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Background Controversy exists whether different continuous positive airway pressure (CPAP) weaning methods infl uence time to wean off CPAP, CPAP duration, oxygen duration, Bronchopulmonary Dysplasia (BPD) or length of admission. Aims In a multicentre randomised controlled trial, the authors have primarily compared CPAP weaning methods impact on time to wean off CPAP and CPAP duration and secondarily their effect on oxygen duration, BPD and time of admission. Methods Between April 2006 and October 2009, 177 infants <30 weeks gestational age (GA) who fulfi lled stability criteria on CPAP were randomised to one of the three CPAP weaning methods (M). M1: Taken 'OFF' CPAP with the view to stay 'OFF'. M2: Cycled on and off CPAP with incremental time 'OFF'. M3: As with M2, cycled on and off CPAP but during 'OFF' periods were supported by 2 mm nasal cannula at a fl ow of 0.5 l/min. Results Based on intention to treat analysis, there was no signifi cant difference in mean GA or birthweight between the groups (27.1±1.4, 26.9±1.6 and 27.3±1.5 (weeks±1SD) and 988±247, 987±249 and 1015±257 (grams±1SD), respectively). Primary outcomes showed M1 produced a signifi cantly shorter time to wean from CPAP (11.3±0.8, 16.8±1.0, 19.4±1.3 (days±1SE) p<0.0001, respectively) and CPAP duration (24.4±0.1, 38.6±0.1, 30.5±0.1 (days±1SE) p<0.0001, respectively). All the secondary outcomes were signifi cantly shorter with M1, (oxygen duration: 24.1±1.5, 45.8±2.2, 34.1±2.0 (days±1SE) p<0.0001, BPD: 7/56 (12.5%), 29/69 (42%), 10/52 (19%) p=0.011 and length of admission: 58.5±0.1, 73.8±0.1 69.5±0.1 (days±1SE) p<0.0001, respectively). Conclusion Method 1 signifi cantly shortens CPAP weaning time, CPAP duration, oxygen duration, BPD and admission time. INTRODUCTIONContinuous positive airway pressure (CPAP) has been used in preterm babies as a mode of respiratory support since the 1970s and is now used in most NICUs. [1][2][3][4][5] Subsequently, it has been shown that CPAP may reduce the need for invasive intubation and ventilation, reduce apnoea of prematurity and postextubation atelectasis. Early use of CPAP reduces the incidence of Bronchopulmonary Dysplasia (BPD (defi ned as an oxygen requirement at 36 weeks corrected gestational age)) and the need for home oxygen. [5][6][7][8][9][10][11] There are several ways of delivering CPAP including head chamber, facemask, nasal prongs and endotracheal tubes. [5][6][7][8] Research and clinical experience have shown that nasal CPAP with nasal prongs is the most effi cient way of delivering continuous distending pressure (CDP) to the alveoli. [5][6][7][8] Once infants are stabilised and breathing adequately on CPAP, the CPAP is usually weaned off gradually. 6 7 Controversy continues over the best method of weaning CPAP and is often approached in an 'ad hoc' manner. 5 7 12-14 Four trials have compared methods of weaning CPAP and its impact on CPAP duration. [15][16][17][18] The fi rst trial studied the changes in respiratory parameters in infants <34 weeks gestational age (GA) requiring CPAP. ...

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Further research is needed to assess the long-term impact of FICare on neonates, parents, and staff.

BackgroundThere are limited data to inform the choice between parental presence at clinical bedside rounds (PPCBR) and non-PPCBR in neonatal intensive care units (NICUs).MethodsWe performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the ‘NICU Parental Stressor Scale’ (a validated tool) and a satisfaction survey. After completion of the trial, we surveyed all healthcare providers who participated at least in one PPCBR rounding episode. We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR.ResultsA total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers’ surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting our understanding of the ways in which PPCBR was beneficial.ConclusionsParents and healthcare providers strongly support PPCBR. NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns.Trial registration numberAustralia and New Zealand Clinical Trials Register number, ACTRN12612000506897.

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Background: Skin injuries remain common in neonates admitted to neonatal intensive care units. While predicting neonates at risk of skin injury may assist in reducing the incidence of injury, currently there is limited evidence on which tool may be superior. Methods: A prospective study was completed during November-December 2016 to evaluate the predictive value of the Skin Risk Assessment and Management Tool (SRAMT). Comparisons were made between SRAMT and Neonatal/Infant Braden-Q Scale (BQS) as well as staff’s capacity to predict a neonate’s risk of skin injury. Data collected included gestation, weight, day of assessment, injury types, causation, medical devices in situ and risk scores. Results: In total, 248 assessments were completed with 38% (93) recorded skin injuries. Median (interquartile range) gestation and weight at assessment were 36.7 (26.86-56.86) weeks and 2.44 (0.99-4.06) kg, respectively. Receiver operating characteristic curve analysis showed the SRAMT had AUC ( SE ) of 0.94 (0.02) compared with 0.82 (0.03) for BQS (0.011, P < .001). The SRAMT and BQS had sensitivity of [(90.0 (80.5-95.9), 72.86 (60.9-82.8)] and specificity [(88.46 (81.7-93.4), 79.23 (71.2-85.8)], respectively. Conclusion: In this study, the SRAMT’s capacity to predict neonates at risk of injury was higher than the Neonatal BQS and staff. Predicting injuries remains complex and often multifactorial.

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