Regional Neonatal Unit Research Articles

Enhancing Neonatal Care: The Vital Role of Pulse Oximetry in the Early Screening of Critical Congenital Heart Diseases and Respiratory Diseases in Rural Areas.

Background Pulse oximetry screening (POS) is acknowledged globally as a noninvasive method to detect critical congenital heart diseases (CCHDs) and respiratory illnesses. However, its value for early diagnosis and treatment remains unrecognized in many hospitals with limited resources around the world. This study aimed to evaluate POS's application in CCHDs, persistent pulmonary hypertension (PPHN), and respiratory distress syndrome (RDS) for early diagnosis and its influence on clinical procedures in rural areas. Methods This prospective observational study included all eligible newborn infants in the regional neonatal unit of a community healthcare center. Their peripheral oxygen saturation was assessed at <24 hours and >24 hours after birth, in the right upper limb and either lower limb. An oxygen saturation of <95% or >3% difference between pre-ductal and post-ductal circulations was considered abnormal. All neonates with abnormal oxygen saturations at >24 hours after birth were subjected to another POS test within two hours of the last test. If the oxygen saturation was still abnormal, it was considered a positive POS test. The POS results were classified as oxygen saturation abnormal (<90%), abnormal (90-94%), and normal (≥95%). All neonates with a positive POS test were referred for echocardiography. Results Overall, 440 infants had documented POS results. A total of 65 (14.77%) infants had a positive POS test result, out of which 39 (8.86%) cases were diagnosed on further evaluation. Four neonates had CCHD (positive predictive value (PPV) = 6.15%), 26 had RDS (PPV = 40%), and nine had PPHN (PPV = 13.85%). Without any further delay, the doctor directed them all to a more advanced facility. Conclusion Our research showed that, in large-scale clinical settings, the addition of pulse oximetry to routine cardiac auscultation could be a reliable and feasible method to screen newborns for CCHD, PPHN, and RDS early on. Our research underscores the importance of implementing routine POS to detect CCHD, RDS, and PPHN in clinical practice.

Identification of the Best Predictive Model for Mortality in Outborn Neonates-Retrospective Cohort Study.

Transportation of sick newborns is a major predictor of outcome. Prompt identification of the sickest newborns allows adequate intervention and outcome optimization. An optimal scoring system has not yet been identified. To identify a rapid, accurate, and easy-to-perform score predictive for neonatal mortality in outborn neonates. All neonates admitted by transfer in a level III regional neonatal unit between 1 January 2015 and 31 December 2021 were included. Infants with congenital critical abnormalities were excluded (N = 15). Gestational age (GA), birth weight (BW), Apgar score, place of birth, time between delivery and admission (AT), early onset sepsis, and sick neonatal score (SNS) were collected from medical records and tested for their association with mortality, including in subgroups (preterm vs. term infants); GA, BW, and AT were used to develop MSNS-AT score, to improve mortality prediction. The main outcome was all-cause mortality prediction. Univariable and multivariable analysis, including Cox regression, were performed, and odds ratio and hazard ratios were calculated were appropriate. 418 infants were included; 217/403 infants were born prematurely (53.8%), and 20 died (4.96%). Compared with the survivors, the non-survivors had lower GA, BW, and SNS scores (p < 0.05); only the SNS scores remained lower in the subgroup analysis. Time to admission was associated with an increased mortality rate in the whole group and preterm infants (p < 0.05). In multiple Cox regression models, a cut-off value of MSNS-AT score ≤ 10 was more precise in predicting mortality as compared with SNS (AUC 0.735 vs. 0.775) in the entire group and in the preterm infants group (AUC 0.885 vs. 0.810). The new MSNS-AT score significantly improved mortality prediction at admission in the whole study group and in preterm infants as compared with the SNS score, suggesting that, besides GA and BW, AT may be decisive for the outcome of outborn preterm infants.

