Umbilical Catheter Research Articles

Novel Assistive Devices for Umbilical Artery Catheterisation

Background: 300+ neonates/year in a New Zealand neonatal intensive care unit (NICU) need umbilical arterial catheterisation (UAC), of whom 7.5% die or have permanent impairment because an umbilical arterial catheter could not be inserted. Complexities associated with the procedure can lead to lengthy procedure times and increased risk of catheterisation failure, increasing the risk of poor outcomes. While several manual techniques are used, very few use assistive devices. Objective: Design and test assistive devices to significantly simplify UAC. Methods: Main requirements include: 1) insertion time <15 minutes; 2) only one practitioner required. The procedure requires two primary tasks: 1) traction (tensioning) of the umbilical cord; 2) dilation of the umbilical artery to admit the (wider, 5F) catheter. A full design analysis addresses these tasks and requirements. Prototypes are evaluated by a NICU clinician using a silicone phantom umbilical cord. Results: A two-device solution was developed, comprising a hands-free traction device and a dilation device. The traction device utilises a small hair-cliplike device with torsional spring and stabilising skirt. The dilator comprises an insertor and a sheath. The insertor tip diameter of 0.1 mm allows easy insertion, while the following sheath dilates the artery to allow catheter insertion. All devices are removed after insertion. UAC time decreased an average of 51.8% over 6 tests versus without assistive devices, and only one practitioner was required. Conclusions: The coordination, complexity, and time for UAC were significantly reduced, using simple, novel assistive devices, which could improve outcomes for infants suffering negative outcomes due to UAC insertion failure.

Imaging of Umbilical Venous Catheter-Related Hepatic Complications in Neonates.

An umbilical venous catheter (UVC) is commonly placed for central venous access in preterm or critically ill full-term neonates to provide total parenteral nutrition (TPN) and medication. However, UVCs can result in complications, including infection, portal vein thrombosis, and hepatic tissue injury. The inadvertent administration of hypertonic fluid through a malpositioned UVC can also cause hepatic parenchymal damage with mass-like fluid collection that simulates a tumorous condition during imaging. Ultrasonography and radiographic examinations play an essential role in detecting UVC-related complications. This pictorial essay aims to present the imaging findings of UVC-related hepatic complications in neonates.

A Study on Incidence, Pattern of Clinical Features, Laboratory Abnormalities and Outcome of Neonatal Polycythaemia in a Tertiary Care Hospital, Odisha, India

Introduction: Neonatal polycythaemia is a commonly encountered morbidity and mortality among neonates admitted to neonatal care units and sick newborn care units. Most affected infants have no clinical symptoms and signs, but neonates may present with lethargy, poor feeding, plethora, cyanosis and jaundice within 12-72 hrs. Aim: To find out the incidence and clinical manifestations of neonatal polycythaemia along with detection of disease by laboratory abnormalities. Materials and Methods: This was a hospital-based, prospective, observational study conducted in the Neonatal Care Unit of Sriram Chandra Bhanja Medical College, Eastern Odisha, India, in 1760 neonates, from October 2018 to September 2020. All neonates admitted through Outdoor and Emergency were included in this study irrespective of gestation, birth weight, maturity and mode of delivery with haematocrit &gt;65% at 12 hours of life. These polycythaemic babies were further categorised on the basis of maturity, gestational age, birth weight, gender and the clinical features, laboratory abnormalities were noted, Partial Exchange Transfusion (PET) when required was done through central route, the umbilical venous catheter was used for withdrawing blood while same amount of normal saline was replaced through a peripheral vein, and in asymptomatic cases additional fluid of 20 mL/kg was added to the daily fluid requirements either through enteral or parenteral route and outcomes were noted. Short-term outcome at 48 hours was measured by decreasing haematocrit with improvement of signs and symptoms. Chi-square test was employed to analyse the collected data using Statistical Package for the Social Sciences (SPSS) software version 20.0. The p-value &lt;0.05 was considered statistically significant. Results: Out of 1760 newborns enrolled, (n=75) were polycythaemic. The Incidence of polycythaemia was 4.26%), which was significantly higher among Small for Gestational Age (SGA) compared to Large for Gestational Age (LGA) neonates (p-value=0.0214). Clinical features in decreasing order were lethargy (66.6%), poor feeding (66.6%), Plethora (53.3%), cyanosis (40%) and jaundice (33.3%). Main laboratory abnormalities were hypoglycaemia (36%), hyperbilirubinaemia (28%), thrombocytopenia (22.66%) and hypocalcaemia (13.3%). Out of 75 polycythemic neonates, n=17 (22.67%) underwent PET and rest 58 (77.33%) neonates were treated with extra fluid of 20 mL/kg/day. Conclusion: Study showed that lethargy and poor feeding were the main presentation and hypoglycaemia as the major laboratory abnormality. The incidence of polycythaemia was high among SGA neonates and the response to partial exchange transfusion as well as extra fluid was good which was characterised by decreasing haematocrit values with improvement of signs and symptoms.

