Regional Neonatal Unit Research Articles

Quality of life of 6-year-old survivors from a regional neonatal unit

Objective: Quality of life (QOL) of children who required treatment in a national neonatal intensive care unit (NICU) during the first week of life was determined at 6 years of age.Method:QOL was assessed using a standardized questionnaire employing a multi-attribute scoring system including the functions: hearing, vision, speech, mobility, emotion, learning, self-care and pain. After excludingthose with congenital neurodevelopmental disorders, questionnaire returns were analyzed from 177 children treated in the NICU in 1990 and a comparative age-matched group of 230 children who did not requireneonatal care. Of these, returns were obtained from 143 (81%) cases and 171 (74%) of the non-treated group.Results: There was no difference in overall ability between the two groups, with 95(66%) of cases and 126 (74%) of the comparison group reporting normal scores in all functions. Children treated in the NICU had decreased scores in individual functions including speech (p = 0.04),mobility (p = 0.009) and self-care (p = 0.006). For the study population, males had lower function in speech (p = 0.04) and learning (p = 0.001), with significantly worse functionoverall (p = 0.02) when compared with female cases. When compared with same-gender children who did not require NICU care, overall function was also significantly worse for male but not female cases(p = 0.0002), and this was largely contributed to by impairment in speech (p = 0.03), mobility (p = 0.04), learning abilities (p = 0.02) and self-care (p = 0.03). Eleven(7.7%) cases compared with just two (1.2%) children who were not treated in the NICU required assistance at school (p = 0.009). No difference was observed when QOL was assessed according to gestationalage and birth weight.Conclusion: Using a simple scoring system this study has shown that, for survivors who required early neonatal intensive care, the QOL at 6 years compared favorably withthat of children not treated in the NICU, especially for girls.

Classification and risk-factor analysis of infections in a surgical neonatal unit

Background/Purpose: Nosocomial infection may result in significant morbidity in surgical neonates. Traditionally, nosocomial infections are classified using time cut-off points. Gastrointestinal carriage of microorganisms has not been used as a criterion for classifying infection in surgical neonates. The aims of the study were to (1) determine the overall infection rate, (2) distinguish between nosocomial and community acquired infections using a 48-hour postadmission cutoff and the carrier state criterion, and (3) determine risk factors for clinical infection. Methods: A 1-year prospective observational cohort study was undertaken in a regional neonatal surgical unit between 1997 and 1998. All infants residing for ≥3 days in the unit were included in the study (n = 167). Patient demographics, including illness severity (PRISM score), were recorded for all infants. Surveillance throat and rectal swabs were obtained on admission and twice weekly thereafter to determine carrier status. Carriage was defined as isolation of the same microorganism from at least 2 consecutive surveillance samples. Infective episodes were diagnosed if a clinical diagnosis of local or general inflammation was microbiologically proven. Results: A total of 167 infants responsible for 174 admissions were studied. Median gestational age was 38 weeks (range, 24 to 42), median birth weight was 3 kg (range, 1 to 3.6), median age on admission was 8 days (range, 0 to 142), median length of hospital stay was 8 days (range, 3 to 95). The diagnoses were gastrointestinal disorders (n = 96), abdominal wall defects (n = 22), neural tube defects and hydrocephalus (n = 17), thoracic disorders (n = 16), urologic disorders (n = 12), and abdominal tumours (n = 4). Twenty-five infants had 33 episodes of infection giving an overall infection rate of 14.9%. The predominant infecting organism was Stapylococcus aureus (n = 11); others were enterococcus, coagulase negative staphylococcus, Candida spp, Gram-negative bacilli, and anaerobes. A total of 27 of 33 infective episodes were caused by microorganisms carried by the infants on admission (primary endogenous). Only 6 children had “true” nosocomial infections. Using a traditional 48 hour cutoff, 87% of the infections were classed as nosocomial. Birth weight, presence of central venous line, PRISM score, and length of stay were identified as significant risk factors for developing clinical infection. Conclusions: (1) Carriage allowed us to identify the true nosocomial infection rate (microorganisms acquired in the unit), which was only 18%. In contrast, using a traditional 48 hour cutoff, 87% of the infections would have been classed as nosocomial and warranted unnecessary cross-infection investigations. (2) The results of this study confirm that birth weight, illness severity (PRISM score), presence of central venous catheter, and length of hospital stay were independent risk factors associated with clinical infection in surgical neonates. J Pediatr Surg 36:276-281. Copyright © 2001 by W.B. Saunders Company.

