Care Of Newborn Infants Research Articles

Neonatal Mortality and Morbidity in Regional Provincial Hospitals in the People's Democratic Republic of Laos.

The aim of this study was to identify the causes and incidences of neonatal diseases and deaths in five provincial hospitals in People's Democratic Republic of Laos retrospectively for the years 2010-12. Data of neonatal patients were collected before a 3-year-training program for medical and nursing staff involved in the care of newborn infants in the provincial and associated district hospitals. In the years 2010-12, a total of 1673 neonatal patients were treated in the provincial hospitals. The reasons of treatment were as follows: 48% infections, 17% complications of prematurity, 14% intrapartum-related complications and 9% other, not categorized diseases. The average mortality rate in all hospitals was 6.5%. The main causes of death were complications because of prematurity, infectious diseases and asphyxia. These data could be the basis for any teaching program aimed at reducing neonatal mortality. Furthermore, they enable an evaluation of the ongoing teaching program.

Valoración de las madres acerca de las recomendaciones para el cuidado del recién nacido al momento del alta hospitalaria

It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.

Maternal assessment of recommendations on the newborn infant care upon hospital discharge.

It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.

IS-027 Family Needs In The Nicu

Especially parents of former preterm infants know exactly what it means to get a preterm baby. The pregnancy can end before the pregnant woman has had a belly or even felt the movements of the baby. Many couples did not yet decide on the baby’s name when it is born. Psychologists often speak about a stolen pregnancy and a stolen normal delivery. Everything turns upside-down from one day to the other, the feelings are extremely mixed and ambiguous; and not all hospitals have psychologists specialised to look after preterm parents. Silke Mader, Co-founder and chairwoman of the European Foundation for the Care of Newborn Infants knows from her own experiences that a family needs much more than medical care and support – the entire family needs to be in the centre of interest. Parents need to be empowered in their parental role from their first day in the NICU. The most important point from the beginning is communication with parents in a respectful and understandable way, accepting their autonomy, helping them with education and guidance to find their parental role. For sure, not all parents are easy to handle, but these parents are in a traumatic situation and some of them stay in the unit for months. Family centred care also means to provide support and help for the many times neglected needs of the siblings. Preterm birth has many side effects and often traumatises the whole family.

Prospective evaluation of three point of care devices for glycemia measurement in a neonatal intensive care unit

Hypoglycemia, if recurrent, may have severe consequences on cognitive and psychomotor development of neonates. Therefore, screening for hypoglycemia is a daily routine in every facility taking care of newborn infants. Point-of-care-testing (POCT) devices are interesting for neonatal use, as their handling is easy, measurements can be performed at bedside, demanded blood volume is small and results are readily available. However, such whole blood measurements are challenged by a wide variation of hematocrit in neonates and a spectrum of normal glucose concentration at the lower end of the test range. We conducted a prospective trial to check precision and accuracy of the best suitable POCT device for neonatal use from three leading companies in Europe. Of the three devices tested (Precision Xceed, Abbott; Elite XL, Bayer; Aviva Nano, Roche), Aviva Nano exhibited the best precision. None completely fulfilled the ISO-accuracy-criteria 15197: 2003 or 2011. Aviva Nano fulfilled these criteria in 92% of cases while the others were <87%. Precision Xceed reached the 95% limit of the 2003 ISO-criteria for values ≤4.2mmol/L, but not for the higher range (71%).Although validated for adults, new POCT devices need to be specifically evaluated on newborn infants before adopting their routine use in neonatology.

Arrhythmia Associated With Tetracaine in an Extremely Low Birth Weight Premature Infant

Infants in NICUs undergo a variety of painful procedures. The management of pain has become an integral part of newborn infant care with the use of both systemic and topical agents to provide analgesia and anesthesia for procedural pain. Tetracaine and prilocaine-lidocaine are the 2 topical anesthetics most frequently used. Tetracaine belongs to an ester group of local anesthetics available as a topical 4% gel (Ametop, Smith and Nephew, Canada). The major side effects reported when using topical anesthetics are cutaneous reactions. There are no definite reports of systemic toxicity in the published literature. We present a recent case of an extremely low birth weight premature infant who developed a clinically significant arrhythmia after topical tetracaine was applied before the insertion of a peripherally inserted central catheter. The infant had no other identifiable cause for the resulting bradycardia that occurred only after Ametop was applied. The cardiac symptoms resolved with treatment. This case highlights a significant potential adverse event when using topical tetracaine.

