Abdul Qader Tahir Ismail

Management of prelabour rupture of membranes (PROM) at term

Abstract Over a 20-month period we identified several cases of neonatal pneumonia associated with prelabour rupture of membranes (PROM) at term. PROM complicates 8%–10% of all pregnancies, yet 60% of cases occur at term. Ascending infection is a contributing factor and the incidence of chorioamnionitis in these patients is relatively high, especially with prolonged membrane rupture. The signs and symptoms NICE recommends patients look out for are not always present as the majority of infections are subclinical, yet associated maternal and neonatal morbidity of chorioamnionitis is potentially devastating. A survey of maternity units in the West Midlands reveals significant variance in management of these cases. Given the lack of consensus and clear evidence on optimal management of PROM at term, we believe early detection of developing infections could be enhanced by using a combination of investigations (at presentation, 12 and 24 h), as well as current advice to self-monitor temperature and vaginal loss.

Newborn pulse oximetry screening in practice

The concept of using pulse oximetry (PO) as a screening test to identify newborn babies with critical congenital heart defects (CCHD) before life-threatening collapse occurs has been debated for some time now. Several recent large studies have consistently shown that PO screening adds value to existing screening techniques with over 90% of CCHDs detected. It can also help identify newborn babies with low oxygen saturations due to infection, respiratory disease and non-critical CCHD. Many countries have now introduced PO screening as routine practice, and as screening gains more widespread acceptance in the UK, we have focused more on the practical aspects of screening in this article. This includes case reports to demonstrate how the different screening modalities for CCHD work together and the experience of hospitals that have already introduced PO screening programmes (Birmingham Womens Hospital and others). Issues discussed include how and when to screen babies in hospital, what to do with a positive screen and how to screen babies born at home. The UK National Screening Committee is currently investigating the potential feasibility of routine PO screening in the UK, and so it is perhaps a suitable time for individual hospitals to consider the possibility of introducing such screening in their maternity units.

Using CRP in neonatal practice

Abstract Objective: C-reactive protein (CRP) is the most widely used infection marker in neonatal practice. Combined with difficulty in early recognition of neonatal sepsis, the number of infants with risk factors for infection, and postnatal maladaptation of non-infectious origin; CRP is often used as a decision making tool for antibiotic therapy. We wished to examine practice regarding neonatal infection and use of CRP. Methods: We designed an online multiple choice questionnaire, asking senior clinicians for their response to realistic postnatal ward scenarios. Results: We had 91 replies, showing a great degree of variation, with no pattern emerging for experience, region, or even individual neonatal units. This was true even for situations covered by the guidelines that have an evidence basis. Conclusions: A recurring theme was duration of antibiotic therapy for an elevated CRP, and once levels are falling, when it is safe to stop treatment. Given a lack of good quality evidence, the National Institute of Clinical Excellence (NICE) guidelines are purposefully non-specific. Further research is required, and if incorporated in future national guidelines, should help promote more widespread use and so reduce potential over- and under-treatment of this patient subset. However, this also requires a greater willingness on the part of pediatricians to ensure practice is evidence based.

A neonatal case of congenital coronary artery fistula

Coronary artery fistulae (CAF) are rare forms of congenital heart disease with an incidence of one in 50 000 live births. The authors present the case of an asymptomatic neonate with a precordial murmur. Pre and postductal saturations, blood pressure and ECG were normal. Echocardiography revealed a large right coronary artery fistula to the right ventricle (4.5 mm). At 11 months, transcatheter occlusion of the fistula with a vascular plug was performed. A year on, the child was thriving, ECG and echocardiogram remained normal. CAF complications and symptoms (including aneurysm, myocardial ischaemia, angina, heart failure and dyspnoea) are commoner in older patients, so traditionally we intervene early. With increasing case reports of spontaneous closure of even large and symptomatic fistulae, management of especially asymptomatic children is unclear. Long-term complications of intervention also remain largely unknown. As such more information is required on the conditions natural history to better manage patients and counsel parents.