Respiratory distress in heavier versus lighter twins.

We performed a retrospective study of twin pairs under 36 weeks gestation admitted to a regional neonatal unit over a three year period to determine if the larger twin of a twin pair is at increased risk of respiratory distress in the immediate postnatal period compared to the smaller twin. Gestation, gender, birth weight, mode and reason for delivery, birth order, and Apgar at 5 minutes were correlated with the need for added oxygen at 4 hours, the need for ventilation, oxygen requirement at 28 days and mortality. One hundred and twenty-four twin pairs were analyzed with a median gestation of 31 weeks (range 23-35). There were 47 female-female pairs, 40 male-male pairs and 37 mixed pairs. Multiple logistic regression revealed no significant increased risk for ventilation in male, heavier or second twins. The need for oxygen at 4 hours was strongly associated with being male and being the second twin, but not with being the heavier twin. However, on analysis of twins of 28 weeks gestation or above a significant association was found between a persisting oxygen requirement at 4 hours and being male (OR 2.2; 95% CI 1.15-4.16), being the heavier twin (OR 1.9; 95% CI 1.03-3.46), and being the second twin (OR 2.7; 95% CI 1.48-4.99). No association was found between mortality and being male, and being the second or smaller twins. Heavier twins above 28 weeks gestation are at increased risk of short term mild respiratory problems following delivery compared to lighter twins at the same gestation. This is not as strong a factor as birth order or male gender, but it is important to be aware of this in antenatal counselling of the parents as the smaller twin is usually perceived to be at greater risk of morbidity.

Effect of Less Frequent Bathing of Preterm Infants on Skin Flora and Pathogen Colonization

To determine if less frequent bathing alters colony count or type of organism in skin flora of preterm infants. Descriptive, repeated measures study. A regional neonatal intensive-care unit. Forty-five preterm infants, 31 weeks mean gestational age (SD +/- 1.6 weeks) and 17 days mean postnatal age (SD +/- 3.7 days). Before the study, all infants received a bath every other day. On Day 1 of the study, a routine sponge bath was given, then no further bathing was performed for 4 days. Serial axillary skin cultures to identify the number of colony forming units (CFU) and type of organism were obtained within 30 minutes of the bath on Day 1 and at the same time on Days 2, 3, and 4. Normal skin flora CFU count, predominantly coagulase-negative staphylococci, increased within 48 hours after bathing compared to values 30 minutes after bathing. There were no differences in normal skin flora CFU on Days 2, 3, and 4. Pathogens were identified in 12 infants for at least one time point during the study. Significantly fewer pathogens were found in the cultures over time, despite longer interval since bathing, and no infant developed symptoms of infection during the study period. Findings from this study suggest that the frequency of bathing of preterm infants can be reduced without increasing the risk of infection.

Hospitalisation for RSV infection in ex-preterm infants—implications for use of RSV immune globulin

BACKGROUNDRespiratory syncytial virus (RSV) specific immune globulin is now being marketed for prevention of RSV infection in ex-preterm infants. However, there are no published UK data on the morbidity or...

Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant?

Acta PaediatricaVolume 89, Issue 5 p. 510-512 Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant? CP Speer, Corresponding Author CP Speer Department of Pediatrics University Children's Hospital, Wuerzburg, GermanyCP Speer, University Children's Hospital, Josef-Schneider-Str. 2, D-97080 Wuerzburg, Germany)Search for more papers by this authorB Robertson, B Robertson Department of Woman and Child Health Karolinska Hospital, Stockholm, SwedenSearch for more papers by this authorHL Halliday, HL Halliday Department of Child Health The Queen's University of Belfast and Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern IrelandSearch for more papers by this author CP Speer, Corresponding Author CP Speer Department of Pediatrics University Children's Hospital, Wuerzburg, GermanyCP Speer, University Children's Hospital, Josef-Schneider-Str. 2, D-97080 Wuerzburg, Germany)Search for more papers by this authorB Robertson, B Robertson Department of Woman and Child Health Karolinska Hospital, Stockholm, SwedenSearch for more papers by this authorHL Halliday, HL Halliday Department of Child Health The Queen's University of Belfast and Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern IrelandSearch for more papers by this author First published: 02 January 2007 https://doi.org/10.1111/j.1651-2227.2000.tb00328.xCitations: 23AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume89, Issue5May 2000Pages 510-512 RelatedInformation

Ionising radiation from diagnostic x rays in very low birthweight babies

AIMTo quantify the exposure of very low birthweight neonates to ionising radiation from diagnosticx-rays.METHODSRetrospective analysis was made of all radiographs performed over 18 months in an integrated special care baby...

