Teford et al(1), have done a remarkable job of recruiting 65% of the original cohort of the Continuous Negative Extra thoracic Pressure (CNEP) study at 9.6-14.9 yrs of age.However their conclusion that there is no long term benefit of CNEP needs to be qualified.
In the original paper benefits were only moderate. There was no improvement in the mortality but a small reduction
in the incidence of BPD...
Teford et al(1), have done a remarkable job of recruiting 65% of the original cohort of the Continuous Negative Extra thoracic Pressure (CNEP) study at 9.6-14.9 yrs of age.However their conclusion that there is no long term benefit of CNEP needs to be qualified.
In the original paper benefits were only moderate. There was no improvement in the mortality but a small reduction
in the incidence of BPD that came down from 32% in control group to 20% in CNEP group(2). Most other parameters were not statistically different. It is well known that patient with BPD have higher respiratory morbidity in terms of reactive airway disease, pneumonia, and brochiolitis(3,4,5). So we can expect the cluster with BPD to have a higher number of respiratory problems later.
In the present follow-up study 65% of patients followed up. It would be important to know how many of the original cases with BPD in earlier study were included in the present follow-up study. It is possible that
selection bias may have included more non BPD cases and under those circumstances the absence of significant difference is not unexpected.
We hope the author can specify if all the cases of BPD in the original study were followed up.
References:
1) K Telford, L Water, H Vyas, B N Manktelow, E S Draper, N Marlow,
Raspiratory outcome in late childhood after neonatal continuous negative
pressure ventilation. Arch Dis Chil Fetal Neonatal Ed 2007;92;F19-F24.
2) Martin P Samuels, Joseph Raine, Theresa Wright, John A. Alexander,
Kate Lockyer, S. Andrew Spencer, David S. Brookfield, Neema Modi, David
Harvey, Carl Bose and David P Southall; Continuous Negative Extrathoracic
Pressure in Neonatal Respiratory Failure; Pediatrics 1996;98;1154-1160
2) Howandi M, Rajah J, Abushrar Z, Parsons H. The severity of
respiratory syncytial virus bronchiolitis in young infants in the
United Arab Emirates, J Trop Pediatr. 2007;53:22-6. Epub 2006 Sep 28
3) Bhandari A, Panitch HB, Pulmonary outcomes in bronchopulmonary
dysplasia. Semin Perinatol. 2006 ;30:219-26.
4) Flamant C, Hallalel F, Nolent P, Chevalier JY, Renolleau S, Severe
respiratory syncytial virus bronchiolitis in children: from short
mechanical ventilation to extracorporeal membrane oxygenation. Eur J
Pediatr. 2005 ;164:93-8. Epub 2004 Nov 25.
Thangaratinam et al(1) should be complimented on the well conducted
systematic review on the accuracy of pulse oximetry in screening for
congenital heart disease (CHD) in asymptomatic neonates. It needs to be
stressed that more than 60% of CHD is actually non-cyanotic and pulse
oximetry would offer little if any assistance in their detection.
Clinical detection of cyanosis is highly clinician dependent...
Thangaratinam et al(1) should be complimented on the well conducted
systematic review on the accuracy of pulse oximetry in screening for
congenital heart disease (CHD) in asymptomatic neonates. It needs to be
stressed that more than 60% of CHD is actually non-cyanotic and pulse
oximetry would offer little if any assistance in their detection.
Clinical detection of cyanosis is highly clinician dependent and mild
cyanosis is likely to be missed by the relatively inexperienced. Routine
pulse oximetry would certainly avoid this risk. Indeed low oxygen
saturations in a well neonate are likely to indicate an underlying
cyanotic heart disease/duct dependent condition. The sensitivity however
will depend on the timing of pulse oximetry. If done too early pulse
oximetry is likely to reveal normal oxygen saturations even in the
presence of cyanotic heart disease because of a patent ductal circulation.
In our hospital pulse oximetry is not a part of routine pre-discharge
neonatal check. It is however an important component of the assessment of
any neonate with a heart murmur. The detection of oxygen saturations of
95% or less in such a neonate is an indication for urgent
echocardiography(2). A review of our practice revealed that in the last one
year the only babies who were noted to have low oxygen saturations(with or
without a murmur) were clinically unwell and symptomatic with signs of
respiratory distress.
