Tertiary Neonatal Intensive Care Unit Research Articles

Predicting the risk of treatment-requiring retinopathy of prematurity in preterm infants in Greece. External validation of DIGIROP prognostic models.

To assess the predictive performance of DIGIROP-v1.0 models in identifying treatment-requiring ROP among infants undergoing ROP screening at a tertiary neonatal intensive care unit in Greece. Retrospective cohort analysis of 640 consecutive screened preterm infants with gestational age (GA) 240/7 to 306/7 weeks and known ROP outcome in the 2nd Neonatology Department of Aristotle University of Thessaloniki (2009-2021). The primary outcome was the development of type 1 ROP according to the Early Treatment of ROP criteria or treatment based on the ophthalmologist's judgement. Sensitivity, specificity, area under the curve (AUC) with corresponding 95% confidence intervals (CI) and calibration plots for the DIGIROP-v1.0 models were displayed. The DIGIROP-Birth-v1.0 model correctly identified 35/43 treated infants (sensitivity 81.4% [95% CI, 66.6%-91.6%], specificity 61.5% [95% CI, 57.4%-65.4%], AUC 0.82 [95% CI, 0.75-0.90]). During the postnatal weeks 6-14 the sensitivity of the DIGIROP-Screen-v1.0 model ranged from 82.6% to 100%. Eleven infants, all with severe comorbidities, that is, congenital malformation(s), syndrome(s), hydrocephalus or history of intestinal surgery, that were treated, were missed by the model, but met criteria for screening according to DIGIROP-v1.0 models' recommendations, and to our unit's routine standards. The DIGIROP-v1.0 models resulted in lower sensitivity and higher specificity in this Greek cohort compared with the Swedish development group. Despite higher GA and BW, infants in our cohort had higher incidence of treated ROP than in Sweden, resulting in an under-estimation of their risk for treatment-requiring ROP. Further validation of the DIGIROP-v2.0 models and potential adjusting are recommended to maximize generalizability in populations with different characteristics.

Mental health of parents with infants in NICU receiving cooling therapy for hypoxic-ischaemic encephalopathy

ABSTRACT Background Parents cuddling their babies during intensive care to promote parent-infant bonding is usual practice in the neonatal intensive care unit (NICU). However, babies undergoing cooling therapy and intensive care are not routinely offered parent-infant cuddles due to concerns of impacting the cooling process or intensive care. We developed the CoolCuddle intervention to enable parents to cuddle babies safely during cooling therapy. We investigated whether CoolCuddle impacted parent-infant bonding and parent’s mental health. Methods We conducted parental interviews and compared mental health and bonding measures in two cohorts of parents; one with access to CoolCuddle and the other where CoolCuddle was not available. Results Ten tertiary NICUs in England and Wales from 2019 to 2023 were involved and 107 families. There were high levels of post-delivery depression amongst all parents. However, at discharge mothers in the CoolCuddle group had significantly less depression, lower EPDS scores, and higher MIBS scores (consistent with better mother-infant bonding) than those where CoolCuddle was not available. All measures appeared similar when re-measured at 8 weeks. Parents reported they were not ready to access psychological support or information whilst on NICU and stressed the need of mental health support following discharge, which was not offered or available. Conclusion The CoolCuddle intervention was associated with a lower prevalence of depression and enhanced bonding scores for mothers at discharge compared to those who did not cuddle their babies. Parents highlighted increased levels of postnatal depression following the sudden and traumatic admission of their infant to NICU after birth asphyxia.

The Frequency of Intraventricular Hemorrhage and its Risk Factors.

Intraventricular hemorrhage (IVH) (is the most prevalent type of cerebrovascular accident in premature infants, which can result in lasting neurological complications. The aim of this study was to ascertain the frequency of IVH and its associated risk factors within our particular context. This cross-sectional study was carried out in a tertiary neonatal intensive care unit of a maternal and neonatal hospital from September 2018 to August 2019. Premature infants under 34 weeks of age and with birth weight < 1500 grams who did not have significant congenital anomalies participated in the study. A brain ultrasound was performed by a sonologist during the first week. The infants were subsequently categorized into two groups: those with and without IVH. A comparative analysis was conducted using the chi-square test and logistic regression. A significance level of p<0.05 was considered statistically significant. Of the 205 premature infants who completed the study, IVH was reported in 107 cases (52.1%), of which 97.3% of ventricular hemorrhages were grade I and II and 2.7% accounted for severe bleeding (grade III and IV). Gestational age less than 28 weeks, weight less than 1000 g, vaginal delivery, asphyxia and resuscitation, history of intubation and mechanical ventilation, cord blood acidity, dopamine infusion, and history of fever and chorioamnionitis in the mother have been found to be significantly associated with increased risk of IVH (p<0.001). Antenatal corticosteroids decreased the risk (OR=10.63). In this study, IVH has been found to be common in infants under 1500 g of weight, but the severe form was low in frequency and was observed significantly in high-risk pregnancies.

