Aj Brouwer

Incidence of infections of ventricular reservoirs in the treatment of post-haemorrhagic ventricular dilatation: a retrospective study (1992-2003).

Background: Since 1992, infants with progressive posthaemorrhagic ventricular dilatation (PHVD) have been treated in the Neonatal Intensive Care Unit, Wilhelmina Children’s Hospital, Utrecht, The Netherlands, with a ventricular reservoir. Objective: To retrospectively study the incidence of infection using this invasive procedure. Methods: Between January 1992 and December 2003, 76 preterm infants were treated with a ventricular reservoir. Infants admitted during two subsequent periods were analysed: group 1 included infants admitted during 1992–7 (n = 26) and group 2 those admitted during 1998–2003 (n = 50). Clinical characteristics and number of reservoir punctures were evaluated. The incidence of complications over time was assessed, with a focus on the occurrence of infection of the reservoir. Results: The number of punctures did not change during both periods. Infection was significantly less common during the second period (4% (2/50) v 19.2% (5/26), p = 0.029). Conclusion: The use of a ventricular reservoir is a safe treatment to ensure adequate removal of cerebrospinal fluid in preterm infants with PHVD. In experienced hands, the incidence of infection of the ventricular reservoir or major complications remains within acceptable limits.

Cognitive and neurological outcome at the age of 5-8 years of preterm infants with post-hemorrhagic ventricular dilatation requiring neurosurgical intervention.

Background: Preterm infants with progressive post-hemorrhagic ventricular dilatation (PHVD) in the absence of associated parenchymal lesions may have a normal neurodevelopmental outcome. Objectives: To evaluate neurodevelopmental and cognitive outcomes among preterm infants with severe intraventricular hemorrhage (IVH) and PHVD requiring neurosurgical intervention. Methods: 32 preterm infants were admitted to a neonatal intensive care unit with PHVD requiring neurosurgical intervention, and were seen in the follow-up clinic for standardized cognitive, behavioral and neurological assessments between 5 and 8 years of age. Only preterm infants with a gestational age (GA) of <30 weeks, as well as preterm and full-term infants with PHVD and full-term infants with perinatal asphyxia are seen in our follow-up clinic at this age. There were 23 infants with a GA of <30 weeks in this study population. For these 23, matched controls were available and compared with the IVH group. Results: The majority (59.4%) had no impairments. None of the children with grade III and 8 of the 15 children (53%) with grade IV hemorrhage developed cerebral palsy. More subtle motor problems assessed with the Movement-ABC score were seen in 39% (n = 9); the mean IQ of all children was 93.4, and 29% of the children had an IQ of <85 (–1 SD). Timing of intervention did not have a beneficial effect on outcome. With respect to cognition, no significant differences were found between the IVH and the control group. Conclusion: The majority of the children in our population had no impairments. Cerebral palsy was not seen in any of the infants with a grade III hemorrhage.

European perspective on the diagnosis and treatment of posthaemorrhagic ventricular dilatation

Background Posthaemorrhagic ventricular dilatation (PHVD) is a serious complication of prematurity with subsequent disabilities. The diagnostic and therapeutic approaches to PHVD vary among neonatal centres. Aim To gain more insight into the different diagnostic criteria and treatment policies on PHVD among neonatal intensive care units across Europe. Methods A PHVD questionnaire was designed and sent to neonatologists in 37 European centres. Results A response was obtained from 32/37 (86%) centres located in 17 European countries. An overall estimated incidence of 7% was reported for severe intraventricular haemorrhages (grades III or IV according to Papile) among premature neonates born below 30 weeks’ gestation. Approximately half of these infants developed PHVD, of whom three-quarters required intervention. Ultrasound measurements of ventricular size were most commonly used to diagnose PHVD (94%). No consensus existed on which ventricular parameters needed to be enlarged and when to start treatment of PHVD. Early intervention (ie, initiated after the ventricular index (VI) exceeded the 97th percentile (p97) according to Levene) was provided in 8/32 centres (25%), whereas 23/32 centres (72%) first started therapy once the VI had crossed the p97+4 mm line and/or when neonates presented with a progressive increase in head circumference or with clinical symptoms of raised intracranial pressure. Wide variation was seen with respect to the applied therapy modalities for cerebrospinal fluid drainage. Conclusion This survey shows that diagnostic and therapeutic approaches to neonates with PHVD vary considerably. Uniform diagnostic criteria would facilitate studies to assess optimal timing and mode of intervention.