Increased survival and deteriorating developmental outcome in 23 to 25 week old gestation infants, 1990–4 compared with 1984–9

AIMSTo assess whether changes in survival over time in infants of 23 to 25 weeks of gestational age were accompanied by changes in the incidence of disability in childhood during...

Does the computer improve the nutritional support of the newborn?

Fifty-two consecutlve infants admitted to a regional neonatal unit and requiring parenteral nutrition were randomly allocated to receive feeds based on either a ‘standard bag’ regimen in which the volume of amino acid and dextrose solutions were given in a fixed ratio of 1:3, but with flexible electrolyte addition, or a computer-assisted regimen, taking into account fluid and nutrient composition of partial enteral feeds, additional intravenous fluids and arterial flushes. The aim of the study was to assess whether the computer-generated prescription would reduce parenteral nutrition solution waste, improve electrolyte balance and promote growth when compared with the less flexible ‘standard bag’ approach. There was no difference in wastage of parenteral nutrition solution, biochemical stability (as indicated by plasma sodium or phosphate), or weight gain between the two groups. We conclude that the considerable flexibility afforded by computer-assisted prescribing may be of little benefit to most patients.

Estimation of pulmonary arterial pressure in the newborn: study of the repeatability of four Doppler echocardiographic techniques.

Despite the increasing use of Doppler echocardiographic (DE) techniques to determine pulmonary arterial pressure in the neonate undergoing intensive care, there have been no studies comparing their repeatability in this population. Our objective was to compare the repeatability of four such techniques in neonates. The study was conducted in two regional neonatal units serving the North East of England. Group A (repeatability between observers): Two experienced observers performed detailed DE examinations, one directly after the other. Group B (within observer repeatability/temporal variability): One observer performed two examinations 1 hour apart. Group A comprised 15 preterm babies (26-36 weeks' gestation, 975-2915 g), most with mild respiratory failure; 4 healthy term babies; and 7 with congenital heart disease, in whom tricuspid regurgitation (TR) only was measured. Their ages were 18 hours to 12 days. Group B comprised 11 babies aged 12-64 hours with moderate to severe respiratory failure; 10 were preterm (26-36 weeks, 785-2800 g). We recorded four measurements: (1) Peak velocity of TR in m/s; (2) peak left-to-right ductal flow velocity (PDAmax in m/s); (3) TPV/RVET ratio; and (4) PEP/RVET ratio, where TPV = time to peak velocity at the pulmonary valve, PEP = right ventricular preejection period, and RVET = right ventricular ejection time. The Bland-Altman analysis was used to produce the coefficient of repeatability (CR: 95% confidence limits of repeatability), also expressed as a repeatability index (CR/mean value) and as a number of "confidence steps"-a measure of sensitivity of the technique to hemodynamic change (range of values within the population/CR). Between-observer and within-observer repeatabilities were similar. Within-observer CR and index (%) results were for TR +/- 0.26 m/s (9%); for PDAmax, +/- 0.48 m/s (39%); TPV/RVET 0.1:1.0 (34%), PEP/RVET 0.12:1.00 (36%). TR and PDAmax had the largest number of confidence steps in the expected range of values (TR 8.5; PDA max 6.5; TPV/RVET 3.2; PEP/RVET 3.2). The most repeatable technique was TR, but PDAmax would also be useful for a serial study owing to the potential for large change. Systolic time interval ratios were less repeatable and likely to be less sensitive indicators of hemodynamic change.

CRIB (clinical risk index for babies) in relation to nosocomial bacteraemia in very low birthweight or preterm infants.

