Need For Assisted Ventilation Research Articles

Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

A number of studies have reported an association between the use of epidural analgesia in labor and the occurrence of intrapartum maternal fever. Studies of term pregnancies have also reported an increase in adverse neonatal outcomes with intrapartum maternal fever. The aim of this retrospective cohort study was to assess the impact of epidural-related temperature elevation on neonatal outcome and to determine whether epidural analgesia is associated with adverse neonatal outcomes without temperature elevation. Participants were low-risk nulliparous women with singleton term pregnancies ≥37 weeks, delivering at a single hospital during 2000. Pregnancies in which infants had documented sepsis, meningitis, or a major congenital anomaly were excluded. In the first phase of this analysis, neonatal outcomes were compared in women receiving (n = 1538) and not receiving epidural analgesia (n = 363) without elevation of intrapartum temperature (≤99.5°F). In the second phase, neonatal outcomes were compared according to the degree of temperature elevation within the group of women receiving epidural (n = 2784). Multiple logistic regression analysis was used to estimate the association of maternal temperature elevation and neonatal outcomes, controlling for confounding variables. During labor, substantially more women receiving epidural (19.2%, 535/2784) developed maternal temperature >100.4°F compared with those not receiving epidural (2.4%, 10/425). No significant differences in adverse neonatal outcomes were found between women receiving and not receiving epidural in the absence of intrapartum temperature elevation (≤99.5°F). There was a significant linear trend among women receiving epidural between maximum maternal temperature and higher risk of all adverse neonatal outcomes examined including hypotonia, need for assisted ventilation, low 1- and 5-minute Apgar scores, and early-onset neonatal seizures. Multiple logistic regression analysis showed that maternal fever >101°F was associated with a 2- to 6.5-times increased risk of all adverse neonatal outcomes. These findings indicate that intrapartum maternal temperature >99.5°F is associated with an increase in adverse neonatal outcomes, with the proportion of affected infants increasing directly with the degree of epidural-related elevated maternal temperature. Epidural use in the absence of temperature elevation is not associated with adverse neonatal outcomes.

Patent Ductus Arteriosus in Premature Neonates

Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a haemodynamically significant patent ductus arteriosus (PDA) can cause cardiovascular instability, exacerbate respiratory distress syndrome, prolong the need for assisted ventilation and increase the risk of bronchopulmonary dysplasia, intraventricular haemorrhage, renal dysfunction, cerebral palsy and mortality. We review the pathophysiology, clinical features and assessment of haemodynamic significance, and provide a rigorous appraisal of the quality of evidence to support current medical and surgical management of PDA of prematurity. Cyclo-oxygenase inhibitors such as indomethacin and ibuprofen remain the mainstay of medical therapy for PDA, and can be used both for prophylaxis as well as for rescue therapy to achieve PDA closure. Surgical ligation is also effective and is used in infants who do not respond to medical management. Although both medical and surgical treatment have proven efficacy in closing the ductus, both modalities are associated with significant adverse effects. Because the ductus does undergo spontaneous closure in some premature infants, improved and early identification of infants most likely to develop a symptomatic PDA could help in directing treatment to the at-risk infants and allow others to receive expectant management.

Can Nebulized Naloxone Be Used Safely and Effectively by Emergency Medical Services for Suspected Opioid Overdose?

Background. Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting. Objective. We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose. Methods. We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics. Results. Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete response, 62 (59%) had partial response, and 20 (19%) had no response. Eleven cases (10%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993. Conclusion. Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations.

Asphyxie périnatale et infirmité motrice d’origine cérébrale (II – Implications médico-légales et prévention)