Improvement of adherence to hand hygiene practice using a multimodal intervention program in a neonatal intensive care.

Nosocomial infections are serious complications among preterm infants admitted to neonatal intensive care units (NICU). Hand hygiene is one of the most effective measures to prevent these infections. This study, performed in a tertiary level NICU, highlights the importance of a multimodal intervention program for adherence to hand hygiene. The compliance with hand hygiene among health care workers of the NICU increased significantly from 23% in the baseline assessment to 50% in the second assessment and the incidence of sepsis decreased from 13.4% to 11.3% after implementation of an intervention program.

Treatment of neonatal progressive ventricular dilatation : A single-centre experience

Abstract Objective: To describe our experience with a cohort of 295 infants with progressive ventricular dilatation occurring in the antenatal or neonatal period. Methods: A search was performed in our cranial ultrasound database. All records and images of infants in whom an imaging diagnosis of progressive ventricular dilatation had been made were retrieved. In addition, modes of treatment were analysed. Results: Between February 1991 and March 2012, 295 neonates were admitted to our level 3 neonatal intensive care unit (NICU), and developed progressive ventricular dilatation for which they required intervention. In the majority of these infants, progressive ventricular dilatation developed following IVH grade III or IV (240/295; 81%) of whom 214/240 (89%) were preterms. Temporary treatment with lumbar punctures and punctures from ventricular reservoirs was sufficient for the majority of the preterms. A ventricular reservoir was inserted in 216/295 infants (73%). The overall infection rate was low (6%). A ventriculoperitoneal shunt (VP shunt) was inserted in 32% of the whole cohort, revision within 3 months was necessary in 20%, and shunt-related infection occurred in 12%. Conclusions: This large, single-centre cohort study reports the management of progressive ventricular dilatation in newborn infants. We have shown that with our approach, complications stay within acceptable limits.

Enemas, suppositories and rectal stimulation are not effective in accelerating enteral feeding or meconium evacuation in low-birthweight infants : a systematic review

Early full enteral feeding in preterm infants decreases morbidity and mortality. Our systematic review covered the effectiveness of rectal stimulation, suppositories and enemas on stooling patterns and feeding tolerance in low‐birthweight infants born at up to 32 weeks. It comprised seven studies published between 2007 and 2014 and covered 495 infants.

