Dwell times and risk of non-elective removal of 1-French peripherally inserted central catheters according to catheter tip position in very preterm infants.

We investigated dwell times and risk of non-elective removal of 975 single-lumen 1-French peripherally inserted central catheters (1FR-PICC) according to tip position in a cohort of very preterm infants with a mean (SD) gestational age of 27+6 (2+1) weeks and a mean (SD) birth weight of 988 (294) g over an eight-year period. Infants with a 1FR-PICC inserted for continuous infusion of intravenous fluids within the first 30 days of life were eligible. Dwell times of PICC with elective versus non-elective removal, risk of non-elective removal of PICC according to tip position, and differences between upper versus lower limb catheter insertion were analysed. 33.8% PICC were removed non-electively. Median (IQR) dwell time was 193 (142-287) versus 154 (102-260) h for elective versus non-elective removal (p < 0.001). Non-elective removal was more common for lower limb insertion sites: 41 versus 31% (p = 0.002). PICC were significantly more likely to be removed non-electively when located in the axillary (odds ratio (OR) 2.08), cephalic (OR 8.93), external iliac (OR 4.99), and femoral (OR 10.31) vein. CONCLUSION: In this cohort, dwell times of 1FR-PICC lines removed non-electively were similar to 1.9- or 2.0FR-PICC. PICC tips positioned in the axillary, cephalic, external iliac, and femoral veins had a higher risk of non-elective removal. What is Known: •Peripherally inserted central catheters (PICC) are widely used in neonatal intensive care. •Previous studies focused on 2-French PICC and newborns of all gestational ages. What is New: •Dwell times of 1-French PICC removed non-electively were similar to 2-French PICC. •1-French PICC tips positioned more peripherally had a higher risk of non-elective removal.

BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is often complicated by pulmonary hypertension (PH). We investigated three biomarkers potentially suitable as screening markers for extremely preterm infants at risk of BPD-associated PH. In this prospective observational cohort study conducted in a tertiary neonatal intensive care unit, 83 preterm infants with BPD born <28-wk gestation and still inpatients at 36-wk corrected age received an echocardiogram and blood tests of B-type natriuretic peptide (BNP), troponin I, and YKL-40. Infants were analyzed according to echocardiographic evidence of tricuspid regurgitation (TR). Thirty infants had evidence of TR on echocardiogram at 36-wk corrected age. Infants with or without TR had similar baseline demographics: mean ± SD gestational age 261 ± 12 vs. 261 ± 11 wk and birth weight 830 ± 206 vs. 815 ± 187 g, respectively. There was no difference in duration of respiratory support. The right ventricular systolic pressure of infants with evidence of TR was 40 ± 16 mmHg. BNP was the only biomarker that proved to be significantly higher in infants with evidence of TR: median (interquartile range) serum level 54.5 (35-105) vs. 41.5 (30-59) pg/ml, P = 0.043. Subgroup analysis of infants with severe BPD requiring discharge on home oxygen or BPD-related mortality revealed similar results. There was no difference between groups for troponin I and YKL-40. In conclusion, increased serum levels of BNP were associated with evidence of TR at 36-wk corrected gestational age in extremely preterm infants, suggesting a potential role as a screening biomarker for BPD-associated PH.

Familial neonatal seizures in 36 families: Clinical and genetic features correlate with outcome.

OBJECTIVE: We evaluated seizure outcome in a large cohort of familial neonatal seizures (FNS), and examined phenotypic overlap with different molecular lesions. METHODS: Detailed clinical data were collected from 36 families comprising two or more individuals with neonatal seizures. The seizure course and occurrence of seizures later in life were analyzed. Families were screened for KCNQ2, KCNQ3, SCN2A, and PRRT2 mutations, and linkage studies were performed in mutation-negative families to exclude known loci. RESULTS: Thirty-three families fulfilled clinical criteria for benign familial neonatal epilepsy (BFNE); 27 of these families had KCNQ2 mutations, one had a KCNQ3 mutation, and two had SCN2A mutations. Seizures persisting after age 6 months were reported in 31% of individuals with KCNQ2 mutations; later seizures were associated with frequent neonatal seizures. Linkage mapping in two mutation-negative BFNE families excluded linkage to KCNQ2, KCNQ3, and SCN2A, but linkage to KCNQ2 could not be excluded in the third mutation-negative BFNE family. The three remaining families did not fulfill criteria of BFNE due to developmental delay or intellectual disability; a molecular lesion was identified in two; the other family remains unsolved. SIGNIFICANCE: Most families in our cohort of familial neonatal seizures fulfill criteria for BFNE; the molecular cause was identified in 91%. Most had KCNQ2 mutations, but two families had SCN2A mutations, which are normally associated with a mixed picture of neonatal and infantile onset seizures. Seizures later in life are more common in BFNE than previously reported and are associated with a greater number of seizures in the neonatal period. Linkage studies in two families excluded known loci, suggesting a further gene is involved in BFNE.

Accuracy of non-invasive blood pressure monitoring in very preterm infants.

PURPOSE: Blood pressure (BP) monitoring is an essential procedure in intensive care. There is controversy about the reliability of non-invasive BP measurements in very preterm infants. This prospective trial compared non-invasive BP monitoring with BP monitoring via an umbilical arterial catheter (UAC) in this population. METHODS: Preterm infants born at less than 32 weeks gestation requiring a UAC for clinical management were eligible. Enrolled infants had up to three BP measurements on the right arm (RA) and right leg (RL) when in a resting state. UAC-BP measurements were noted immediately after the non-invasive BP was displayed on the monitor. Measurements were analysed in subgroups according to birth weight: no greater than 750 g, 751-1,000 g, above 1,000 g. Statistical analysis reports median, range, and Bland-Altman analysis. RESULTS: Sixty infants were included. Median (range) gestational age was 26.4 weeks (23.6, 31.2); birth weight 924 g (581, 1,518). A total of 1,865 measurements were performed (RA: 935, RL: 930). Mean difference (95% limits of agreement) for infants no greater than 750 g: RA 2.53 mmHg (-11.18, 16.24), RL -0.804 mmHg (-12.65, 11.04); for infants 751-1,000 g: RA 3.535 mmHg (-9.6, 16.7), RL -1.239 mmHg (-13.14, 10.66); for infants above 1,000 g: RA -1.65 mmHg (-13.47, 10.17), RL -4.101 mmHg (-14.17, 5.96). CONCLUSIONS: Although the average differences between invasive and non-invasive BP measurements are acceptable, the range of under- and overestimation of non-invasive BP measurements is large and not consistent, making reliance on non-invasive modalities to guide circulatory management problematic. If arterial BP monitoring is not available, our results suggest measuring non-invasive BP on the leg in preterm infants with a birth weight no greater than 1,000 g.