REX SHUNT IN CHILDREN: COULD DYSFUNCTION BE PROGNOSED? A RETROSPECTIVE ANALYSIS.

The aim: To analyze retrospectively our experience of Rex shunt in children with symptomatic portal hypertension, its effect on hypersplenism regression and varices eradication, assess shunt survival and investigate risk factors, that could lead to shunt dysfunction and thrombosis. Materials and methods: 24 children (16 males, 8 females) ,with portal hypertension included into the study. All surgeries were performed within single center in a period from January 2010 to March 2022. Follow up period was 6.75±1.19 years. Results: Age at diagnosis was 5.39±0.64 years. 5 (20.8%) had umbilical catheter in anamnesis. 16 (66.7%) manifested bleeding episodes as the first sign of portal hypertension. 9 (37.5%) of children manifested severe hypersplenism. Age at Rex shunting was 7.5±0.7 years. In 7 (31.8%) cases Rex shunt thrombosis occurred. 1 successful thrombectomy and 6 splenorenal shunting were performed. Kaplan-Meyer analysis showed Rex shunt survival 0.670 (95%CI 0.420-0.831). Logistic regression model indicated thrombocytes count (p=0.0423) and cytopenia (p=0.0272) as factors that could influence shunt thrombosis. Follow-up group included 18 patients. Spleen volume regression became significant by 1 p/o year p<0,05, thrombocytes significant increasement reached in 1 p/o months (p<0.01), varices involution was achieved by 1 p/o year (p<0,001). Conclusions: Rex shunt effectiveness in study group was 70.9%., shunt survival assessed 0.670 (95%CI 0.420-0.831). Rex shunt was effective in bleeding prophylaxis in all patients of follow up group. Preoperative thrombocytes count (p=0.0423) and cytopenia (p=0.0272) were detected as factors that could influence shunt thrombosis, that is to be considered in RS preoperative period and require following studies.

Extra-hepatic portal vein thrombosis in children: Single center experience.

We aimed to discuss our experience in management of children with extra-hepatic portal vein thrombosis (EHPVT). This retrospective cohort study included 62 children with EHPVT. All patients' records were reviewed. The patients' socio-demographic data, post-natal history, disease presentation and clinical examination were collected. Data from laboratory investigations - complete blood count, liver function tests, renal function tests, abdominal ultrasound/Doppler studies, upper endoscopic findings and treatment regimens - were collected whenever available. Of the 62 patients, 62.9% were male and 37.1% were female. The mean age at disease presentation was 3.5 ±2.7 years. The main initial clinical presentation of the disease was hematemesis and/or melena (30 cases; 48.4%). History of umbilical catheterization (UVC) was present in 60% of cases. The thrombophilia profile was assessed in 17 patients, of whom 12 (70.6%) were found to have a coagulation disorder. Splenomegaly was present in 91.7% of the patients. Hematological abnormalities in the form of cytopenias were present in most cases. Ultrasound revealed the presence of collaterals in 76.2%. Upper endoscopy showed the presence of varices in 45 cases, all of which needed endoscopic intervention, while in 11 cases the varices were either low grade or absent and thus were subjected only to medical treatment with propranolol and 6 cases were lost to follow-up. Splenectomy was done in only one case and 2 cases underwent the Rex operation. Variceal bleeding is the most common clinical presentation of EHPVT in children. UVC is still the main etiological factor of EHPVT in our cohort especially with presence of thrombophilic disorder.