Cardiopulmonary Physiology of Hypoxemic Respiratory Failure among Preterm Infants with Septic Shock

To examine cardiopulmonary physiological alterations associated with hypoxemic respiratory failure (HRF; fraction of inspired oxygen ≥0.60) among preterm neonates requiring vasopressors/inotropes during sepsis (septic shock). We conducted a retrospective cohort study from 2015 through 2022 at a tertiary neonatal intensive care unit. Neonates <34 weeks gestational age who had septic shock and underwent a comprehensive targeted neonatal echocardiography (TNE) ≤72 hours of sepsis onset were included. TNE findings of patients with shock and HRF were compared with those with shock without HRF. Indices of pulmonary vascular resistance (PVR), right (RV) and left (LV) ventricular systolic and diastolic function, measured using conventional, tissue Doppler imaging and speckle-tracking echocardiography, were examined. Of 52 included infants with septic shock, 19 (37%) also had HRF. Baseline characteristics were similar. On TNE, although the HRF group more frequently had bidirectional/right-to-left flow across the patent ductus arteriosus (67% vs. 33%; p=0.08), all indices of PVR and RV function were similar. However, the HRF group demonstrated reduced LV systolic function [ejection fraction: 51.8±12.3 vs. 62.6±13.0%; global peak systolic longitudinal strain -15.2±4.5 vs. -18.6±4.5%], diastolic function [early (2.3±1.0 vs. 3.6±1.2 /s) and late (2.4 (1.9, 2.6) vs. 2.8 (2.3, 3.5) /s diastolic strain rate], and higher frequency of LV output <150 ml/min/kg (44 vs. 12%); all p<0.05. Acute HRF occurring in preterm neonates with septic shock is associated with alterations in TNE measures of LV function, and not PVR or RV function. Future studies should evaluate the impact of supporting LV function in these patients.

Voluntary Neonatal Medication Incident Reporting-A Single Centre Retrospective Analysis.

Background: Medication errors in neonatal intensive care units (NICUs) are prevalent, with dosage and prescription errors being the most common. Aims: To identify the common medication errors reported over twelve years using a voluntary, nonanonymous incident reporting system (RiskMan clinical incident reporting information system) at an Australian tertiary NICU. Methods: This was a single-centre cohort study conducted at a tertiary NICU. All medication-related incidents (errors) reported prospectively through the RiskMan online voluntary reporting database from January 2010 to December 2021 were included. The medication incidents were grouped into administration, prescription, pharmacy-related, and others, which included the remaining uncommon incidents. Results: Over the study period, 583 medication errors were reported, including administration-related (41.3%), prescription-related (24.5%), pharmacy-related (10.1%), and other errors (24%). Most incidents were reported by nursing and midwifery staff (77%) and pharmacists (17.5%). Most outcomes were minor or insignificant (98%), with only a few resulting in major or significant harm. There was one extreme incident that may have contributed to the death of a neonate and nine moderate incidents. Conclusions: Our results demonstrate that medication errors are common and highlight the need to support improvement initiatives and implement existing evidence-based interventions in routine practice to minimise medication errors in the NICU.

Point-of-care procalcitonin trends in suspected neonatal late-onset infection: a prospective observational study.

