Admission Temperature Research Articles

Relationship between admission temperature and risk of cerebral palsy in infants admitted to Special Care Unit in a low resource setting: a retrospective single-center study

Relationship between admission temperature and risk of cerebral palsy in infants admitted to Special Care Unit in a low resource setting: a retrospective single-center study

Admission temperature and neonatal outcomes - single-centre experience in Saudi Arabia

This study aimed to investigate the association between admission hypothermia (AH), neonatal mortality and major neonatal morbidities in preterm infants <33 weeks' gestation. An additional aim of the study was to examine changes in the prevalence of admission hypothermia after the initiation of a thermoregulation quality improvement (QI) project. This is a retrospective cohort study of preterm infants < 33 weeks' gestation born at King AbdulAziz Medical City Riyadh (KAMC-R) between January 2017 to December 2020. Eight-hundred infants were born during the study period. Four hundred and one infants (50.1%) had an admission temperature of <36.5°C and a further 399 (49.9%) had an admission temperature of >36.5°C. The mortality before discharge was 15.7% in infants with AH compared to 4.8% among those with an admission temperature above 36.5°C. This remained statistically significant after adjustments for gestational age and maternal PET status on a multivariate analysis (P=.001, OR 2.7,95%CI 1.5-4.7). The need for mechanical ventilation (P=.005) and incidence of surgical NEC (P=.030) were significantly different between the two temperature groups. Mean (SD) admission temperature increased from 36.3°C to 36.6°C following the thermoregulation intervention program (P <.001). Admission temperature <36°C is associated with higher mortality in the first week (P=.001, OR 3.3,95% CI (1.7-6.6)) and increased incidence of cystic PVL (P=.04, OR 2.1, CI (1.03-4.3)). Preterm infants with AH suffered higher mortality and greater neonatal morbidities.

Very Low Birth Weight Outcomes and Admission Temperature: Does Hyperthermia Matter?

National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the relationships between admission temperature and outcomes in very low birth weight (VLBW) babies in a unit with low rates of hypothermia and a higher rate of hyperthermia. This was an observational study based on routinely collected data including demographics, admission temperature, survival and major morbidity outcomes. Subjects were 1104 consecutive inborn VLBW babies admitted to a Neonatal Intensive Care Unit in United Kingdom between 2010 and 2017. Results: 155 (14%) of babies were hypothermic (&lt;36.5 °C) with only 21 (1.9%) &lt; 36 °C, and 254 (23%) of babies were hyperthermic (&gt;37.5 °C). The rate of major abnormality on cranial ultrasound scan was increased in the hyperthermic babies compared to the normothermic babies (37/239 (15.5%) vs. 54/601 (9%), relative risk (95% CI) 1.723 (1.166 to 2.546), p = 0.006). There was no difference in survival or other major morbidity in the hyperthermic babies compared to the normothermic babies. There was no association between hypothermia and survival or any major morbidity, although this probably reflects the low power of the study given the low rates of significant hypothermia. Higher admission temperature was associated with an increase in the risk of major cranial ultrasound abnormality using multiple logistic regression analysis (p = 0.007) with an increased odds ratio (95% CI) of 1.48 (1.11 to 1.97) for each degree of increase. We conclude that admission hyperthermia is independently associated with an increased risk of preterm brain injury. It is not possible to state whether this is a causative association, or whether the association is a consequence of a shared aetiology of perinatal infection.

Temperature Derangement on Admission is Associated With Mortality in Burn Patients-A Nationwide Analysis and Opportunity for Improvement.

Although single-institution studies have described the relationship between hypothermia, burn severity, and complications, there are no national estimates on how temperature on admission impacts hospital mortality. This study aims to evaluate the relationship between admission temperature and complications on a national scale to expose opportunities for improved outcomes. The US National Trauma Data Bank (NTDB) was analyzed between 2007 and 2018. Mortality was modeled using multivariable logistic regression including burn severity variables (% total burn surface area (TBSA), inhalation injury, emergency department (ED) temperature), demographics, and facility variables. Temperature was parsed into three categories: hypothermia (<36.0°C), euthermia (36.0-37.9°C), and hyperthermia (≥38.0°C). A total of 116,796 burn encounters were included of which 77.9% were euthermic, 20.6% were hypothermic and 1.45% were hyperthermic on admission. For every 1.0C drop in body temperature from 36.0°C, mortality increased by 5%. Both hypothermia and hyperthermia were independently associated with increased odds of mortality when controlling for age, gender, inhalation injury, number of comorbidities, and %TBSA burned (p < .001). All temperatures below 36.0°C were significantly associated with increased odds of mortality. Patients with ED temperatures between 32.5 and 33.5°C had the highest odds of mortality (22.0, 95% CI 15.6-31.0, p < .001). ED hypothermia and hyperthermia are independently associated with mortality even when controlling for known covariates associated with inpatient death. These findings underscore the importance of early warming interventions both at the prehospital stage and upon ED arrival. ED temperature could become a quality metric in benchmarking burn centers to improve mortality.

