A recent audit conducted at Newham University Hospital on prolonged
unconjugated jaundice supports the findings of Tyrell et al. in Hillingdon
with regards to delayed screening in newborns [1], and in addition
suggests the need for selected screening tests in babies who are otherwise
well. Reducing the number of tests for initial screening is important for
cost implications and for accurately detecting and treating the com...
A recent audit conducted at Newham University Hospital on prolonged
unconjugated jaundice supports the findings of Tyrell et al. in Hillingdon
with regards to delayed screening in newborns [1], and in addition
suggests the need for selected screening tests in babies who are otherwise
well. Reducing the number of tests for initial screening is important for
cost implications and for accurately detecting and treating the common
causes of prolonged jaundice. The Children’s Liver Disease Foundation
advise only testing split bilirubin in healthy term infants, and if the
conjugated fraction is low then testing total bilirubin weekly until
resolution.[2] Prolonged jaundice is rarely the marker for
haematological, hepatobiliary, metabolic, endocrine, infectious and
genetic disorders.[3] It would therefore seem sensible as first line
testing to include a small number of laboratory tests with the focus on
detecting conjugated hyperbilirubinaemia, hypothyroidism and sepsis. A
larger range of tests could then be performed only if required.
A retrospective audit into screening for prolonged unconjugated
jaundice in very low birthweight infants between November 2006 and
November 2007 indicated that only certain tests would be necessary
initially for detecting many causes of prolonged unconjugated jaundice.
11% (12/107) of very low birthweight infants underwent a prolonged
jaundice screen during this period. Birthweight ranged from 1.2-1.47kg,
and age at the time of the screen ranged from 13-62 days. 18 different
types of tests were ordered totalling 103, and as well as basic blood
tests included urine culture, urine for REDS and G6PD levels. No results
in 2 years were positive for REDS, G6PD or hypothyroidism. Positive
results were for anaemia (1), raised CRP (1) and urine cultures (4). 66%
of urine cultures that were ordered were positive for bacteria. Results
indicate that excluding certain tests would reduce unnecessary testing and
cost and still detect a significant number of positive results appropriate
for first line screening.
Findings from these audits suggest that screening for prolonged
jaundice be delayed for 1 week longer than current practice1. In addition
first line tests in well babies with no abnormal clinical signs should
only include split bilirubin, FBC, CRP, TFT and urine culture. If further
testing is required specialist tests can be directed by clinical findings
and results from the initial screen.
1. Impact for delayed screening for prolonged jaundice in the
newborn.
Tyrell et al. Archives Dis Child Fetal Neonatal Ed 2009;94(2):F154
2. Jaundice Protocol Children’s Liver Disease Foundation March 2005
www.childliverdisease.org
3. N Ratnaval, N Kevin Ives. Investigation of prolonged neonatal
jaundice. Current Paediatrics 2005;13(2):85-91.
In this study it was reported that, the "frequency of apnoea in the
30 seconds after GER (GER-triggered apnoeas) was greater than that
detected in the 30 seconds before (p = 0.01). ..A strong correlation
between total number of apnoeas and the difference between apnoeas
detected 30 seconds after and before GER was found (p = 0.034)"(1).
These data are consistent with both apnoea and GER being caused by an
enrgy...
In this study it was reported that, the "frequency of apnoea in the
30 seconds after GER (GER-triggered apnoeas) was greater than that
detected in the 30 seconds before (p = 0.01). ..A strong correlation
between total number of apnoeas and the difference between apnoeas
detected 30 seconds after and before GER was found (p = 0.034)"(1).
These data are consistent with both apnoea and GER being caused by an
enrgy deficit. The presence of an energy deficit in adults, identified
from the presence of a gastric intramucosal acidosis, is predictive of
weaning failure (2).
1. L Corvaglia, D Zama, S Gualdi, M Ferlini, A Aceti, and G Faldella
Gastro-oesophageal reflux increases the number of apnoeas in very preterm
infants
Arch. Dis. Child. Fetal Neonatal Ed. 2009; 94: F188-F192
2. Mohsenifar; Angela Hay; Jeffrey Hay; Michael I. Lewis; and Spencer
K. Koerner. Gastric Intramural pH as a Predictor of Success or Failure in
Weaning Patients from Mechanical Ventilation Annals of Internal Medicine.