Procalcitonin-guided antimicrobial decision-making has been shown to be safe in adult intensive care settings. Most antimicrobial exposure in neonatal units is in culture-negative conditions. We hypothesise that Procalcitonin aids antimicrobial stewardship efforts in suspected Late-Onset Neonatal Sepsis. Neonates were enrolled if they were aged over 72 h and were placed on antibiotics for a suspected infection. Procalcitonin levels were taken at set timepoints for the duration of antimicrobial exposure. Three subgroups were created: non-infectious episodes, blood culture-negative infectious episodes, and bloodstream infections. Eighty-five suspected infectious episodes were recruited across two tertiary neonatal and paediatric intensive care units. There was a significant difference between the median PCT in bloodstream infections (BSI) compared to non-infectious episodes (2.13 versus 0.26 µg/L, p < 0.001). A cut-off of 0.5 µg/L had sensitivity 92.9% and specificity 68% for bloodstream infections at 24 h. The difference between median PCT values at 24 h was significant (0.27 vs 7.08; p < 0.001) for feed intolerance vs. NEC Grade IIIa-IIIb subgroups. Procalcitonin levels taken 24 h following evaluation for late-onset neonatal infection are useful in out ruling BSI or severe Necrotising Enterocolitis. Up to 30% of antimicrobial exposure could be avoided with the use of Procalcitonin levels in low-risk neonates. This study demonstrates the utility of serial Procalcitonin measurements in antimicrobial stewardship efforts in the Neonatal Unit. Procalcitonin can be used to aid in antimicrobial decision making in suspected Late-Onset neonatal infection. Procalcitonin testing at twenty-four hours in episodes of Gastrointestinal deterioration can out rule Bells Grade III Necrotising Enterocolitis.

63 Utilization of vasopressin and norepinephrine in neonates with cardiorespiratory compromise: A multicenter retrospective cohort study in Canada

Abstract Background Data regarding neonatal clinical experience with Vasopressin (VA) and Norepinephrine (NE) are limited to small studies. The lack of large-scale studies with safety and efficacy data is preventing the widespread adoption of these agents. Objectives To describe epidemiological data on utilization of NE and VA in neonates including their indications, effectiveness and overall outcomes across 3 tertiary Neonatal Intensive Care Units (NICU) in Canada. Design/Methods This retrospective cohort study involved neonates who received NE or VA between January 1, 2015-December 31, 2020 at 3 tertiary NICUs. Data regarding demographic information, indications of use, dosing details, and clinical outcomes were described using mean, standard deviations (SD), frequencies and percentages. When appropriate, a comparative analysis was performed using Mann-Whitney U tests or the chi-square test as appropriate. Post-initiation changes in physiological variables and laboratory parameters over time were analyzed using repeated measure ANOVA. Results 133 neonates (VA:70, NE:63) were included in this study. Baseline demographic features, clinical characteristics at initiation, indication of use, dosing details and clinical response in neonates exposed to both agents are summarized in Table 1. VA was commonly used for oxygenation failure due to persistent pulmonary hypertension of the newborn (PPHN), while NE was commonly used for hypotension due to septic shock. NE was frequently used as a 1st line inotropic agent, whereas VA was used more as an additive agent [30 (47.6%) vs 12 (18.6%); p=&amp;lt;0.001]. During treatment, lower sodium levels were recorded in the VA group vs the NE group [126.5 (8.6) vs 132 (7); p=.035], but other safety parameters were similar. The time to reach predefined stability parameters were similar in both groups. Significant improvement in physiological parameters were seen over time with both agents (Figure 1). Mortality within 7 days of use was high in the cohort, but comparable between VA and NE groups [18 (25.7%) vs 22 (34.9%), p=0.206]. Other neonatal morbidities were comparable between groups (Table 1). Conclusion This multicenter study provides pragmatic insights into the current use of NE and VA in neonates. Our study reports the effective use of each agent in distinct patient subgroups. This cohort represented neonates with high illness severity; however, exposure to either agent did not independently increase the risk of mortality or adverse outcomes. Further prospective studies exploring its optimal use and cardiopulmonary effects would be interesting.