The effect of placental transfusion on hemodynamics in premature newborns: a randomized controlled trial

Despite of growing evidence of the beneficial effects of placental transfusion techniques, there is no available sufficient data about their effects on vulnerable hemodynamics and myocardium of premature infants. The purpose of this work is to study ventricular functions and hemodynamics after applying different placental transfusion techniques, delayed cord clamping (DCC), cut cord milking (C-UCM), and intact cord milking (I-UCM). Sixty-four infants delivered whether by C-section or vaginal delivery were randomly assigned to undergo C-UCM (20–30 cm), I-UCM (3–4 strippings), and DCC (30–60 s). Functional echocardiography was done on day 1 and day 3 of life for 57 infants. Primary outcome variable was superior vena cava flow measurement in infants having placental transfusion in the first 24 h of life and between 64 and 72 h. Secondary outcomes were other echocardiographic and clinical hemodynamic parameters, and biventricular functions in those infants. Of a total 196 preterm infants ≤ 32 weeks delivered in the study period, from January 2021 to August 2021, 57 infants were eligible and survived till the second examination. They were randomly assigned to the three groups. Neonates randomly assigned to DCC had significantly higher superior vena cava flow and lower right ventricular systolic function in the first 24 h of life. This finding vanished at day 3. Neonates undergone different methods of placental transfusions had similar hemoglobin, admission temperature, and mean blood pressure in the first 24 h of life.Conclusion: Despite their potential benefits, placental transfusions have shown to alter the hemodynamics and adversely affect myocardial function of premature neonates.Trial registration: This trial was registered in the clinical trial gov NCT04811872.What is Known:• Placental transfusion techniques might have benefits regarding prematurity- related morbidities and mortality.What is New:• Placental transfusion might adversely affect the myocardium and alter hemodynamics in premature infants.

Improving the admission temperatures of preterm infants in the neonatal unit

Use of plan-do-study-act cycles to increase the proportion of preterm infants born at <32 weeks’ gestation admitted to a neonatal unit with a body temperature of 36.5–37.4°C.

Rare stroke mechanisms in 4154 consecutive patients: causes, predictors, treatment, and outcomes

BackgroundRare mechanisms of stroke (RMS) in acute ischemic stroke (AIS) have rarely been studied applying a systematic approach. Our aim was to define the frequency, etiologies, predictors, and outcomes of RMS in a consecutive series of AIS.MethodsData from consecutive patients from 2003 to 2016 were derived from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Frequency of subcategories of RMS was calculated. In a case–control design, RMS were compared to strokes of all other mechanisms. Outcome was assessed with 3-month Rankin-shift and 12-month mortality and recurrence rates.ResultsOut of 4154 AISs, 222 (5.3%) were found to have a RMS (42.0% female, median age 66 years). The most frequent RMS etiologies were medical interventions (25.6%), active oncological disease (22.5%), and vasculitis (11.7%). In multivariate analysis, RMS patients were younger, had more preceding and bilateral strokes, and a higher admission temperature. They were associated with less traditional risk factors and more systemic disease (such as AIDS, coagulopathy, and cancer). RMS also had more early ischemic changes on plain CT, less revascularization treatments, and more symptomatic hemorrhagic transformations. They presented significantly higher 3-month disability (Rankin-shift-ORadj 1.74), 12-month recurrence (ORadj 1.99), and mortality rates (ORadj 2.41).ConclusionsRMS occurred in 5.3% of a large population of consecutive AISs and are most frequently related to medical interventions, cancer, and vasculitis. RMS patients have less traditional risk factors but more systemic comorbidities, hemorrhagic transformations, recurrences, and a worse long-term outcome. Identification of RMS has direct implications for early treatment and long-term outcome.