Magnetic Catheter Placement in Neonates: A Handheld Solution to Radiation Exposure and Operational Delays (Adv. Sensor Res. 1/2023)

Magnetic Tracking In article number 2200029, Jurgen Kosel and co-workers present a novel 5Dmagnetic tracking system for subcutaneous medical devices, providing the capability for precise device localization in an extremely compact and portable pocket-size format. The system is entirely benign, avoids X-rays, and can be used to immediately confirm the proper placement of umbilical catheters and endotracheal tubes in neonates.

Infectious Risks Related to Umbilical Venous Catheter Dwell Time and Its Replacement in Newborns: A Narrative Review of Current Evidence.

The use of umbilical venous catheters (UVCs) has become the standard of care in the neonatal intensive care unit (NICU) to administer fluids, medications and parenteral nutrition. However, it is well known that UVCs can lead to some serious complications, both mechanical and infective, including CLABSI (Central Line-Associated Bloodstream Infections). Most authors recommend removing UVC within a maximum of 14 days from its placement. However, the last Infusion Therapy Standards of Practice (INS) guidelines recommends limiting the UVC dwell time to 7 to 10 days, to reduce risks of infectious and thrombotic complications. These guidelines also suggest as an infection prevention strategy to remove UVC after 4 days, followed by the insertion of a PICC if a central line is still needed. Nevertheless, the maximum UVC dwell time to reduce the risk of CLABSI is still controversial, as well as the time of its replacement with a PICC. In this study we reviewed a total of 177 articles, found by using the PubMed database with the following search strings: "UVC AND neonates", "(neonate* OR newborn*) AND (UVC OR central catheter*) AND (infection*)". We also analyze the INS guidelines to provide the reader an updated overview on this topic. The purpose of this review is to give updated information on CVCs infectious risks by examining the literature in this field. These data could help clinicians in deciding the best time to remove or to replace the UVC with a PICC, to reduce CLABSIs risk. Despite the lack of strong evidence, the risk of CLABSI seems to be minimized when UVC is removed/replaced within 7 days from insertion and this indication is emerging from more recent and larger studies.

Magnetic Catheter Placement in Neonates: A Handheld Solution to Radiation Exposure and Operational Delays

AbstractThe use of subcutaneous devices has greatly advanced the field of medicine and surgery. However, localizing these devices internally requires imaging techniques such as X‐ray or ultrasound. A novel magnetic tracking system for subcutaneous medical devices is presented, providing the capability for precise device localization in an extremely compact and portable pocket‐size format. It is entirely benign, avoids X‐rays, and can be used to immediately confirm the proper instrument placement. It is implemented on umbilical catheters and endotracheal tubes and is characterized by bench‐test, cadaveric, and in vivo studies. The systems consist of a magnetic tip fixed to the distal end of the subcutaneous device, as well as a Magnetic Sensing‐Array Device that utilizes a matrix of magnetic field sensors to localize the magnetic tip. The bench‐tests show a high localization accuracy for a distance up to 4 cm. The accuracy is slightly reduced during cadaveric and in vivo tests, due to factors impacting the application, such as the dermal surface topography. Regardless, the magnetic subcutaneous medical device tracking system is shown to be robust in performance and functionality in real‐world clinical applications, and with its intuitive approach and portability, it has the potential to make real‐time subcutaneous device tracking widely accessible.

Liver Abscess in a Cyanotic Newborn.