77 Antenatal MgS04 in very preterm babies is not related to improved 36 month neurodevelopmental outcomes once accounting for neonatal interventions

Abstract Background Magnesium Sulphate (MgSO4) has become a standard practice for fetal neuroprotection prior to delivery of very-preterm babies due to an association with MgSO4 and reduction of cerebral palsy at 2 years of age in randomized clinical trials. Objectives In a prospective cohort of very preterm babies, we aimed to define the association between antenatal MgSO4 administration and neurodevelopmental outcome. Design/Methods We included a prospective cohort of 265 infants born ≤ 32 weeks’ gestation recruited at three tertiary neonatal intensive care units (NICU). Infants underwent two brain MRIs, one in the initial weeks after birth and one at term-equivalent age. Neurodevelopmental follow-up assessments were completed using the Bayley-3 at 3 years. Univariate analysis was undertaken to determine whether MgSO4 was associated with outcome. Multiple maternal and neonatal factors were analyzed according to their relationship with outcome. Gestational age was accounted for in all models. Maternal factors associated with MgSO4 administration were hypertension, multiple births and antenatal corticosteroid administration. Neonatal factors were sex, neonatal resuscitation, major surgery, and moderate-severe white matter injury (volume &amp;gt;40mm3). Multivariable linear regression models of maternal and neonatal risk factors were used to account for potential confounders based on those factors that were significantly (p&amp;lt;0.05) associated in univariate analysis. Results On univariate analysis, MgSO4 administration was inversely associated with 36-month motor scores (p&amp;lt;0.05). On the multivariable analysis, no maternal confounders had an impact on the relationship between MgSO4 and outcome (Table 2). MgS04 was no longer statistically related to any Bayley outcomes after adjusting for confounders at 36 months (Table 2). Neonatal surgery was related to poorer 36-month motor and cognitive outcomes. Conclusion Antenatal MgSO4 exposure was not associated with improved measures on the Bayley scales at 3 years after adjusting for potential confounders. However, neonatal interventions remained significant risk factors for poorer neurodevelopmental outcome.

69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers

Abstract Background Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide. Objectives To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria. Design/Methods This retrospective study (2019-2022) included infants born at &amp;lt;33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment. Results We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of &amp;gt;104/mL or &amp;gt;107/L and &amp;gt;105/mL or &amp;gt;108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU &amp;gt;105/mL or &amp;gt;108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2]. Conclusion There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.

Quality Improvement Measures in Reducing Hypothermia Among At-risk Preterm Neonates in a Neonatal Intensive Care Unit

Background Hypothermia is a significant concern in most neonatal units in both term and preterm, which increases the risk of mortality and morbidity. We aimed to reduce the incidence of hypothermia among at-risk preterm neonates upon admission to the neonatal intensive care unit (NICU) from a baseline of 75%-30% over 15 months. Methods This quality improvement study in a tertiary NICU implemented multiple plan-do-study-act (PDSA) cycles for all inborn neonates with a gestational age of less than 34 weeks or birth weight under 1500 g. The key outcome measure was the incidence of hypothermia, expressed as a percentage. Potential barriers to normothermia were evaluated using fishbone analysis and a key-driver diagram. Baseline data were collected over 3 months, and two PDSA cycles were performed over 18 weeks using a bundled approach and a sustenance phase over 9 months. Key interventions involved the optimization of environmental temperature at various locations, the use of polyethylene wraps for resuscitation, the proper use of transport incubators, and through raising awareness among healthcare professionals. Results A total of 319 neonates were part of the study. The baseline incidence of hypothermia (outcome measure) decreased from a median of 83% to 20.5% after two PDSA cycles and was sustained for over 9 months with reinforcement measures. Only two neonates had hyperthermia during the study period (balancing measure), and 96% compliance with documentation was achieved. Conclusions Quality improvement measures with simple policy reinforcement and a bundled approach can help reduce the incidence of hypothermia in at-risk preterm neonates.

Case–control study of milk curd obstruction in newborn infants in a tertiary surgical neonatal intensive care unit

BackgroundMilk curd obstruction (MCO), in which milk becomes inspissated, is a rare, serious, complication of preterm birth. Case reports implicate male sex and bovine-derived human milk fortifier (HMF) use as...

Clinical outcomes of myelomeningocele infants without antenatal surgery: Mortality and morbidity in a tertiary ICU setting

Clinical Outcomes of Meningomyelocele Infants Without Antenatal Surgery: Mortality and Morbidity in a Tertiary ICU Setting Objective To investigate the early clinical outcomes of infants with meningomyelocele Material and methods We included infants with meningomyelocele who had undergone treatment in our tertiary neonatal intensive care unit. We included all patients with meningomyelocele between 2016-2023. We retrospectively recorded data and assessed perinatal history, morbidity, and mortality status. A p-value of

Prevalence of unplanned extubation in a tertiary care neonatal intensive care unit.