The introduction of a simulated thermoregulation intervention to improve very low birth weight infant initial admission temperatures in a neonatal intensive care unit

Premature infant thermoregulation is a critical, yet challenging, component of neonatal resuscitation. Admission hypothermia is associated with multiple negative outcomes in very low birth weight (VLBW) infants. This study assessed the effect of a thermoregulation-focused simulation intervention on VLBW infant’s initial admission temperatures within a level 4 neonatal intensive care unit. Seven multidisciplinary simulations were run in 2018 involving multiple members of the neonatal resuscitation team and led by neonatal fellows. Admission temperatures, gestational age, birth weight, maternal chorioamnionitis, antenatal steroids, caesarian section rate and need for intubation during the initial resuscitation were compared from 2019, the year following the simulation intervention, to 2017, the year preceding the simulation. Simulation participant data were collected. Admission temperatures in VLBW infants increased from 36.0°C in 2017 to 36.5°C in 2019 following the simulation intervention ( This study demonstrated that the initiation of a thermoregulation simulation intervention has the potential to improve VLBW infant admission temperatures and supports the benefits of simulation-based training.

Admission temperature of very low birth weight infants and outcomes at three years old

The lower body temperature of preterm newborns at admission to neonatal intensive care units (NICUs) is inversely associated with their morbidities and mortalities before discharge. This retrospective cohort study aimed to determine whether admission rectal temperature in very low birth weight infants (VLBWIs) is independently associated with a composite outcome of death or moderate-to-severe neurodevelopmental impairments as defined by a performance developmental quotient of < 70 at three years of age. VLBWIs admitted to the NICU between April 2010 and March 2016 were assesed. Developmental assessment was completed in 216 newborns. Nine and two infants died before and after discharge, respectively. A higher admission temperature was associated with a lower incidence of death or moderate-to-severe neurodevelopmental impairments with adjustment for gestational age, sex, antenatal steroid use, Apgar score, severe intraventricular hemorrhage, and severe bronchopulmonary dysplasia (odds ratio [OR] 0.424; 95% confidence interval [CI] 0.250–0.717; p = 0.001). The admission temperature remained as an independent variable of adverse outcome at three years of age even when the study cohort was limited to surviving infants (OR 0.448; 95% CI 0.259–0.774; p = 0.004). Further studies are needed to assess whether avoiding low body temperature at admission results in better long-term neurodevelopmental outcomes in VLBWIs.

Tubo-ovarian abscesses and the effect of transvaginal ultrasound guided drainage – a retrospective cohort study

Objective:Tubo-ovarian abscesses (TOA) are a serious complication to pelvic inflammatory disease with long-term complications such as infertility and chronic pain. Treatment consists of intravenous antibiotics combined with laparoscopic or transvaginal ultrasound-guided drainage (TVULD), but the evidence regarding optimal treatment are scarce, and evaluation of short- and long-term effects have yielded inconsistent results. Our aim was to evaluate the effect of transvaginal ultrasound-guided drainage with antibiotic treatment on both short- and long-term outcomes for patients admitted with a tubo-ovarian abscess. Methods:All women admitted with a TOA to our department were included from March 2017- May 2020. They were evaluated with a gynecological examination, TVUL, white blood cell count (WBC) and CRP. All received intravenous antibiotics and were evaluated for possible TVULD. All received orally administered antibiotics upon discharge, and follow-up was with a 1-3-month interval until patients were without symptoms or underwent laparoscopic surgery. Results:Forty patients were included, 30 (75%) premenopausal. Mean size of TOA were 6.3 cm (SD 2.3), and 35 (87.5%) patients received both antibiotics and drainage. Eighteen (45%) patients underwent secondary surgery following the TOA, and comparing the surgery vs. non-surgery group, we found that at admission temperature, WBC count at admission, aspirated material in ml and need of more than one drainage predicted undergoing laparoscopy following discharge. However, when performing multivariate analysis comparing the two groups regarding the abovementioned factors as well as age, admission time, antibiotic treatment time and follow-up, we did not find any statistically significant difference (p=0.072). Finally, we found that more than one drainage increased the risk of undergoing laparoscopy (OR 8, CI 1.43-44.92). Conclusion:TVULD combined with antibiotics are a safe and effective treatment for TOAs. We found a trend supporting that patients needing laparoscopy following initial TVULD present with a more severe clinical picture and that different clinical and paraclinical factors could be used as predictors for undergoing secondary laparoscopy. Finally, we saw that patients with more than one drainage, have an increased risk of requiring secondary laparoscopy. These findings and predictors need to be tested and confirmed in larger prospective studies.

