Erez Nadir

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis

Objectives We performed a systematic review and meta-analysis of all the available evidence to assess the efficacy and safety of paracetamol for the treatment of patent ductus arteriosus (PDA) in neonates, and to explore the effects of clinical variables on the risk of closure. Data source MEDLINE, Scopus and ISI Web of Knowledge databases, using the following medical subject headings and terms: paracetamol, acetaminophen and patent ductus arteriosus. Electronic and manual screening of conference abstracts from international meetings of relevant organisations. Manual search of the reference lists of all eligible articles. Study selection Studies comparing paracetamol versus ibuprofen, indomethacin, placebo or no intervention for the treatment of PDA. Data extraction Data regarding efficacy and safety were collected and analysed. Results Sixteen studies were included: 2 randomised controlled trials (RCTs) and 14 uncontrolled studies. Quality of selected studies is poor. A meta-analysis of RCTs does not demonstrate any difference in the risk of ductal closure (Mantel–Haenszel model, RR 1.07, 95% CI 0.87 to 1.33 and RR 1.03, 95% CI 0.92 to 1.16, after 3 and 6 days of treatment, respectively). Proportion meta-analysis of uncontrolled studies demonstrates a pooled ductal closure rate of 49% (95% CI 29% to 69%) and 76% (95% CI 61% to 88%) after 3 and 6 days of treatment with paracetamol, respectively. Safety profiles of paracetamol and ibuprofen are similar. Conclusions Efficacy and safety of paracetamol appear to be comparable with those of ibuprofen. These results should be interpreted with caution, taking into account the non-optimal quality of the studies analysed and the limited number of neonates treated with paracetamol so far.

Late better than early elective term Cesarean section.

Aim:  Caesarean section (CS) deliveries have increased, mostly because of patient/obstetrician preference. Although CS decreases the risk of delivery‐related injuries, it increases the risk for respiratory and neurological complications. Complication rates are reportedly higher for elective CSs for term infants performed at 37–38 gestational weeks than later. We investigated this difference in an Israeli cohort.

ISO 9001 in a neonatal intensive care unit (NICU)

PURPOSE The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. DESIGN/METHODOLOGY/APPROACH The process started with the department heads decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. FINDINGS In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. RESEARCH LIMITATIONS/IMPLICATIONS The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. PRACTICAL IMPLICATIONS The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ORIGINALITY/VALUE ISO 9001 is becoming a recommended tool to improve clinical service quality.

Service Management of Special Care Units: Lessons Learned in Manufacturing

Special care units express an increasing interest in adopting methods for quality management, previously developed and implemented in manufacturing firms. The paper examines the analogy between service management in special care units and the management of manufacturing processes. This paper is based on the authors’ implementation of ISO 9001:2000 in a neonatal intensive care unit. It maps the major processes and entities that create the treatment outcome, conducting a focused comparison between healthcare organizations/special care units and manufacturing organizations. To verify the performance of various major processes in healthcare the authors recommend the use of the Yield performance measurement. The literature review shows that a comparison between manufacturing and service organizations is both useful and valid even though service organizations differ from manufacturing organizations. Despite the complexities of treating humans and the level of uncertainty that goes hand in hand with health care decision making, strict product and/or customer treatment identification and specifications can raise the level of success in achieving positive results.

The Duration of Breastfeeding and Its Association with Metabolic Syndrome among Obese Children.

Objective. The objective of this study was to evaluate whether duration of breastfeeding is associated with a lower prevalence of metabolic syndrome in obese children. Methods. A retrospective analysis of obese children aged 3 to 18 years followed at a pediatric outpatient clinic at a single center between the years 2008 and 2012. The children were divided according to their breastfeeding duration: no breastfeeding, a short period of breastfeeding, and a long term breastfeeding. Also, they were divided into metabolic and nonmetabolic syndrome groups, based on physical examination and laboratory tests. Results. Out of 4642 children who visited the clinic, 123 were obese and were included in the study. About half of them matched the metabolic syndrome criteria. There was no correlation between the prevalence of metabolic syndrome and the duration of breastfeeding. Hypertension, abnormal low levels of HDL, high levels of HbA1c, and high fasting triglyceride levels were very common in our study population, yet no statistical significance was noted among the different breastfeeding groups. Conclusion. In this study, breastfeeding was not associated with a reduced risk for metabolic syndrome, compared with formula feeding, in children who are obese.

Antimicrobial Resistance Among Uropathogens That Cause Childhood Community-acquired Urinary Tract Infections in Central Israel.

In this retrospective study 829 positive urine cultures were analyzed. Escherichia coli bacterium was the leading uropathogen (86%). Almost 60% were resistant to ampicillin and first generation cephalosporins, and about 30% of them resistant to amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Almost none of them were resistant to second and third generation cephalosporins, aminoglycosides, ciprofloxacin or nitrofurantoin.

Neonatal Chest Wall Rhabdomyosarcoma

An infant was born at term with a huge chest mass diagnosed as rhabdomyosarcoma. Treatment consisted of surgical resection and chemotherapy. We describe this very rare congenital mass and the problematic therapeutic management of such a tumor in a newborn.

PO-0780 Postnatal Follow-up Of Newborns With Prenatal Diagnosis Of Hydronephrosis

Background Prenatal Hydronephrosis is diagnosed in 1–5% of pregnancies worldwide. The diagnosis of antenatal hydronephrosis (ANH) causes stress to the parents and dilemmas to the paediatrician. Objectives To examine the correlation between the degree of the renal pelvic dilatation (RPD) detected by the first 2–5 days of life and the postnatal outcome. To investigate the correlation between bilateral hydronephrosis and the nephrologic outcome. To discuss the possibility of decreasing the postnatal examinations of these healthy babies. Methods During a period of two years, we enrolled 143 term newborns with ANH. These babies had an ultrasound at the age of 2–5 days and a second ultrasound at the age of 4–6 weeks. After the examinations they were referred to our nephrologist. Results Out of 8370 live-births, 143 infants had ANH. Six babies never completed the exam. At the first exam 69 babies were normal, 62 babies had mild, 3 babies had moderate and 3 babies had severe RPD. On their second ultrasound 76 had normal findings, 36 had mild, 8 had moderate and 12 had severe RPD. 132 babies completed both of the examinations. Bilateral hydronephrosis was detected in 33 cases during their first ultrasound while on the second only 27. There were 11 infants with UPJ obstruction 9 of them with severe RPD. We found 10 babies with VUR. Six babies needed surgical intervention. Conclusions There seems to be a correlation between the degree of RPD and the presence of postnatal pathology. Bilateral hydronephrosis probably carries increased risk for postnatal pathology.