Bacterial and Candida Colonization of Neonates in a Regional Hospital in South Africa.

Neonatal colonization with multidrug-resistant (MDR) Enterobacter spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterococcus faecium (ESKAPE) and Candida spp. often precedes invasive hospital-acquired infections. We investigated the prevalence and dynamics of neonatal ESKAPE and Candida spp. colonization from hospital admission until discharge (or death) and followed up for invasive disease. Prospective longitudinal surveillance for neonatal ESKAPE and Candida spp. colonization was conducted over 6 months at a South African regional hospital. Neonates enrolled at birth had swabs (nasal, 2× skin and rectal) collected within 24 hours and every 48-96 hours thereafter, until discharge or death. ESKAPE and Candida spp. were cultured for and antimicrobial susceptibility was performed on bacterial isolates. Whole-genome sequencing was undertaken on paired samples with the same bacterial species from colonizing and invasive disease episodes in the same child. Of 102 enrolled neonates, 79% (n = 81) were colonized by ≥1 ESKAPE organism by time of discharge or death. Forty-four percent (36/81) were colonized within 24 hours of birth. Common colonizers were K. pneumoniae (70%; n = 57) and Enterobacter spp. (43%; n = 35). Almost all MDR organisms (93%) were Gram-negative. Forty-two (45%, 42/93) newborns acquired Candida spp. (skin only) colonization, commonly Candida parapsilosis (69%; n = 29). For 2 children with K. pneumoniae colonization and sepsis, the bloodstream and colonizing isolates were genetically different, whereas the single A. baumannii colonizing and blood isolate pair were genetically identical. We report a high prevalence of MDR ESKAPE and Candida spp. colonization in a regional neonatal unit. Interventions to reduce the high incidence of hospital-acquired neonatal infections should include reducing high colonization rates.

Exploring right ventricular function applicability in a prediction model to identify preterm infants with early bronchopulmonary dysplasia (REPORT-BPD study): a mixed-methods observational cohort feasibility study protocol.

Bronchopulmonary dysplasia (BPD) is a chronic disease that affects the immature lungs of preterm infants. Infants born before 32 weeks of gestation are at a greater risk of developing BPD due to the need for respiratory support with higher oxygen requirement. Pulmonary vascular remodelling in early BPD can impose an additional burden on the right ventricle (RV) and RV dysfunction. This protocol outlines the study design and aims to formulate a prediction model to identify early BPD through the data generated from echo scans analysis. The mixed-methods observational cohort feasibility study, which comprises three work-packages (WPs), will be conducted at the regional neonatal unit, University Hospital Plymouth, Plymouth, UK. WP-I will recruit 40 preterm infants; each participant will have two heart scans performed in the first ten days after birth (DABs). WP-II will collect the documentation of the participating preterm infants' parents in the study neonatal unit diaries in the first 10 DABs. WP-III will involve semi-structured interviews of 10-15 parents of participating preterm infants and 10-15 health professionals who participated in WP-I. The study recruitment will be conducted over 18-months. The start date is 01 June 2022. WP-I and WP-II recruitment will occur during this period, while WP-III recruitment will occur during the second half. The results are expected to be submitted for publication by mid-2024. This paper outlines the study design. If the study successfully identifies the most sensitive echo parameter in recognising the RV dysfunction associated with early BPD, it will be an important finding in constructing an early BPD prediction model. ClinicalTrials.gov Identifier is NCT05235399.

Study protocol for a population-based observational surveillance study of culture-confirmed neonatal bloodstream infections and meningitis in South Africa: Baby GERMS-SA

IntroductionWorldwide, neonatal mortality remains high accounting for 47% of childhood deaths in 2019 and including an estimated 500 000 deaths from neonatal infections. While 42% of global neonatal deaths occur...