Umbilical venous catheterisation is a common bedside procedure in the neonatal intensive care unit (NICU). Complications including thrombus formation, thromboembolism, vessel perforation, haemorrhage, and central line-associated bloodstream infection can be seen after the procedure. Pyogenic liver abscess is a rare but life-threatening complication of umbilical venous catheterisation. A male infant with cyanotic congenital heart disease was admitted to NICU. An umbilical venous catheter (UVC) was inserted. Abdominal X-ray showed an improperly positioned UVC, it was removed and replaced with a newer one. On the seventh day, the infant had abdominal distension and his clinical condition deteriorated. Abdominal ultrasonography (US) revealed a hepatic abscess. US-guided percutaneous abscess drainage was performed. Empiric antibiotic treatment was initiated and culture revealed Staphylococcus. The patient was followed by serial US and the lesion was completely resolved after three weeks. In conclusion, clinical worsening associated with gastrointestinal symptoms in a cyanotic infant with UVC should raise suspicion for liver abscess. Key Words: Neonate, Hepatic abscess, Umbilical venous catheter, Cyanotic heart disease.

Rapidly Progressive Pericardial Effusion and Cardiac Tamponade in a Term Infant with an Umbilical Venous Catheter: A Case Report

Pericardial effusion (PCE) in neonates has various clinical presentations depending on the amount and speed of fluid accumulation and can cause cardiac tamponade (CT). We report a case of rapidly accumulating PCE and near-fatal CT with an umbilical venous catheter successfully resolved by emergent echo-guided pericardiocentesis in a term infant who had been hospitalized with meconium aspiration syndrome and persistent pulmonary hypertension. This case report suggests that if a patient with an intracardiac umbilical catheter shows sudden cardiopulmonary instability, the possibility of PCE and CT should be considered. Furthermore, if necessary, emergency drainage of the PCE and removal of the umbilical catheter should be immediately performed.

Feeding Neonates and Infants Prior to Surgery for Congenital Heart Defects: Systematic Review and Meta-Analysis.

Necrotising enterocolitis (NEC) is a significant cause of mortality and morbidity in neonates requiring cardiac surgery. Feeding practices vary significantly across institutions and remain controversial. We conducted a systematic review of the literature and a meta-analysis to identify associations between feeding practices and necrotising enterocolitis. This study was carried out in accordance with the PRISMA guidelines. A literature search was performed in November 2022 using the Cochrane Central Register, Embase, and Pubmed. Two investigators then independently retrieved eligible manuscripts considered suitable for inclusion. Data extracted included gestational age, birth weight, sex, nature of congenital heart lesion, type of operation performed, time on ventilator, ICU stay, hospital stay, post-operative feeding strategy, and complications. The methodological quality was assessed using the Downs and Black score for all randomised control trials and observational studies. The initial search yielded 92 studies. After removing duplicates, there were 85 abstracts remaining. After excluding ineligible studies, 8 studies were included for the meta-analysis. There was no significant risk of NEC associated with pre-operative feeding [OR = 1.22 (95% CI 0.77,1.92)] or umbilical artery catheter placement [OR = 0.91 (95% CI 0.44, 1.89)] and neither outcome exhibited heterogeneity [I2 = 8% and 0%, respectively]. There was a significant association between HLHS and NEC [OR = 2.56 (95% CI 1.56, 4.19)] as well as prematurity and NEC [OR 3.34 (95% CI 1.94, 5.75)] and neither outcome exhibited heterogeneity [I2 = 0% and 0%, respectively]. There was no association between NEC and pre-operative feeding status in neonates awaiting cardiac surgery. Pre-operative feeding status was not associated with prolonged hospital stay or need for tube assisted feeding at discharge. HLHS and prematurity were associated with increased incidence of NEC.

The incidence and mortality rate of catheter-related neonatal pericardial effusion: A meta-analysis.