Obstetric litigation is a growing problem in developed countries and its escalating cost together with increasing medical insurance premiums is a major concern for maternity service providers, leading to obstetric practice cessation by many practitioners. Fifty-four to 74 % of claims are based on cardiotocographic (CTG) abnormalities and their interpretation followed by inappropriate or delayed reactions. A critical analysis is performed about the nine criteria identified by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics in their task force on Neonatal Encephalopathy and Cerebral Palsy: four essential criteria defining neonatal asphyxia and five other suggesting an acute intrapartum event sufficient to cause cerebral palsy in term newborns. The importance of placental histologic examination is emphasized in order to confirm sudden catastrophic events occurring before or during labor or to detect occult thrombotic processes affecting the fetal circulation, patterns of decreased placenta reserve and adaptative responses to chronic hypoxia. It may also exclude intrapartum hypoxia by revealing some histologic patterns typical of acute chorioamnionitis and fetal inflammatory response or compatible with metabolic diseases. Magnetic resonance imaging (MRI) of the infant's damaged brain is very contributive to elucidate the mechanism and timing of asphyxia in conjunction with the clinical picture, by locating cerebral injuries predominantly in white or grey matter. Intrapartum asphyxia is sometimes preventable by delivering weak fetuses by cesarean sections before birth, by avoiding some “sentinel” events, and essentially by responding appropriately to CTG anomalies and performing an efficient neonatal resuscitation. During litigation procedures, it is necessary to have access to a readable CTG, a well-documented partogram, a complete analysis of umbilical cord gases, a placental pathology and an extensive clinical work-up of the newborn infant including cerebral MRI. Malpractice litigation in obstetric care can be reduced by permanent CTG education, respect of national CTG guidelines, use of adjuncts such as fetal blood sampling for pH or lactates, regular review of adverse events in Clinical Risk Management (CRM) groups and periodic audits about low arterial cord pH in newborns, admission to neonatal unit, the need for assisted ventilation and the decision-to-delivery interval for emergency operative deliveries. Considering the fast occurrence of fetal cerebral hypoxic injuries, and thus despite an adequate management, many intrapartum asphyxias will not be preventable. Conversely, well-documented hypoxic-ischemic brain insults during the antenatal period do not automatically exclude intrapartum suboptimal obstetric care.

1344 Respiratory Outcomes of Late Preterm Infants

Several studies have shown that late preterm infants (LPI) are at higher risk for respiratory disorders than term infants.Objective: To evaluate occurrence of respiratory disorders, need for respiratory support, use and timing of specific adjunctive pulmonary therapies in LPI.Methods: Using electronic medical charts, we performed a retrospective analysis of all LPI (34 0/7 to 36 6/7 wks) born from January 2005 to December 2009 in a tertiary level NICU.Results: During the study period, 856/14443 infants born alive were LPI (5.9%). They accounted for 58.9% of preterm births. Majority of LPI were 36 weeks (53.9%), followed by 35 weeks (28.4%) and 34 weeks (17.8%).Transient tachypnea of the newborn (5.8%) was the most common pulmonary illness, followed by respiratory distress syndrome (4.7%), apnea (1.5%), air leak (1.3%) and persistent pulmonary hypertension (0.5%). Composite respiratory morbidity was 12.4%:A total of 69 (8.1%) patients received NCPAP only, 19 (2.2%) mechanical ventilation, 17 (2%) surfactant, 8 (0.9%) chest tube and 4 (0.5%) inhaled nitric oxide.Fig 1 shows the highest levels of respiratory support for each GA.Fig 2 shows times at which each treatment was started.Median length of positive pressure ventilation was 40.5 hours (IQR 16.9-91.6).Mortality was 0.4%.Conclusion: Compared with literature, our population showed lower incidence of mortality, respiratory disorders and need for assisted ventilation, probably due to a great proportion of more mature infants.

978 Renal Insufficiency in New Born

We accomplished a retrospective study which purpose is to analysis of the clinical, causes and therapeutics characteristics of renal insufficiency to new born admitted in our unit. Patients and Methods: we studied all patients having a renal insufficiency, hospitalized in the care of neonatal intensive care during year 2007. Results: We have collected 45 cases. The age at the time of the taking care varies between 4 hours and 27 days of life. New born advance terms were 22, while the premature were 23 cases. Renal function was normal at all mothers. Delivery from below was made in 40 cases and by Caesarian section in 5 cases. Ultrasound scan, in prenatal period, was normal in 18 cases, and put in an obvious place 2 cases of oligohydramnios and a case of polyhydramnios. Hypotrophy newborns accounted for 40% of cases. 20 babies were in need of intubation and ventilation which 9 died. Kidney failure was pre-renal in 42 cases and postrenal in 3 cases in connection with the valves of the posterior urethra. Ultrasound renal was abnormal in 5 cases, normal in 35 cases, and it has not been achieved in the remaining cases. Evolution was favorable in most cases. Three patients (6%) were in chronic renal failure in relation to the valves of the posterior urethra. The death occurred in 26.6% of cases. Comparison of newborn deaths and those well advanced out as factors of neonatal mortality, the need for assisted ventilation, oliguria and the cause of renal failure.