Factores de riesgo asociados a deterioro clínico en el traslado de recién nacidos enfermos

Adequate neonatal transport is a key component in the care of newborn infants that require transfer. Objective. To determine the characteristics and risk of clinical deterioration during neonatal transport. Material and Methods. This was an observational and prospective study that consecutively included newborn infants transferred to the Neonatal Intensive Care Unit (NICU) of the Hospital Garrahan. The TRIPS (Transport Risk Index of Physiology Stability) risk score was measured pre- and post-transport. A diagnosis of clinical deterioration was made when the post-transport TRIPS score was higher than the pre-transport score. Newborns characteristics, transport distance, newborns status upon admission, need for immediate cardiorespiratory support (ICRS), and death before the 7th day and at discharge were recorded. Bivariate and multivariate analyses were used to assess the associations with clinical deterioration . Results. A total of 160 transferred newborn infants were enrolled, gestational age (GA) was 35 ± 3 weeks; birth weight (BW) 2482 ± 904 g and median age 2 days. Most were referred due to cardiorespiratory (50%) or surgical (34%) illnesses. Of them, 91 (57%) had clinical deterioration and 46% hypothermia. Forty nine neonates required ICRS and 28 died (twelve before 7 days after admittance). Variables assessed were not associated with the risk of clinical deterioration. Mortality was higher in the group with clinical deterioration (OR: 3.34; 95% CI: 1.2-8.7), even when severity of the clinical picture was considered (OR A: 3; 95% CI: 1.2-8.3). Clinical deterioration during transport was associated with the need for ICRS (OR: 2.4; 95% CI: 1.2-5). Conclusions. In our experience transferred newborn infants often suffered loss of stability or clinical deterioration, regardless of their characteristics, and this was related to a higher mortality. Therefore, it is critical to optimize care strategies during all neonatal transports.

Evidence‐based neonatology – today and tomorrow

In June 2011, nearly 200 delegates from over 30 countries were gathered in Stockholm, Sweden, for the first ever evidence-based neonatology conference (EBNEO) (see Fig. 1). Three days were filled with interactive lectures and discussions. Given all good feedback from speakers and delegates, the organizers have already decided to arrange a second EBNEO, which will take place in Egypt in March 2013. –Neonatal medicine has experienced a remarkable development through research. But, it may be difficult to translate this knowledge into clinical guidelines. Our mission with the conference was to facilitate the dissemination of evidence-based neonatal medicine, and to create a platform for communication between leading experts and neonatal staff. The overall vision is that care of newborn infants should be based on the best available evidence and that all newborn babies should have the same right to the best care no matter where they are born, says Stefan Johansson, Titus Schlinzig and Mikael Norman from the EBNEO organizing committee. –The target audience was staff working in neonatal intensive care units around the world. Neonatologists, neonatal nurse practitioners, registered nurses, respiratory technicians, dieticians and other staff categories. We had representatives from all continents and a large proportion of the participants were clinically active. This resulted in an informal and interactive atmosphere throughout the meeting, says Stefan Johansson. The program was put together to get the audience an evidence-based view on a variety of hot topics in neonatology. Central line-associated blood stream infection (CLABSI), hyperbilirubinaemia, hypotension, oxygenation, respiratory distress syndrome (RDS) and retinopathy of prematurity (ROP) were some of the many themes presented. In all, the evidence for and against over one hundred interventions in neonatal care was presented and discussed during the meeting. In addition, the question how to best implement new knowledge in clinical practice ran like a common thread throughout the conference. –It usually takes a long time before new evidence is implemented in clinical practice. There are also large outcome variations between different neonatal intensive care units (NICUs), even in the same country. Another problem is that many of the systematic literature reviews published today are inconclusive and fail to provide specific recommendations. There is a need for new ideas in recognition of best evidence. For example, well-designed observational studies can sometimes have the same value as randomized clinical trials, says Mikael Norman and mentions the lecture held by Professor Shoo Lee, from the Canadian neonatal network. –He presented a method for continuous evidence-based quality improvement. In addition to using available published evidence, the network collects data to evaluate local unit practices associated with outcome differences. In this way, successful practices in one NICU can be identified, tested and implemented for a faster targeted change in other NICUs, Mikael Norman explains. In this supplement to Acta Paediatrica, published online, you will find papers based on some of the presentations from the conference. To serve people who could not come to Stockholm, all lectures are also available online free of charge on the EBNEO webcast for 1 year. The EBNEO was organized by Karolinska Institutet and Karolinska University Hospital, together with an international program committee, but the idea to arrange a conference in evidence-based neonatology originated from 99 nicu, an international web community for professionals in neonatal medicine, with the aim to make neonatal staff share experience and knowledge regardless of geographical boundaries. –Our aim is that the conference should circulate around the world between different countries and continents. The next time we will meet in Cairo, Egypt, in March 2013, and we hope there will be a third EBNEO in 2015. We have seen that there is a need for a conference in evidence-based neonatology, and we already have a long list of topics to highlight at future EBNEO meetings, says Stefan Johansson. EBNEO conference: http://www.ebneo.org EBNEO webcast: http://www.webbtv.nu/ebneo2011 Live tweets: http://twitter.com/ebneo 99NICU web community: http://www.99nicu.org The author has declared no potential conflicts.