Temporal trends in routine predischarge pulse oximetry screening: 6 years’ experience in a UK regional neonatal unit

ObjectivesTo evaluate the continued impact of pulse oximetry screening (POS) in a regional neonatal unit (NNU) and identify trends in screening outcomes in comparison with our previous experience.DesignRetrospective review of...

Impact of pulse oximetry screening to detect congenital heart defects: 5\xa0years\u2019 experience in a UK regional neonatal unit

Pulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50–70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%.Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools.What is Known:• Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects.• Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee.What is New:• To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice.

Time to positivity (TTP) of neonatal blood cultures: a trend analysis over a decade from Ireland

Background and aims: Blood culture (BC) remains gold standard for the evaluation and diagnosis of neonatal sepsis. Time when BC becomes positive and the type of microorganism isolated are crucial in deciding the antimicrobial management. Likely pathogenicity of organisms growing in BC could potentially be predicted based on the “time to positivity” (TTP). We aimed to estimate the predictive value of isolating a likely pathogenic organism depending on TTP; evaluate the aetiological trend and neonatal mortality rate due to culture-proven neonatal sepsis for over a decade and verify whether the application of a “36 hour rule” to discontinue empiric antibiotics in well newborn infants with negative BC would be safe.Methods: Retrospective review of BC results over a 14-year period from a regional neonatal unit in Ireland. Laboratory data were independently extracted in relation to BC results from the laboratory information management system (LIMS-iLAB). Neonatal mortality data were collected from multiple sources. Statistical analysis included logistic regression, chi-square, and Mann–Whitney U-test.Results: Over a 14-year period 11,432 neonatal BC specimens were incubated of which 605 (5.3%) turned positive. Overall, the commonest organism grown was coagulase-negative Staphylococcus (CoNS), 416 (68.8%). Main pathogenic organisms were Staphylococcus aureus 23 (3.8%), Enterococcus spp. 22 (3.6%), E.coli 21 (3.5%), group B Streptococcus (GBS) 18 (3.0%), and Klebsiella species 9 (1.5%). Gram-negative organisms had the shortest TTP, with Klebsiella spp. having a median TTP of 10 h and E. coli 11 h. For Gram-positives, GBS had a median TTP of 12 h, Enterococcus species 14 h, with S. aureus growing at a median time of 15 h. All of the Klebsiella spp. and other Coliforms were detected within 24 h, with, 95.2% of E.coli, 94.4% of GBS, 95.5% of Enterococci, and 95.7% of S. aureus, flagging positive in 24 h. Using logistic regression the omnibus test of the coefficients in the resulting model was significant (p < .001). Our observed coefficient (β) for TTP was 0.144; shorter the TTP higher was the likelihood of isolating a pathogenic organism, with an odds ratio (OR) of 1.155. We also report a relatively low blood culture proven sepsis-specific neonatal mortality rate of 0.403/1000 live births and in all such instances observed TTP was less than 24 h.Conclusion: Duration of this study exceeds that of most of the neonatal blood culture TTP analysis published to-date. A shorter TTP is an important adjunct to suggest the growth of a pathogenic organism while managing suspected neonatal sepsis. TTP if < 24 h per se would not necessarily confirm the growth of a highly pathogenic organism; however, if a positive growth is likely to happen for a significant neonatal pathogen, in more than 98% the TTP would be within 24 h. This offers the clinician more of negative predictive value than a positive one; when there is no growth in BC. Our observation on TTP reiterate the National Institute of Health and Care Excellence (NICE) guideline of discontinuation of empiric antibiotics after 36 h in and clinically well and BC negative newborn infants.

Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission

DesignA qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in...