Morbidity and Mortality of Bloodstream Infections in Patients With Severe Burn Injury

Bloodstream infections are common in burn patients. To evaluate the effects of bloodstream infections in patients with severe burn injuries. A retrospective, pairwise-matched, risk-adjusted cohort study in a 6-bed burn unit was done. "Exposed" patients with microbiological evidence of bloodstream infections (n = 76) were compared with nonexposed patients (n = 103) matched for burn severity (identical Belgian Outcome in Burn Injury score) and length of hospitalization (≥time-to-event in exposed patients). Main outcome measures were length of hospitalization and mortality. Predominant pathogens were Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci, and Candida species. Median patient age was 42 years (interquartile range [IQR], 31-52). Median total burned surface area was 40% (IQR, 25%-50%). Inhalation injury occurred in 54%. Median burn injury score was 4 (IQR, 2-5). Median length of stay before onset of bacteremia was 11 days (IQR, 5.3-19.8). Appropriate antimicrobial therapy was initiated within the first 48 hours in 76%. The exposed group had a higher need for vasopressive/inotropic support (P = .02); need for ventilatory assistance and renal replacement therapy did not differ significantly between groups. Hospital mortality did not differ (P = .30). However, bloodstream infection was associated with longer durations of hospitalization (P < .001) and mechanical ventilation (P < .001). In this cohort of burn patients, bloodstream infections did not adversely affect survival, but greater durations of ventilator dependency and hospital stay increased costs of care.

Short versus conventional term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease - THe "REDUCE" trial

International guidelines advocate a 10 to 14-day course of systemic glucocorticoid therapy in the management of COPD exacerbations. The optimal duration of therapy is unknown and glucocorticoids have serious adverse effects. The aim of this trial is to demonstrate non-inferiority of a five-day compared to a 14-day course of systemic glucocorticoids with respect to COPD outcome, thereby significantly reducing steroid exposure and side effects in patients with COPD exacerbations. This is a randomised, placebo-controlled, non-inferiority multicentre trial. Patients with acute COPD exacerbation are randomised to receive 40 mg of prednisone-equivalent daily for 14 days (conventional arm) or glucocorticoid treatment for 5 days, followed by placebo for another 9 days (intervention arm). Follow-up is 180 days. The primary endpoint is time to next exacerbation. Secondary endpoints include cumulative glucocorticoid dose, time to open-label glucocorticoid therapy, glucocorticoid-associated side effects and complications, duration of hospital stay, death, change in FEV1, need for assisted ventilation, clinical outcome assessed by standardised questionnaires, and suppression of the hypothalamic-pituitary-adrenal axis. Mean age (± SD) of patients who finished the study was 70 ± 11 years. 12% had mild or moderate disease, whereas severe and very severe stages were found in 30 and 58%, respectively. At the time of inclusion, 20% of patients were under treatment with systemic glucocorticoids. If the strategy of significantly reducing cumulative exposure to glucocorticoids while taking advantage of their beneficial short-term effects proves to be successful, it will warrant a change in common glucocorticoid prescription practice, thereby improving the management of COPD.

PICO Summary: Does early surfactant administration with brief mechanical ventilation (less than 1h) followed by extubation compared to later selective surfactant administration, continued mechanical ventilation, and extubation from low respiratory support lead to decreased need for assisted ventilation and lung injury in spontaneously breathing infants with signs of RDS?

PICO Summary: Does early surfactant administration with brief mechanical ventilation (less than 1h) followed by extubation compared to later selective surfactant administration, continued mechanical ventilation, and extubation from low respiratory support lead to decreased need for assisted ventilation and lung injury in spontaneously breathing infants with signs of RDS?

General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study

Objective. To compare neonatal short-term outcome in patients who underwent spinal, general anaesthesia and conversion from spinal to general anaesthesia.Methods. One hundred seventy-nine pregnant women undergoing elective caesarean section were allocated randomly to general (n = 89) or spinal anaesthesia (n = 90) and compared with 63 patients who required conversion to general anaesthesia. Umbilical cord artery pH, Apgar score as well as its individual parameter and need for assisted ventilation were evaluated.Results. No differences were found in pH values (p = 0.35), while the need for assisted ventilation differed significantly (p = 0.001). The rate of depressed newborns was 1.1% in the spinal group, 25.9% in the general group and 12.7% in the conversion group with a significant difference for all comparisons. At 5-min, all newborns were vigorous. At 1 min, a higher score for each parameter was found in spinal group with respect to general group, while ‘activity’, ‘grimace’ and ‘respiration’ showed a higher score in conversion group than in general group. At 5 min, a difference was found only for ‘activity’.Conclusions. All kinds of anaesthesia seem to be safe, but loco-regional blockade shows more advantages on the neonatal outcome also when a conversion is necessary.