Positive blood cultures in very low birthweight or preterm infants usually reflect bacteraemia, septicaemia, or failure of asepsis during sampling and lead to increased costs and length of stay. Rates of nosocomial, or hospital acquired, bacteraemia may therefore be important indicators of neonatal unit performance, if comparisons are adjusted for differences in initial risk. In a preliminary study the risk of nosocomial bacteraemia was related to initial clinical risk and illness severity measured by the clinical risk index for babies (CRIB). Nosocomial bacteraemia was defined as clinically suspected infection with culture of bacteria in blood more than 48 hours after birth. One or more episodes of nosocomial bacteraemia were identified retrospectively in 36 of 143 (25%) infants in a regional neonatal unit between 1992 and 1994. Biologically plausible models were developed using regression analysis techniques. After correcting for period at risk, nosocomial bacteraemia was independently associated with gestation at birth and CRIB. Death was independently associated with CRIB, but not with nosocomial bacteraemia. CRIB may contribute, with other explanatory variables, to more comprehensive predictive models of death and nosocomial infection. These may facilitate future risk adjusted comparative studies between groups of neonatal units.

Gastroschisis in the Decade of Prenatal Diagnosis: 1983-1993

Fifty cases (24 males, 26 female) of gastroschisis were admitted to the Regional Neonatal Surgical Unit at the Royal Hospital for Sick Children in Yorkhill, Glasgow, between January 1983 and October 1993. The mean birthweight was 2.17 kgs and mean gestation was 35.8 weeks. Prenatal diagnosis was made by ultrasound scan in 39 cases (78%) and 33 (66%) were delivered in the Regional Obstetric Unit and Fetal Medicine Centre at the Queen Mother's Hospital, Yorkhill, Glasgow, immediately adjacent to the neonatal surgical unit. Spontaneous vaginal delivery occurred in 23 (46%) but Caesarean section was performed in 27 (54%). Sixteen Caesarean sections were emergencies and 11 elective (5 on account of dilated bowel loops). Associated bowel problems were noted in 11 (22%)--atresia (5), stenosis (2), ischaemia (1), duodenal perforation (1), ileal perforation (1) and jejunal band obstruction (1). Primary closure was achieved in 42 (84%) and there were 5 deaths (10%). Prenatal diagnosis and mode of delivery showed no direct correlation with mortality (10%) in this series. Emergency Caesarean section was necessary for fetal indications in 28%. The prediction of compromised or damaged intestine by prenatal ultrasound was unreliable and the majority of cases of atresia and stenosis escaped detection. However, it is concluded that prenatal diagnosis and delivery in a regional centre offers the best outcome for the fetus. Further study is needed to define "at risk" pregnancies and fetuses and to determine the role of intervention.

Neonatal herpes simplex infection: Keys to early diagnosis

To highlight the clinical features of neonatal herpes simplex (HSV) infection that might facilitate earlier diagnosis. Fifteen year retrospective review of proven neonatal HSV cases from a regional neonatal referral unit. Fifteen cases reviewed: 10 with central nervous system (CNS) disease, three with skin, eyes or mouth (SEM) disease and two with disseminated disease (DIS). A median 4 day delay occurred between symptom onset and hospital admission. All cases presented after maternity hospital discharge, most commonly with feeding problems and lethargy. Six patients presented with skin lesions; parental genital herpes was reported in three (20%) cases. Seven infants died, four without acyclovir treatment and three of 11 treated cases. Three of five CNS disease survivors and all infants with SEM disease were normal at follow up. Acyclovir improves outcome in neonatal HSV infection. To improve outcome further earlier recognition of the non-specific presenting features of the disease is required.

Wound infection in pediatric surgery: A study in 1,094 neonates

In an analysis of 1,433 wounds created in 1,094 neonates admitted to a regional neonatal surgical unit during the period April 1975 to December 1987, the mean incidence of infection was 16.6%. During this time there was an increase in the incidence of infection from 12.5% in the first 6 years to 18.8% in the last 7 years (P < .01). Contaminated wounds had an infection rate of 20.7%, whereas the rate in clean wounds was 11.1% (P < .001). Gestational age and birth weight had no influence on the incidence of wound infection. Increasing wound length (P < .001), increasing duration of operation (P < .001), and contamination at operation (P < .001) were all associated with a higher incidence of infection. Staphylococcal species were the most frequently isolated organisms from all categories of infected wounds (clean, potential, and actual contamination).

Which central venous catheter for neonatal use?