The Impact of Neonatal Service ReOrganisation on Feeding of Preterm Infants (&lt;34 Weeks): A Prospective Cohort Study in a Regional Neonatal Unit from 1992 to 2010

Objectives: To describe Neonatal Intensive Care Unit (NICU) feeding practices during the neonatal period and explore predictors of any breast milk feeding at discharge among very preterm infants admitted before and after re-organisation of neonatal services in a region of the UK. Methods: Data on feeding of preterm infants (<34+0 weeks) at four time-points in the neonatal period and at discharge were collected prospectively on 1018 infants admitted to a regional NICU over a 19-year period. These data were subjected to unadjusted and adjusted analyses and time trends calculated before and after the transition. Results: Initiation of breast milk feeding in preterm infants increased throughout the study. However, the proportion of infants receiving breast milk declined steadily through the neonatal period and beyond. Before re-organisation, breast milk feeding (any) at discharge increased year-by-year (slope coefficient for trend 0.127, p<0.001). After re-organisation, the trend slowed down/decelerated (slope coefficient for trend 0.071, p 0.32). Any breast milk feeding at day 7 of life, singleton pregnancy, and length of hospital stay were associated with any breast milk feeding at discharge. Conclusions: Breast milk feeding of preterm infants increased in line with secular trends. However, this trend fell away following neonatal service reorganisation. This finding suggests that service providers and commissioners should monitor infant feeding trends in NICUs against national trends, as a benchmark of maternal and infant wellbeing and service delivery. The early predictors of any breast milk feeding at discharge found in this study need further research to validate their usefulness.

Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery

BackgroundNeonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit.MethodsThe study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework.ResultsSix themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care.ConclusionsThis study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

G528(P) A daily regional conference call: maximising efficiency of repatriation. the impact on neonatal units in the west of scotland

Context This project has been carried out between the regional neonatal units, the Neonatal Managed Clinical Network (NMCN) and the Neonatal Transport team (NTS). It has involved multidisciplinary team work between all the health boards in the region with input from key medical, nursing and network staff. Problem It became apparent to the NMCN that neonatal cot capacity in the region was frequently highly occupied and under pressure. We wanted to have a proactive method of identifying cot capacity issues early and maximise our repatriation processes whilst identifying any delays. As a trainee representative at the NMCN meetings, I suggested setting up a regional teleconference call to address these issues. A multidisciplinary team were tasked with setting up this call. Assessment of problem and analysis of its causes The working group contacted key staff within the region’s neonatal community to canvass opinion with regards to regional cot capacity issues. Discussions confirmed that issues with limited availability of cots often became apparent late in the day and left clinicians spending significant amounts of time locating cots. Units and NTS were not always aware what was happening elsewhere until multiple phone calls and time had been spent trying to find out such information. Consent was gained to set up a daily teleconference call between the units and NTS to obtain information about the regional cot capacity. Intervention The call takes place each day at 12.30pm, chaired by the Transport Consultant. Each unit is represented by the Duty Consultant and/or Nurse in Charge. Information is collected upon unit status, staffing issues, cot availability, expected admissions and babies awaiting repatriation or transfer for specialist investigation. The call takes less than 15 min. The information is recorded by NTS and electronically shared with Network administration where it is regularly analysed. Study design A PDSA cycle was undertaken to set-up, test, implement and analyse effectiveness of the intervention. Strategy for change Mock calls were undertaken by the working group to trial the call, test the process of change and refine the data to be collected. Following small adjustments the call went live. A start date, time and telephone number was communicated with senior staff within the region. Data was collated. Measurement of improvement Data was collated as above then analysed and shared with unit managers using real time figures and run charts. Analysis revealed that there were no delays in transport due NTS but that delays in repatriation due to receiving unit cot capacity issues are not uncommon. Effects of changes When units are busy, other units in the region have worked together to relieve capacity issues when able. Units and NTS are aware earlier in the day what the cot issues are. Units are including the regional activity information in their handovers. The call allows efficient planning of workload and implementation of solutions more effectively. The teleconference call has now been extended to include large units elsewhere in the country. Lessons learnt Through feedback and analysis, we have further refined the data collected, maximising call effectiveness. Data collection has demonstrated significant issues with cot capacity which will be used to campaign for funding for more cots and staff. Message for others The conference call was rapid to implement and embed into clinical practice. This is because it is quick and addresses issues close to the priorities of all users. Transfers can be undertaken more efficiently, ultimately saving clinician time.