183: The effect of 17 alpha-hydroxyprogesterone caproate (17OHPC) on neonatal outcomes in infants delivering between 32-40 weeks

ObjectiveTo compare neonatal outcomes between infants exposed to 17OHPC and those not exposed.Study DesignA retrospective examination of data from women enrolled for outpatient perinatal services between 1/01/2005 and 3/01/2009 identified deliveries at 32-40.9 weeks (w) gestational age at delivery (GAD) of live-born, singletons without anomalies. Each infant record was labeled as to if the mother had received at least 5 17OHPC injections during pregnancy (Y/N). Infants from women with indicated delivery due to maternal medical or fetal complications, or if the mother received <5 doses of 17 OHPC were excluded. Data were compared between 17OHPC exposed and non-exposed infants within each GAD group (32-33.9w, 34-35.9w, 36-37.9w, 38-40.9w) using Pearson′s chi-square and Mann-Whitney U test statistics.ResultsOverall, 13, 580 infants were studied: 4425 (32.6%) were exposed to 17OHPC and 9155 (67.4%) had no exposure. No significant differences were found in rates of low birth weight, macrosomia, respiratory problems, need for assisted ventilation, hypoglycemia, jaundice, or neonatal death for 17OHPC exposed vs. non-exposed infants within any GAD group, all p>0.05. Infants exposed to 17OHPC with GAD between 36-37.9 weeks had lower rates of NICU admission than those not exposed (10.0% vs. 12.7%, p=0.022).ConclusionWeekly administration of 17OHPC for prevention of preterm delivery does not appear to effect short-term neonatal outcomes among pregnancies after 32 weeks gestation. ObjectiveTo compare neonatal outcomes between infants exposed to 17OHPC and those not exposed. To compare neonatal outcomes between infants exposed to 17OHPC and those not exposed. Study DesignA retrospective examination of data from women enrolled for outpatient perinatal services between 1/01/2005 and 3/01/2009 identified deliveries at 32-40.9 weeks (w) gestational age at delivery (GAD) of live-born, singletons without anomalies. Each infant record was labeled as to if the mother had received at least 5 17OHPC injections during pregnancy (Y/N). Infants from women with indicated delivery due to maternal medical or fetal complications, or if the mother received <5 doses of 17 OHPC were excluded. Data were compared between 17OHPC exposed and non-exposed infants within each GAD group (32-33.9w, 34-35.9w, 36-37.9w, 38-40.9w) using Pearson′s chi-square and Mann-Whitney U test statistics. A retrospective examination of data from women enrolled for outpatient perinatal services between 1/01/2005 and 3/01/2009 identified deliveries at 32-40.9 weeks (w) gestational age at delivery (GAD) of live-born, singletons without anomalies. Each infant record was labeled as to if the mother had received at least 5 17OHPC injections during pregnancy (Y/N). Infants from women with indicated delivery due to maternal medical or fetal complications, or if the mother received <5 doses of 17 OHPC were excluded. Data were compared between 17OHPC exposed and non-exposed infants within each GAD group (32-33.9w, 34-35.9w, 36-37.9w, 38-40.9w) using Pearson′s chi-square and Mann-Whitney U test statistics. ResultsOverall, 13, 580 infants were studied: 4425 (32.6%) were exposed to 17OHPC and 9155 (67.4%) had no exposure. No significant differences were found in rates of low birth weight, macrosomia, respiratory problems, need for assisted ventilation, hypoglycemia, jaundice, or neonatal death for 17OHPC exposed vs. non-exposed infants within any GAD group, all p>0.05. Infants exposed to 17OHPC with GAD between 36-37.9 weeks had lower rates of NICU admission than those not exposed (10.0% vs. 12.7%, p=0.022). Overall, 13, 580 infants were studied: 4425 (32.6%) were exposed to 17OHPC and 9155 (67.4%) had no exposure. No significant differences were found in rates of low birth weight, macrosomia, respiratory problems, need for assisted ventilation, hypoglycemia, jaundice, or neonatal death for 17OHPC exposed vs. non-exposed infants within any GAD group, all p>0.05. Infants exposed to 17OHPC with GAD between 36-37.9 weeks had lower rates of NICU admission than those not exposed (10.0% vs. 12.7%, p=0.022). ConclusionWeekly administration of 17OHPC for prevention of preterm delivery does not appear to effect short-term neonatal outcomes among pregnancies after 32 weeks gestation. Weekly administration of 17OHPC for prevention of preterm delivery does not appear to effect short-term neonatal outcomes among pregnancies after 32 weeks gestation.

