estimation. We however wish to point out that palpation of the tip of the endotracheal tube (ETT) in the suprasternal fossa continues to provide the simplest means to ens...

    Show More
  • Use of antenatal steroids
    HD Dellagrammaticas
    Dear Editor

    We read with interest the excellent review by Dr Ng on the fetal and neonatal hypothalamic-pituitary-adrenal axis.(1) Although the issue of antenatal administration of steroids is addressed in a separate section of the paper it is practically restricted to their antenatal use for the prevention of respiratory distress syndrome and other complications of prematurity.

    We would agree that this is the commonest...

    Show More
  • Presentation of sensitivity alone may mislead
    Gabrielle Laing

    Dear Editor

    Lees et al report that advanced nurse practitioners (ANNPs) are significantly more effective than trainee paediatricians in detecting abnormalities on neonatal examination. This is an important finding but the paper raises some methodological and clinical issues.

    The authors report the sensitivity of the examinations. Given the intrinsic trade off between sensitivity and specificity, it would...

    Show More
  • Guidelines for prevention of neonatal Group B Streptococcal infections
    Yim-Yee Chan
    Dear Editor

    The article by Beardsall et al[1] once again raises awareness of this important and as yet unresolved issue for the UK. We would like to make two related points:

    (1) Although the authors have discussed both early and late onset Group B Streptococcus disease, perinatal intervention is effective in preventing only early onset Group B Streptococcus disease.

    (2) A common related scenario...

    Show More
  • 'PTV': should it be patient triggered and patient terminated ventilation?
    Nadarasa Visveshwara
    Dear Editor

    We were surprised at the results of the two studies published in your journal by Baumer[1] and Bersford et al[2]. Our experience with triggered ventilation over 10 years is shown in the table below:

    Complications of prematurity 1991-99

    Show More