Yves Hennequin

Skin-to-skin back transfers provide a feasible, safe and low-stress alternative to conventional neonatal transport

Skin-to-skin (STS) contact is increasingly practised in neonatal intensive care units (1), especially to dampen the detrimental impact of negative stress (2). These days, high-risk infants are usually transferred in utero to centralised tertiary level care units. Once these infants have been born, stabilised and are ready for convalescence, they are back transferred to less specialist neonatal units near their homes. This transfer is an additional event that has an impact on the stress, comfort and safety of the parents and infants (3). STS contact has been the favourite mode of back transfer in our department for the last three years, as this has been shown by other studies to provide a more comfortable and less stressful mode than conventional transport (4,5). Our experience is presented with regards to the physiological stability of the infants, the mothers’ stress and an evaluation by the medical professionals involved. Stabilised term and preterm newborns without respiratory support and intravenous lines were eligible for an STS back transfer from the Hospital Erasme, which is the academic medical centre of the Free University of Brussels. The mothers and infants were accustomed to STS during their NICU stay. Informed consent was obtained from the mother. She was on a gurney in a semi-seated position, with the infant lying on her chest in the Kangaroo position (Figs 1 and 2), restrained by a Lycra elastic band fitted to her. The mother was dressed according to the weather, wearing upper clothing with a front opening and covered with extra blankets. In the ambulance, she was positioned facing the rear of the vehicle and restrained with two seat belts, according to the Belgian regulations for adult ambulance transport. The ambulance company and its insurers agreed coverage of STS transport before the mother and infant were transferred. The mother and infant were accompanied by a neonatal nurse, which is also standard procedure for conventional back transfers. The infant’s heart and respiratory rates, temperature and oxygen saturation were registered before, during and after the transfer. On arrival, the mothers were asked if the mode of transport alleviated their stress and asked to provide a score based on a scale from zero for bad to 10 for excellent. The opinions of the neonatal nurse who accompanied the mothers and infants and of the staff member who provided initial care at the arrival hospital were registered in the same way. We STS back transferred 94 preterm and term infants, including four pairs of twins during the study period from January 2014 to December 2016 (Table 1). No significant changes in the infants’ physiological parameters and no untoward effects were reported. The mothers said that the STS transfer helped to

Acute neonatal collapse resulting from pericardial effusion

Sir: In response to the original paper of Drs Bagtharia, Kempley and Hla [1], we would insist that pericardial effusion related to a central venous catheter is not a rare complication of a central line and is a life threatening event. During recent years we have observed five premature infants born between 26 and 34 weeks of gestational age. The first one had a subclavian line (24G, polyurethane) inserted with difficulty. He was ventilated because of severe chronic lung disease. He suddenly presented clinical deterioration and a major pericardial effusion was diagnosed post-mortem. Two other babies had a polyurethane micro-catheter 27G inserted in the arm. The first sign of the pericardial effusion was cardiomegaly in one baby and an acute abdominal swelling in the other; 15 ml and 12 ml fluid was obtained respectively by pericardiocentesis. The second newborn died from acute hypoxic injury. The location of the catheter tip had been checked by ultrasonography and found normal the day before death. Spontaneous displacement of the catheter could be the cause of a transmural necrosis seen at the apex of the right ventricle at autopsy. The two last premature infants had an umbilical venous catheter (polyurethane 5 CH). Pericardial effusion was discovered by routine cardiac ultrasonography in one and because of acute hepatomegaly in the other. On pericardiocentesis, 12 ml and 20 ml fluid were withdrawn respectively. Both babies improved rapidly. In four cases, ultrasonography was necessary to confirm the diagnosis and treatment consisted of pericardiocentesis and catheter removal. Analysis of the fluid was consistent with total parenteral fluid without infection. In our department no pericardial effusion was observed with the silicone 23G (0.6 mm) central venous catheter more commonly used than the polyurethane catheter. Presumably the kind of material used and not only the position is important.