Orotracheal intubation and mechanical ventilation (MV) have become routine practices in intensive care units. Unplanned extubation (UE) is one of the most important complications, particularly in premature infants and critically ill newborns. The objective of this study was to determine the prevalence of UE in a tertiary care neonatal intensive care unit (NICU). In this analytical cross-sectional retrospective study, all data, including perinatal data, indications for ventilatory support, days of MV at the time of UE, work shift, month of the event, reintubation, and postextubation complications, were obtained from the manual review of clinical charts. In total, 151 neonates, who received invasive MV, were included in this study. The prevalence of UE was 2.0/100 days of ventilation. The most affected were premature infants, with a gestational age of ≤ 32 weeks (54.7%) and a birth weight of ≤ 1500 g. The main cause for UE was deficient fixation of the endotracheal tube (ETT) (27.7%). Most UE events occurred during night shifts (48.1%). Reintubation was required in 83.3% of newborns. Immediate complications developed in 96.3% of the UE events, including desaturation (57.7%) and bradycardia (36.5%). The prevalence of UE was high, particularly in premature infants, with a high rate of reintubation and immediate complications. Standardized protocols for ETT care must be implemented to reduce these events.

Embedding the ‘CoolCuddle’ intervention for infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy in NICU: an evaluation using normalisation process theory

ObjectivesNewborn infants exposed to lack of oxygen and blood flow to the brain around birth may develop brain dysfunction (hypoxic-ischaemic encephalopathy—HIE). These infants undergo 72 hours of cooling therapy and...

Bacteriological Profile and Antibiotic Susceptibility of Neonatal Sepsis Cases in the Neonatal Intensive Care Unit of a Tertiary Hospital in Türkiye.

We aimed to determine the demographic data, mortality, and morbidity of early- and late-neonatal sepsis cases, the etiologic agents in these cases, and the antibiotic susceptibility of these agents. This study was conducted retrospectively in a tertiary neonatal intensive care unit (NICU). The demographic, clinical, and laboratory data of newborns diagnosed with culture-proven sepsis within 24 months were evaluated. Two hundred and eleven culture data points belonging to 197 infants were evaluated. Forty percent of the infants had a history of premature birth. The most common clinical findings were respiratory distress and feeding intolerance. Coagulase-negative staphylococci (CoNS) were detected most frequently as early- and late-sepsis agents. The most common Gram-negative bacteria detected as late-sepsis agents were Klebsiella spp. and Escherichia coli (E. coli). The overall mortality rate was 10%. Neonatal sepsis continues to have high mortality rates in tertiary NICUs. CoNS was the most common agent, highlighting the importance of developing and maintaining personnel training and handwashing practices. It will be important to consider the resistance rates of Klebsiella spp., the most common Gram-negative agent in late-onset sepsis (LOS) cases, to commonly used antibiotics in empirical treatments.

Platelet-Related Indicators: Potential Role in Early Prediction of Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease in extreme preterm infants, and inflammation is the main contributor that initiates this lung injury. As platelet-related indicators such as platelet-to-lymphocyte ratio (PLR) and platelet-to-neutrophil ratio (PNR) are potential systemic inflammatory biomarkers and it has been shown to be good predictors of lung diseases. The objective of this study was to assess the potential role of platelet-related indicators in early prediction for BPD. Methods: Neonates with gestational ages &lt;32 weeks (w) from two tertiary neonatal intensive care units between January 2019 and April 2022 were included and the association between the platelet-related indicators and BPD were analyzed by logistic regression analysis and receiver operating characteristic curve. Results: 533 preterm infants were admitted, including 165 preterm infants with BPD and 368 preterm infants without BPD. The infants in the BPD group had higher PLR and PNR at birth, lower platelet (P) count at 2 w than those in the without BPD group. The high PLR at birth, high PNR at birth and low P at 2 w were independently associated with the risk of BPD. PLR at birth represented a predictive value for BPD with the area under the curve (AUC) being 0.589, sensitivity was 0.661, and specificity was 0.579 when the threshold was 135.33. PNR at birth represented a predictive value for BPD with the AUC being 0.576, sensitivity was 0.612, and specificity was 0.589 when the threshold was 129.12. P at 2 w represented a predictive value for BPD with the AUC being 0.668, sensitivity was 0.548, and specificity was 0.711 when the threshold was 285.5. The predictive value of the model was improved when including PLR at birth, PNR at birth, P at 2 w, and gestational age, with AUC being 0.798, sensitivity was 0.754, and specificity was 0.737. Conclusions: Combining PLR at birth, PNR at birth, P at 2 w, and gestational age improved the value in early prediction of BPD.

