Increased hyphal branching and growth of ectomycorrhizal fungus Lactarius rufus by the helper bacterium Paenibacillus sp.

Paenibacillus sp. EJP73 has been previously demonstrated as a mycorrhization helper bacterium (MHB) for the Lactarius rufus-Pinus sylvestris symbiosis in both laboratory and glasshouse experiments. In the present study, the effect of Paenibacillus sp. EJP73 metabolites on L. rufus EO3 pre-symbiotic growth was tested in two agar plate-based systems. Specifically, volatile metabolites were investigated using a dual plate system, in which the presence of strain EJP73 resulted in a significant negative effect on L. rufus EO3 hyphal radial growth but enhanced hyphal branching and reduced internode distance. Soluble metabolites produced by strain EJP73 were tested on L. rufus EO3 growth in single-agar plate assays by incorporating bacterial cell-free whole or molecular weight fraction spent broth into the agar. Whole spent broth had a negative effect on hyphal growth, whereas a low molecular weight fraction (100-1,000) promoted colony radial growth. Headspace and spent broth analysis of strain EJP73 cultures revealed 2,5-diisopropylpyrazine to be the most significant component. Synthesised 2,5-diisopropylpyrazine and elevated CO2 (2,000 ppm) were tested as specific volatile metabolites in the dual plate system, but neither produced the response shown when strain EJP73 was present. Increased pre-symbiotic hyphal branching leading to increased likelihood of plant infection may be an important MHB mechanism for strain EJP73. Although the precise signal molecules could not be identified, the work suggests a number of metabolites may work synergistically to increase L. rufus root colonisation.

Accelerometer measures in extremely preterm and or extremely low birth weight infants and association with abnormal general movements assessments at 28- and 32-weeks postmenstrual age.

BACKGROUND: Assessment of general movements (GMs) in preterm infants is qualitative and potentially subjective. Accelerometers provide quantitative data that could overcome the problems of the GMs assessment. STUDY AIMS: To determine if quantitative measures (obtained from four tri-axial accelerometers) correlate with GMs assessments performed in the preterm period at 28- or 32-weeks postmenstrual age (PMA). STUDY DESIGN: Prospective observational study. Tri-axial accelerometers were applied to the dorsum of each hand and foot at 28- and 32-weeks PMA. Simultaneous video recordings of the babies' spontaneous movements were made to assess GMs. SUBJECTS: Eligible babies were born <28-weeks PMA or had a birth weight of <1000 g. Babies were recruited before they reached 33-weeks PMA. OUTCOME MEASURES: GMs assessments were made offline on the video recordings. Forty-six quantitative motor parameters were calculated during the same periods of activity and compared with GMs assessments. RESULTS: At 28-weeks PMA, 24/43 (55.8 %) babies had abnormal GMs. At 32-weeks PMA, 26/57 (45.6 %) had abnormal GMs. The inter-rater reliability of the GMs was poor. When comparing MDS measures between; infants with normal and those with abnormal GMs, at 28-weeks PMA, 7/46 parameters were significantly different, and at 32-weeks PMA, 19/46 parameters were significantly different. CONCLUSION: Isolated use of quantitative movement measures, obtained from four tri-axial accelerometers before hospital discharge, correlate with the GMs assessments at both 28-weeks and 32-weeks PMA. Accelerometers may provide a useful screening tool for abnormal GMs in preterm infants and could overcome issues with inter-rater reliability.

Transfer of preterm infants from incubator to open cot at lower versus higher body weight.

BACKGROUND: The use of incubators in helping to maintain a thermoneutral environment for preterm infants has become routine practice in neonatal nurseries. As one of the key criteria for discharging preterm infants from nurseries is their ability to maintain temperature; the infant will need to make the transition from incubator to open cot at some time before discharge. The timing of this transition is important because, when an infant is challenged by cold, the infant attempts to increase its heat production to maintain body temperature. The increase in energy expenditure may affect weight gain. The practice of transferring infants from incubators to open cots usually occurs once a weight of around 1700 - 1800 g has been reached; however, this practice varies widely among neonatal units. This target weight appears to be largely based on tradition or the personal experience of clinicians, with little consideration of the infant's weight or gestational age at birth. OBJECTIVES: The main objective was to assess the effects on weight gain and temperature control of a policy of transferring preterm infants from incubator to open cot at lower versus higher body weight. SEARCH STRATEGY: Searches were undertaken of MEDLINE from April 2007 back to 1950, CINAHL from April 2007 back to 1982 and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007). The title and abstract of each retrieved study were examined to assess eligibility. If there was uncertainty, the full paper was examined. SELECTION CRITERIA: Trials in which preterm infants were allocated to a policy of transfer from incubators to open cots at a lower body weight versus at a higher body weight. DATA COLLECTION AND ANALYSIS: Quality assessments and data extraction for included trials were conducted independently by the reviewers. Data for individual trial results were analysed using relative risk (RR) and mean difference (MD). Results are presented with 95% confidence intervals (CI). Due to insufficient data, meta-analysis could not be undertaken. MAIN RESULTS: Five studies were identified as potentially eligible for inclusion in this review. Three studies were excluded as neither random nor quasi-random allocation to the exposure was employed. Two small quasi-randomised studies, involving 74 preterm infants are included in this review. These studies compared the transfer of infants to open cots at 1600 - 1700 g vs. 1800- 1900 g, and 1700 g vs. 1800 g. Data for only two prespecified outcomes could be included in this review. No statistically significant difference was shown for either return to incubator [one trial (N = 60) RR 2.00; 95% CI 0.40 to 10.11] or daily weight gain measured in g/kg/day [one trial (N = 14) MD 1.00 g/kg/day; 95% CI -2.89, 4.89]. Due to insufficient data, meta-analysis was not performed and effects on clinically important outcomes could not be adequately assessed. AUTHORS' CONCLUSIONS: There is currently little evidence from randomised trials to inform practice on the preferred weight for transferring preterm infants from incubators to open cots. There is a need for larger randomised controlled trials to address this deficiency.

Prophylactic systemic antibiotics to reduce morbidity and mortality in neonates with central venous catheters.

BACKGROUND: The use of central venous catheters is recognised as a risk factor for nosocomial infection. Prophylactic antibiotics may be effective in preventing catheter-related blood stream infection in newborns but may also have the undesirable effect of promoting the emergence of resistant strains of micro-organisms. OBJECTIVES: To determine the effect of prophylactic antibiotics on mortality and morbidity in neonates with central venous catheters. SEARCH STRATEGY: Searches were done of the Cochrane Neonatal Review Group Specialised Register, MEDLINE from 1950 to April 2007, CINAHL from 1982 to April 2007, and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2 2007). Previous reviews (including cross references) were also searched. SELECTION CRITERIA: Randomised controlled trials or quasi-randomised controlled trials of adequate quality in which either individual newborn infants or clusters of infants were randomised to receive prophylactic antibiotics (not including antifungals) versus placebo or no treatment. Infants must have had central venous catheters, been full term infants less than 28 days old or preterm infants up to 44 weeks (postmenstrual) corrected age. DATA COLLECTION AND ANALYSIS: Criteria and methods used to assess the methodological quality of the trials: standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. The review authors extracted data independently. Attempts were made to contact study investigators for additional information as required. MAIN RESULTS: Three small studies have been included in this review. Prophylactic antibiotics in neonates with central venous catheters had no effect on overall mortality (typical RR 0.68, 95% confidence interval 0.31, 1.51). Prophylactic antibiotics in neonates with central venous catheters decreased the rate of proven bacterial sepsis (typical RR 0.38, 95% confidence interval 0.18, 0.82). Prophylactic antibiotics in neonates with central venous catheters decreased the rate of suspected or proven bacterial septicaemia (typical RR 0.40, 95% confidence interval 0.20, 0.78). No resistant organisms colonising infants were identified in any of the studies. No pooled data were available for other important outcome measures such as chronic lung disease or neurodevelopmental outcome. AUTHORS' CONCLUSIONS: Prophylactic systemic antibiotics in neonates with a central venous catheter reduces the rate of proven or suspected septicaemia. However, this may not be clinically important in the face of no significant difference in overall mortality and the lack of data on long-term neurodevelopmental outcome. Furthermore, there is a lack of data pertaining to the potentially significant disadvantages of this approach such as the selection of resistant organisms. The routine use of prophylactic antibiotics in infants with central venous catheters in neonatal units cannot currently be recommended.

Gas exchange during perfluorocarbon liquid immersion: life-support for the ex utero fetus.

BACKGROUND: Respiratory mortality and morbidity remain major consequences of extreme prematurity. Percutaneous transfer of oxygen and carbon dioxide is possible in the newborn human. Perfluorocarbon (PFC) liquids have excellent oxygen and carbon dioxide carrying capacity. Animals can breath immersed in perfluorocarbon liquids and maintain adequate gas exchange. Our hypothesis is that the combination of spontaneous tidal perfluorocarbon breathing and respiration through the skin immersed in perfluorocarbon will allow adequate gas exchange in the preterm newborn. In this pilot study we aimed to observe the effects of immersion in FC-77 perfluorocarbon liquid on the preterm lamb. PILOT DATA: Four preterm lambs at 100-115 days gestation were delivered using a modified EXIT procedure. Immediately after complete delivery, the catheterised lamb was immersed in warm, oxygenated FC-77 perfluorocarbon liquid. Physiological monitoring was done for up to 60 min. All lambs were warmed adequately and seemed to have centrally intact circulation initially. All had little or no respiratory effort and there was no appreciable lung expansion. All had severe respiratory acidosis. DISCUSSION: For the provision of immediate ex utero care to the 'fetus' there are three requirements: adequate gas exchange surfaces and sufficient oxygen and carbon dioxide gradients, a functioning circulation, and an environment capable of keeping the lamb warm (thus minimising metabolic demand, oxygen consumption and carbon dioxide production). In this pilot study the greatest initial problem was the severe and rapidly worsening respiratory acidosis. The major problem was a lack of respiratory drive. No lung expansion from the outset would yield zero contribution to gas exchange from the lungs. An intact central circulation does not necessarily mean that the pulmonary circulation, respiratory drive and/or the skin circulation are adequate. For adequate gas exchange to occur it will require a 'breathing' animal with expanded alveoli. If the transition from the normal in utero state to immersion in PFC was immediate, and lung expansion was achieved, it could still be possible to achieve adequate gas exchange through the skin and lungs of the extremely preterm newborn. HYPOTHESIS: Given the potential for gas exchange across the skin of the extremely preterm infant we hypothesise that the immersion of extremely preterm infants in PFC liquid will allow optimal percutaneous gas exchange to occur. Given some lung gas exchange with less injurious liquid ventilation (spontaneous or mechanical) we hypothesise that the combination of skin and lung gas exchange will provide sufficient gas exchange to support life.

Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed.

BACKGROUND: Breast milk provides optimal nutrition for newborn infants, and the ideal way for infants to receive breast milk is through suckling at the breast. Unfortunately, this may not always be possible, as there are numerous reasons why a newborn infant may not be able to breastfeed and, as a result, require supplemental feeding. Currently, there are a variety of ways in which newborn infants can receive supplemental feeds. Traditionally, bottles and nasogastric tubes have been used; however, more recently, cup feeding has become a popular practice in many nurseries in an attempt to improve breastfeeding rates. There is no consistency to guide the choice of supplementation. OBJECTIVES: To determine the effects of cup feeding versus other forms of supplemental enteral feeding on weight gain and achievement of successful breastfeeding in newborn infants who are unable to fully breastfeed. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2006), CINAHL (1982 - April 2006) and MEDLINE (1966 - April 2006). SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing cup feeding to other forms of enteral feeding for the supplementation of newborn infants. DATA COLLECTION AND ANALYSIS: Quality assessments and data extraction for included trials were conducted independently by the review authors. Outcomes reported from these studies were: weight gain, proportion not breastfeeding at hospital discharge, proportion not feeding at three months of age, proportion not feeding at six months of age, proportion not fully feeding at hospital discharge, proportion not fully breastfeeding at three months of age, proportion not fully breastfeeding at six months of age, average time per feed (minutes), length of stay and physiological events of instability such as bradycardia, apnea, and low oxygen saturation. For continuous variables such as weight gain, mean differences and 95% confidence intervals were reported. For categorical outcomes such as mortality, the relative risks (RR) and 95% confidence intervals were reported. MAIN RESULTS: Four studies were eligible for inclusion. The experimental intervention was cup feeding and the control intervention was bottle feeding in all four studies included in this review. There was no statistically significant difference in the incidence of not breastfeeding at hospital discharge in three included studies (typical RR 0.82, 95% CI 0.62, 1.09) and not breastfeeding at three months in two included studies (typical RR 0.88, 95% CI 0.76, 1.03) or six months for the one study that reported this outcome (RR 0.91, 95% CI 0.78, 1.05). There was a statistically significant difference in not fully breastfeeding at hospital discharge (from three included studies) in favour of cup feeding (typical RR 0.75, 95% CI 0.61, 0.92). However, this was not statistically significant at three months (one study, RR 1.18, 95% CI 0.88, 1.58) or six months (one study, RR 1.31, 95% CI 0.89, 1.92). There was no statistically significant difference in weight gain from one study that reported this outcome (MD -0.60, 95% CI -3.21, 2.01). In the one study that assessed it, there was a significantly increased length of hospital stay in the cup fed infants [mean difference between groups was 10.1 days (95% CI 3.9, 16.3)]. Time to full breastfeeding was not assessed in any study. AUTHORS' CONCLUSIONS: Cup feeding cannot be recommended over bottle feeding as a supplement to breastfeeding because it confers no significant benefit in maintaining breastfeeding beyond hospital discharge and carries the unacceptable consequence of a longer stay in hospital.

Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants.

BACKGROUND: Intubation is associated with bacterial colonisation of the respiratory tract and, therefore, may increase the risk of acquiring an infection. The infection may prolong the need for mechanical ventilation and increase the risk of chronic lung disease. The use of prophylactic antibiotics has been advocated for all mechanically ventilated newborns in order to reduce the risk of colonisation and the acquisition of infection. However, there is the possibility that the harm this may cause might outweigh the benefit. OBJECTIVES: To assess the effects of prophylactic antibiotics on mortality and morbidity in intubated, ventilated newborn infants who are not known to have infection. In separate comparisons, two different policies regarding the prophylactic use of antibiotics in intubated, ventilated infants were reviewed: 1) among infants who have been intubated for mechanical ventilation, a policy of prophylactic antibiotics for the duration of intubation versus placebo or no treatment 2) among intubated, ventilated infants who have been started on antibiotics at the time of intubation but whose initial cultures to rule out sepsis were negative, a policy of continuing versus discontinuing prophylactic antibiotics. SEARCH STRATEGY: MEDLINE (January 1950 to March 2007), CINAHL (1982 to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2007), the Cochrane Neonatal Group Specialised Register and reference lists of articles were searched. SELECTION CRITERIA: Randomised controlled trials of sufficient quality in which mechanically ventilated newborn infants are randomised to receive prophylactic antibiotics versus placebo or no treatment. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality. MAIN RESULTS: Two studies met the criteria for inclusion in this review. One was of insufficient quality to draw any meaningful conclusions. The other was of fair quality and found no significant differences between treatment and control groups in any of the reported outcomes, however, the rates of septicaemia were not reported. AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials to support or refute the use of prophylactic antibiotics when starting mechanical ventilation in newborn infants, or to support or refute continuing antibiotics once initial cultures have ruled out infection in mechanically ventilated newborn infants.

Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical artery catheters.

BACKGROUND: Umbilical artery catheters are often used in unwell neonates. Infection related to the use of these catheters may cause significant morbidity and mortality. The use of prophylactic antibiotics has been advocated for all newborns with umbilical artery catheters in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm, such as the emergence of antibiotic resistant organisms, may outweigh benefit. OBJECTIVES: The primary objective was to assess whether prophylactic antibiotics reduce mortality and morbidity in neonates with umbilical artery catheters. Two different policies regarding the prophylactic use of antibiotics in neonates with umbilical artery catheters were reviewed: 1) a policy of prophylactic antibiotics for the duration of catheterisation (or other fixed duration of antibiotic treatment) versus placebo or no treatment among neonates with umbilical artery catheters; 2) a policy of continuing versus discontinuing prophylactic antibiotics among neonates with umbilical artery catheters who had been started on antibiotics at the time of catheterisation but whose initial cultures to rule out sepsis are negative. SEARCH STRATEGY: MEDLINE (January 1950 to May 2007), CINAHL (1982 to May 2007), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), the Cochrane Neonatal Group Specialised Register and reference lists of articles were searched. SELECTION CRITERIA: Randomised and some non-randomised (i.e., quasi-randomised trials) controlled trials of adequate quality in which newborn infants with umbilical artery catheters are randomised to receive prophylactic antibiotics versus placebo or no treatment. DATA COLLECTION AND ANALYSIS: Two reviewer authors independently assessed trial quality. MAIN RESULTS: Two quasi-randomised trials have been included. However, given their poor quality, we have not pooled the results. There were no statistically significant differences in important outcomes in either study. AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials to support or refute the use of prophylactic antibiotics when umbilical artery catheters are inserted in newborn infants, and no evidence to support or refute continuing antibiotics once initial cultures rule out infection in newborn infants with umbilical artery catheters.

Disposable nappies for preventing napkin dermatitis in infants.

BACKGROUND: Napkin dermatitis is a common condition that occurs in otherwise healthy infants. It causes discomfort to infants, anxiety to parents and caregivers and contributes to the load on the health care system. A large variety of napkins, both disposable and non-disposable, are available. Evidence is required to assist carers and health care workers in making informed decisions when balancing the pros and cons of different napkin choices. OBJECTIVES: To assess whether disposable napkins prevent napkin dermatitis in infants. SEARCH STRATEGY: We searched the Skin Group Specialised Register (up to June 2003), the Cochrane Central Register of Controlled Trials in (The Cochrane Library, Issue 3, 2004), MEDLINE (from 1966 to November 2004), EMBASE (from 1980 to February 2003) and CINAHL (from 1982 to November 2004). We searched reference lists of articles. We contacted lead investigators in the area and companies that manufacture disposable napkins for access to unpublished trials. SELECTION CRITERIA: Randomised controlled trials in which disposable napkins were compared with other types of disposable napkins or non-disposable napkins, in infants up to two years of age, for preventing napkin dermatitis. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. The same two authors independently assessed trials for methodological quality. Attempts were made to contact trial authors of the trials identified for clarification of methods and results of published trials. MAIN RESULTS: We identified 28 studies of the effects of various napkin types on napkin dermatitis. Seventeen studies from nine reports were included. Eleven studies were excluded due to methodology that did not fit the inclusion criteria of this review. Due to the poor reporting of methodology and results of the studies found in this review, there were no quantitative data available for analysis (or meta-analysis). Although the included studies appeared to favour cellulose-core disposable napkins over cloth, absorbent gelling material over cellulose-only core napkins, breathable outer shell over occlusive outer shell napkins and linings impregnated with formulations over plain linings, all of these studies were open to bias due to flawed methodology. AUTHORS' CONCLUSIONS: There is not enough evidence from good quality randomised controlled trials to support or refute the use and type of disposable napkins for the prevention of napkin dermatitis in infants.

Continuous infusion versus intermittent flushing to prevent loss of function of peripheral intravenous catheters used for drug administration in newborn infants.

BACKGROUND: The use of peripheral intravenous cannulae is common in newborn babies. Many of them require an intravenous line only for medications and not for fluid. Currently there is little uniformity in methods used to maintain cannula patency. OBJECTIVES: The object of this review was to determine which method was better for maintaining intravenous lines used in neonates for intravenous medication only: intermittent flushing or continuous infusion SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), CINAHL (from 1982 to June 2004) and MEDLINE (from 1966 to June 2004) . SELECTION CRITERIA: Randomised controlled trials comparing continuous infusion to intermittent flushing to maintain patency of intravenous cannulas. Units of randomisation might include individual catheters or individual babies. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Two studies were eligible for inclusion. In one study only one of our primary outcomes was available: the duration of cannula patency for the first cannula used per infant was slightly longer in the continuous infusion group, but not significantly so, with a mean difference of -4.3 hours (95% CI -18.2 to 9.7). In the second study, only one of our primary outcomes was available: the mean (SD) number cannulas used per infant in the first 48 hours was less in the intermittent flush group with a mean difference of -0.76 cannulas (95% CI -1.37 to -0.15). No results were available for any of our other primary outcomes: in the published report, results were reported per catheter rather than per infant, a number of infants received more than one intravenous catheter (39 infants received an unknown number of catheters). The overall duration of cannula patency was significantly longer in the intermittent flush group with a mean duration of patency in the intermittent flush group of 2.1 days (SD 1.0) compared with the continuous infusion group where the mean duration of patency was 1.0 days (SD 0.5) - Student's t test P value 0.0003. AUTHORS' CONCLUSIONS: It is difficult to draw reliable conclusions given the way the data were analysed and reported in the two included studies. The reliability of the results is uncertain. However, given the caution in interpreting these data, it should also be noted that the use of intermittent flushes was not associated in either study with a decreased cannula life or any other disadvantages, thus lending some support for the use of intermittent flushing of cannulas in a selected population in neonatal nurseries.

Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical venous catheters.

BACKGROUND: Umbilical venous catheters are often used in unwell neonates. Infection related to the use of these catheters may cause significant morbidity and mortality. The use of prophylactic antibiotics has been advocated for newborns with umbilical venous catheters in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm may outweigh benefit. Prophylactic antibiotics may be effective in preventing catheter-related blood stream infection, but may have the undesirable effect of promoting the emergence of resistant strains of micro-organisms. A policy of prophylactic antibiotic use should take into account this possibility, and has been used as a basis for arguing against its implementation. OBJECTIVES: The primary objective was to assess whether prophylactic antibiotics, in neonates with umbilical venous catheters, reduce mortality and morbidity. In separate comparisons, we planned to review two different policies regarding the prophylactic use of antibiotics in neonates with umbilical venous catheters: 1) Among neonates with umbilical venous catheters, a policy of prophylactic antibiotics for the duration of catheterisation (or other fixed duration of antibiotic treatment) versus placebo or no treatment; 2) Among neonates with umbilical venous catheters who had been started on antibiotics at the time of catheterisation, but whose initial cultures to rule out sepsis are negative, a policy of continuing versus discontinuing prophylactic antibiotics. SEARCH STRATEGY: We searched MEDLINE (January 1966 to April 2005), CINAHL (1982 to April 2005), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005). SELECTION CRITERIA: Randomised controlled trials or quasi-randomised trials in which newborn infants with umbilical venous catheters are randomised to receive prophylactic antibiotics versus placebo or no treatment. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality. MAIN RESULTS: One study, of poor quality, met the criteria for inclusion in this review. Twenty-nine term infants, who had umbilical venous catheters inserted specifically for transfusion procedures for hyperbilirubinaemia or polycythaemia, allocated non-randomly (quasi-randomised - alternate allocation) to treatment (n = 15) or control (n = 14) groups. Those in the treatment group received penicillin and gentamicin for three days. 5/15 infants given antibiotics and 5/14 control infants having positive blood cultures three days after catheter insertion. All positive blood cultures were considered contaminated, due to lack of corroborating clinical and haematological evidence of infection. Therefore, no infants were identified with evidence of septicaemia. AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials to support or refute the use of prophylactic antibiotics when umbilical venous catheters are inserted in newborn infants. There is no evidence to support or refute continuing antibiotics once initial cultures rule out infection in newborn infants with umbilical venous catheters.

Topical vitamin A, or its derivatives, for treating and preventing napkin dermatitis in infants.

BACKGROUND: Napkin dermatitis (nappy or diaper rash) is a non-specific term used to describe inflammatory eruptions (rashes) in the napkin area. Most infants develop napkin dermatitis at least once during their infancy. Topical vitamin A has been suggested as a treatment for napkin dermatitis. OBJECTIVES: To determine if treatment with topical vitamin A is successful in either preventing napkin dermatitis, or producing resolution or decreasing the severity of napkin dermatitis. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (May 2005); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005); Ovid MEDLINE from 1966 to August 2005; EMBASE (2003 to May 2005); Ovid OLDMEDLINE (1950 to 1965); and CINAHL (1982 to August 2005). We also searched reference lists of articles. SELECTION CRITERIA: Randomised controlled trials, where the topical application of medication containing vitamin A (or its derivatives) was compared with either placebo, no treatment or other topical medication, for the prevention or treatment of napkin dermatitis in infants aged from zero to two years. DATA COLLECTION AND ANALYSIS: Two authors (AJD and MWD) identified and checked titles and abstracts obtained from the searches, and reviewed the full text where necessary. They decided which trials met the inclusion criteria, and recorded their methodological quality. They assessed studies as either adequate, unclear or inadequate using the following key criteria: (a) randomisation (method of generation and concealment of allocation); (b) blinding; (c) loss to follow-up. MAIN RESULTS: We did not find any studies for the treatment of napkin dermatitis. We found only one study comparing the use of topical application of medication containing vitamin A, with another topical medication or placebo, to prevent napkin dermatitis. This included study, of 114 newborn infants, reported no significant differences between groups with regard to the severity or duration of napkin dermatitis. AUTHORS' CONCLUSIONS: For the treatment of napkin dermatitis there is no evidence to support or refute the use of topical vitamin A preparations. For the prevention of napkin dermatitis there is no evidence to suggest that topical vitamin A alters the development of napkin dermatitis. Further RCTs are required to determine whether topical vitamin A is efficacious in treating or preventing napkin dermatitis.

