Objective of the study was to compare number of X-rays performed for neonatal central line tip positioning when real-time US is used compared to X-ray only, and to assess consequences on position accuracy, irradiation and cost. Retrospective monocentric cohort study conducted at Evelina London Children's Hospital Neonatal Unit over 6 months. Study was conducted during implementation of US for line tip localisation with formulation of US protocol. Tip position on X-ray was reviewed by one neonatologist and one radiologist and inter-rater agreement calculated. Criteria for good, satisfactory or inadequate position of the tip were defined. Estimated effective radiation dose and cost for each X-ray was determined. Two hundred seventy-four lines were inserted (nPICC, UVC, UAC). Eighty-three lines were scanned with US (US group); 191 lines were not (no-US group). Number of X-rays performed was significantly lower in the US group: 1.19 vs. 1.5 (p 0.001), related to a significantly lower percentage of lines requiring multiple X-rays (38.7% no-US group vs. 19.9% US group; p 0.004). Accuracy was higher in US group with more lines at cavoatrial junction (p 0.05) and was significantly increased with US use for lines inserted from lower limbs (22.9% and 76.2%, p 0.001). Inter-rater agreement was strong (k > 0.8). US group received lower mean radiation dose (p < 0.001) and cost related to X-ray was significantly reduced (p 0.001).Conclusion: Real-time US use for line tip positioning in the NICU significantly decreased the number of X-rays performed and was associated with better-positioned lines, decreased irradiation and cost. What is Known:• The use of point-of-care ultrasound (PoCUS) by critical care providers in neonatology has increased in recent years. International guidelines advocate for the use of PoCUS as valid guidance to practical procedures in neonatology. • Central catheters (umbilical catheters and neonatal peripherally inserted central catheters) are among the most commonly used devices to support NICU patients. Proper positioning is crucial to avoid complications and PoCUS has high sensitivity and specificity in accurately determining line tip position. The current standard practice for line tip position confirmation in neonatology is still conventional radiography despite multiple evidenc suggest significant inaccuracy of X-ray compared to ultrasound. What is New: • PoCUS implementation for line tip positioning leads to a significant decrease in the number of X-rays performed, in radiation effective dose and costs. PoCUS evaluation of central catheters significantly increases the accuracy of the final line tip position with more lines at the cavoatrial junction. • Training is fundamental for univocal interpretation of ultrasound images and an effective learning strategy is being proposed.
Aim:To investigate if there is a correlation between rSO2 values detected by NIRS and neuromotor and behavioral outcome of premature neonates at 18 months corrected age.Material and method: 9 premature neonates (mean birth weight 1800 grams, mean gestational age 31 weeks) were monitored with Near Infrared Spectroscopy using INVOS during the first 72 hours of life. Outcome at 18 months corrected age was assessed by unsing Amiel Tison Neurological Examination and Bayley III test. rSO2 was correlated with the results of these tests. Results:A period of at least 30 minutes of rSO2 lower than 50% during the first 24 hours of life was significantly correlated with the presence of the motor deficit: inability to walk independently at 18 months corrected age (p < 0.001); significantly lower postural tone (p< 0.005) and with a score in Bayley gross motor subtest under 85% for the corrected age (p< 0.001) and in the fine motor subtest under 80% for the corrected age (p< 0.03). There were not noted statistically significant differences regarding the cognitive and language subtests. Conclusions:Lower rSO2 during the first 24 hours of life was significantly associated with motor deficit and with lower scores in the gross motor and fine motor subtests in the Bayley scale
Aims:To assess the use of continuous positive airways pressure (CPAP) in Irish special and intensive care nurseries. Methods:A one-page questionnaire on the use of CPAP was sent to a Consultant Neonatologist/ Paediatrician and a senior neonatal nurse at each of the 28 delivery units in the Republic and Northern Ireland. We asked for what clinical indications and in what patient groups CPAP was used; which pressure generating devices and nasal interfaces were used; and what pressures were used (cmH 2 0). We also asked about the use of NIMV/NIPPV/ BiPAP. Finally a question was asked about each units practice when discontinuing CPAP.Results: Replies were received from doctors and nurses at all units (56/56, 100%).Nasal CPAP was used at 24/28 units. CPAP is used as an aid to extubation in all units who ventilate infants (24/24, 100%). The Infant Flow Driver (Viays Healthcare, Yorba Linda CA, USA) is the most commonly used pressure-generating device used in 22/24 (92%) units, SiPAP 14/24 (58%) and Bubble CPAP in 5/24 (21%). All units use short binasal prongs with over half of units also using nasal mask interfaces. Infants at 16/24 units receive NIMV, with a starting rate that varies (mean 25bpm, range 10-50bpm). All but 3 units give trial periods off CPAP before stopping treatment. CONCLUSIONS: CPAP is widely used to support extremely preterm infants with RDS. When NIMV is used there appears to be a wide variation in the inflation rates and peak inflating pressures (PIP) that are used. COULD EARLY NEONATAL FEATURES PREDICT THE NEED FOR USE OF A CERTAIN ANTICONVULSANT TO CONTROL NEONATAL SEIZURES?A.I. Backgroudn and aims: Using specific targeted anticonvulsivants in the postasphzxia seizures could result in an earlier control of these and less drug-associated toxicity. The aim of the study was to investigate if there are certain features in the case of newborns with postasphyxial seizures to predict that these will be controlled by only by Lidocaine. Methods:In 15 neonates with postasphyxial seizures the treatment was as follows: Phenobarbital 20 mmg/kg i.v loading dose followed by another dose of 20 mg/kg, followed by phenitoin 20 mg/kg loading dose and midazolam beginning with 0.06 mg/kg to 1.2 mg/kg/hour.. followed by Lidocaine 2 mg/kg loading dose -10 minutes followed by 6 mg/ kg/hour for 12 hours, 4 mg/kg/hour for 12 hours and 2 mg/kg/hour for 12 hours. There were noted: APGAR scores, pH and base excess in the umbilical artery at birth, time to first breath, aEEG pattern at 6 hours. Conclusions: Increased base excess in the umbilical artery, longer time to first breath and a depressed aEEG pattern could select from the population of neonates with postasphyxial seizures a cathegory in which the seizures could be controlled by lidocaine only. Results
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