A standardized implementation of multicenter quality improvement program of very low birth weight newborns could significantly reduce admission hypothermia and improve outcomes

BackgroundAdmission hypothermia (AH, < 36.5℃) remains a major challenge for global neonatal survival, especially in developing countries. Baseline research shows nearly 89.3% of very low birth weight (VLBW, < 1500 g) infants suffer from AH in China. Therefore, a prospective multicentric quality improvement (QI) initiative to reduce regional AH and improve outcomes among VLBW neonates was implemented.MethodsThe study used a sequential Plan—Do—Study—Act (PDSA) approach. Clinical data were collected prospectively from 5 NICUs within the Sino-Northern Neonatal Network (SNN) in China. The hypothermia prevention bundle came into practice on January 1, 2019. The clinical characteristics and outcomes data in the pre-QI phase (January 1, 2018– December 31, 2018) were compared with that from the post-QI phase (January 1, 2019–December 31, 2020). Clinical characteristics and outcomes data were analyzed.ResultsA total of 750 in-born VLBW infants were enrolled in the study, 270 in the pre-QI period and 480 in the post- QI period, respectively. There were no significant differences in clinical characteristics of infants between these two phases. Compared with pre-QI period, the incidence of AH was decreased significantly after the QI initiative implementation in the post-QI period (95.9% vs. 71.3%, P < 0.01). Incidence of admission moderate-to-severe hypothermia (AMSH, < 36℃) also decreased significantly, manifesting a reduction to 38.5% in the post-QI (68.5% vs 30%, P < 0.01). Average admission temperature improved from after QI (35.5 pm 0.7℃ vs. 36.0 pm 0.6℃, P < 0.01). There was no increase in proportion the number of infants with a temperature of > 37.5 °C or thermal burns between the two groups. The risk ratio of mortality in infants during the post-QI period was significantly lower in the post-QI period as compared to the pre-QI period [adjusted risk ratio (aRR): 0.26, 95% confidence interval (CI): 0.13–0.50]. The risk ratio of late-onset neonatal sepsis (LOS) also significantly lowered in the post-QI period (aRR: 0.66, 95% CI: 0.50–0.87).ConclusionImplementation of multicentric thermoregulatory QI resulted in a significant reduction in AH and AMSH in VLBW neonates with associated reduction in mortality. We gained a lot from the QI, and successfully aroused the attention of perinatal medical staff to neonatal AH. This provided a premise for continuous quality improvement of AH in the future, and might provide a reference for implementation of similar interventions in developing countries.Trial registrationTrial registration number: ChiCTR1900020861. Date of registration: 21 January 2019(21/01/2019). Prospectively registered.

Availability of active therapeutic hypothermia at birth for neonatal hypoxic ischaemic encephalopathy: a UK population study from 2011 to 2018

ObjectiveTherapeutic hypothermia (TH) commenced soon after birth for neonatal hypoxic ischaemic encephalopathy (HIE) improves survival and reduces neurodisability. Availability of active TH at the place of birth (Immediate-TH) in the...

Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants.

AimHypothermia is associated with increased morbidity and mortality in preterm infants. A local audit revealed 60% preterm infants ≤32 weeks gestation and/or very low birth weight (VLBW) infants (<1500 g) had an abnormal body temperature at admission. This study compares thermoregulatory outcomes before and after the implementation of a thermoregulation bundle in the birthing environment.MethodsThis retrospective cohort study reviewed thermoregulatory data for all inborn preterm (≤32 weeks) and/or VLBW infants for a period of 30 months before (Group 1: 1st January 2013 to 30 June 2015) and after changes to thermoregulation practice (Group 2: 1st July 2015 to 31 December 2017). The key practice changes included: improved anticipation and staff preparedness, wrapping infant in a polyethylene sheet, using a polyethylene lined bonnet, using servo‐control mode at birth and during transport.ResultsThere were 282 and 286 infants in group 1 and group 2 respectively, with similar baseline characteristics. A clinically and statistically significant improvement was observed in the proportion of infants with normothermia (33% in group 1 to 60% in group 2, P < 0.0001) including the sub‐group of extremely preterm (<28 weeks gestation) infants (38 to 60%, P = 0.0083). A higher mean admission temperature was observed for group 2 (36.10°C ± 0.78 in group 1 vs 36.52°C ± 0.61 in group 2, P < 0.0001). Moderate hypothermia was reduced by two‐thirds in group 2 (41–12%, P = <0.0001).ConclusionsThe introduction of a thermoregulation bundle improved admission temperature, improved the proportion of normothermia and reduced moderate hypothermia in preterm infants.

Relationship between Admission Temperature and Risk of Cerebral Palsy in Infants Admitted to Special Care Unit in a Low Resource Setting: A Retrospective Single-Center Study.