Critical Evaluation of Pulmonary Contusion in the Early Post-Traumatic Period: Risk of Assisted Ventilation

This study attempts to accurately quantify pulmonary contusion and predict those patients most likely to require assisted ventilation early in their hospital course. Patients admitted to a Level I trauma center were evaluated for pulmonary contusion by helical CT scan. Scans were reviewed by a single radiologist who attempted to accurately quantify contusion as a percentage of total lung volume. These patients were then followed for 48 hours in an attempt to use CT measurements of contusion to predict those that would require assisted ventilation early in their hospital course. After using numerous exclusion criteria, 152 patients were included in the study. Of these, 31 patients (20%) required assisted ventilation within 48 hours of hospital admission. Twenty per cent pulmonary contusion proved to be a highly predictive variable leading to need for assisted ventilation. Of patients sustaining <20 per cent contusion, only 7 of 92 (8%) required assisted ventilation versus 24 of 60 (40%) sustaining >20 per cent contusion. Pulmonary contusion is a significant injury especially when contusion volume exceeds 20 per cent of total lung volume. With accurate measurement of contusion, we can identify those patients at high risk of requiring assisted ventilation early in their hospital course.

The Impact of an Early Ibuprofen Treatment Protocol on the Incidence of Surgical Ligation of the Ductus Arteriosus

This study sought to determine whether early treatment of premature infants with ibuprofen would result in a reduced incidence of surgical ligation of patent ductus arteriosus. Secondary outcomes included duration of hospitalization, assisted ventilation and supplemental oxygen, mortality rate, persistent patent ductus arteriosus (PDA), hypotension, intraventricular hemorrhage, and intestinal perforation. Outcomes among 105 very low-birth-weight (VLBW) infants managed by clinical use of indomethacin were compared with outcomes of 80 infants treated under a standardized protocol for ibuprofen therapy on the first day of life among infants <25 weeks estimated gestational age (EGA) and among infants of 25 to 28 weeks EGA with respiratory distress syndrome or history of antenatal steroids. The incidence of PDA ligation was significantly lower among the early ibuprofen group than among the clinical indomethacin group (0/80 versus 9/105, P = 0.0056). No differences were found in secondary outcomes. The effect persisted (P = 0.0100 to 0.0153) when corrected for birth weight, EGA, gender, Apgar scores, initial pH and base deficit, transport from another hospital, surfactant treatment, and need for assisted ventilation. In our neonatal intensive care unit, the incidence of PDA ligation among VLBW infants decreased after adoption of an early ibuprofen treatment protocol.

Mortality rate in neonates infected with extended-spectrum β lactamase-producing Klebsiella species and selective empirical use of meropenem

Infection with resistant gram-negative bacteria is a growing threat to hospitalised patients. To determine factors associated with mortality among infants infected by extended-spectrum beta-lactamase-producing Klebsiella species (Klebs-ESBL) and to assess whether selective empirical use of meropenem (MERO) is associated with high mortality. Medical records of neonates admitted from January 2002 to December 2003 who had positive blood and/or cerebrospinal fluid (CSF) culture with Klebs-ESBL were reviewed for clinical, management and outcome information. Univariate and multivariate logistic regression analyses were performed to determine factors associated with mortality among infants with culture-proven Klebs-ESBL. A hundred patients had positive blood (n=97) and/or CSF cultures (n=9) owing to Klebs-ESBL. Overall mortality rate was 30%. The mortality rates among those who were empirically started on a combination of piperacillin-tazobactam and amikacin (Pip-Taz+Amik) (n=48), meropenem (MERO) (n=40) and in those not started on MERO or Pip-Taz+Amik) (n=12) were 25%, 32% and 42%, respectively. Non-survivors were younger (p=0.01), had cardio-respiratory compromise or required assisted ventilation at presentation (p<0.001), and were not started on antibiotics, MERO or Pip-Taz+Amik (p<0.001). On multivariate analysis, factors associated with mortality were vaginal delivery (OR -7.07, 95% CI 2.14-23.39), a need for assisted ventilation at onset of illness (OR -4.94, 95% CI 1.12-21.86) and not starting empirical MERO or Pip-Taz+Amik (OR -17.01, 95% CI 2.41-120.23). While empirical use of carbapenems for nosocomial sepsis might be appropriate in areas where Klebs-ESBL is prevalent, their use can be restricted to those with cardio-respiratory compromise or severe sepsis without an increase in mortality.

