Two-year outcomes for infants with low cord pH at birth.

OBJECTIVE: To determine the long-term outcome of infants born with cord pH ≤ 7.0 and no clinical evidence of asphyxia at birth. SETTING: Tertiary Referral Centre. A prospective matched cohort study was conducted. 51 term infants were recruited following singleton birth with venous cord pH ≤ 7.0. For each recruited baby a healthy baby with normal cord pH ≥ 7.20 was recruited matched for gestation, gender and mode of delivery. Ages and Stages Questionnaires (ASQ)(TM) and Health Screening Questionnaires (HSQ) were sent out at 24 months of age. Two independent assessors, blinded to the case assignment, reviewed intrapartum and neonatal events to look for clinical evidence of birth asphyxia among the cases. RESULT: From 102 infants recruited, 62 questionnaires (24 cases, 38 controls) were returned. 20 matched pairs with no clinical evidence of birth asphyxia were available for analysis. The groups were similar except in terms of birth weight; the pH ≥ 7.0 group had mean birth weight 584 g lower than controls (p = 0.005). The ASQ motor scores were lower in children born with low cord pH (p = 0.019); however, once adjusted for birth weight, the difference was not significant (p = 0.289). CONCLUSION: It is unlikely that abnormal cord pH in otherwise healthy neonates leads to a substantially increased risk of abnormal neurodevelopmental outcome or severe health problems by 2 years of age.

What is the impact of structured resuscitation training on healthcare practitioners, their clients and the wider service? A BEME systematic review: BEME Guide No. 20.

A large number of resuscitation training courses (structured resuscitation training programmes (SRT)) take place in many countries in the world on a regular basis. This review aimed to determine whether after attending SRT programmes, the participants have a sustained retention of resuscitation knowledge and skills after their initial acquisition and whether there is an improvement in outcome for patients and/or their healthcare organisation after the institution of an SRT programme. All research designs were included, and the reported resuscitation training had to have been delivered in a predefined structured manner over a finite period of time. Data was extracted from the 105 eligible articles and research outcomes were assimilated in tabular form with qualitative synthesis of the findings to produce a narrative summary. Findings of the review were: SRTs result in an improvement in knowledge and skills in those who attend them, deterioration in skills and, to a lesser extent, knowledge is highly likely as early as three months following SRTs, booster or refresher sessions may improve an individual's ability to retain resuscitation skills after initial training and the instigation of resuscitation training in a healthcare institution significantly improves clinical management of resuscitations and patient outcome (including survival) after resuscitation attempts.

Clinician observation of physiological trend monitoring to identify late-onset sepsis in preterm infants.

AIM: To determine whether trends in routinely collected physiological variables can be used retrospectively to classify infants according to the presence or absence of late-onset neonatal sepsis. METHODS: Case control study. Thirty infants born < or =32 weeks of gestation who developed late-onset sepsis were matched with 30 controls for gestational and postnatal age but remained sepsis free. For each infant, 25 clinicians inspected 48 h of routine monitoring of heart rate, respiratory rate and oxygen saturation. Clinicians were asked to determine whether the recording was obtained from an infant who did or did not develop sepsis and also indicate how confident they were in their judgement. Clinicians were stratified into three groups by professional role. RESULTS: The median correct assignment of infant's recordings was 67% (IQR 62-72). When very confident, this improved to 82% (IQR 67-88). Overall sensitivity was 53% (IQR 43-63) and specificity 80% (IQR 67-87). Advanced neonatal nurse practitioners consistently assigned babies to the correct group more often than other professional groups. CONCLUSION: The simple observation physiological trend graphs can classify infants according to the presence or absence of late-onset neonatal sepsis. The accuracy of this method is good to strong but varies with experience of neonatal intensive care.