SummaryBackground Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries.

Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.Methods: A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission.

The availability of a textile 32-electrode belt for neonatal EIT imaging with simple, fast, accurate and reproducible placement on the chest strengthens the potential of EIT to be used for regional lung monitoring in critically ill neonates and infants.

Use of humidifiers in nursery units must be avoided as the risk of disseminating Legionella in neonates is very high. In neonates legionellosis should be suspected when signs of infection first appear and take an unusual course, even when no pulmonary infiltrates appear.

BackgroundPrematurity and low birth weight are significant predictors of perinatal morbidity and mortality and are influenced by the overall health and socioeconomic status of the pregnant mother. Although Cyprus is characterized by the highest prematurity rate in Europe (13.1% in 2014), the relationship between maternal health and socioeconomic characteristics with prematurity and low birth weight has never been investigated. We aimed to investigate the association of maternal demographic, clinical and socioeconomic characteristics with premature delivery and low neonatal birth weight in Cyprus.MethodsIn a case-control design, questionnaire data were collected from 348 women who gave birth prematurely (cases) and 349 women who gave birth at term (controls). Information was obtained on gestation duration and birth weight as well as maternal demographic, socioeconomic and clinical profiles, including parameters such as smoking, body mass index, alcohol consumption, presence of gestational diabetes and mental health factors.ResultsPremature delivery was associated with greater maternal age (OR: 1.12, 95% CI: 1.06–1.18), absence of gestational diabetes (OR: 0.53, 95% CI: 0.30–0.97), long working hours (OR: 3.77, 95% CI: 2.08–6.84) and emotional stress (OR: 8.5, 95% CI: 3.03–23.89). Within the cases group, emotional stress was also associated with lower birth-weight (β: -323.68 (95% CI: -570.36, − 77.00).ConclusionsThe findings of this study demonstrate the positive association of maternal psychological factors, working conditions as well as maternal age with prematurity and low birth weight in Cyprus. Additional, prospective, studies are needed in the country to further investigate these associations and inform public health intervention measures.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0603-7) contains supplementary material, which is available to authorized users.

Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care.

Electrical impedance tomography (EIT) allows non-invasive and radiation-free monitoring of regional ventilation distribution and changes in end-expiratory lung volume in critically ill patients of all ages. In the vulnerable neonatal and pediatric population, EIT can be used to identify adverse events like atelectasis, pneumothorax and endotracheal tube malposition and potentially guide the personalized selection of ventilator settings. Previous studies have examined EIT in small patient groups during short measurement periods of only a few hours or less under highly controlled circumstances. What This Study Adds to the Field:In the Continuous Regional Analysis Device for Neonate Lungs (CRADL) project, we performed the first multi-center observational study on the use of EIT in critically ill neonates and young children with or at risk for respiratory failure. Including 200 patients, we demonstrated that continuous EIT monitoring for up to 72 hours is feasible, safe and can be used for continuous monitoring of ventilation distribution in neonates and infants in a routine clinical setting.

Objective: Non-adhesive textile electrode belts offer several advantages over adhesive electrodes and are increasingly used in neonatal patients during continuous electrical impedance tomography (EIT) lung monitoring. However, non-adhesive belts may rotate in unsedated patients and discrepancies between chest circumference and belt sizes may result in a gap between electrodes near the sternum. This project aimed to determine the effects of belt rotation and sternal electrode gap on commonly used lung EIT parameters. Approach: We developed a simulation framework based on a three-dimensional finiteelement model and introduced lung regions with little or no ventilation that could be changed according to a decremental positive end-expiratory pressure (PEEP) trial. Four degrees of sternal gap and belt rotation were simulated and their effect on the EIT parameters silent spaces, centre of ventilation, global inhomogeneity index and overdistension/collapsed lung (OD/CL) analysed. Additionally, seven premature infants were examined to assess the influence of leftward and rightward belt rotations in a clinical setting. Main results: Small violations of the electrode equidistance criterion and rotations of the belts less than one electrode space exert only minor effects on the EIT parameters and do not impede the interpretation. Rotations of two and three electrode spaces induce nonnegligible effects that might lead to flawed interpretations. The "best PEEP" determined with the OD/CL approach was robust and identifiable with all studied sternal gaps and belt rotations.Significance: We revealed an important challenge for neonatal EIT applications related to a wide electrode gap at the sternum and belt rotation, which should be avoided in clinical application.