Neonatal pericardial effusion (PCE) is one of the most severe complications of central catheters in neonates with its rapid progression and high mortality. We aim to estimate the overall incidence and mortality of catheter-related neonatal PCE, more importantly, to identify possible predictors for clinical reference. We searched MEDLINE, Embase, Cochrane Library, Web of Science, china national knowledge infrastructure, Wanfang Data, and Sinomed databases for subject words "central catheter," "neonate," "pericardial effusion" and their random words till June 8, 2020. This meta-analysis is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Possible predictors of occurrences and deaths were extracted and assessed cooperatively. The pooled incidence rate of catheter-related neonatal PCE was calculated using a random effects model. Twenty-one cohort studies and 99 cases were eligible. Pooled incidence is 3·8‰[2.2‰, 6.7‰]. Polyurethane catheters generate significantly more neonatal PCE than silicone counterparts (P < .01). 27% of the patients die. The mortality of patients with bradycardia is higher than others (P < .05). Catheters with a guidewire result in more deaths than umbilical venous catheter (UVC) and peripherally inserted central catheters (PICC) (P < .05). Without pericardiocentesis, mortality increases (P < .01). The difference of deaths between reposition and removing the catheter is insignificant (P > .05). Central catheters in Seldinger Technique (with a guidewire) put neonates at greater risk of PCE and consequent death. Silicone catheters excel at avoiding deadly catheter-related PCE, which could be a better choice in neonatal intensive care units (NICU). When catheter-related PCE occurs, timely diagnosis and pericardiocentesis save lives.

Care practices and short-term clinical outcomes of very low birth weight infants in Yangtze River Delta in China

BackgroundIntensive care is of great significance for very low birth weight infants (VLBWI). The Yangtze River Delta is the most ecomonically developed area in China. However, there are few data on the care practices and survival of VLBWI in this region.ObjectivesTo investigate the prevalence, care practices and motality of VLBWI in Yangtze River Delta in China.MethodsA multi-center retrospective investigation study was conducted at five tertiary hospitals within the Yangtze River Delta in China from January to December 2017. Clinical data included the general characteristics of the infants and the mothers, clinical prognosis, care practices in NICUs was collected by trained research members.ResultsDuring the study period, 1059 VLBWIs were included. Infants with birth weight < 750 g, 750-1000 g, 1000-1250 g and 1250-1500 g accounted for 2.3, 14.9, 34.8 and 47.8%, respectively. Premature rupture of membranes (17.8%) was the main cause of premature delivery. The catheterization rates of umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) were 25.0 and 64.4%, respectively. The duration of parenteral nutrition was 27.0 ± 19.5 d, the meantime of feeding tube indwelling was 36.2 ± 24.2 d. The corrected gestational age of the infants who reached full oral feeding was 35.8 ± 2.7 weeks. The breast feeding rate in the investigated infants was 61.9%. The mortality rate of preterm infants was 3.4%. The incidence of main complications BPD, PDA, ROP, NEC and sepsis were 24.9, 29.9, 21.7, 9.4 and 13.3% respectively.ConclusionsMaternal and infant care practices need to be improved in the very preterm births. This study provides a baseline for the improvement in the further study.

‘Introduction to paediatrics’ course – use of simulation to introduce foundation doctors to paediatrics as a novel specialty

Post-graduate doctors typically apply for speciality training during, or soon after, the Foundation Two Year, however many have very limited exposure to Paediatrics. This was compounded during the COVID-19 pandemic, as access to taster days was significantly reduced. Previously, simulation-based taster days in Undergraduate Medicine [1] and Anaesthetics [2] have been shown to be valuable. We therefore provided an ‘Introduction to Paediatrics’ course aimed at doctors with an interest in pursuing a career in Paediatrics. The aims of the course were to: experience a range of common Paediatric presentations and procedural skills, learn about applying for Paediatrics, and learn about a career in Paediatrics. Learners attended a one-day face-to-face programme held in our Learning and Resource centre, including a simulation suite. Learners were exposed to four scenarios designed to cover a wide range of common Paediatric scenarios. These included: bronchiolitis in an ex-preterm baby; bilious vomiting in a neonate; febrile seizures; and diagnosis of diabetes in a teenager. The scenarios were designed to be challenging but accessible to doctors without previous experience of Paediatrics. An embedded faculty member in the role of a Paediatric registrar was available to provide support during the scenario if requested. Complementing these scenarios were two procedural skills stations (neonatal life support and umbilical venous catheterisation), and a series of short talks on a career in Paediatrics. The participants were asked to feedback via an online survey. Nine foundation doctors attended the pilot course. Only one of them had any formal postgraduate experience in Paediatrics, and all of them were considering applying to Paediatric training. All the participants stated that they would recommend the course to someone who was considering Paediatric training and that the day was useful in deciding whether to do Paediatrics training or not. Using a Likert scale, they rated all the scenarios and the procedural skills as ‘Good’ or ‘Very good’. When asked to give a star rating out of 5, the mean was 4.9. This course appears to be an effective way of providing foundation doctors with a ‘taster’ of Paediatrics. The participants enjoyed the course and would recommend it to others. Although not a substitute for clinical Paediatric experience, it provides another opportunity for interested foundation doctors to learn about a specialty. Based on the success of this course, we hope to deliver this course on a regular basis. 1. Thorley-Dickinson V, Kasfiki E, Stephenson T, Purva M.‘A day in the life of a doctor’: Simulation-based taster day for college students intending to apply to medical school. BMJ Simulation and Technology Enhanced Learning. 2014;1:A47 2. Khoud, Ahmed Ben, Matthew Aldridge and Jeremy Purdell-Lewis. ‘P8 The anaesthetic taster course: our experience of running a simulation taster course with near-peer tutors.’ BMJ Simulation and Technology Enhanced Learning. 2018;4:A54–A55.

Development and Testing of a Hybrid Simulator for Emergent Umbilical Vein Catheter Insertion Simulation Training.

Emergent umbilical venous catheter (eUVC) insertion is the recommended vascular access in neonatal resuscitation. Although the theoretical knowledge can be taught, existing models are either unrealistic (plastic) or train only the steps of the task. This study aimed to develop and test a hybrid simulator for eUVC insertion training that would be realistic, reproducible, easy to build, and inexpensive, thereby facilitating detailed learning of the procedure. Development took place in the Poitiers simulation laboratory using a neonatal mannequin into which a real umbilical cord was integrated. In the first phase, pediatric and emergency physicians and residents tested the model. In the second phase, another group of participants tested the hybrid simulator and the same neonatal mannequin associated with an artificial umbilical cord. Participants completed a satisfaction survey. A real umbilical cord connected to an intra-abdominal reservoir containing artificial blood was added to the mannequin, allowing insertion of the eUVC, drawback of blood, and infusion of fluids using the real anatomical structures. The model was easily reproduced and assembled in less than 30 minutes; the cost of construction and use was evaluated at €115. One hundred two participants tested the model, 60 in the first phase and 42 in the second. The success rate was higher in fully trained compared with untrained participants. All were satisfied, 97% found the model realistic, and 78.6% strongly recommended the use of this model. The participants believed that the hybrid simulator allowed better learning and a gain in performance and self-confidence in comparison with the same mannequin with an artificial umbilical cord. A hybrid simulator was developed for eUVC insertion. Participants were satisfied with this model, which was realistic, reproducible, easy to use, inexpensive, and facilitated an understanding of the anatomy and performance of all steps for successful eUVC insertion.

The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes.

Venous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data. This is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables. The authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices (P < 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [P < 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50-0.54], reason/indication for intravenous therapy (P < 0.001, HR = 0.85, 95% CI: 0.82-0.87), and the side of insertion of the device (P < 0.001, HR = 1.25, 95% CI: 1.24-1.27) had a significant relationship with outcomes. Four subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.

An Unusual Cause of Lower Gastrointestinal Bleeding

Question: An 18-year-old engineering graduate presented with complaints of recurrent bleeding per rectum since the age of 2 years. There had been bouts of fresh, painless bleeding with a sharp decline in the hemoglobin levels (the lowest level reached was 2.9 g/dL) that had required multiple blood transfusions since. He was born at full term via vaginal delivery. There was no history of neonatal sepsis, hospitalization, or umbilical vein catheterization. Neurocognitive developmental milestones were appropriate for age.

The effects of different procedures on pain levels in preterm and term infants in neonatal intensive care unit: a cross-sectional survey of pain assessment in newborns.

Newborns show a series of behavioral and physiological reactions to painful stimuli. The current study aimed to determine the effect of different procedures on the pain levels of newborns in the Neonatal Intensive Care Unit (NICU). One hundred ninety-six newborns with gestational age (GA) of 23-40weeks, birth weight (BW) between 2235 ± 911g were included. Painful procedure (PP) (vascular access (VA), heel prick (HP), umbilical catheter (UC), orogastric catheter (OC), and intubation (I)) were recorded. Pain during the PP was evaluated with Neonatal Infant Pain Scale (NIPS). Pulse and O2 saturation were recorded before (BP), during (DP) and after (AP) procedure. NIPS total scores were found to be significantly higher with term infants (p < 0.05). When NIPS total scores were compared according to the type of PP, significant difference was observed between groups (p = 0.000). Positive correlation was found between birth week (p = 0.000, r = 0.364), BW of infants and NIPS total score (p = 0.000, r = 0.371), pulse values of DP and NIPS total score (p = 0.000, r = 0.386). Negative correlation was found between O2 saturation values DP and the NIPS total scores (p = 0.000, r = -0.405). It is concluded that as GA and BW increase, so do the pain responses of the infant, which showed that the pain thresholds of term-preterm infants are different, and decrease as GA and BW increase.

Regulation of skeletal muscle protein synthesis in the preterm pig by intermittent leucine pulses during continuous parenteral feeding.

Extrauterine growth restriction is a common complication of preterm birth. Leucine (Leu) is an agonist for the mechanistic target of rapamycin (mTOR) complex 1 (mTORC1) signaling pathway that regulates translation initiation and protein synthesis in skeletal muscle. Previously, we showed that intermittent intravenous pulses of Leu to neonatal pigs born at term receiving continuous enteral nutrition increases muscle protein synthesis and lean mass accretion. Our objective was to determine the impact of intermittent intravenous pulses of Leu on muscle protein anabolism in preterm neonatal pigs administered continuous parenteral nutrition. Following preterm delivery (on day 105 of 115 gestation), pigs were fitted with umbilical artery and jugular vein catheters and provided continuous parenteral nutrition. Four days after birth, pigs were assigned to receive intermittent Leu (1600 µmol kg-1 h-1 ; n = 8) or alanine (1600 µmol kg-1 h-1 ; n = 8) parenteral pulses every 4 h for 28 h. Anabolic signaling and fractional protein synthesis were determined in skeletal muscle. Leu concentration in the longissimus dorsi and gastrocnemius muscles increased in the leucine (LEU) group compared with the alanine (ALA) group (P < 0.0001). Despite the Leu-induced disruption of the Sestrin2·GATOR2 complex, which inhibits mTORC1 activation, in these muscles (P < 0.01), the abundance of mTOR·RagA and mTOR·RagC was not different. Accordingly, mTORC1-dependent activation of 4EBP1, S6K1, eIF4E·eIF4G, and protein synthesis were not different in any muscle between the LEU and ALA groups. Intermittent pulses of Leu do not enhance muscle protein anabolism in preterm pigs supplied continuous parenteral nutrition.

Removal of Broken Umbilical Venous Catheter from Inferior Vena Cava Via Cardiac (Femoral) Catheterization: A Case Report in Neonatal Intensive Care Unit (NICU) of Mataria Teaching Hospital

Removal of Broken Umbilical Venous Catheter from Inferior Vena Cava Via Cardiac (Femoral) Catheterization: A Case Report in Neonatal Intensive Care Unit (NICU) of Mataria Teaching Hospital