Efficacy of antimicrobial-impregnated catheters in preventing sepsis post epicutaneo-caval catheter (ECC) removal in neonates: A retrospective study.

Epicutaneo-caval catheters (ECC) are vital in neonatal intensive care units (NICU) in enabling prolonged venous access. Despite their benefits, central line-associated bloodstream infections (CLABSI) pose a potential risk. The ECC removal procedure may contribute to an increased risk of post removal sepsis through biofilm release. Antimicrobial-impregnated ECCs have been proposed as a potential solution to prevent this complication, but research on their effectiveness in neonates is limited. To compare post-ECC or neonatal peripherally inserted central catheter (n-PICCs) removal sepsis rates when using conventional or antimicrobial-impregnated catheters in neonates. A retrospective, single center cohort analysis using 2019 data from 421 neonates after successful ECC insertion at the Women's Wellness and Research Center, a large tertiary level NICU in Qatar. The study systematically collected data on demographics, insertion, and removal as well as microbiology, and infection data. Statistical analyses compared conventional and antimicrobial ECCs, with a focus on the incidence of sepsis within 72 hr post-removal. After excluding non-eligible, 349 cases were included in the analysis (138 conventional, 211 antimicrobial-impregnated). There were no significant demographic differences between the two groups. The CLABSI incidence was higher amongst the antimicrobial ECC group (4% vs 0.6%, p = 0.031). Among the included neonates, the confirmed post-removal sepsis incidence was 4.3% (6 cases) for the conventional and 10% (21 cases) for the antimicrobial ECC groups, which was not statistically significant (p = 0.055). The study noted a higher, but statistically insignificant, incidence of post removal sepsis when using antimicrobial-impregnated ECCs. This finding raises questions about the effectiveness of antimicrobial ECCs in preventing post-removal sepsis in this patient population. Further randomized trials are needed to assess the role of antimicrobial ECCs amongst neonates and to refine neonatal ECC care strategies.

Lung Recruitment Before Surfactant Administration in Extremely Preterm Neonates

A multicenter randomized clinical trial (RCT) showed a lung recruitment maneuver using high-frequency oscillatory ventilation just before surfactant administration (ie, intubate-recruit-surfactant-extubate [IN-REC-SUR-E]) improved the efficacy of treatment compared with the standard intubate-surfactant-extubate (IN-SUR-E) technique without increasing the risk of adverse neonatal outcomes. To examine follow-up outcomes at corrected postnatal age (cPNA) 2 years of preterm infants previously enrolled in an RCT and treated with IN-REC-SUR-E or IN-SUR-E in 35 tertiary neonatal intensive care units. This was a follow-up study of infants recruited into the primary RCT from 2015 to 2018 at 35 tertiary neonatal intensive care units (NICUs) in Italy. Follow-up examinations included neurodevelopmental, growth, and respiratory outcomes of these children at cPNA 2 years. Participants included spontaneously breathing extremely preterm neonates (24 0/7 to 27 6/7 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 hours of life. Data were analyzed from April 2023 to January 2024. Infants were randomly assigned (1:1) to IN-REC-SUR-E or IN-SUR-E and then followed up. The primary outcome was the occurrence of death after discharge or major disability at cPNA 2 years. Secondary outcomes were neurodevelopmental outcomes (major disability, cerebral palsy, cognitive impairment, visual deficit, or auditory deficit), anthropometric measurements (weight, length, and head circumference), and recurrent respiratory infections and hospitalizations because of respiratory causes at 2y cPNA. A total of 137 extremely preterm infants (median [IQR] gestational age, 26.5 [25.3-27.5] weeks and 75 [54.7%] female), initially enrolled in the original RCT, were followed up at cPNA 2 years, including 64 infants in the IN-SUR-E group and 73 infants in the IN-REC-SUR-E group. There were no significant differences in the occurrence of death after discharge or major disability at cPNA 2 years (IN-SUR-E: 13 children [20.3%] vs IN-REC-SUR-E: 10 children [13.7%]; P = .36). There were no significant differences in incidence of disability, cerebral palsy, or cognitive impairment in the IN-REC-SUR-E group compared with the IN-SUR-E group. There were no significant differences in anthropometric measurements (weight, length, and head circumference) between groups. There were no significant differences in the incidence of recurrent respiratory infections or in hospitalizations because of respiratory causes between groups. In this RCT of lung recruitment before surfactant vs standard care there were no significant differences between the 2 groups in death, neurodevelopmental outcomes, anthropometric measurements, or recurrent respiratory infections at the 2-year follow-up. These findings can aid clinicians in decision-making for the best strategy to administer surfactant, considering long-term outcomes.