Gastric Intramural pH as a Predictor of Success or Failure in Weaning
Patients from Mechanical Ventilation
We read with interest the case report of Dharmaraj et al. published
in your journal (1). The authors described a full term infant born by an
emergency caesarean section. At birth this newborn had a depressed skull
fracture on the right parietal bone. Neurosurgical elevation of the
fracture was performed at age of 2 weeks after birth. In the discussion
the authors mentioned that reduction by vacuum...
We read with interest the case report of Dharmaraj et al. published
in your journal (1). The authors described a full term infant born by an
emergency caesarean section. At birth this newborn had a depressed skull
fracture on the right parietal bone. Neurosurgical elevation of the
fracture was performed at age of 2 weeks after birth. In the discussion
the authors mentioned that reduction by vacuum extraction (obstetric
vacuum or breast milk extractor) has been described as a possibility of
treatment. In our paper (2) we distinguished two types of congenital
depression of the neonatal skull: deformed skull depression (deformation
without fracture) and fractured skull depression (fracture accompanied by
depression). Clinically it is impossible to differentiate between these
two entities. We used a non-surgical approach (application of obstetric
vacuum extractor on the newborn's skull depression) for the treatment of
skull depression without fracture. There exists some concern regarding the
use of non-surgical methods (especially in the presence of a skull
fracture) due to the possibility of intracranial complications such as
subdural hematoma or the presence of extradural or subdural of clot or
bone fragment (3). In order to exclude this concern we suggest Dharmaraj
et al to recommend a head CT scan prior to the initiation of a non-
surgical treatment. This precaution is essential for selection of cases of
congenital skull depression that are appropriate for a non-surgical
approach.
References
1.Dharmaraj ST, Embleton ND, Jenkins A, Jones G. Depressed skull
fracture in a newborn baby. Arch Dis Child Fetal Neonatal Ed 2009;
94:F137.
2.Ben-Ari J, Merlob P, Hirsch M, Reisner SH. Congenital depression of
the neonatal skull. Eur J Obstet Gynecol Reprod Biol 1986;22:249-55
3.Volpe JJ. Skull fracture. In Neurology of the Newborn, W B Saunders
Comp. Philadelphia, 4th ed, 2001, p 815-7.
Herrman et al demonstrated that patent ductus arteriosus (PDA) closes
spontaneously in most of the cases of a select group of very low birth
weight infants. We did a similar retrospective observational study, at
North Trent Regional Intensive Care Unit (Jessop Wing) in Sheffield, in
infants diagnosed with PDA on echocardiogram, done for the murmur on
routine baby check examination or for other clini...
Herrman et al demonstrated that patent ductus arteriosus (PDA) closes
spontaneously in most of the cases of a select group of very low birth
weight infants. We did a similar retrospective observational study, at
North Trent Regional Intensive Care Unit (Jessop Wing) in Sheffield, in
infants diagnosed with PDA on echocardiogram, done for the murmur on
routine baby check examination or for other clinical indication as per our
unit policy.
184 cardiac echocardiograms were done between Sept 2007 and Sept 2008
by the consultant radiologists. Mean age of echocardiograms was 2.3 days
(Range from 0-17 days). 83 cases were found to have PDA with or without
persistent foramen ovale (PFO), without any other significant pathology.
42 Cases had only PDA while 41 had both PDA and PFO. PDA was categorised
into three categories: small (< 2mm), moderate (2-4mm) and large (>
4mm).
Out of 83 cases, 60 had small PDA, moderate PDA in 21 cases while 2
cases had large PDA. All the infants were followed up in the neonatal
follow up clinic by the consultant neonatologists with special interest
in cardiology. PDA was assigned as closed either by the repeat
echocardiogram in the clinic or in presence of entirely normal cardiac
examination. No infant went into cardiac failure and none of them required
bacterial endocarditis prophylaxis.
In agreement to Hermann et al, our data showed that PDA spontaneously
closed in all cases except 2 cases. One case had congenital rubella and
this infant needed duct ligation surgically. While second case is being
followed up for small PDA but with a strong family history of duct
ligation. In the second very interesting case significant number of the
family members had duct ligation.
Persistent patent ductus arteriosus (PDA) is a common pathology in
the preterm whose traditional treatment has been indomethacin. Recently,
ibuprofen has shown its effectiveness in closing the PDA with less
hemodynamic effects.
