Feasibility of implementing pulse oximetry screening for congenital heart disease in a community hospital.

OBJECTIVE: Pulse oximetry has been recognized as a promising screening tool for critical congenital heart disease (CCHD). The aim of this research was to study the feasibility of implementation in a community hospital setting. STUDY DESIGN: Meetings were conducted to determine an implementation plan. Pulse oximetry was performed on the right hand and foot after 24 h of age. Newborns with a saturation ≤ 95% or a ≥ 3% difference were considered to have a positive screen. Screening barriers, screening time and ability to effectively screen all eligible newborns were noted. RESULT: From January 2009 through May 2010, of 6841 eligible newborns, 6745 newborns (98.6%) were screened. Of the nine infants with positive pulse oximetry screens, one had CCHD, four had CHD and four others were determined to have false positive screens. Average screening time was 3.5 min (0 to 35 min). CONCLUSION: Pulse oximetry can be implemented successfully in community hospitals without an excessive number of false positives or additional nursing staff.

Dorsal penile nerve block vs topical placebo for circumcision in low-birth-weight neonates.

OBJECTIVE: To investigate the efficacy and safety of dorsal penile nerve block (DPNB) and eutectic mixture of lidocaine (EMLA) for palliation of pain associated with circumcision in low-birth-weight infants. DESIGN: Randomized, blinded, controlled trial. SETTING: Intensive care nursery (step down unit) at Georgetown University Medical Center, Washington, DC. PARTICIPANTS: Fifty neonates with weights of 1600 to 2500 g at the time of circumcision who were discharged from the hospital between May 1994 and June 1995 were randomly assigned to the DPNB, EMLA, or control group. Twenty-five infants who were otherwise eligible were excluded because of parental refusal of consent to participate. INTERVENTIONS: Infants in the DPNB and EMLA groups received anesthesia with subcutaneous injection of 1% lidocaine hydrochloride or topical EMLA, respectively. The control group received sham anesthesia with topical placebo (acid mantle cream). MAIN OUTCOME MEASURES: Changes in physiologic variables (heart rate, blood pressure, oxygen saturation, and respiratory rate) and behavioral score 20 minutes before, during, and 5 and 20 minutes after circumcision between DPNB and control groups. Surgical complications and adverse effects were also monitored. RESULTS: Fifty infants were enrolled in the study: 19 randomized to the DPNB group, 19 to the control group, and 12 to the EMLA group. Enrollment into the EMLA group was suspended early because of redness and blistering of the foreskin in 2 infants, and this entire group was excluded from further analysis. The clinical course was similar in all groups of infants. All circumcisions were performed without complication or technical difficulty. Statistically significant differences were noted in heart rate, respiratory rate, and behavioral score when comparing the DPNB group with controls during and after circumcision. CONCLUSION: Dorsal penile nerve block is safe and effective in controlling pain associated with circumcision in low-birth-weight infants.

In utero nephrostomy catheter placement.

In utero diagnosis of severe oligohydramnios and fetal ureteral pelvic outlet obstruction resulted in the placement of nephrostomy catheters in two fetuses. The amniotic fluid index improved, mid-chest thoracic circumference increased and renal calyceal dilation decreased in both patients. Both neonates had evidence of pulmonary hypoplasia but survived. This new technique offers an alternative for antenatal management of obstructive uropathy when the bladder is not accessible or is distal to the site of the obstruction.

Ultrasound guidance of suprapubic bladder aspiration in neonates.

We performed a prospective, randomized trial comparing ultrasound guidance of suprapubic bladder aspiration with unguided aspiration. The acquisition of urine improved with ultrasound guidance from 60% to 96.4%. The number of needle insertions decreased and the amount of urine obtained increased. Ultrasonography is a useful tool for bladder aspiration.