Enteral Nutrition in Neonates on Inotropic Support Admitted to a Tertiary Neonatal Intensive Care Unit: A Prospective Cohort Study.

Background Early initiation of enteral feeding in neonates on inotropic support may improve clinical outcomes compared to intravenous fluids, but the safety and optimal inotrope levels for enteral nutrition remain unclear. This study aims to assess the early initiation of enteral feeding versus intravenous fluids in newborns on inotrope support andto compare the clinical outcome in terms of hospital stay, morbidity, and mortalityin neonates with enteral feed versus intravenous (IV) fluid group on inotropes. It also focuses on evaluating the safety of enteral nutrition in neonates with inotropic support and determining the cutoff levels of the inotropes at which enteral feed is well tolerated. Methodology A prospective cohort study was conducted at a tertiary care center in northern Karnataka from June 2022 to December 2023. Neonates born after 28 weeks or more of gestation or weighing more than 1000 grams with fluid nonresponsive shock were enrolled for the study. Neonates with gastrointestinal comorbidities or birth weight below 1000 grams, younger than 28 weeks of gestation, and with lethal congenital malformations were excluded. Eligible neonates were enrolled by the investigator into enteral and intravenous fluid groups at the clinical discretion of the treating neonatologist. Enteral feeding commenced with expressed breast milk or milk from milk bankafter 6 hours of stable circulation while the intravenous fluid group received no feed initially. Inotropes were tapered upon stable circulation with feed volumes adjusted based on tolerance. The data obtained was entered into a Microsoft Excel sheetand statistical analyses were performed using IBM SPSS Statistics software, version 20. The results were presented as mean, standard deviation counts, percentagesand diagrams. For normally distributed continuous variables between the two groups, they were compared using an independent sample t-test. For not normally distributed variables, the Mann-Whitney U test was used. Categorical variables between the two groups were compared using the chi-square test and Fisher's exact test and p<0.05 was considered statistically significant. Results The study included 142 neonates (71 per group). The enteral nutrition grouphad a higher percentage (62; 87.32%) of improved and discharged neonates than the intravenous fluid group(56; 78.87%).The mean time to reach full feeds was significantly lower in the enteral nutrition group (6.04 days) as compared to the intravenous fluid group (9.78 days), with a p-value of < 0.0001. Similarly, the duration of neonatal intensive care unit (NICU) stay was significantly shorter for enteral nutrition group (7.38 days) compared to intravenous fluid group (11.37 days), also with a p-value of < 0.0001. Three patients (4.22%) chose to get discharged against medical advice in the enteral nutrition group while five patients (7.04%) did the same in the intravenous fluid group. The death rate was also higher among intravenous fluid group (10; 10.08%) compared to enteral nutrition group (6; 8.45%).Independent samples t-test showed significant differences in time to reach full feed and duration of NICU stay between cases and controls. Conclusion Neonates receiving enteral feeds had significantly shorter NICU stays, suggesting improved clinical management. Adrenaline (0.1 mcg/kg) with dobutamine (10 mcg/kg) emerged as the optimal inotrope combination for feed tolerance.

Neonatal hyperinsulinism: a retrospective study of presentation and management in a tertiary neonatal intensive care unit in the UK

ObjectiveReports of hyperinsulinism typically focus on infants managed by highly specialised services. However, neonates with hyperinsulinism are initially managed by neonatologists and often not referred to specialists. This study aimed...