Extra uterine development of preterm kidneys.

OBJECTIVE: We carried out a study to determine the impact of prematurity on renal development. The primary outcomes measured were nephrinuria and albuminuria; renal volume and glomerular filtration rate were the secondary outcomes. METHODS: Preterm neonates born at less than 28 weeks of gestation, with birth weight between 10th and 90th centile (appropriate for gestational age), were recruited and underwent assessments at 28, 32 and 37 weeks postmenstrual age (PMA). RESULTS: Fifty-three premature neonates and 31 term neonates (control) were recruited. The median gestational age of the premature neonates was 26.4 [24.7-27.4] weeks, with a mean birth weight of 886 (179) g. The mean gestational age of term neonates was 39.1 (1.2) weeks and the mean birth weight was 3406 (406) g. The median age of the term neonates was 6.5 [3.0-12.5] days. The total kidney volume (TKV) almost doubled from 10.3 (2.9) cm3 at 28 weeks PMA to 19.2 (3.7) cm3 at 37 weeks PMA (P = 0.0001). TKV at 37 weeks PMA was significantly smaller compared to term neonates (19.2 (3.7) vs 26.3 (7.0) cm3; P = 0.0001). However, there was no significant difference in estimated glomerular filtration rate (eGFR) between premature neonates (at 37 weeks PMA) and term neonates (control) (43.5 [39.7-48.9] vs. 42.0 [38.2-50.0] mL/min/1.73 m2; P = 0.75). There was a statistically significant decline in nephrin-creatinine ratio and albumin-creatinine ratio from 32 to 37 weeks PMA. CONCLUSIONS: Despite having a smaller renal volume (and fewer nephrons), extremely premature neonates achieve similar eGFRs at corrected term as term-born neonates, likely through single nephron hyperfiltration. Extremely premature neonates also show evidence of glomerular injury.

Comparing Point of Care International Normalised Ratio testing with laboratory testing methods in a cardiac inpatient population.

AIMS AND OBJECTIVE: To compare agreement between International Normalised Ratio results from Point of Care testing with laboratory testing for cardiac inpatients receiving warfarin sodium. BACKGROUND: Availability of point of care technology for International Normalised Ratio testing offers considerable benefits to patients and health care staff across a range of context. DESIGN: Prospective comparison study. METHOD: Setting--Four cardiac wards in a regional referral hospital in New South Wales, Australia. Participants--50 cardiovascular inpatients receiving warfarin therapy, including those patients being converted from intravenous heparin sodium. Intervention-Point of Care International Normalised Ratio testing via finger prick using the CoaguChek®XS attended within one hour of laboratory International Normalised Ratio testing. Paired International Normalised Ratio results were compared using spearman rank and Mann-Whitney rank sum. Bland-Altman plots were used to demonstrate agreement. RESULTS: One hundred and seventeen blinded paired tests were carried out, 44 on patients receiving intravenous heparin. Laboratory and Point of Care International Normalised Ratio testing were highly significantly correlated (r = 0.953, p < 0.0001, n = 117). There was close agreement between Point of Care International Normalised Ratio and laboratory International Normalised Ratio results for patients receiving warfarin regardless of whether they were receiving heparin sodium. There was a mean bias of +0.2 units (95% CI 0.145-0.246). The presence of diabetes significantly reduced the difference between paired tests. Bias significantly increased above an International Normalised Ratio of 4.5 units. Ninety-seven per cent of all values fell between 20% limits of agreement after accounting for the mean bias of +0.2 units. CONCLUSION: Results indicated Point of Care International Normalised Ratio testing can be used for clinical decision making for cardiovascular inpatients receiving warfarin. Clinical guidelines need to be developed and tested in appropriate population groups and across different contexts, because of the potential for significant patient benefit. RELEVANCE TO CLINICAL PRACTICE: Point of Care International Normalised Ratio results in time and procedural efficiency, care responsiveness, cost saving, increased patient comfort and reduced handling errors (Pharmacotherapy 22; 2002: 677), as well as the potential for continuity of care.

CPAP use in babies with respiratory distress in Australian special care nurseries.

AIM: This study sought to identify the number of special care nurseries (SCNs) already using CPAP in 2004, and the number considering its use in the following 2 years, and to describe the characteristics of those hospitals. METHODS: All Australian hospitals with >200 registered deliveries in the year 2002, a SCN and at least one paediatrician were eligible (n = 157). Separate questionnaires were sent to the nurse unit manager (NUM) and the paediatrician responsible for the SCN in late 2004. RESULTS: Of 157 eligible SCNs, 143 (91%) responded. CPAP was being used in 24/143 (17%). Of those nurseries not already using CPAP a further 45/119 (38%) were considering doing so in 2005/2006. State/Territory, greater availability of junior medical staff, use of a helicopter/airplane for transferring infants to tertiary centres and number of paediatricians were significantly associated with use of CPAP (all P < 0.05). Consideration of use was significantly associated with greater availability of junior medical staff, larger numbers of births and time to nearest (tertiary) centre (all P < 0.05). CONCLUSION: There is a strong predisposition for the use of CPAP in SCNs despite the lack of evidence for its benefits or risks there. Studies are urgently required on the clinical benefits and risks of CPAP in a non-tertiary centre before the widespread introduction of CPAP takes place.