I read different various studies on Ibuprofen versus indomethacin in
the treatment of PDA with great interest. Despite this common occurrence,
opinion about the u...
Persistent patent ductus arteriosus (PDA) is a common pathology in
the preterm whose traditional treatment has been indomethacin. Recently,
ibuprofen has shown its effectiveness in closing the PDA with less
hemodynamic effects.
I read different various studies on Ibuprofen versus indomethacin in
the treatment of PDA with great interest. Despite this common occurrence,
opinion about the use of interventions to promote closure of a PDA is
controversial (1). There are no universal guidelines. There is no clear
benefit of one therapy or intervention over other. However, now with more
and more studies evidence is accumulating.
Su et al (2) clearly demonstrated from their study that Ibuprofen is
as effective as indomethacin for the early-targeted PDA treatment in
extremely premature infants, without increasing the incidence of
complications. These results are similar to the metaanalysis from 11
studies by Gimeno Navarro et al (3) where they found that ibuprofen was as
effective as indomethacin in closing PDA. There was no significant
differences were found in the incidence of complications except for less
renal impairment with ibuprofen.
Some studies have raised concerns regarding the incidence of raised
bronchopulmonary dysplasia (BPD) in patients treated with ibuprofen as
compared to indomethacin. However, most of the studies have shown lower
incidence of oliguria (renal complications) in patients treated with
ibuprofen as compared to indomethacin.
In my experience from working in the different neonatal units I have
found ibuprofen equally effective to indomethacin. We have tried to treat
patients with indomethacin if they are few days old and in that case
indomethacin also prevents the intraventricular haemorrhage. If a patient
with haemodynamically significant PDA has been about 2 weeks old or had
other recent medications with renal side effects then ibuprofen may prove
safer.
Now evidence is accumulating that if PDA is not haemodynamically
significant then it may be best to leave untreated. Because of the lack of
evidence of benefit from treatments for closure, and recent data that
suggest that both medical (4) and surgical (5) treatments for the PDA are
associated with poor outcomes, an increasing number of clinicians rarely
treat PDAs, unless haemodynamically significant.
References:
1. Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus
in the premature infant: is it pathologic? Should it be treated? Curr Opin
Pediatr 2004; 16:146–51.
2. Su BH, Lin HC, Chiu HY, Hsieh HY, Chen HH, Tsai YC. Comparison of
ibuprofen and indomethacin for early-targeted treatment of patent ductus
arteriosus in extremely premature infants: a randomised controlled trial.
Archives of Disease in Childhood - Fetal and Neonatal Edition 2008;93:F94-
F99.
3. Gimeno Navarro A, Modesto Alapont V, Morcillo Sopena F, Fernández
Gilino C, Izquierdo Macián I, Gutiérrez Laso A. Ibuprofen versus
indomethacin in the preterm persistent patent ductus arteriosus therapy:
review and meta-analysis. An Pediatr (Barc) 2007; 67(4):309-18.
4. Schmidt B, Roberts RS, Fanaroff A, et al. Indomethacin
prophylaxis, patent ductus arteriosus, and the risk of bronchopulmonary
dysplasia: further analyses from the Trial of Indomethacin Prophylaxis in
Preterms (TIPP). J Pediatr 2006; 148: 730–4.
5. Kabra NS, Schmidt B, Roberts RS, et al. Neurosensory impairment
after surgical closure of patent ductus arteriosus in extremely low birth
weight infants: results from the Trial of Indomethacin Prophylaxis in
Preterms. J Pediatr 2007; 150: 129–34.
Persistent patent ductus arteriosus (PDA) is a common pathology in
the preterm whose traditional treatment has been indomethacin. Recently,
ibuprofen has shown its effectiveness in closing the PDA with less
hemodynamic effects.
I read different various studies on Ibuprofen versus indomethacin in
the treatment of PDA with great interest. Despite this common occurrence,
opinion about the u...
Persistent patent ductus arteriosus (PDA) is a common pathology in
the preterm whose traditional treatment has been indomethacin. Recently,
ibuprofen has shown its effectiveness in closing the PDA with less
hemodynamic effects.
