Tracking national neonatal transport activity and metrics using the UK Neonatal Transport Group dataset 2012-2021: a narrative review.

There are no internationally agreed descriptors for categories of neonatal transports which facilitate comparisons between settings. To continually review and enhance neonatal transport care we need robust categories to develop benchmarks. This review aimed to report on the development and application of key measures across a national neonatal transport service. The UK Neonatal Transport Group (UK-NTG) developed a core dataset and benchmarks for transported infants and collected annual national data. Data were reported back to teams to allow benchmarking and improvements. From 2012 to 2021, the rate of UK neonatal transfers increased from 18 to 22/1000 live births despite a falling birth rate. Neonatal transfers on nitric oxide increased until 2016 before plateauing. The proportion of transport services able to provide high frequency oscillation and servo-controlled therapeutic hypothermia increased over the study period. High-flow nasal cannula oxygen use increased, becoming the most frequently used non-invasive respiratory support mode. For infants <27 weeks of gestational age, transfers for uplift of care in the first 3 days of life have fallen from 420 (2016) to 288 (2020/2021) and for lack of neonatal capacity from 24 (2016) to 2 (2020/2021). The rate of ventilated infants completing transfer with CO2 out of the benchmark range varied from 9% to 13% with marked variation between transport services' rates of hypocapnia (0-10%) and hypercapnia with acidosis (0-9%). The development of the UK-NTG dataset supports national tracking of activity and clinical trends allowing comparison of patient-focused benchmarks across teams.

Docetaxel in the treatment of children with refractory or relapsed hepatoblastoma.

We report on the use of single-agent docetaxel (100 mg/m(2) in children >10 kg, 3.3 mg/kg in children <10 kg), given as a 1-hour infusion at 21-day intervals in 5 children with relapsed or refractory hepatoblastoma. One patient achieved complete remission of pulmonary metastases after 2 courses of docetaxel and remains well 10 years later, after completion of 13 courses of docetaxel and whole-lung radiotherapy. One patient showed a partial response to docetaxel based on α-fetoprotein measurements. Docetaxel shows some activity in progressive hepatoblastoma in this small case series and is a potential drug for future study in this disease.

Review of resuscitation training amongst consultants and middle grade paediatricians.

AIMS: To review the resuscitation training of senior and middle grade paediatricians. METHODS: A questionnaire was sent to all paediatricians above the level of senior house officer in the Eastern Region of the UK to determine: (1) completion of basic life support (BLS) training in the previous year; (2) previous attendance at a paediatric/neonatal advanced life support course; (3) resuscitation provider accreditation; (4) instructor status. RESULTS: Replies were received from 153 out of 160 paediatricians. During the study period 48% 95% CI (36% and 60%) of general hospital consultants (GC), 40% (21% and 61%) of community consultants (CC), 75% (59% and 87%) of specialist registrars (SpRs) and 53% (28% and 77%) of non-consultant grade doctors (T/SG) had received BLS training. 86% (76% and 93%) GC, 24% (9% and 45%) CC, 100% (91% and 100%) SpRs and 82% (57% and 96%) of T/SG had previously attended an advanced life support (ALS) course. Accredited provider skills were maintained by 54% (41% and 65%) GC, 12% (3% and 31%) CC, 83% (67% and 93%) SpRs and 53% (28% and 77%) of T/SG. Only 28% GC, 4% CC, 20% SpRs and 6% T/SG were instructors on any of the advanced courses. CONCLUSIONS: Most paediatricians have attended an ALS courses at some point during their training. Consultants are poor at maintaining/re-certifying their advanced resuscitation skills. Few paediatric consultants and residents instruct on ALS courses.

Active versus passive cooling during neonatal transport.

BACKGROUND AND OBJECTIVE: Therapeutic hypothermia is now the standard of care for hypoxic-ischemic encephalopathy. Treatment should be started early, and it is often necessary to transfer the infant to a regional NICU for ongoing care. There are no large studies reporting outcomes from infants cooled passively compared with active (servo-controlled) cooling during transfer. Our goal was to review data from a regional transport service, comparing both methods of cooling. METHODS: This was a retrospective observational study of 143 infants referred to a regional NICU for ongoing therapeutic hypothermia. Of the 134 infants transferred, the first 64 were cooled passively, and 70 were subsequently cooled after purchase of a servo-controlled mattress. Key outcome measures were time to arrival at the regional unit, temperature at referral and arrival at the regional unit, and temperature stability during transfer. RESULTS: The age cooling was started was significantly shorter in the actively cooled group (46 [0-352] minutes vs 120 [0-502] minutes; P <.01). The median (range) stabilization time (153 [60-385] minutes vs 133 [45-505] minutes; P = .04) and age at arrival at the regional unit (504 [191-924] minutes vs 452 [225-1265]) minutes; P = .01) were significantly shorter in the actively cooled group. Only 39% of infants passively cooled were within the target temperature range at arrival to the regional unit compared with 100% actively cooled. CONCLUSIONS: Servo-controlled active cooling has been shown to improve temperature stability and is associated with a reduction in transfer time.