New Pharmacological Approaches in Infants with Hypoxic-Ischemic Encephalopathy

New knowledge of the pathophysiology and evolution of hypoxic-ischemic brain injuries has made feasible interventions to improve clinical outcomes for newborns surviving birth asphyxia. Brain injury following hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. The specific pathologic processes preceding the onset of irreversible cerebral injury appear to be a combination of several mechanisms that are variable according to the severity and duration of the insult and to biochemical modifications in the brain. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy, as well as to predict their outcome. The role of oxidative stress in newborn morbidity with respect to the higher risk of free radical damage in these babies is growing. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Potential neuroprotective strategies targeting different pathways leading to neuronal cell death in response to hypoxic-ischemic insult have been investigated: hypothermia, erythropoietin, iminobiotin, deferioxamine, magnesium, allopurinol, xenon, melatonin and statins. Hypothermia is currently the only recognized beneficial therapy. However, many infants still develop significant adverse outcomes. It is becoming evident that the association of moderate hypothermia with neuroprotective drugs may enhance the outcome. By virtue of their pleiotropic effects without toxic effects, melatonin and statins may act at different levels of the multiple mechanisms responsible for the progression of the neurodegenerative process and represent promising neuroprotectants, alone or as additional adjunctive therapy, for reducing brain injury and its long-term sequelae in infants. More clinical studies are needed to clarify the role of these potential neuroprotective drugs.

High-Flow Nasal Cannulae and Nasal Cpap use in Non-Tertiary Special Care Nurseries in Australia and New Zealand

Background: Non-tertiary centres (NTCs) in Australia and New Zealand are increasingly providing non-invasive respiratory support, including high flow nasal cannulae (HFNC) and nasal continuous positive airway pressure (nCPAP), to newborn infants. We aimed to determine the proportion of NTCs in these countries treating newborn infants with HFNC and nCPAP, and how these are used.Methods: We surveyed public and private NTCs in Australia, and public NTCs in New Zealand, between April and August 2010. The survey, directed at senior medical and nursing staff, consisted of questions regarding unit demographics, HFNC and nCPAP use.Results: 149 units were contacted. 117 responses were received regarding HFNC use, from 88% of public hospitals and 64% of private hospitals surveyed. Ten (7%) NTCs (nine public, one private) used HFNC in the care of newborn infants. HFNC was used for respiratory distress syndrome from birth (9/10 units), as a weaning mode from nCPAP (5/10), and as treatment for apnoea (3/10). Flow rates used range from 1-8 Litres/minute (L/min), with typical minimum flow rate 1 L/min and maximum 4-6 L/min. The main perceived advantages of HFNC over nCPAP were ease of nursing care and infant comfort. Many respondents had concerns about the lack of evidence for HFNC use in newborn infants. The rate of nCPAP use has increased to 44% compared with 17% in an Australian survey six years earlier.Conclusions: HFNC is being used in NTCs in Australia and New Zealand, and the use of nCPAP has increased over time.

Current Management of the Infant Who Presents with Neonatal Encephalopathy

Neonatal encephalopathy after perinatal hypoxic-ischemic insult is a major contributor to global child mortality and morbidity. Brain injury in term infants in response to hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy as well as predict their outcome. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Therapeutic hypothermia is the most promising neuroprotective intervention to date for infants with moderate to severe neonatal encephalopathy after perinatal asphyxia and has currently been incorporated in many neonatal intensive care units in developed countries. However, only 1 in 6 babies with encephalopathy will benefit from hypothermia therapy; many infants still develop significant adverse outcomes. To enhance the outcome, specific diagnostic predictors are needed to identify patients likely to benefit from hypothermia treatment. Studies are needed to determine the efficacy of combined therapeutic strategies with hypothermia therapy to achieve maximal neuroprotective effect. This review focuses on important concepts in the pathophysiology, diagnosis, and management of infants with neonatal encephalopathy due to perinatal asphyxia, including an overview of recently introduced novel therapies.