I read different various studies on Ibuprofen versus indomethacin in
the treatment of PDA with great interest. Despite this common occurrence,
opinion about the use of interventions to promote closure of a PDA is
controversial (1). There are no universal guidelines. There is no clear
benefit of one therapy or intervention over other. However, now with more
and more studies evidence is accumulating.
Su et al (2) clearly demonstrated from their study that Ibuprofen is
as effective as indomethacin for the early-targeted PDA treatment in
extremely premature infants, without increasing the incidence of
complications. These results are similar to the metaanalysis from 11
studies by Gimeno Navarro et al (3) where they found that ibuprofen was as
effective as indomethacin in closing PDA. There was no significant
differences were found in the incidence of complications except for less
renal impairment with ibuprofen.
Some studies have raised concerns regarding the incidence of raised
bronchopulmonary dysplasia (BPD) in patients treated with ibuprofen as
compared to indomethacin. However, most of the studies have shown lower
incidence of oliguria (renal complications) in patients treated with
ibuprofen as compared to indomethacin.
In my experience from working in the different neonatal units I have
found ibuprofen equally effective to indomethacin. We have tried to treat
patients with indomethacin if they are few days old and in that case
indomethacin also prevents the intraventricular haemorrhage. If a patient
with haemodynamically significant PDA has been about 2 weeks old or had
other recent medications with renal side effects then ibuprofen may prove
safer.
Now evidence is accumulating that if PDA is not haemodynamically
significant then it may be best to leave untreated. Because of the lack of
evidence of benefit from treatments for closure, and recent data that
suggest that both medical (4) and surgical (5) treatments for the PDA are
associated with poor outcomes, an increasing number of clinicians rarely
treat PDAs, unless haemodynamically significant.
References:
1. Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus
in the premature infant: is it pathologic? Should it be treated? Curr Opin
Pediatr 2004; 16:146–51.
2. Su BH, Lin HC, Chiu HY, Hsieh HY, Chen HH, Tsai YC. Comparison of
ibuprofen and indomethacin for early-targeted treatment of patent ductus
arteriosus in extremely premature infants: a randomised controlled trial.
Archives of Disease in Childhood - Fetal and Neonatal Edition 2008;93:F94-
F99.
3. Gimeno Navarro A, Modesto Alapont V, Morcillo Sopena F, Fernández
Gilino C, Izquierdo Macián I, Gutiérrez Laso A. Ibuprofen versus
indomethacin in the preterm persistent patent ductus arteriosus therapy:
review and meta-analysis. An Pediatr (Barc) 2007; 67(4):309-18.
4. Schmidt B, Roberts RS, Fanaroff A, et al. Indomethacin
prophylaxis, patent ductus arteriosus, and the risk of bronchopulmonary
dysplasia: further analyses from the Trial of Indomethacin Prophylaxis in
Preterms (TIPP). J Pediatr 2006; 148: 730–4.
5. Kabra NS, Schmidt B, Roberts RS, et al. Neurosensory impairment
after surgical closure of patent ductus arteriosus in extremely low birth
weight infants: results from the Trial of Indomethacin Prophylaxis in
Preterms. J Pediatr 2007; 150: 129–34.
I read this article by Bell with keen interest where author has
discussed about the need of blood transfusion in preterm babies. He has
suggested very practical and useful steps to minimise the number of the
blood transfusions in the preterm babies. The threshold for the blood
transfusion in preterm babies varies from centre to centre, within the
United Kingdom.
I read this article by Bell with keen interest where author has
discussed about the need of blood transfusion in preterm babies. He has
suggested very practical and useful steps to minimise the number of the
blood transfusions in the preterm babies. The threshold for the blood
transfusion in preterm babies varies from centre to centre, within the
United Kingdom.
In one of my retrospective analysis study done in a regional tertiary
neonatal intensive care unit at St. Mary’s Hospital, Manchester had shown
that all (100% cases) the preterm babies requiring oxygen were transfused
when the haemoglobin level fell down < 12gm/dl. All these babies were
requiring respiratory support as well. Two of the well thriving babies
well transfused when haemoglobin level fell down < 8gm/dl.