PS-307 National Recommendations For The Investigation Of Early Onset Neonatal Sepsis: Lumbar Puncture Incidence And Indications

Background Early onset sepsis (EOS) is a leading cause of morbidity and mortality in newborns. The incidence of culture-positive EOS in UK neonates is 0.9/1000 live births. We aimed to compare EOS investigation practice with The National Institute of Clinical Excellence (NICE) guidelines (2012) for investigation, and determine factors that influence LP acquisition. Method We conducted a retrospective observational study in a regional neonatal unit, using data from 213 babies investigated for EOS ( 2 risk factors, or other clinical indicators). Results Data was collected from 213 term babies (228 infection episodes). Clinical concern for infection was identified in 52/228. These infants had more respiratory distress and shock than those without clinical concern. (p Conclusion Despite its low incidence EOS causes substantial clinical concern. LPs were not carried out in a number of infants despite meeting NICE criteria. Maternal risk factors and maximum CRP appear to determine the acquisition of LP more than physician ‘concern’ of infection.

PO-0725d Red Cell Transfusion Requirement In Preterm Infants Of Twin Or Higher Order

<h3>Background</h3> Preterm infants often require red cell transfusions (RCT) during their neonatal unit stay. Recently many studies have focussed on reducing the transfusion requirements e.g. delayed cord clamping, cord milking. Majority of these studies do not include the preterm infants that are of twin or higher order. This study was designed to investigate if the transfusion requirements in twins were different from singletons. <h3>Method</h3> Retrospective data was collected from patient records for preterm infants below 32 weeks gestation admitted to regional tertiary neonatal unit at Nottingham City Hospital from October 2011 to February 2013. We compared transfusion requirements in singletons versus neonates of twin or higher order. All infants, singletons or twins, received similar neonatal care in terms of nutrition, supplements and thresholds for RCT. <h3>Results</h3> A total of 113 infants (37 twins group and 76 singleton group) were identified at gestation below 32 weeks. Groups were comparable in terms of weight, sex distribution, haemoglobin at admission and mode of delivery. 48.6% of preterm twin and higher order infants required RCT compared to 53.9% of singleton infants (p = 0.6892) and on an average requiring 1 transfusion compared to 1.4 RCT per infant who were singleton. Outcomes at 6 weeks were comparable between the 2 groups. <h3>Conclusion</h3> We conclude that preterm twin and higher order infants have comparable RCT requirements to singleton infants. This emphasises the need to focus on strategies to impact on the use of RCT in this population subgroup. <h3>Ackowledgements</h3> PD Dr Heike Rabe for her guidance in planning the study.

An exploration of anaemia in low-birthweight infants exposed to perinatal zidovudine at the neonatal unit at a regional hospital in Durban

Objective: The objective of the study was to determine the prevalence and degree of anaemia in low-birthweight neonates exposed to intrauterine zidovudine (AZT) at a regional hospital neonatal unit in Durban.Design: This was a descriptive, cross-sectional study.Background: Perinatal exposure to AZT has been shown to cause anaemia in full-term babies. The effects of AZT in this group need to be established as there is a low-birthweight rate of 12.8% of anaemia in South Africa.Outcome measures: Outcomes measures of the study were the neonatal haemoglobin (Hb) levels, gestational age and duration of AZT exposure.Results: The total prevalence of anaemia was 47% in the 95 neonatal birth records analysed. The prevalence of anaemia was 16.7% and a mean Hb of 17 g/dl in the 26- to 28-week gestational age category; a prevalence of anaemia of 37% with a mean Hb of 16 g/dl in the 29- to 31-week category; and a prevalence of 54.8% of anaemia with a mean Hb of 17 g/dl in the > 31-week category. The mean Hb in the neon...