Understanding neonatal jaundice: UK practice and international profile

Over the last 25 years there have been considerable advances in the treatment and technologies used in the care of newborn infants. Most of these advances are related to the care of the premature infants and there have been few changes in the management of conditions commonly seen in term infants. Neonatal jaundice is one of the commonest neonatal disorders and has been recognized since early history. Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant and its importance lies in the ability of the bilirubin pigment so produced to cross the blood brain barrier resulting in neurotoxicity. Prolonged neonatal jaundice (after 14 days of age) may be an indication of an underlying liver disorder. The approach to neonatal jaundice has remained largely unchanged over the last two to three decades. We continue to rely on visual inspection to assess the severity of early neonatal jaundice. We have technology that is effective in reducing the level of bilirubinaemia but in the UK there is no clear consensus as to the level at which jaundice should be treated. We do not have a standardized approach to the management of prolonged jaundice and there is potential for infants with significant liver problems to be diagnosed at a relatively late stage. Some countries (for example the US) have professional bodies who have introduced guidelines to ensure a standardized approach to the jaundice infant. We have little information about neonatal jaundice treatment in other parts of the developing world.

Historical Perspectives: Perinatal Profiles: Alexandre Minkowski: Founder of "Biology of the Neonate"

Almost every country boasts pioneers in the field of neonatology. Most neonatologists in the United States are familiar with the role that the French obstetricians Stephane Tarnier and Pierre Budin played in promulgating the use of incubators for preterm infants. In addition, Budin wrote about umbilical cord clamping and outlined many important principles of the care of newborn infants in his book “Le Nourisson” (The Nursling), which was published in French in 1900 and in English in 1907. However, the person in France who arguably exerted the greatest influence on neonatology in the 20th century is the pediatrician Alexandre Minkowski. Minkowski was born in Paris in 1915 to two Jewish psychiatrists, Eugeǹe and Francoise Minkowski, who originally were from Poland. His secondary education was at L'Ecole Alsacienne, and he attended medical school at the University of Paris. During the Second World War he joined the resistance movement in Paris in 1941 and subsequently was awarded the Medaille de la Resistance as well as the Croix de Guerre 39–45 (1939 to 1945 War Cross). Immediately after the war, he was awarded a Rockefeller Foundation Bursary to study with Clement Smith at Harvard from 1946 through 1947. He was one of many international pediatricians who spent time with Clem Smith in Boston learning about fetal and neonatal physiology. He remained in the United States for some time after this, assimilating knowledge about clinical neonatology from pediatricians interested in the field such as Julius Hess in Chicago and Sam Levine in New York. He returned …

Dr. Lucey, Editor of Pediatrics Receives Two Honors

A new endowed chair in neonatal medicine at the University of Vermont College of Medicine honors internationally renowned neonatologist and Pediatrics Editor-in-Chief Jerold F. Lucey, M.D., Wallace Professor of Neonatology at UVM. Established through a lead gift from the nonprofit Vermont Oxford Network, along with dozens of other donors, the $2 million endowment fund aims to promote advances in the care of newborn infants and their families through research, education, and quality improvement. On Sept. 25, Lucey also received $50,000 for the 2007 Alfred I. duPont Award for Excellence in Children's Health Care from the Nemours Foundation in recognition of his significant contributions to improving the quality of health care delivered to children. Dr. Lucey joined the UVM faculty in 1956 and established Vermont's first neonatal unit in 1972. He pioneered several innovations in premature infant care, including …

Inequalities in birth outcomes in Russia: evidence from Tula oblast

This paper describes pregnancy outcomes and identifies their determinants in a Russian region, in the year 2000. It includes all births and perinatal deaths recorded as occurring in Tula oblast. The socio-economic correlates of adverse outcomes are explored using logistic regression; outcomes and their determinants are compared with other countries. Perinatal mortality in Tula in 2000 was 16.8/1000 births. The frequencies of low birthweight, low ponderal index and preterm birth were higher in Tula than in other industrialised countries. Mean birthweight increased with increasing education and was higher in married than in single mothers, and higher in ethnic Russians than in others. Survival in the perinatal period was substantially lower at all birthweights than in Sweden, which has the lowest neonatal mortality rate in Europe. There are wide inequalities in fetal development in Russia, especially in relation to maternal education, and the adverse outcomes appear to reflect a combination of adverse fetal development (implying the need for policies that improve the health of prospective mothers) and poor survival (implying the need for more effective care for newborn infants).