While working in another regional tertiary neonatal intensive care
unit, Jessop Wing in Sheffield, we transfused all the extremely sick
preterm babies (with refractory hypotension, PPHN or requiring 100%
oxygen) when their haemoglobin level fell down < 13 gm/dl. We
transfused the babies if haemoglobin fell down < 12gm/dl and either
they required respiratory support or oxygen requirement was > 40% in
the first week of life. All oxygen dependent babies in the first week or
respiratory support with oxygen after first week get blood transfusion if
haemoglobin level fall < 11gm/dl. A well growing baby will get blood
transfusion if the haemoglobin level will fall < 7gm/dl.
A recent retrospective audit on the blood testing from unit clearly
showed that we do repeat blood tests far often than needed for these
extremely sick and fragile babies. Blood loss by the phlebotomy is one of
the most important reasons for a blood transfusion in small preterm
babies. Care providers for these preterm babies should make their local
guideline to minimise the blood loss by phlebotomy. Judicious individual
care plan should be made before ordering the blood tests.
Other methods as suggested by Bell like delayed cord clamping,
adequate nutrition by introducing total parenteral nutrition at an early
stage and further investigating importance of erythropoietin in preterm
babies can help in minimising the blood transfusion in the preterm babies.
We should stick to the single – donor transfusion programmes to minimise
the complications. In my experience we have been trying to transfuse the
preterm babies from the single donor whenever possible by using small
neonatal blood transfusion packs as suggested by Bell.
Recently Wilkinson et al. proposed a framework for decision making
and clinical practice for the care of infants born at the limits of
viability. (1) They emphasize the importance of using estimates of
outcomes to individualize decision making. Their framework utilizes
gestational age as the primary variable for predicting outcomes, which are
based on data from the EPICure studies.(2, 3) They ack...
Recently Wilkinson et al. proposed a framework for decision making
and clinical practice for the care of infants born at the limits of
viability. (1) They emphasize the importance of using estimates of
outcomes to individualize decision making. Their framework utilizes
gestational age as the primary variable for predicting outcomes, which are
based on data from the EPICure studies.(2, 3) They acknowledge that other
factors may modify outcomes and “should be taken into account when
discussing management with parents”. However, these factors are not
incorporated into the basic framework of decision making. Because some
modifiers may have a profound effect on outcomes, we suggest that they
should be incorporated into estimates used for counseling and decision
making.
Tyson et al. developed a model for predicting outcomes of infants
born between 22 and 25 weeks' gestation that incorporates five factors
(gestational age, gender, birth weight, antenatal corticosteroids, and
single or multiple birth). (4) Using this model, a hypothetical example
illustrates the effect antenatal factors, in addition to gestational age,
may have on outcomes. For example, a 23-week, singleton, female infant
with a birth weight of 550 grams, whose mother received antenatal
corticosteroids has an estimated survival of 33% and survival without
profound impairment of 22%. Likewise, for a 23-week, singleton, male
infant with a birth weight of 450 grams, whose mother did not receive
antenatal corticosteroids these rates are 8% and 4%, respectively.
Survival based on the EPIcure study data, using gestational age alone,
would be approximately 11%. (1)
A predictive model that incorporates major modifiers of outcomes adds
precision to estimates and facilitates decision making. We suggest
development of a framework for decision making, with a structure similar
to that proposed by Wilkinson et al., but based on a predictive model and
not gestational age alone.
References
1. Wilkinson AR, Ahluwalia J, Cole A, Crawford D, Fyle J, Gordon A,
et al. Management of babies born extremely preterm at less than 26 weeks
of gestation: a framework for clinical practice at the time of birth. Arch
Dis Child Fetal Neonatal Ed 2009;94(1):F2-5.
2. Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR. The
EPICure study: outcomes to discharge from hospital for infants born at the
threshold of viability. Pediatrics 2000;106(4):659-71.
3. EPICure PG. Survival and early morbidity of extremely preterm
babies in England: changes since 1995. Arch Dis Child Fetal Neonatal Ed
2008;93 (Suppl 1):A33-4.
4. Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. Intensive care
for extreme prematurity--moving beyond gestational age. N Engl J Med
2008;358(16):1672-81.
We read with interest the article by Tiskumara R et al on the
epidemiology of neonatal infections in Asia.1 This study highlights the
relatively high incidence of neonatal sepsis and the antimicrobial
resistance pattern in this part of the world. However, we have some
reservations with regard to the reported findings of the study, in
particular the incidence of group B streptococcal (GBS) infections.
The authors report...