Admission of all gestations to a regional neonatal unit versus controls: Neonatal morbidity

To describe the neonatal course and morbidity of all infants admitted to the regional neonatal intensive care unit (NICU) at Christchurch Women's Hospital (CWH) and to compare these with term control infants who were not admitted, in one calendar year. Infants in both NICU and control cohorts were enrolled in a 2-year follow-up study. All infants born over a 12-month period from February 2001 and admitted to the NICU, whose parents were domiciled in a defined geographical region, were eligible for study, together with every eighth healthy infant born at term and not admitted (to a total of 300). Comprehensive perinatal and neonatal data were collected for all enrolled infants. A total of 387 NICU infants (86% eligible) were enrolled in the study together with 306 controls. Forty-one percent of NICU admissions were term and 40% were 33-36 weeks gestation. Term NICU infants were more likely to be born following induction of labour or by Caesarean section (34%, of which 50% were pre-labour) than control infants (18%, of which 32% were pre-labour). Infants of <28, 28-32, 33-36 and > or =37 weeks accounted for 74, 16, 7 and 3% of assisted ventilation days and 18, 31, 31 and 20% of total baby days, respectively. The need for assisted ventilation and length of NICU stay was inversely proportional to gestation. However, preterm infants of 28 weeks gestation and greater, as well as term infants, account for a high proportion of the NICU workload.

Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2x2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients.

Percutaneous closure of a prenatally diagnosed large coronary artery fistula with an Amplatzer vascular plug immediately after delivery

We describe successful percutaneous closure of a prenatally diagnosed large coronary fistula originating from the right coronary sinus and draining into the right ventricle in a one-day-old neonate using an Amplatzer vascular plug. Early intervention may be a useful tool in such cases with large fistulas to avoid complications such as severe congestive heart failure, myocardial ischaemia, need for assisted ventilation and longer hospital stay.

Pregnancy complications associated with hepatitis C: data from a 2003-2005 Washington state birth cohort

The objective of the study was to determine the effect of hepatitis C virus (HCV) on selected maternal and infant birth outcomes. This population-based cohort study using Washington state birth records from 2003 to 2005 compared a cohort of pregnant women identified as HCV positive from birth certificate data (n = 506) to randomly selected HCV-negative mothers (n = 2022) and drug-using HCV-negative mothers (n = 1439). Infants of HCV-positive mothers were more likely to be low birthweight (odds ratio [OR], 2.17; 95% confidence interval [CI] 1.24, 3.80), to be small for gestational age (OR, 1.46; 95% CI, 1.00, 2.13), to need assisted ventilation (OR, 2.37; 95% CI, 1.46, 3.85), and to require neonatal intensive car unit (NICU) admission (OR, 2.91; 95% CI, 1.86, 4.55). HCV-positive mothers with excess weight gain also had a greater risk of gestational diabetes (OR, 2.51; 95% CI, 1.04, 6.03). Compared with the drug-using cohort, NICU admission and the need for assisted ventilation remained associated with HCV. HCV-positive pregnant women appear to be at risk for adverse neonatal and maternal outcomes.

No cost TSE “mask”: A technically simple and effective face tent reduces severe oxygen desaturation and the need for assisted ventilation in deeply sedated patients during upper GI endoscopy

No cost TSE “mask”: A technically simple and effective face tent reduces severe oxygen desaturation and the need for assisted ventilation in deeply sedated patients during upper GI endoscopy

Rituximab-responsive Guillain–Barré syndrome following allogeneic hematopoietic SCT

Rituximab-responsive Guillain–Barré syndrome following allogeneic hematopoietic SCT