Clinical decision support systems for neonatal care

Clinical decision support systems (CDSS) are computer-based information systems used to integrate clinical and patient information to provide support for decision-making in patient care. They may be useful in aiding the diagnostic process, the generation of alerts and reminders, therapy critiquing/planning, information retrieval, and image recognition and interpretation. CDSS for use in adult patients have been evaluated using randomised control trials and their results analysed in systematic reviews. There is as yet no systematic review on CDSS use in neonatal medicine. To examine whether the use of clinical decision support systems has an effect on 1. the mortality and morbidity of newborn infants and 2. the performance of physicians treating them The standard search method of the Cochrane Neonatal Review Group was used. Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004), MEDLINE (from 1966 to August 2004), EMBASE (1980-2004), CINAHL (1982 to August 2004) and AMED (1985 to August 2004). Randomised or quasi-randomised controlled trials which compared the effects of CDSS versus no CDSS in the care of newborn infants. Trials which compared CDSS against other CDSS were also considered. The eligible interventions were CDSS for computerised physician order entry, computerised physiological monitoring, diagnostic systems and prognostic systems. Studies were assessed for eligibility using a standard pro forma. Methodological quality was assessed independently by the different investigators. Two studies fitting the selection criteria were found for computer aided prescribing and one study for computer aided physiological monitoring.Computer-aided prescribing: one study (Cade 1997) examined the effects of computerised prescribing of parenteral nutrition ordering. No significant effects on short-term outcomes were found and longer term outcomes were not studied. The second study (Balaguer 2001) investigated the effects of a database program in aiding the calculation of neonatal drug dosages. It was found that the time taken for calculation was significantly reduced and there was a significant reduction in the number of calculation errors.Computer-aided physiological monitoring: one eligible study (Cunningham 1998) was found which examined the effects of computerised cot side physiological trend monitoring and display. There were no significant effects on mortality, volume of colloid infused, frequency of blood gases sampling (samples per day) or severe (Papile Grade 4) intraventricular haemorrhage. Published data did not permit us to analyse effects on long-term neurodevelopmental outcome. There are very limited data from randomised trials on which to assess the effects of clinical decision support systems in neonatal care. Further evaluation of CDSS using randomised controlled trials is warranted.

Neonatal Resuscitation: What Role for Volume Expansion?

The article by Wyckoff et al1 in this issue of Pediatrics is an interesting review of intravenous volume expansion for neonatal resuscitation in a single tertiary care center. The authors conclude that volume expansion is used infrequently at their medical center, that the use is most often contrary to a widely used set of recommendations,2 and that the utility is uncertain. Recommendations for intravenous volume expansion during neonatal resuscitation were not included in older textbooks and discussions of resuscitation in the delivery room.3 The sixth edition of Standards and Recommendations of Hospital Care of Newborn Infants 4 did include a statement on resuscitation, citing the administration of blood or plasma expanders if the infant is in hypovolemic shock. The successor publication, Guidelines for Perinatal … Address correspondence to William J. Keenan, MD, Department of Pediatrics, St Louis University, 1465 S Grand, St Louis, MO 63119. E-mail: keenanwj{at}slu.edu

Advances in optical imaging of the newborn infant brain.

New methods of imaging the oxygenation, hemodynamics, and metabolism of the newborn infant brain are being developed, based on illumination of the head with near-infrared light. Techniques known as optical topography and optical tomography have the potential to provide valuable information about the function of the normal brain, and about a variety of cerebral pathology such as hypoxic-ischemia. Optical methods provide a unique means of monitoring brain oxygenation safely in an intensive care environment without interference with the normal handling of the infant. Studies on infants have focused on the assessment of steady-state regional cerebral perfusion and tissue oxygenation, as well as monitoring hemodynamic changes in response to sensory stimulation. Recent technological and methodological advances in this research field are reviewed, and the likely impact of optical imaging methods on the care of newborn infants is assessed.

Preventing kernicterus: Almost there

Preventing kernicterus: Almost there

Bedside Graphical Display of Lung Mechanics: A Clinical Experience of Use in the NICU

Pulmonary function analysis by graphical display is becoming increasingly available to clinicians caring for newborn infants. Many of the currently available infant ventilators are able to provide this information in one form or another. Interpretation of these graphics in a ventilated newborn infant who is also making spontaneous effort can be challenging. There is a relative dearth of information that is directly applicable to the often bizarre appearances seen in tiny premature infants breathing out of synchrony with the ventilator. This is an area where there is a need for sharing of experience and dissemination of information for better education for all involved in providing care for newborn infants. We present our observational experience of analyses of pulmonary graphics displayed by infants on a tertiary intensive care unit (ICU). We highlight what we believe are significant differences in the graphical displays between pediatric and adult patients and newborn infants. We also present some clinical situations, commonly faced in the neonatal ICU (NICU), where we have found the use of pulmonary graphics particularly useful.