Background: Deviations from normothermia affect early mortality and morbidity, but the impact on neurodevelopment of the survivors is unclear. We aimed to investigate the relationship between neonatal temperature at admission and the risk of cerebral palsy (CP) at one month of age in a low-resource setting. Methods: This retrospective study included all inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) between 1 January 2019 and 31 December 2020. The neurological examination at one month of age was performed using the Hammersmith method. The relationship between the admission temperature and the risk of CP was investigated using logistic regression models, with temperature modeled as the non-linear term. Results: High/moderate risk of CP was found in 40/119 (33.6%) of the neonates at one month of age. A non-linear relationship between the admission temperature and moderate/high risk of CP at one month of age was found. The lowest probability of moderate/high risk of CP was estimated at admission temperatures of between 35 and 36 °C, with increasing probability when departing from such temperatures. Conclusions: In a low-resource setting, we found a U-shaped relationship between the admission temperature and the risk of CP at one month of life. Expanding the analysis of the follow-up data to 12–24 months of age would be desirable in order to confirm and strengthen such findings.

A Conceptual 3-D Design of a Non-Destructive Two-Layer Quasi-Force-Free Magnet for Megagauss Field Generation

On the basis of prior research, a conceptual three-dimensional (3-D) configuration of a non-destructive two-layer magnet capable of generating megagauss-level magnetic field was developed. The design is based on the concept of quasi-force-free coils, in which conductors have a special shape tailored to minimize mechanical stresses caused by electromagnetic forces. Multivariate multi-physical finite element simulations were used as the main tool for developing the presented configuration. The magnetic system was analyzed for its ability to withstand Lorentz forces, and calculations demonstrate that the design ensures maximum stresses in the windings significantly less than the magnetic pressure of the generated field. That reveals a possibility of achieving a megagauss field in the system, provided that certain requirements are met for the used materials. Such requirements were formulated and are realistic (e.g., ultimate strength about 1 GPa for the conductors). Estimation of the possible pulse duration limited by the admissible temperature of the conductors allowed us to perform a transient electromagnetic analysis. Results highlight the importance of mitigating the skin effect in the system, and possible ways for that are proposed. The energy of the magnetic field in the proposed system is estimated to be about 1 MJ, which is significantly less than the energy in magnets of more conventional configurations with similar bore diameters.

Choice of gas temperature at the turbopump turbine inlet

The article considers some issues of choosing the gas temperature at the inlet of a liquid rocket engine turbopump turbine. The turbine is one of the key elements of the engine and its operability depends on the gas temperature. In addition, the turbine inlet gas temperature determines its power and main parameters of the engine chamber pressure and thrust. The higher turbine inlet gas temperature, the higher the chamber pressure and the better engine performance. The permissible temperature of the turbine structure is determined by the required safety margins and durability of the turbine rotor blades. For expendable engines, the safety margin is determined by the material short-term strength at maximum gas temperature. For reusable engines with a long service life, the safety factor is determined by the material long-term strength. The article presents the main factors affecting the choice of the generator gas temperature. It shows that one of the main factors is the non-uniformity of the temperature field at the turbine inlet. The choice of maximum admissible temperature is determined not so much by the engine schematic with the afterburning of oxidizing or reducing generator gas, but by the strength and durability of the structure with account of the influence of temperature factors.

Decreased moderate admission hypothermia in extremely preterm newborns.

Admission temperature is inversely correlated with mortality and morbidity risk in extremely preterm newborns (EPNs). As almost all EPNs require advanced resuscitation at birth, we improved a simple and comprehensive management protocol to reduce admission hypothermia. This study reports the changes over the past 15 years in the rate of admission hypothermia in all EPNs. It clarified the distribution of admission temperature and the risk factors for developing admission hypothermia in recent EPNs. This single-center study retrospectively analyzed the EPNs delivered at our institution between January 2006 and December 2020. The comprehensive management protocol, including warming equipment, plastic wrapping, aluminum-polyethylene sheet, and room temperature, was applied to avoid heat loss during resuscitation. On admission, the rectal temperature was measured and defined as moderate (32.0-35.9 °C) or mild (36.0-36.4 °C) hypothermia. Overall (n = 432), the rate of admission with moderate hypothermia decreased from 48% in 2006 to 8% in 2020. In the recent evaluation of 80 EPNs delivered in 2017-2020, 10 (13%) and 26 (33%) had moderate and mild hypothermia on admission, respectively. Extremely preterm newborns with moderate-to-mild hypothermia had a significantly smaller gestational age and lower birthweight than those without hypothermia. No significant differences in the other perinatal and environmental risk factors were observed between EPNs with and without hypothermia. Our comprehensive management protocol reduced the rate of moderate hypothermia on admission in EPNs to only 13%. However, eliminating mild hypothermia remains a challenge and requires continuous improvement, especially in smaller EPNs.

