Rosemarie Anne Boland

Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia.

Background The aim of this study was to determine if the National Institute of Child Health and Human Development (NICHD) calculator, designed to predict mortality or neurosensory disability in infants 22–25 weeks’ gestation, was valid for contemporary Australian infants. Method Outcome data at 2 years of age for 114 infants who were liveborn in Victoria, Australia, in 2005, between 22 and 25 completed weeks’ gestation, weighing 401–1000 g at birth, and free of lethal anomalies, were entered into the NICHD online calculator. Predicted outcomes were then compared with the actual outcomes. Results Of the 114 infants, 99 (87%) were inborn and 15 (13%) were outborn. The overall prediction of death for inborn infants was 47.1% compared with the actual death rate to 2 years of age of 49.5%. The area under the curve (AUC) was 0.803 (95% CI 0.718 to 0.888; p<0.001) for mortality, comparable with the AUC for the NICHD study (AUC: 0.753; 95% CI 0.737 to 0.769; p<0.001). The accuracy for predicting death was not as precise for outborn infants (AUC: 0.643; 95% CI 0.337 to 0.949; p=0.36). The calculator overestimated the combined outcome of death or survival with major disability at 72.0%, compared with an actual rate of 60.5%. Conclusions The NICHD outcome estimator was helpful in predicting mortality for inborn infants, 22–25 weeks’ gestation, but was less precise for outborn infants. It overestimated the combined outcome of death or major disability in infants born in Victoria, Australia, in 2005.

Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22–31 weeks’ gestation in non-tertiary hospitals in Victoria over two decades

Very preterm infants born in non‐tertiary hospitals (‘outborn’) are known to have higher mortality rates compared with infants ‘inborn’ in tertiary centres.

A comparison of different mask holds for positive pressure ventilation in a neonatal manikin

Background Ventilation during neonatal resuscitation is typically initiated with a face mask, but may be ineffective due to leak or obstruction. Objective To compare leak using three methods of mask hold. Methods Medical and nursing staff regularly involved in neonatal resuscitation used the three holds (two-point, two-handed, spider) on a manikin in a random order to apply positive pressure ventilation (PPV) at standard settings each for 1 min while mask leak was recorded. Results Participants (n=53) varied in experience (1–23 years) and hand size. Combined median (IQR) leak was 14 (2–46)% and was not different among the holds. Conclusions There was no difference in the leak measured using the three different mask holds.

What are we telling the parents of extremely preterm babies

Parent counselling and decision‐making regarding the management of preterm labour and birth are influenced by information provided by healthcare professionals regarding potential infant outcomes.

Very preterm birth before arrival at hospital

Our aim was to report perinatal characteristics of very preterm births before arrival (BBAs) at a hospital, and perinatal and infant mortality rates up to one year, comparing BBAs with births in a hospital.

Neonatal intensive care at 22-24 weeks’ gestation: How low should we go?: Neonatal intensive care

Neonatal intensive care at 22–24 weeks’ gestation: How low should we go? Rosemarie A Boland 1,2,3 and Jennifer R Bowen Clinical Sciences, Murdoch Children’s Research Institute, Department of Obstetrics and Gynecology, University of Melbourne, Paediatric Infant Perinatal Emergency Retrieval, Royal Children’s Hospital, Melbourne, Victoria, Department of Neonatology, Royal North Shore Hospital, New South Wales and Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia

Optimizing Outcomes in Regionalized Perinatal Care: Integrating Maternal and Neonatal Emergency Referral, Triage, and Transport

Opinion statementThe purpose of integrating emergency maternal referral and triage capability into a neonatal retrieval service is to improve the effectiveness of regionalized perinatal care and to ensure opportunities for in utero transfer are maximized. Evidence for the effectiveness of regionalized perinatal care is presented, emphasizing the striking difference in survival of outborn extremely preterm (EPT) infants compared with inborn EPT infants. Barriers to achieving high rates of in utero transfer are identified and strategies to address preventable factors discussed. There is evidence of variation in rates of outborn extremely preterm births. As birth in transit is a rare event, this variation suggests there are opportunities for significant improvement in areas with high rates of outborn extremely preterm births. Variation in the level of risk aversion by triaging obstetricians and transport platform providers may be a significant preventable factor in deciding if a particular high-risk pregnant woman is deemed safe to transfer. Collaboration between obstetricians triaging these referrals and their neonatal retrieval colleagues within an integrated service is proposed as a model to address such issues. The integrated perinatal emergency referral and retrieval service is a key component of a system structured to support regionalized care. We propose this service should sit below the regional entity responsible for clinical governance that provides an imprimatur to ensure timely and equitable access to perinatal services for high-risk women and their newborn infants.

1004 Three Different Mask Holds for Positive Pressure Ventilation in a Neonatal Mannequin

Background and Aim Mask ventilation is commonly used for neonatal resuscitation. Variable leak and inconsistent tidal volumes are reported in mannequin and delivery room studies. We compared the spider hold (SH) against the two-point top hold (TPTH), and two-handed hold (THH) for delivering positive pressure ventilation (PPV). Methods 53 participants from 5 professional groups provided PPV with each hold for 1 minute to a mannequin, using a T-piece resuscitator (PIP/PEEP 30/5 cmH2O, 40–60 inflations/min). Mask leak and expired tidal volume (TVE) were measured with a flow sensor. ANOVA was used to compare the average median leak from each participant for each hold and by professional group. Results 7324 inflations were analysed. Abstract 1004 Table 1 Leak (%) mean(SD) Professional Group TPTH n=2554 inflations SH n=2384 inflations THH n=2406 inflations Consultant n=10 34(28) 39(40) 45 35) Fellow n=10 33(27) 32(32) 33(35) Registrar n=10 31(22) 38(23) 13(14) Midwife n=12 40(30) 43(36) 48(36) Neonatal nurse n=11 35(28) 38(34) 40(33) The mean (SD) leak was 35(27)%, 38(34)% and 39(33)% for the TPTH, SH and THH respectively (p=0.003). The mean (SD) TVE was not significantly different between the three holds (p=0.09). The lowest mean (SD) leak was measured with the THH by registrars 13(14)% and highest by midwives with the THH 48(36)% (p=0.001). Conclusion Each hold can be used to give PPV. The SH does not appear to reduce leak when compared to the other holds.