Complications in 100 percutaneous central venous catheters used for parenteral nutrition were monitored prospectively in patients on a regional neonatal medical and surgical unit. Infants were randomly allocated to receive either a Vygon Epicutaneous catheter or Dow Corning silastic tubing. The majority of lines —63 — were removed electively when parenteral feeding was no longer required. The most common serious complication was catheter sepsis for which 11 lines were removed; all patients made a complete recovery. Minor mechanical complications were encountered with 17 catheters. There was no difference in performance or complication rate comparing the two types of catheter. Percutaneous central venous catheters provide a suitable and safe means of administration of parenteral nutrition to preterm infants over an extended period of time.

Normal blood pressure measurements in very low birthweight babies : P.J. Powell, P. Assassa, A. Ellis, S. Hollis ∗ and M.J. Robinson, Hope Hospital Regional Neonatal Unit, Salford. ∗Medical Statistician, Salford Health Authority

Normal blood pressure measurements in very low birthweight babies : P.J. Powell, P. Assassa, A. Ellis, S. Hollis ∗ and M.J. Robinson, Hope Hospital Regional Neonatal Unit, Salford. ∗Medical Statistician, Salford Health Authority

Selenium and glutathione peroxidase levels in premature infants in a low selenium community (Christchurch, New Zealand).

By world standards, the selenium status of the adult population of Christchurch, New Zealand is low. To determine the status of infants undergoing neonatal intensive care, plasma and red cell selenium and glutathione peroxidase levels were measured in infants admitted to the regional neonatal unit. Plasma levels in all newborn infants were one third to one half those in adults. Premature infants had levels significantly lower than those in cord blood from term infants, but their levels were not different from those of term infants admitted to the unit. There were no differences between adult and infant red cell levels. The premature infants remaining in the neonatal unit showed dramatic decreases in plasma selenium and glutathione peroxidase with age, with many infants having selenium levels of less than 0.13 mumol/L (10 micrograms/L). Low levels were seen in infants fed orally as well as those on parenteral nutrition. Thus, the low selenium status of New Zealanders is associated with particularly low selenium levels in premature infants. Because these infants have a high risk for oxidative diseases such as bronchopulmonary dysplasia (chronic lung disease) and retinopathy of prematurity, the possibility that these conditions are more serious in the New Zealand population needs to be assessed and consideration given to dietary supplementation.

Is neonatal inspired gas humidity accurately controlled by humidifier temperature?

To investigate: a) the relationship between humidifier temperature and inspired gas humidity and b) the effect of insulating the inspiratory tube on "rainout" (condensate). Observational study. Regional neonatal unit in a university hospital. Forty-eight infants receiving assisted ventilation, of whom 31 infants were nursed in incubators and 17 under radiant heaters. Despite always maintaining humidifier temperature greater than 34.7 degrees C, inspired gas humidity decreased below the American National Standards Institution minimum of 30 mg H2O/L on 35 of 479 occasions. At a humidifier temperature of 36 degrees C, inspired gas humidity varied between 17 and 43 mg H2O/L. In incubators set at a temperature of 34.1 +/- 1.3 (SD) degrees C, inspired gas humidity was linearly related to humidifier temperature, but with wide scatter (p less than .001, r2 = .28). In cooler incubators set at 32.9 +/- 1.8 degrees C, inspired gas humidity varied inversely with humidifier temperature. This variation was attributed to condensate due to inspired gas cooling within the incubator. Insulation of the inspiratory tubing reduced condensate by only 15%. Inspired gas humidity cannot be predicted reliably from humidifier temperature. Accurate control will require a new generation of humidifiers that measure inspired gas humidity.

Timing of surgery in congenital diaphragmatic hernia

Eighty-six consecutive patients with congenital diaphragmatic hernia presenting within 6 hours of birth to a regional neonatal surgical unit were reviewed. Patients were managed under a policy of delayed surgery which has evolved during the 6-year study period. Overall survival (to leave hospital) was 70.9%. There were only seven postoperative deaths (10.3% of operations). Analysis of the 25 deaths in the light of postmortem findings and published exclusion criteria indicates that the availability of extracorporeal membrane oxygenation would have made little difference to overall survival.

Anesthesia and Brain Damage in the Newborn

Departments of Anesthesia and Radiology, North West Regional Neonatal Surgical Unit, St. Mary's Hospital, Whitworth Park, Manchester, England