Melissa Luig

Epidemiology of necrotizing enterocolitis – Part II: Risks and susceptibility of premature infants during the surfactant era: A regional study

Objectives:  We observed a reduced incidence of necrotizing enterocolitis (NEC) despite increased survival of extremely premature infants over the last two decades. A different susceptibility pattern to NEC according to gestation has been proposed. We aim to examine the influence of perinatal risk factors for NEC in infants less than 32 weeks gestation, in our region, in the post‐surfactant era.

Epidemiology of necrotizing enterocolitis – Part I: Changing regional trends in extremely preterm infants over 14 years

Objectives:  Advances in perinatal care include exogenous surfactant, unequivocal acceptance of antenatal steroids and in utero and ex utero transfers to tertiary centres. Increased survival of extremely premature infants may change the incidence and outcome of necrotizing enterocolitis (NEC). Our aim was to examine the trends in the incidence of NEC, surgery and mortality in infants of 24–28 weeks gestation in a retrospective regional review of three epochs over a span of 14 years.

Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study.

OBJECTIVE To compare neurodevelopmental outcomes of extremely preterm infants diagnosed with patent ductus arteriosus (PDA) who were treated medically or surgically and those who were not diagnosed with PDA or who did not undergo treatment for PDA. STUDY DESIGN This retrospective population-based cohort study used data from a geographically defined area in New South Wales and the Australian Capital Territory served by a network of 10 neonatal intensive care units. Patients included all preterm infants born at <29 completed weeks of gestation between 1998 and 2004. Moderate/severe functional disability at 2-3 years corrected age was defined as developmental delay, cerebral palsy requiring aids, sensorineural or conductive deafness (requiring bilateral hearing aids or cochlear implant), or bilateral blindness (best visual acuity of <6/60). RESULTS Follow-up information at age 2-3 years was available for 1473 infants (74.8%). Compared with infants not diagnosed with a PDA or who did not receive PDA treatment for PDA, those with medically treated PDA (aOR, 1.622; 95% CI, 1.199-2.196) and those with surgically treated PDA (aOR, 2.001; 95% CI, 1.126-3.556) were at significantly greater risk for adverse neurodevelopmental outcomes at age 2-3 years. CONCLUSION Our results demonstrate that treatment for PDA may be associated with a greater risk of adverse neurodevelopmental outcome at age 2-3 years. This was particularly so among infants born at <25 weeks gestation. These results may support permissive tolerance of PDAs; however, reasons for this association remain to be elucidated through carefully designed prospective trials.

Dwell time and risk of central-line-associated bloodstream infection in neonates

BACKGROUND Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). AIM To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. METHODS The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). FINDINGS There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12-20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. CONCLUSION There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.

Unilateral vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely preterm infants

Left vocal cord paralysis (LVCP) is variably reported post ligation of patent ductus arteriosus (PDA). Our objective was to determine the incidence of LVCP and identify predictive factors and associated morbidities in preterm infants post PDA ligation.

Is it feasible to identify preterm infants with respiratory distress syndrome for early extubation to continuous positive airway pressure post-surfactant treatment during retrieval?

Preterm infants with respiratory distress syndrome (RDS) requiring surfactant treatment are often retrieved mechanically ventilated to the receiving hospital. INSURE (INtubate, SURfactant, Extubate) technique is not routinely performed by Newborn and Pediatric Emergency Transport Services NSW (NETS) during retrieval. This study aims to evaluate the likelihood of using INSURE technique during retrieval. We attempted to study the clinical characteristics of preterm infants with RDS who were favourably extubated (FE) shortly after admission to the receiving hospital.

A Retrospective Study of Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy

Abstract Objectives: Therapeutic hypothermia (TH) is now standard treatment for moderate to severe hypoxic ischemic encephalopathy (HIE), secondary to intrapartum hypoxia, and has been performed in our neonatal unit since 2008. Objectives of this study included the assessment of compliance with the TH protocol and the evaluation of 2-year outcomes. Materials and Methods: Medical records of all the infants who underwent TH (2008-2014) were reviewed and relevant data were extracted. The laboratory database was used to extract blood test results. Follow-up clinic records were reviewed to gather data for 2-year outcomes. Outcome at 2 years was dichotomized as normal (survival with no or mild impairment) and abnormal (death or survival with moderate or severe impairment). Regression analysis was performed to determine the association of perinatal variables with an abnormal outcome. Results: Seventy-seven infants were treated with TH with 40/77 (52%) cooled as per the protocol. Treatment with TH for stage 1 HIE was the most common reason for protocol noncompliance. A total of 71 infants had HIE (n = 26, 24, and 21 with modified Sarnat stages 1, 2, and 3 respectively). Sixteen infants with HIE (22.5%) died; all had stage 3 HIE. Forty-one infants were seen at ≥2 years. Of these, 34 infants (83%) had a normal outcome. The clinical stage of HIE was the strongest predictor of an abnormal outcome. Normal 2-year outcome was seen in 94%, 84%, and 5% of stages 1, 2, and 3 HIE respectively. Conclusions: We noted a high degree of variation from the TH protocol. Clinical staging of HIE remains the strongest predictor of long-term outcome.

Vein of Galen aneurysmal malformation: Pit‐falls in the diagnosis

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation. We report a case of VGAM being associated with presence of bilateral hydrocephalus, gross cardiomegaly and is unique in two ways. Firstly, clinical presentation was associated with a large discrete cystic swelling along right side of the neck, which has not previously been reported. Secondly, this was a missed diagnosis of VGAM due to omission of colour Doppler study while performing diagnostic fetal cranial ultrasound just prior to delivery, following referral for assessment on a previously identified abnormality.