PC.57 Trends in mortality in a regional neonatal unit over 21 years demonstrate a halving of neonatal deaths

Trends in the patterns of mortality on neonatal units have been changed the last two decades, particularly in the case of fatal infection. The aims of this study were to...

ABSTRACT 727

Background and aims: Necrotizing Enterocolitis (NEC) is a devastating disease affecting up to 5% infants admitted to neonatal-units. Mortality in patients requiring laparotomy is as high as 50%. Whilst most of these patients are managed in tertiary neonatal units in the UK, in our region the neonatal surgical unit is based at Alder Hey Children’s Hospital rather than at the regional neonatal unit. Following surgical intervention these patients are admitted to the paediatric intensive care unit (PICU) particularly for the sicker patients who are too unstable for transfer. Aims: To report our institution results after acute surgical NEC. Methods: Ten years retrospective review of prospectively collected data (January 2003 – December 2012). Inclusion: Infants needing laparotomy for neonatal NEC. Exclusion: NEC managed with conservative treatment, known congenital heart disease. Mortality was measured at PICU discharge and surgical follow up. PICU morbidity was measured with PIM2, length of PICU stay (LOS). Results: Over ten years period out of 186 patients were coded with NEC 109 needed laparotomy. Median gestation was 27weeks (range23-41). There were 26 deaths in the immediate post-operative period and 16 more deaths by 3 months follow up. Median PIM2 on admission was 0.07 (+/-0.02) against observed PICU mortality rate of 24% and SMR of 4.3, thus significantly under predicting mortality. Conclusions: PICU survival rates after acute surgical NEC is 70%, and 61.4% in the immediate and 3 months post-op period respectively. This is comparable to reported rates for patients managed in neonatal units.

G119(P) Reducing Catheter Associated Blood Stream Infections and Peripheral Line Insertions on a Regional Neonatal Unit

AimsCatheter associated blood stream infection (CABSI) is a serious complication of central vessel catheterisation (CVC). During 2010 a series of policy changes were introduced including the use of multi-lumen umbilical...

The impact of routine predischarge pulse oximetry screening in a regional neonatal unit

Objectives(i) To evaluate the impact of routine early pulse oximetry screening on the rate of unexpected neonatal unit (NNU) admissions and the need for echocardiography. (ii) To review the outcomes...

Prevalence and Characteristics of Rib Fractures in Ex-preterm Infants

This study aimed to identify the prevalence and characteristics of rib fractures in ex-preterm infants. Infants born at <37 weeks' gestation and admitted before 2011 to 3 regional neonatal units were identified from admission registers. For 2 centers, these data were available from 2000 onward and, for another center, from 2005. Electronic records were searched to identify chest radiographs performed up to age 1 year. Chest radiograph reports were then reviewed for evidence of rib fractures, and the case notes of all affected individuals were scrutinized. Of the 3318 eligible preterm infants, 1446 had a total of 9386 chest radiographs. Of these infants, 26 (1.8%) were identified as having a total of 62 rib fractures. Their median (range) gestation at birth was 26 weeks (23-34). The median chronological age of these infants at the time of the radiograph was 14 weeks (5 weeks to 8 months). The median corrected gestational age at the time of the radiograph was 39 weeks (34 weeks to 4 months). Of the 62 fractures, 27 (36%) were sited posteriorly, and 15 (53%) of the infants with posterior rib fractures were diagnosed with osteopathy of prematurity. Classic risk including conjugated hyperbilirubinemia and diuretics, were present in 23 of 26 (88%) infants. A full skeletal survey was performed in 8 of 26 (31%). Investigations for nonaccidental injury occurred in 4 of 26 (15%) cases. Evidence of rib fractures is present in ~2% of ex-preterm infants. The evaluation of these fractures in infancy requires a detailed neonatal history irrespective of the site of rib fracture.