Non-pharmacological analgesia: effective but underused

Losacco et al s1 review of practice across European neonatal units regarding the use of non-pharmacological analgesia (NPA) for painful procedures in neonatal units has highlighted the relatively infrequent use of these techniques. This is despite good evidence confirming the effectiveness of NPA2 and evidence of deleterious effects of pain in babies, both short term3 (decreased oxygenation, haemodynamic instability and raised intracranial pressure) and long term4 (neurodevelopmental delay and altered perceptions of pain in later life).nnWe have recently conducted an audit on the use of NPA for neonates, comparing our current practice at Good Hope Hospital, Birmingham, UK, against our hospital guidelines. As a part of this process, we have also carried out a review of literature on the use of NPA and assessed whether the current hospital guidance meets evidence-based recommendations.nnClinical staff in various neonatal and paediatric clinical areas at Good Hope Hospital were requested to fill in questionnaires every time they carried out a painful procedure in an infant. Forty-six questionnaires were filled in total; 8 from the postnatal wards, 11 from the childrens assessment unit or paediatric ward and 27 from the neonatal unit.nnFor postnatal wards, the ages for which the procedures were carried out ranged from day 1 to 4. Five of the eight babies were given sucrose (0.6 ml …

Do Oral Steroids Aid Recovery in Children With Bell's Palsy?:

There is growing evidence that steroids are not beneficial for treatment of paediatric patients with Bells palsy. To investigate, we conducted a retrospective longitudinal study examining notes of 100 children, over 12 years coded for facial nerve palsy. Of the 79 diagnosed with Bells palsy, all recovered, and for 46 patients we had data on interval from onset of symptoms to resolution (median duration in treated group = 5 weeks, range = 39; median duration in untreated group = 6 weeks, range = 11; P = .86). From our results, we conclude that all children with Bells palsy recovered, with or without steroid treatment, with no statistically significant difference in symptoms duration. Complications of unresolved Bells palsy can have important long-term functional and psychosocial consequences. Therefore, we need further research on use of steroids in children with complete/severe cases; it would be a shame to omit treatment due to “absence of evidence” rather than “evidence of absence.”

Cross-species transfer of group B streptococcus via ingestion?

No abstract available

Vegan carriage of group B streptococcus: a questionnaire study utilising social media

No abstract available.

Strangulated diaphragmatic hernia presenting at 7 weeks of life as intractable shock.

A 7-week-old infant presented to hospital pale and floppy, with 5u2005s capillary refill time. Blood gas showed severe acidosis (pH 6.86, partial pressure of carbondioxide 10.55u2005kPa, base excess 21.1). Hypotension persisted despite several fluid boluses so she was intubated and started on inotropic support. A chest X-ray revealed a congenital diaphragmatic hernia (CDH). Despite steroids and blood transfusions she remained unstable, and could not be resuscitated following cardiac arrest. Postmortem revealed 39u2005cm of herniated, necrotic colon. 5–25% of CDH presents after the neonatal period, and while not associated with pulmonary hypoplasia is primarily still a diaphragmatic defect. In late presenting cases, herniation occurs shortly prior to developing symptoms; therefore, an antenatal ultrasound (US) cannot pick it up. If we could diagnose the isolated diaphragmatic defect antenatally, this would allow elective postnatal surgical closure. This is not feasible currently; however, with the advent of antenatal three-dimensional US scans it may be possible in the future.

Intrapartum antibiotic prophylaxis for prevention of group B streptococcal disease in preterm infants

Vergnano et al 1 showed that of 48 infants with early-onset group B streptococcal (GBS) sepsis, 32 mothers had risk factors for neonatal infection, but only 6 mothers were given adequate intrapartum antibiotic prophylaxis (IAP). However, neonatal audit as a tool to define the adequacy of IAP administrations inherently biased simply because infants with GBS sepsis are likely to be born to mothers who have not received IAP. To define the effectiveness of IAP administration, we audited the notes of 102 women with risk factors for early-onset sepsis in 2011.nnThe results are as follows: