G. D. T. Inglis

Establishing normal values of central venous pressure in very low birth weight infants

The objective of this paper is to establish a reference range of central venous pressure (CVP) values during the first 4 days of life in very low birth weight (VLBW) infants. A prospective observational study with continuous monitoring of CVP in VLBW newborns who had an umbilical venous catheter (UVC) positioned in or near the right atrium is conducted. All UVCs were inserted as part of normal care of the infants. The mean CVP (mCVP) was monitored for 72 h from recruitment, or until the UVC was removed. The mean mCVP was calculated for each infant. The median of the mean mCVPs was then calculated. Data were analysed in 17 infants. The median gestational age was 27 weeks and median birth weight was 940 g. Sixteen were mechanically ventilated and of these, six also received continuous positive airway pressure (CPAP) during the study period. One infant received no respiratory support. One infant died during the study period. The lowest mean mCVP was 2.8 mmHg and the highest was 13.9 mmHg. The median mean mCVP was 4.9 mmHg (interquartile range 4.4-6.1). The normal range of CVP in VLBW infants during the first 4 days of life is wider than previously suggested.

A randomised controlled trial of blended learning to improve the newborn examination skills of medical students.

Objective To evaluate the hypotheses that a blended learning approach would improve the newborn examination skills of medical students and yield a higher level of satisfaction with learning newborn examination. Method Undergraduate medical students at a tertiary teaching hospital were individually randomised to receive either a standard neonatology teaching programme (control group), or additional online access to the PENSKE Baby Check Learning Module (blended learning group). The primary outcome was performance of newborn examination on standardised assessment by blinded investigators. The secondary outcomes were performance of all ‘essential’ items of the examination, and participant satisfaction. Results The recruitment rate was 88% (71/81). The blended learning group achieved a significantly higher mean score than the control group (p=0.02) for newborn examination. There was no difference for performance of essential items, or satisfaction with learning newborn examination. The blended learning group rated the module highly for effective use of learning time and ability to meet specific learning needs. Conclusions A blended learning approach resulted in a higher level of performance of newborn examination on standardised assessment. This is consistent with published literature on blended learning and has implications for all neonatal clinicians including junior doctors, midwifes and nurse practitioners.

Neonatal blood cultures: Effect of delayed entry into the blood culture machine and bacterial concentration on the time to positive growth in a simulated model

Aims:  To determine if: time from blood culture inoculation to positive growth (total time to positive) and time from blood culture machine entry to positive growth (machine time to positive) is altered by delayed entry into the automated blood culture machine, and if the total time to positive differs by the concentration of organisms inoculated into blood culture bottles.

Leak around endotracheal tubes in ventilated newborns: An observational study

The study aims to determine the incidence and magnitude of leak around endotracheal tubes (ETTs) in ventilated babies in our unit, and to identify any relationship between weight, gestation, head position or ETT tip position, and the amount of leak.

Relationship between blood culture collection method and proportion of contaminated cultures in neonates

This study aims to document methods of blood culture collection used in our neonatal unit and to determine whether or not the proportion of contaminated cultures varied according to method of collection. Two specific comparisons of interest were the proportion of contaminated cultures in samples collected via (i) preferred versus non‐preferred methods, and (ii) peripheral cannulae at the time of insertion versus separate arterial or venous puncture.

Antimicrobial Susceptibility of Bacteria Isolated from Newborns with Suspected or Confirmed Necrotising Enterocolitis

Antimicrobial Susceptibility of Bacteria Isolated from Newborns with Suspected or Confirmed Necrotising Enterocolitis Aim. This audit aimed to identify which bacteria were associated with necrotising enterocolitis (NEC) and determine their antibiotic sensitivities. Methods. A retrospective audit of all infants with a diagnosis of suspected NEC or confirmed NEC and a positive culture (blood/faeces/operative specimen or vascular access device) between January 2000 and September 2007 was performed. Results. Ninety nine infants had a diagnosis of suspected (45) or confirmed NEC (54). Seventeen patients had suspected (5) or confirmed (12) NEC and a positive culture result. 12 babies had positive blood cultures associated with their NEC. Only 4 of the 12 cases of NEC with a positive blood culture received adequate first line cover for their subsequently identified infecting organism. Conclusions. Due to the limitations of this study we are unable to make general recommendations on the first line antibiotic choice for babies with suspected or confirmed NEC. Our current regime of Ampicillin, Gentamicin and Metronidazole failed to adequately treat 8 of the 12 organisms subsequently isolated in blood cultures. Only the combination of Vancomycin and Meropenem would have adequately treated all the bacteria identified. The concern with this approach is the possible emergence of multi drug resistant bacteria.