Nasale cpap: een kwaliteitsverbetering bij prematuur geboren kinderen

Introduction: Continuous positive airway pressure (cpap) is increasingly being used in the care of preterm infants. There are a variety of complex mechanisms by which this is achieved. With the introduction of a dedicated cpap device (the Infant Flow), it seems that in daily practice the need for mechanical ventilation decreases.Aim of study: To compare outcome of morbidity and mortality in two groups of nicu patients treated with two different nasal cpap devices.Subjects: Neonates <32 weeks and <1500 grams admitted to the Neonatal Intensive Care Unit at the Wilhelmina Childrens Hospital, Utrecht, were included. 592 neonates in period 1 (January 2, 1999-September 27, 2001) and 349 neonates in period 2 (July 2, 2002-December 31, 2003) were compared. Neonates in period 1 were treated with ncpap with constant flow produced by a regular ventilator (Stephanie). Neonates in period 2 were treated with ncpap with variable flow applied by the Infant Flow.Methods: Retrospectively clinical characteristics, mortality, antenatal and postnatal corticosteroids, irds, bpd, surfactant suppletion, nec, pda, sepsis, ivh, pvl and rop were compared. Additionally the numbers of ventilation days were compared.Results: Clinical characteristics were comparable. In period 2 mortality was significantly lower (p<0.01). The use of postnatal corticosteroids was significantly less in period 2 (p<0.001), the group using the Infant Flow. A significant reduction of ventilation days was found in period 2: mean ventilation days 4.8 d, sd 0.5, compared with period 1: mean ventilation days 7.4 d, sd 0.5 (p<0.05).Conclusions: In this study a lower mortality, less use of postnatal corticosteroids and a lower number of ventilation days was demonstrated with the use of a dedicated nasal cpap device. With a dedicated ncpap device quality of care improved in preterm infants.SamenvattingInleiding: Continuous positive airway pressure (cpap) wordt in toenemende mate toegepast voor het ondersteunen van de ademhaling bij prematuur geboren kinderen. Er zijn diverse technieken mogelijk om cpap toe te dienen. Met de introductie van de Infant Flow lijkt de behoefte aan kunstmatige beademing af te nemen.Doel van de studie: Het vergelijken van de uitkomsten van morbiditeit en mortaliteit tussen twee groepen nicu-patiënten die behandeld werden met twee verschillende methoden van toedienen van nasale cpap.Onderzoekspopulatie: Retrospectief werden 592 neonaten in periode 1 (1 januari 1999-27 september 2001) en 349 neonaten in periode 2 (1 juli 2002-31 december 2003) vergeleken. Neonaten in periode 1 werden behandeld met nasale cpap met een constante flow die gegeven werd door een dubbele nasofaryngeale canule met behulp van een standaard beademingsmachine voor neonaten (Stephanie). Neonaten in periode 2 werden behandeld met nasale cpap met een variabele flow, gegeven met behulp van een zogenoemde nasale ‘prong’ door middel van de Infant Flow.Methoden: Retrospectief werden de klinische gegevens, mortaliteit, antenataal en postnataal corticosteroïdengebruik, irds, bpd, toediening van surfactant, het aantal beademingsdagen, het voorkomen van nec, pda, sepsis, ivh, pvl en rop in beide perioden vergeleken.Resultaten: Klinische gegevens waren vergelijkbaar. Het gebruik van postnatale corticosteroïden was significant minder in periode 2 (p<0,001), de groep waarin de Infant Flow gebruikt werd. Ook de mortaliteit was significant lager (p<0,01) in periode 2. Er werd tevens een significante vermindering van beademingsdagen gevonden (periode 1: 7,4, sd 0,5, periode 2: 4,8, sd 0,5, p<0,05).Conclusie: In deze studie werd een lagere mortaliteit, minder gebruik van postnatale corticosteroïden en minder beademingsdagen aangetoond bij het gebruik van een specifiek nasaal cpap-apparaat. Met een apparaat speciaal toegepast voor het geven van nasale cpap wordt de kwaliteit van zorg bij te vroeg geborenen verbeterd.

Kangaroo Care: Experiences and Needs of Parents in Neonatal Intensive Care: A Systematic Review ‘Parents’ Experience of Kangaroo Care’

Abstract This review is focusing on the experiences and needs of parents with infants within NICU regarding Kangaroo Care. Ten studies with qualitative designs were included. Kangaroo Care was overall experienced as positive; giving parents the opportunity to get to know their babies and (re-) construct their parenting role. Parents need potential barriers like communication, support, environment and physical needs to be facilitated in a way that they contribute to a positive experience. Keywords: Experiences; Kangaroo care; Needs; NICU; Parents

O-162 Clinical Implications Of Mri-procedure In Preterm Neonates

Background and aim Magnetic Resonance Imaging (MRI) of the brain at 30 weeks Postmenstrual age (PMA) is part of routine care for preterms born <28 weeks gestational age (GA), because of their high risk of brain injury. The aim was to evaluate fluctuations in vital parameters following the MRI procedure. Methods and patients We compared clinical parameters in 30 infants 4 h before and after the MRI: number of apneas and bradycardias, changes in oxygen requirement, respiratory support, and rectal temperature. Oral chloralhydrate sedation (30–50 mg/kg) was administered upon discretion of the attending neonatologist. Results Infants had the following clinical characteristics: mean GA 26 + 4 wks (24–28 wks), mean BW 1012 g (610–1520 g), PMA at scan was 30 + 6 wks (29 + 6–31 + 6 wks) with weight of 1397 g (980–1860 g). Infants <1500 g, were transported in an MRI-compatible incubator (26/30). 12/30 (40%) infants were sedated with chloralhydrate. None of the infants had >4 apneas or >3 bradycardias before the MRI. After the MRI 5 infants (all unsedated) had >4 apneas (5–7 apneas), 2 infants (1 sedated) had >3 bradycardias (5–6). After the MRI, FiO2 was increased in 10/30 patients, max change 0.06, more respiratory support was needed in 5 infants (3 sedated): PEEP from +4 to PEEP +5 cmH2O, and temperature was lower in 20/30 patients, max decrease 1,3°C (before 37.1°C (36.3–37.9°C) vs. 36.6°C (35.9–37.4°C)). Conclusions Early MRI scanning using an MRI incubator is a relatively safe procedure in clinically stable infants. Use of sedation was not associated with clinically relevant changes, although these findings warrant further investigation.