Echocardiography confirmed a diagnosis of persistent pulmonary
hypertension in these cases. None of the babies picked up to have a heart
murmur on the post-natal wards were found to have low oxygen saturations.
As per our departmental protocol all neonates with heart murmurs who are
clinically well and have normal pulses, blood pressure, oxygen saturations
(pre and post-ductal) and ECG are discharged home to be followed up in
our cardiac clinic in 8-12 weeks. In the cardiac clinic repeat pulse
oximetry is carried out along with echocardiography. Two of the babies who
had oxygen saturations of 100% at the time of neonatal assessment were
noted to have oxygen saturations below 95% when seen in this clinic at
about 8-10 weeks of age. Both were confirmed to have cyanotic heart
disease (Truncus arteriosus and Tetralogy of Fallot). Clearly pulse
oximetry in the neonatal period had failed to detect these cases. Thus the
sensitivity of pulse oximetry in the early neonatal period appears to be
low even in the presence of a heart murmur. This raises doubts regarding
feasibility of pulse oximetry as a screening tool for cyanotic CHD.
Perhaps as the authors suggest a large well designed study is required to
answer this important question.
References:
1. Thangaratinam S, Daniels J, Ewer AK, Zamora J, Khan KS. Accuracy of
pulse oximetry in screening for congenital heart disease: a systematic
review. Arch Dis Child Fetal Neonatal Ed 2007;92:F176-F180.
2. Johnson R, Holzer R. evaluation of asymptomatic heart murmurs. Current
Paediatrics 2006;15(7): 532-538.
Whilst the authors very rightly consider the impact of birth weight
standards vs estimated fetal weight on the implications in epidemiology of
neonatal mortality and morbidity, the authors fail to acknowledge the
significant influence of regional and country variations in fetal and
birth weights.
The birth weight standard used in this comparison, from the Child
Growth Foundation (1), is ba...
Whilst the authors very rightly consider the impact of birth weight
standards vs estimated fetal weight on the implications in epidemiology of
neonatal mortality and morbidity, the authors fail to acknowledge the
significant influence of regional and country variations in fetal and
birth weights.
The birth weight standard used in this comparison, from the Child
Growth Foundation (1), is based on UK births, whilst the estimated fetal
growth weights standard is based on Scandinavians (2). Scandinavians as
adults are both taller and heavier on average than UK adults. There is
also evidence than birth weights of Scandinavians are also heavier than
the birth weights of UK infants (3). It is therefore logical to assume
that the fetal weights of Scandinavians at some point must begin to
deviate from those of UK fetuses.
The authors show (Figure 1) for the Mersey cohort, that the z-scores
based on the birth weight standard have a more symmetrical distribution
than those based on the estimated fetal weight standard, where a fairly
significant skew to the left is observed. However, such an effect could
also be a natural consequence of the variation in weights between
Scandinavia and the UK.
Yours sincerely
Dr K Hemming
References:
1. London. The Child Growth Foundation, cgflondon@aol.com.
2. Marsal K, Persson PH, Larsen T, et al. Intrauterine growth curves
based on electronically estimated fetal weights. Acta Paediatr 1996; 85:
843-8.
3. K. Hemming, J. L. Hutton, S. V. Glinianaia, S. Jarvis, M. J.
Platt (2006) A comparison of birthweight standards for Europe.
Developmental Medicine and Childhood Neurology - 48:906-912.
Browning Carmo et al’s demonstrated that neonates with duct dependent
congenital heart disease (CHD) treated with low dose prostaglandin E1
(PGE1) may not require mechanical ventilation for safe transport. (1)
The Pediatric Department, University of Padova Neonatal Emergency
Transport Service (NETS) provides about 200 neonatal transports/year in
East-Veneto Region, Italy, with a total population referral...
Browning Carmo et al’s demonstrated that neonates with duct dependent
congenital heart disease (CHD) treated with low dose prostaglandin E1
(PGE1) may not require mechanical ventilation for safe transport. (1)
The Pediatric Department, University of Padova Neonatal Emergency
Transport Service (NETS) provides about 200 neonatal transports/year in
East-Veneto Region, Italy, with a total population referral base of 2,3
million people in a radius of approximately 150 km. In the referral area,
there are approximately 25,700 births/year in 25 units. Tranfers are made
generally by ground ambulance and the average time spent for each
transport is about 185 min (range 60-346). (2)
According to the transport protocol, patients with known or suspected CHD
with ductal dependency or with signs of circulatory or respiratory failure
are suitable to be cared by the dedicated transport team (a neonatologist,
a nurse, and paramedic ambulance personnel). The transport protocol does
not recommend routine intubation for apnea prevention during PGE1
infusion.
During the period 1 Jan 2002-31 Dec 2006, 115 transferred neonates had
cardiovascular problems. Among them, 51 (44%) were treated with PGE1
infusion for CHD (59% cyanogen, 41% left outflow obstruction) and 9
patients (18%) were intubated due to severe hypoxia or acidosis before the
transport team arrival. PGE1 starting dose (25 to 50 ng/kg/min) was higher
than that reported by Browning Carmo et al.1 Among the spontaneous
breathing patients, none required ventilation or emergency intubation and
no adverse events were recorded.
In agreement with Browning Carmo et coll, 1 our data show that for short
distances ground transport, transfer of otherwise stable newborns with CDH
needing PGE1 infusion may be safe without routine mechanical ventilation,
even with higher PGE1 doses.
An improved prenatal diagnosis (only 14% in our population) could help to
prevent haemodynamic instability after birth ensuring earlier and safer
transfer. However, due to the potential deleterious effects of physiologic
derangements in these patients, the presence of personnel with expertise
in neonatal resuscitation is best advisable.(3)
References:
1. Browning Carmo KA, Barr P, West M, et al Transporting newborn infants
with suspected duct dependent congenital heart disease on low-dose
prostaglandin E1 without routine mechanical ventilation. Arch Dis Child
Fetal Neonatal Ed 2007; 92:F117-F119.
2. Trevisanuto D, Doglioni N, Ferrarese P, et al. Neonatal
pneumothorax: comparison between neonatal transfers and inborn infants. J
Perinat Med 2005; 33:449-454.
3. Bu’Lock FA. Transporting babies with known heart disease; who,
what and where. Arch Dis Child Fetal Neonatal Ed 2007;92:F80-F81.
I read with interest the paper by Bizzarro et al. In their case-
control study, for each case with Serratia bacteraemia they have selected
two uninfected controls matched for birth weight and date of birth. The
advantages of individually matching cases and controls on potential
confounding factors is that the sample size required for the study to have
adequate power is much smaller than if there was no...
I read with interest the paper by Bizzarro et al. In their case-
control study, for each case with Serratia bacteraemia they have selected
two uninfected controls matched for birth weight and date of birth. The
advantages of individually matching cases and controls on potential
confounding factors is that the sample size required for the study to have
adequate power is much smaller than if there was no matching.
Unfortunately, in their multivariate analysis, they used a logistic
regression model as if it was a classical unmatched case-control study. In
such a study where cases are individually matched with controls, a
conditional logistic regression model should have been used to preserve
the matching, as the cases and controls are not truly independent but
purposefully individually matched.[1-3] Their meticulous matching efforts
in this important study deserve no less.
References:
1- Breslow NE, Day NE. Statistical Methods in Cancer Research. Volume
I— The design and analysis of case-control studies with complex sampling.
Vol 32 of IARC Scientific Publications, 1980. Lyon: International Agency
for Research on Cancer.
2- Breslow NE. Statistics in epidemiology: the case-control study.
Journal of the American Statistical Society 1996;91: 14–28.
3- Katz MH. Multivariable analysis. A practical guide for cinicians.
1999. Cambridge University Press.
We read with great interest the letter of Anand et al. in this
journal on the use of different modes of analgesia and anaesthesia during
retinal surgery for retinopathy of prematurity (ROP) (1). We fully agree
that the administration of sedation, analgesia and paralysis on the
neonatal ward avoids delay in treatment and eliminates the unnecessary
transfer of neonates before and following surgery (2)....
We read with great interest the letter of Anand et al. in this
journal on the use of different modes of analgesia and anaesthesia during
retinal surgery for retinopathy of prematurity (ROP) (1). We fully agree
that the administration of sedation, analgesia and paralysis on the
neonatal ward avoids delay in treatment and eliminates the unnecessary
transfer of neonates before and following surgery (2).
We would like to point to an additional point not yet considered in the
current analysis, i.e. the potential impact of the type of surgery on
perioperative management and outcome. Cryotherapy and laser
photocoagulation are both effective to prevent visual impairment for
threshold ROP. In contrast, there are almost no reports on non-
ophthalmologic outcome.
We therefore retrospectively evaluated the effect of the surgical
technique on postoperative clinical management and inflammatory response,
based on retrospective analysis of postoperative management of infants who
received cryotherapy (2000-2001) or laser photocoagulation (2001-2005) but
otherwise underwent the same postoperative standardized approach. Duration
of postoperative ventilation, of administration of analgesics and until
regain of full enteral feeding were recorded. CRP values in the first week
after surgery were collected.
Retinal surgery was performed in 35 infants. Sixteen infants were treated
with cryotherapy. 19 received laser photocoagulation. There were no
significant differences in birth weight, gestational age at birth, weight
or postnatal age at surgery between both groups. In contrast, a
significant decrease in duration of postoperative ventilation (hours,
p<0.02) and in duration of intravenous analgesics (hours, p<0.03)
was observed. Finally, the time until regain of full enteral feeding
(hours, p<0.05) was significantly shorter in infants who received laser
photocoagulation (3).
A similar study on the absence of CRP increase following laser treatment
in this journal stimulate us to evaluate the impact of type of surgery
(4). In the same cohort, data on 56 CRP values were available, of whom 31
in infants after cryo-ablation and 25 in infants after laser
photocoagulation. Median CRP level after cryo-ablation was significantly
higher compared to median CRP level after laser photocoagulation (p =
0.02, all Mann-Whitney U test) (5).
We therefore conclude that the use of laser photocoagulation of
threshold retinopathy was associated with a faster postoperative recovery
and a blunted inflammatory response compared to cryo-treated infants. The
differences in surgical technique might therefore further contribute to
the differences in anaesthetic management and postoperative outcome.
References:
1.Anand D, Etuwewe B, Clark D, Yoxall CW. Anaesthesia for treatment
of retinopathy of prematurity. Arch Dis Child Fetal Neonatal Ed
2007;92:154-5.
2.Allegaert K, Van de Velde M, Debeer A, Casteels I, Devlieger H.
Cryotherapy versus laser photocoagulation for threshold retinopathy of
prematurity: impact on short term postoperative management. Bull Belge
Ophthalmol 2006;300:7-10.
3.Allegaert K, Tibboel D. Shouldn’t we reconsider procedural
techniques to prevent neonatal pain ? Eur J Pain 2007 (online available).
4.Daniels JG, Adams GG. Effect of laser photocoagulation for
retinopathy of prematurity on C reactive protein. Arch Dis Child Fetal
Neonatal Ed 2004;89: F470.
5.Allegaert K, Devlieger H, Casteels I. Reduced inflammatory response
after laser photocoagulation compared with cryoablation for threshold
retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 2005; 42:264-6.
Drs Meier and Engstrom raise a number of issues regarding our paper
and its conclusions.
Their first concern is our use of the terms "precision" and "accuracy",
which they claim are incorrect. Although it is true that the term
"precision" can be used to capture repeatability of a measurement (as
Meier and Engstrom have reported themselves), it can be (and has been)
also used in the fashion that we des...
Drs Meier and Engstrom raise a number of issues regarding our paper
and its conclusions.
Their first concern is our use of the terms "precision" and "accuracy",
which they claim are incorrect. Although it is true that the term
"precision" can be used to capture repeatability of a measurement (as
Meier and Engstrom have reported themselves), it can be (and has been)
also used in the fashion that we describe.(1)Meier and Engstrom's
assertion that our definition is incorrect is, therefore, incorrect - it's
just different. The same goes for our definition of accuracy.
It is correct that our results differ from previous studies, including
those of drs Meier and Engstrom. We agree that this may be due to
different measurement conditions. Whilst test weighing may perform
reasonably well under strictly controlled conditions (as Meier and
Engstrom have shown) it is unlikely that such conditions can be
implemented in practice. It is not the performance of the test weighing
under laboratory conditions that is important, it is its performance "in
the field" (i.e., on a busy newborn ward under daily practical
conditions)that counts. As our results clearly show, test weighing is an
unreliable procedure to estimate milk intake under those conditions. This
has been recognized by other eLetter writers.
The scale we used was described carefully, with brand name, type number,
design aim (to weigh infants in single grams) and measurement
characteristics (we reported the repeatability - or precision, if we
follow Meier and Engstrom's definition - of measurements which was
actually VERY good, with an SD of repeated measurements of < 1 g, or
< 0.5%). This should reassure drs Meier and Engstrom's that this scale
was, indeed, designed to measure reliably down to the single gram. The
measurement characteristics of our scale are not inferior to the scales
used by Meier and Engstrom, which, in their words, were "specifically
designed to detect such small differences in weight". The Royal Dutch
Pharmaceutical Society, whose published guidelines we followed, apparently
uses stricter standards for weighing purposes than drs Meier and Engstrom
do. It would be shortsighted to call the American standard "incorrect" -
it's just different.
Although drs Meier and Engstrom correctly raise the point that test
weighing may be reliable under strictly controlled conditions, our results
clearly show that it is not in daily clinical practice. That does not
justify the qualification that our results are "incorrect" or theirs are
correct. They're just different, and complementary. We believe that our
results justify the abandoning of test weighing in daily clinical
practice, and it would appear from the other letters that this view is
endorsed by others.
Zwolle, March 2007
Paul Brand
Reference:
1. Streiner DL, Norman GR. "Precision" and "accuracy": two terms that
are neither. J Clin Epidemiol 2006;59:327-30.
This article links immediate cord clamping (ICC) to childhood mental
retardation (MR).
“NO CONSENSUS EXSISTS ABOUT THE OPTIMAL TIME TO CLAMP THE UMBILICAL
CORD.”
The study shows that ICC generates more anemia than delayed cord
clamping (DCC) – by removing more blood volume than DCC removes. The
amount of placental transfusion (PT) determines a neonate’s blood volume.
ICC causes “hypo...
This article links immediate cord clamping (ICC) to childhood mental
retardation (MR).
“NO CONSENSUS EXSISTS ABOUT THE OPTIMAL TIME TO CLAMP THE UMBILICAL
CORD.”
The study shows that ICC generates more anemia than delayed cord
clamping (DCC) – by removing more blood volume than DCC removes. The
amount of placental transfusion (PT) determines a neonate’s blood volume.
ICC causes “hypotension, hypovolemia and infant anemia” [1] resulting in
“cognitive deficits.” At what time will DCC prevent these injuries?
Physiological Placental transfusion (PPT) is generated by gravity and
/ or by uterine contraction, is regulated by the child’s reflexes, and is
terminated by reflexive closure of the umbilical vessels when the child
has attained a maximal, optimal blood volume. [2] PPT provides enough iron
to prevent infant anemia during the first year of life. [3]
This study (and all others on cord clamping) fails to define the
physiological norm – a cohort of babies 34 – 36 weeks with physiological
cord closure (PCC) – that would have established normal values for
hemoglobin and ferritin at one hour and at ten weeks. PPT (no cord clamp
used) results in a healthy neonate with a normal blood volume. This
ensures optimal function of all vital organs and optimal growth and
development of the brain; ischemic encephalopathy, infant anemia, and MR
are prevented. Physiology is not harmful.
PCC often occurs within 3 to 5 minutes of birth, but some cords will
pulsate for more than 15 minutes. [2] A portion of the DCC group in this
study could have optimal blood volumes. The study is very valuable in
emphasizing the dangers of immediate cord clamping (ICC) – infant anemia
and childhood mental retardation in the western world.
In relation to the above, a large study (Dade Co. Florida, 2000+
children in the WIC program, 1999) correlated IQ in grade school with
infant anemia – Hgb in gms/l. [4]
• For each decrement in hemoglobin, the risk of mental retardation
increased by 1.28
• Children with low birth weights were 2.5 times more likely to be
retarded than children with normal birth weights
• Boys were 2.17 times more likely to be retarded than girls
Iron is given to women, infants and children in the WIC program. ICC
is the only plausible explanation for the above anemia. Anemic preterm
babies are “high risk” for MR. Most autistic children are mentally
retarded; there are many more autistic boys than autistic girls. ICC is
widely practiced. The autism epidemic parallels the ICC and infant anemia
epidemics.
It is high time for the perinatal professions TO CLAMP ALL CORDS AT
THE OPTIMAL TIME – AFTER THE PLACENTA IS DELIVERED. Normal placental
transfusion prevents infant anemia and prevents “cognitive deficits.”
obgmmorley@aol.com
www.autism-end-it-now.org
References:
[1] Linderkamp O. Placental Transfusion: Determinants and Effects. Clinics
in Perinatology, 1982, 9: 559-592
[2] Gunther M. The transfer of blood between the baby and the
placenta in the minutes after birth. Lancet 1957;I:1277-1280.
[3] Wilson, Windle, Howard. Deprivation of Palcental Blood as a
Cause of Iron Deficiency in Infants. American Journal of Childhood
Diseases 1941
[4] Elyse Krieger Hurtado, Angelika Hartl Claussen, and Keith G,
Scott. Early Childhood Anemia and mild or moderate mental retardation. Am.
J. Clin. Nutr. 1999: 69:115-9.
Test weighing of preterm and term infants was a common scene in the
UK paediatric practice in the past. Over the years this has become less
preferred method of determining if the baby is getting sufficient breast
milk or not.
I agree with the authors that this is an accurate procedure if
carried out properly and in controlled conditions but would like to point
out that there is a fine line...
Test weighing of preterm and term infants was a common scene in the
UK paediatric practice in the past. Over the years this has become less
preferred method of determining if the baby is getting sufficient breast
milk or not.
I agree with the authors that this is an accurate procedure if
carried out properly and in controlled conditions but would like to point
out that there is a fine line between accuracy and inaccuracy of this
procedure in general. As has been already mentioned by others the accuracy
depends on the use of good weighing scales preferably electronic and
health care workers trained in weighing babies and infants. More over the
UK practice in the past was to admit the babies to a paediatric ward and
carryout this procedure over twenty four hour period, before and after
each feed. In my experience this procedure also caused anxiety in the
majority of parents. Not surprisingly test weighing went out of fashion.
In the current cost cutting era in the UK NHS, test weighing
procedure cannot be considered a value for money. However, it will
continue to be used in the developing world, accurate or not.
Kenny and Goodman reported on four cases of neonatal arterial
thrombosis presenting as congenital heart disease (1). Arterial thrombosis
is rare in neonates and even more rare in the aorta as it occurs most
frequently in the iliac, femoral and cerebral arteries, mainly secondary
to catheterization of an umbilical artery. Thus, the description of four
cases of “spontaneous” neonatal arterial thrombosis i...
Kenny and Goodman reported on four cases of neonatal arterial
thrombosis presenting as congenital heart disease (1). Arterial thrombosis
is rare in neonates and even more rare in the aorta as it occurs most
frequently in the iliac, femoral and cerebral arteries, mainly secondary
to catheterization of an umbilical artery. Thus, the description of four
cases of “spontaneous” neonatal arterial thrombosis is interesting as is
the discussion on active management. However, we would like to point out
that the aetiology of thrombosis remained unknown in 3 out of 4 cases and
that investigation was mainly limited to thrombophilia screening.Inherited
thrombophilia is actually an important thrombosis risk factor but not the
only one. In 2001
we described a case of congenital aortic arch thrombosis in a female
newborn delivered by cesarean section at 37 weeks of gestation because
ultrasonography revealed fetal cardiomegaly and cardiac hypertrophy and it
was difficult to image the aorta and aortic flow, mimicking a congenital
aortic coarctation (2).The clinical, laboratory, virologic and
anatomopathologic findings and the absence of other causes of aortic
thrombosis,in primis inherited thrombophilia, made it possible to
attribute the case to a severe congenital cytomegalovirus(CMV)infection.
The literature contains many case reports on the role of CMV infection in
vascular thrombosis (3). It is now known that herpesviruses, particularly
CMV, can infect and grow in endothelial cells, altering the
thromboresistant surface of intact vascular endothelium by mechanisms that
directly damage the endothelium and procoagulant activity. CMV is the most
common congenital infection and its prevalence in newborns ranges between
0.2 and 2.2% (4). A wide spectrum of disease severity has been documented:
the majority of infected newborns are asymptomatic but ~15% have
disseminated disease and central nervous system involvement with severe
sequelae. Thus, we believe that CMV infection should be included in the
investigation of neonatal arterial thrombosis, because detection of
congenital CMV infection will allow prompt therapeutic and rehabilitative
strategies to curb subsequent damage.
References:
1. Kenny D, Tsai-Goodman B. Neonatal arterial thrombus mimicking
congenital heart disease. Archives of Disease in Childhood - Fetal and
Neonatal Edition 2007;92:F59-F61.
2. Lanari M, Lazzarotto T, Papa I, Venturi V, Bronzetti G, Guerra B,
Faldella G, Corvaglia L, Picchio FM, Landini MP, Salvioli GP. Neonatal
Aortic Arch Thrombosis as a Result of Congenital Cytomegalovirus
Infection. Pediatrics Vol. 108 No. 6 December 2001, pp. e114.
3. Abgueguen P, Delbos V, Chennebault JM, Payan C, Pichard E.
Vascular thrombosis and acute cytomegalovirus infection in immunocompetent
patients: report of 2 cases and literature review. Clin Infect Dis. 2003
Jun 1;36(11):E134-9.
4. Stagno S. Cytomegalovirus. In: Remington JS, Klein JO, eds.
Infectious Disease of the Fetus and Newborn Infant. 5th ed. Philadelphia,
PA: WB Saunders Co; 2001:389–424.
Dear Editor,
Teford et al(1), have done a remarkable job of recruiting 65% of the original cohort of the Continuous Negative Extra thoracic Pressure (CNEP) study at 9.6-14.9 yrs of age.However their conclusion that there is no long term benefit of CNEP needs to be qualified.
In the original paper benefits were only moderate. There was no improvement in the mortality but a small reduction in the incidence of BPD...
Dear Editor,
Thangaratinam et al(1) should be complimented on the well conducted systematic review on the accuracy of pulse oximetry in screening for congenital heart disease (CHD) in asymptomatic neonates. It needs to be stressed that more than 60% of CHD is actually non-cyanotic and pulse oximetry would offer little if any assistance in their detection. Clinical detection of cyanosis is highly clinician dependent...
Dear Editor,
Whilst the authors very rightly consider the impact of birth weight standards vs estimated fetal weight on the implications in epidemiology of neonatal mortality and morbidity, the authors fail to acknowledge the significant influence of regional and country variations in fetal and birth weights.
The birth weight standard used in this comparison, from the Child Growth Foundation (1), is ba...
Dear Editor,
Browning Carmo et al’s demonstrated that neonates with duct dependent congenital heart disease (CHD) treated with low dose prostaglandin E1 (PGE1) may not require mechanical ventilation for safe transport. (1) The Pediatric Department, University of Padova Neonatal Emergency Transport Service (NETS) provides about 200 neonatal transports/year in East-Veneto Region, Italy, with a total population referral...
Dear Editor,
I read with interest the paper by Bizzarro et al. In their case- control study, for each case with Serratia bacteraemia they have selected two uninfected controls matched for birth weight and date of birth. The advantages of individually matching cases and controls on potential confounding factors is that the sample size required for the study to have adequate power is much smaller than if there was no...
Dear Editor,
We read with great interest the letter of Anand et al. in this journal on the use of different modes of analgesia and anaesthesia during retinal surgery for retinopathy of prematurity (ROP) (1). We fully agree that the administration of sedation, analgesia and paralysis on the neonatal ward avoids delay in treatment and eliminates the unnecessary transfer of neonates before and following surgery (2)....
Dear Editor,
Drs Meier and Engstrom raise a number of issues regarding our paper and its conclusions. Their first concern is our use of the terms "precision" and "accuracy", which they claim are incorrect. Although it is true that the term "precision" can be used to capture repeatability of a measurement (as Meier and Engstrom have reported themselves), it can be (and has been) also used in the fashion that we des...
Dear Editor,
This article links immediate cord clamping (ICC) to childhood mental retardation (MR).
“NO CONSENSUS EXSISTS ABOUT THE OPTIMAL TIME TO CLAMP THE UMBILICAL CORD.”
The study shows that ICC generates more anemia than delayed cord clamping (DCC) – by removing more blood volume than DCC removes. The amount of placental transfusion (PT) determines a neonate’s blood volume. ICC causes “hypo...
Dear Editor,
Test weighing of preterm and term infants was a common scene in the UK paediatric practice in the past. Over the years this has become less preferred method of determining if the baby is getting sufficient breast milk or not.
I agree with the authors that this is an accurate procedure if carried out properly and in controlled conditions but would like to point out that there is a fine line...
Dear Editor,
Kenny and Goodman reported on four cases of neonatal arterial thrombosis presenting as congenital heart disease (1). Arterial thrombosis is rare in neonates and even more rare in the aorta as it occurs most frequently in the iliac, femoral and cerebral arteries, mainly secondary to catheterization of an umbilical artery. Thus, the description of four cases of “spontaneous” neonatal arterial thrombosis i...
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