Non-reassuring results in agreement trial comparing glass and plastic capillary tubes for neonatal blood gas sampling.

AIM: To determine agreement between neonatal capillary blood gases taken with plastic and glass tubes. METHODS: An agreement study was carried out in a regional tertiary neonatal unit. Inpatient babies ≥1 kg were recruited to the study when parents gave consent. After taking the routine glass capillary tube sample, a plastic tube sample was taken and run if the heel continued to bleed. Successful sample pairs were recorded and analysed against pre-defined acceptable differences. Assessment was also made of differences in failure rates between tube types for each parameter. RESULTS: Twenty-eight babies provided 135 blood gas pairs, of which five pairs were excluded. Successful pairing of results was achieved for pH in 105 valid samples. There were more failed plastic samples than glass, reaching significance for almost all parameters. pH, pO2 and pCO2 showed poor agreement (<80%) between glass and plastic tubes. On limited analysis of one successful blood gas pair per neonate to minimise bias, results remained non-reassuring. CONCLUSION: The findings of this study do not advocate switching from glass to plastic capillary tubes in our Newborn Intensive Care Unit. Further studies are required to assess agreement of glass and plastic capillary tubes for neonatal blood gas sampling.

Extremely low-dose dexamethasone to facilitate extubation in mechanically ventilated preterm babies.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a major respiratory complication of extreme prematurity. Dexamethasone is effective in reducing ventilation requirements in babies with BPD, but follow-up studies have raised concerns about long-term neurological sequelae. Few studies have investigated the lowest dose effective for weaning from mechanical ventilation. OBJECTIVES: Between January 2004 and December 2008 the practice in a tertiary neonatal unit was to use extremely low doses of dexamethasone for severe BPD, commencing at 0.05 mg/kg/day and decreasing over 9 days, with a cumulative dose of 0.24 mg/kg. The objective of this observational study was to assess the effectiveness of the extremely low-dose course in facilitating extubation. METHODS: The babies who had received extremely low-dose dexamethasone to facilitate weaning from mechanical ventilation were identified. Details of treatment and respiratory support were recorded. Serial oxygenation indices (OI) during the dexamethasone course were calculated, and these were analysed to assess the effect of treatment on ventilation requirements. RESULTS: One hundred and ninety extremely preterm babies were admitted during this 5-year period. Sixteen babies received extremely low-dose dexamethasone. The median gestation was 25 weeks and the median birth weight was 644 g. Before starting dexamethasone, the median OI was 10.6, but by day 7 of treatment it had fallen to 5.4. By the end of the course, 12 of the 16 babies had been successfully extubated. CONCLUSIONS: This short dexamethasone course appears effective in facilitating extubation. Randomised trials with long-term follow-up are needed to determine the role of extremely low-dose dexamethasone in preterm babies with evolving BPD.