Predicting the Severity of Acute Appendicitis of Young Children (

Objective: There is a lack of assessment methods of acute appendicitis in little children. The purpose of this study was to develop and internally validate a nomogram for predicting the severity of acute appendicitis of young children (<3 years old).Methods: We develop a prediction model based on a training dataset of 121 patients (<3 years old) with acute appendicitis. Admission information was collected between January 2010 and January 2021, which contained demographic characteristic, laboratory examinations, treatment and pathology type, etc. Logistic regression analysis was used to identify independent risk factors and establish the predictive model. C-index and calibration curves were applied to evaluate the performance of the nomogram. Then corrected C-index was calculated to conduct internal verification by using the bootstrapping validation. Decision curve analysis determined clinical application of the prediction model.Results: Predictors contained in the prediction nomogram included weight for age, onset time (from developing symptoms to hospital), admission temperature, leukocyte count, neutrophil ratio, and total bilirubin. Logistic regression analysis showed that weight for age (X1) < -2.32 SD (P = 0.046), onset time (X2) > 2.5 days (P = 0.044), admission temperature (X3) > 38.5°C (P = 0.009), leukocyte count (X4) > 12.185*109/L (P = 0.045), neutrophil ratio (X5) > 68.7% (P = 0.029), and total bilirubin (X6) > 9.05 μmol/L (P = 0.035) were found to be significant for predicting the severity of appendicitis. The logistic regression equation was logit (P) = −0.149X1 + 0.51X2 + 1.734X3 + 0.238X4 + 0.061X5 + 0.098X6 – 75.229. C-index of nomogram was calculated at 0.8948 (95% Cl: 0.8332–0.9567) and it still was 0.8867 through bootstrapping validation. Decision curve analysis showed that when the threshold probability ranged from 14 to 88%, there is a net benefit of using this prediction model for severity of appendicitis in little children.Conclusion: This novel nomogram incorporating the weight for age, onset time, admission temperature, leukocyte count, neutrophil ratio, and total bilirubin could be conveniently used to estimate the severity of appendicitis of young children <3 years old) and determine appropriate treatment options in time.

Predictors of fever response in tuberculous meningitis: A clinical, MRI and biomarker study.

Central nervous system (CNS) has a different immune surveillance system; therefore, fever at admission and timeline of fever response after antitubercular treatment (ATT) may follow a different course in CNS infection. We report the predictors of fever response in tuberculous meningitis (TBM) including the effect of tumour necrosis factor-α (TNF-α) in cerebrospinal fluid (CSF) and its gene expression at mRNA of peripheral blood mononuclear cells (PBMCs). Fifty-seven patients with TBM were prospectively evaluated. Their clinical findings and severity of meningitis were recorded. The expression of TNF-α gene in PBMCs was quantified by real-time polymerase chain reaction and TNF-α concentration in CSF by cytokine bead array both in the patients and 14 matched controls. All the patients had history of fever for a median duration of 75days. The admission temperature ranged between 37.2°C and 40°C and correlated with CSF cell counts (p<0.05). Cranial MRI was abnormal in 54 (94.7%) and revealed exudates in 33(57.9%), hydrocephalus in 27(47.4%), infarction in 27(47.4%) and tuberculoma in 33(57.9%) patients. Fever subsided after a median duration of 18 (2 60)days of treatment. Twelve (21.8%) patients only became afebrile within 10days. The expression of TNF-α gene correlated with CSF concentration of TNF-α (p=0.02) and independently predicted duration of defervescence [adjusted hazard ratio 1.02 (95% CI 1.00-1.04; p=0.01). In the patients with TBM, defervescence takes longer time, and TNF-α gene expression predicts the duration of defervescence. Future studies are needed to evaluate the role of TNF-α-modifying drugs in TBM.

Introduction of 24 h Resident Consultant Cover in a Tertiary Neonatal Unit-Impact on Mortality and Clinical Outcomes.

Background: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Methods: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010–2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant). Results: In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6–4.3) h] compared to the resident period [0.5 (0.3–1.5) h, p < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, p = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, p = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted p < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation. Conclusions: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.