An electronic literature search for articles published between January 1990 and September 2011 was conducted by using the PubMed, CINAHL, SCOPUS, and Cochrane Library databases. The update of this clinical practice guideline is the result of reviewing a total of 124 articles: 3 randomized controlled trials, 103 prospective trials, 1 retrospective study, 3 case studies, 11 review articles, 2 surveys and 1 consensus paper on transcutaneous monitoring (TCM) for P(tcO(2)) and P(tcCO(2)). The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria: (1) Although P(tcCO(2)) has a good correlation with P(aCO(2)) and is a reliable method to evaluate plasma CO(2) levels, it is recommended that arterial blood gas values be compared to transcutaneous readings taken at the time of arterial sampling, in order to verify the transcutaneous values, and periodically as dictated by the patient's clinical condition. (2) It is suggested that P(tcCO(2)) may be used in clinical settings where monitoring the adequacy of ventilation is indicated. (3) It is suggested that P(tcO(2)) and P(tcCO(2)) may be used in determining the adequacy of tissue perfusion and monitoring of reperfusion. (4) It is suggested that TCM should be avoided in the presence of increased thickness or edema of the skin and/or subcutaneous tissue where the sensor is applied. (5) It is recommended that sites used for a TCM be changed as often as necessary and that they be alternated and observed to avoid thermal injury. Manufacturer recommendations should be followed.

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Objective International Classification of Diseases (ICD) codes in electronic health records (EHRs) are increasingly used for health services research, in spite of unknown diagnostic accuracy. The accuracy of ICD codes to identify bronchopulmonary dysplasia (BPD) is unknown. Study design Retrospective cohort study in a single-center NICU ( n = 166) to evaluate sensitivity and specificity of ICD-10 codes for the diagnosis of BPD. Analysis of large insurance claims database ( n = 7887) to determine date of assignment of the code. Results The sensitivity of any BPD-related ICD codes ranged from 0.82 to 0.95, while the specificity ranged from 0.25 to 0.36. In a large national insurance database, the most common date of ICD-9 or ICD-10 code assignment was the day of birth, which is inconsistent with the clinical definition. Conclusions ICD codes registered for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.

Background Preterm neonates are at risk for respiratory illness including respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). Recent advancements in neonatal medicine have introduced less invasive forms of respiratory support for neonates with RDS and BPD, including continuous positive airway pressure (CPAP) and humidified “high-flow” therapy via nasal cannula (HFNC). There is limited evidence documenting the impact of these respiratory supports on neonatal swallowing function. Objective This article presents the results of a structured literature review that sought to determine the evidence to support the practice of feeding neonates in the neonatal intensive care unit (NICU) by mouth while on CPAP or HFNC. Methods A systematic search of PubMed was completed to identify relevant, peer-reviewed literature reporting original data that addressed the identified objective. Results Five studies were identified that related to oral feeding and/or swallowing while on CPAP or HFNC in neonates. Conclusions Given the limited evidence available to support the practice of feeding neonates in the NICU by mouth while on CPAP or HFNC, and the potential for adverse respiratory events related to the underlying respiratory disease, the authors urge caution with this practice, and highlight the urgent need for further research in this area.

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