We read with interest the article by Tiskumara R et al on the
epidemiology of neonatal infections in Asia.1 This study highlights the
relatively high incidence of neonatal sepsis and the antimicrobial
resistance pattern in this part of the world. However, we have some
reservations with regard to the reported findings of the study, in
particular the incidence of group B streptococcal (GBS) infections.
The authors report GBS to be the most common organism causing early onset
sepsis (EOS) in the participating units. This, in our opinion, does not
portray the true picture because:
a. The information from the National Neonatal Perinatal Database
(NNPD) of India, one of the largest databases from Asia that prospectively
collected information regarding all live-births from 16-18 major
hospitals, found the proportion of neonatal sepsis caused by GBS to be
<1.0%. The consistent pattern seen across all 3 phases of data
collection - 1995, 2000 and 2002-2003, also argues against any
‘epidemiological shift’ over the years (Table).2, 3, 4 This information,
available in the public domain, was probably missed by the esteemed
authors.
b. In a recently published review on neonatal sepsis in developing
countries, GBS was found to be responsible for only 0.2, 7.1 and 7.8
percent of sepsis in East Asia, Middle East/Central Asia, and South Asia
respectively (the proportion increased to 13.1% in EOS from all developing
countries but it could have been due to inclusion of centers from Africa
with a relatively high incidence of GBS).5
c. Of the heterogeneity between study sites: GBS was isolated from
only 4 out of 7 centers in the present study; units in Iran, India and
Thailand did not have any episodes of GBS infection. Also, the number of
episodes of EOS was very small (n=47).
Given these facts, the authors’ conclusion that ‘the pattern of
organisms in Asia is similar to that of resource-rich countries’ does not
seem to be appropriate. As the authors themselves point out, the selection
bias (study units being better resourced than others in the region) could
be responsible for these results.
References:
1. Tiskumara R, Fakharee SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud
M, Lee JK, Chow CB, Shenoi A, Halliday R, Isaacs D; Asia-Pacific Neonatal
Infections Study. Neonatal infections in Asia. Arch Dis Child Fetal
Neonatal Ed 2009; 94:F144-8.
2. Neonatal morbidity and mortality: report of the National Neonatal-
Perinatal Database. Indian Pediatr 1997;34:1039-42.
3. National Neonatal Perinatal Database. Report for the year 2002-03.
India: National Neonatology Forum; 2004. Available at:
http://www.newbornwhocc.org/nnpd.htm
4. Deorari AK. For the Investigators of National Neonatal perinatal
Database. Changing pattern of bacteriologic profile in neonatal sepsis
among intramural babies. J Neonatol 2006; 20: 8-15.
5. Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with
sepsis in newborns and young infants in developing countries. Pediatr
Infect Dis J 2009; 28:S10-8.
North Trent regional Neonatal Intensive Care unit (Jessop Wing) is
supported by the tertiary paediatric cardiology in Leeds. Newborn infants
with suspected duct dependent cardiac conditions have to be transferred
out to Leeds or other paediatric cardiology centre for assessment or
further management. We identified 12 babies who were transferred on
prostaglandin E1 (Prostaglandin).
North Trent regional Neonatal Intensive Care unit (Jessop Wing) is
supported by the tertiary paediatric cardiology in Leeds. Newborn infants
with suspected duct dependent cardiac conditions have to be transferred
out to Leeds or other paediatric cardiology centre for assessment or
further management. We identified 12 babies who were transferred on
prostaglandin E1 (Prostaglandin).
Out of 12 cases, 10 were transferred to Leeds while 2 cases had to be
transferred to Liverpool. 53% cases (7 out of 12) were transferred on a
dose of (≤ 10 ng/kg/min while 47% cases required (¡Ý 10 ng/kg/min of
Prostaglandin.
6 out of the 7 infants requiring small dose of Prostaglandin (¡Ü 10
ng/kg/min) were transferred successfully without need of ventilation. They
were self breathing in air. One baby was ventilated before transfer
because of apnoea after starting Prostaglandin. None of the self breathing
infants had apnoea during the transport.
In infants requiring (¡Ý 10 ng/kg/min of Prostaglandin, all required
intubation and ventilation before transfer. 3 out of the 5 cases required
100 ng/kg/min of Prostaglandin to open the duct in collapsed infants or
non-responding cases. In one case, Prostaglandin was started on 100
ng/kg/min while in 2 cases it was started at 10 ng/kg/min but had to be
increased to get the desired response.
