A study published in Neonatology Vol. 98, No. 2, 2010, compared impact of 5 french catheters placed either via the nostrils or oral route on apneas of prematurity. They did not notice any difference. Most important take from this study is that, smallest NG tube may be safer for nasal placement. Since, highest airway resistance is in the nostrils, it is better to use smallest possible NG tubes.
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=279617&Ausgabe=253868&ProduktNr=224215
Tuesday, March 30, 2010
Friday, March 12, 2010
NEC-Peritoneal drainage does not stabilize preterm infants with BW <1500 grams
J.Ped.Surg Feb 2010.
NET trial compared the peritoneal drainage (PD) in NEC with perforation with laporotomy. PD did not stabilize before intervention. Moreover, PD group had worsening cardiovascular status. Hence, PD does not stabilize the infants with NEC with perforation.
NET trial compared the peritoneal drainage (PD) in NEC with perforation with laporotomy. PD did not stabilize before intervention. Moreover, PD group had worsening cardiovascular status. Hence, PD does not stabilize the infants with NEC with perforation.
NEC-Observe or Operate
Journ.Ped. Surgery Feb 2010 page 310- if 3 metabolic derangement were noted within 24 hours of observation then operation is better than observation. The 7 metabolic derangement were 1) positive blood culture <96 hours, 2) pH <7.25 or receiving Hco3, 3) I/T of >0.2
4) Na <130, 5) Platelets <50k and neutrophils <2000.
babies with bad outcome-death or TPn at discharge was higher if 3 or more metabolic derangement were noted.
4) Na <130, 5) Platelets <50k and neutrophils <2000.
babies with bad outcome-death or TPn at discharge was higher if 3 or more metabolic derangement were noted.
Wednesday, March 10, 2010
Pulse Oximetry To Detect Congenital Heart defects-Prospective study in 42,240 newborns from 34 institutions
European Journal of Pediatrics March 2 2010. http://www.springerlink.com/content/5x66262886393842/
If an oxygen saturation (SpO2) of ≤95% was measured on lower extremities and confirmed after 1 h, complete clinical examination and echocardiography were performed. POS was true positive in 14, false positive in 40, true negative in 41,384 and false negative in four children (three had been excluded for violation of study protocol). Sensitivity, specificity, positive and negative predictive value were 77.78%, 99.90%, 25.93% and 99.99%, respectively.
POS can substantially reduce the postnatal diagnostic gap in cCHD, and false-positive results leading to unnecessary examinations of healthy newborns are rare. POS should be implemented in routine postnatal care.
If an oxygen saturation (SpO2) of ≤95% was measured on lower extremities and confirmed after 1 h, complete clinical examination and echocardiography were performed. POS was true positive in 14, false positive in 40, true negative in 41,384 and false negative in four children (three had been excluded for violation of study protocol). Sensitivity, specificity, positive and negative predictive value were 77.78%, 99.90%, 25.93% and 99.99%, respectively.
POS can substantially reduce the postnatal diagnostic gap in cCHD, and false-positive results leading to unnecessary examinations of healthy newborns are rare. POS should be implemented in routine postnatal care.
Thursday, March 4, 2010
ECHO predictor for symptomatic PDA
Journal of perinatology-http://www.nature.com/jp/journal/vaop/ncurrent/abs/jp201014a.html
Serial echocardiograms obtained in 115 ELBW at less than or equal to10 day postnatal were examined to estimate PDA size using the PDA:left pulmonary artery (LPA) diameter ratio: greater than or equal to1 indicated a large PDA.
Neonates with moderate to large PDA at less than or equal to4 day had 15-times greater likelihood of requiring treatment for sPDA than those with a small PDA (95% confidence interval (CI): 5.6–41). Sensitivity, specificity and PPV of the PDA:LPA at <27 weeks was 80, 86 and 92%, respectively.
Serial echocardiograms obtained in 115 ELBW at less than or equal to10 day postnatal were examined to estimate PDA size using the PDA:left pulmonary artery (LPA) diameter ratio: greater than or equal to1 indicated a large PDA.
Neonates with moderate to large PDA at less than or equal to4 day had 15-times greater likelihood of requiring treatment for sPDA than those with a small PDA (95% confidence interval (CI): 5.6–41). Sensitivity, specificity and PPV of the PDA:LPA at <27 weeks was 80, 86 and 92%, respectively.
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