In agreement with Browing Carmo et al (1) and Ferrarese P et al (2),
we conclude that most of the babies can be safely transported on small
dose of Prostaglandin (¡Ü 10 ng/kg/min) without any need of intubation and
ventilation. These babies should be accompanied (transported) by the
medical personnel with expertise in neonatal intubation and ventilation.
References:
1. Browning Carmo KA, Barr P, West M, Hopper NW, White JP, Badawi N.
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. Ferrarese P, Marra A, Doglioni N, Zanardo V, Trevisanuto D.
Routine mechanical ventilation for transferred neonates with duct
dependent congenital heart disease. Arch Dis Child Fetal Neonatal Ed
2007; 92:F422.
A recent audit conducted at Newham University Hospital on prolonged unconjugated jaundice supports the findings of Tyrell et al. in Hillingdon with regards to delayed screening in newborns [1], and in addition suggests the need for selected screening tests in babies who are otherwise well. Reducing the number of tests for initial screening is important for cost implications and for accurately detecting and treating the com...
In this study it was reported that, the "frequency of apnoea in the 30 seconds after GER (GER-triggered apnoeas) was greater than that detected in the 30 seconds before (p = 0.01). ..A strong correlation between total number of apnoeas and the difference between apnoeas detected 30 seconds after and before GER was found (p = 0.034)"(1).
These data are consistent with both apnoea and GER being caused by an enrgy...
Dear Editor,
We read with interest the case report of Dharmaraj et al. published in your journal (1). The authors described a full term infant born by an emergency caesarean section. At birth this newborn had a depressed skull fracture on the right parietal bone. Neurosurgical elevation of the fracture was performed at age of 2 weeks after birth. In the discussion the authors mentioned that reduction by vacuum...
Dear Editor,
Herrman et al demonstrated that patent ductus arteriosus (PDA) closes spontaneously in most of the cases of a select group of very low birth weight infants. We did a similar retrospective observational study, at North Trent Regional Intensive Care Unit (Jessop Wing) in Sheffield, in infants diagnosed with PDA on echocardiogram, done for the murmur on routine baby check examination or for other clini...
Dear Editor,
Persistent patent ductus arteriosus (PDA) is a common pathology in the preterm whose traditional treatment has been indomethacin. Recently, ibuprofen has shown its effectiveness in closing the PDA with less hemodynamic effects.
I read different various studies on Ibuprofen versus indomethacin in the treatment of PDA with great interest. Despite this common occurrence, opinion about the u...
Dear Editor,
Persistent patent ductus arteriosus (PDA) is a common pathology in the preterm whose traditional treatment has been indomethacin. Recently, ibuprofen has shown its effectiveness in closing the PDA with less hemodynamic effects.
I read different various studies on Ibuprofen versus indomethacin in the treatment of PDA with great interest. Despite this common occurrence, opinion about the u...
Dear editor,
I read this article by Bell with keen interest where author has discussed about the need of blood transfusion in preterm babies. He has suggested very practical and useful steps to minimise the number of the blood transfusions in the preterm babies. The threshold for the blood transfusion in preterm babies varies from centre to centre, within the United Kingdom.
In one of my retrospective...
Dear Editor,
Recently Wilkinson et al. proposed a framework for decision making and clinical practice for the care of infants born at the limits of viability. (1) They emphasize the importance of using estimates of outcomes to individualize decision making. Their framework utilizes gestational age as the primary variable for predicting outcomes, which are based on data from the EPICure studies.(2, 3) They ack...
We read with interest the article by Tiskumara R et al on the epidemiology of neonatal infections in Asia.1 This study highlights the relatively high incidence of neonatal sepsis and the antimicrobial resistance pattern in this part of the world. However, we have some reservations with regard to the reported findings of the study, in particular the incidence of group B streptococcal (GBS) infections. The authors report...
Dear Editor,
North Trent regional Neonatal Intensive Care unit (Jessop Wing) is supported by the tertiary paediatric cardiology in Leeds. Newborn infants with suspected duct dependent cardiac conditions have to be transferred out to Leeds or other paediatric cardiology centre for assessment or further management. We identified 12 babies who were transferred on prostaglandin E1 (Prostaglandin).
Out of...
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