A regioselective cycloaddition route to isoxazoleboronic esters.

Alkynylboronates participate in 1,3-dipolar cycloaddition reactions with nitrile oxides to provide isoxazoleboronic esters with excellent levels of regiocontrol; additionally, these potentially valuable synthetic intermediates have been shown to participate efficiently in Suzuki coupling reactions.

Expression of cross-reactive surface antigens by microfilariae and adult worms of Brugia pahangi during infections in cats.

Microfilariae of Brugia pahangi were labelled with 125-Iodine using the reagent IODOGEN. Electron microscope autoradiographs of sections of iodinated microfilariae showed that the label was strictly confined to their sheath. Adult worms were also iodinated by the same procedure. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) analysis of detergent extracts of radio-labelled parasites revealed components of molecular weights 113, 81-71, 46 and 33 kDa in microfilariae, and of molecular weights 29, 20 and 16 kDa in adult worms. All but the 33 kDa component of microfilariae were immunoprecipitable with sera of infected cats and therefore antigenic. Antibodies to the 81-71 kDa and the 46 kDa microfilarial antigens were detected by immunoprecipitation before patency. Similarly, the 29 kDa antigen of adult worms was immunoprecipitable before the fourth moult. Therefore, during infection in cats, these antigens cross-react with epitopes present on earlier developmental stages.

A preliminary study of the application of the transductal velocity ratio for assessing persistent ductus arteriosus.

OBJECTIVE: To compare the transductal velocity ratio (TVR) of the persistent ductus arteriosus (PDA) with other echocardiographic criteria for haemodynamic significance of a PDA. METHODS: This was a prospective study (from January 1997 to August 1998) in the nurseries of the Royal Women's Hospital, Melbourne. Infants with a clinically suspected PDA were eligible and included if the echocardiogram showed a PDA with a structurally normal heart and the TVR had been measured. The PDA was assessed for evidence of left heart dilatation, the presence of reverse or absent diastolic flow in the descending aorta, the pattern of Doppler flow velocity waveform in the ductus arteriosus, and subjective assessment of ductal diameter on the real time image. The peak systolic velocity (PSV) was obtained from the pulmonary and aortic ends of the PDA, and the TVR calculated by dividing the PSV at the pulmonary end by the PSV at the aortic end. RESULTS: Forty two infants had 59 echocardiographs with their TVR calculated. Mean (SD) birth weight was 1008 (362) g. Mean (SD) gestational age at birth was 27.4 (2.2) weeks with a mean (SD) corrected gestational age of 28.7 (2.7) weeks. The mean TVR was decreased in those infants with a high left atrial diameter/aortic diameter (LA/Ao) ratio (1.9 v 2.8, p = 0.0032) or reverse/absent diastolic flow in the descending aorta (2.1 v 3.0, p = 0.02). This difference was greater if those two criteria were combined (1.7 v 3.4, p = 0.0027). The mean TVR was decreased in infants with a wide open duct seen on two dimensional imaging (1.5 v 3.0, p < 0.0001) or pulsatile flow seen on pulsed Doppler in the PDA (1.9 v 3.4, p = 0.0001). The LA/Ao and left ventricle internal diameter/aortic diameter (LVIDd/Ao) ratios were higher in the group with a TVR < 1.8 than in the other two groups; these differences were statistically significant. CONCLUSIONS: The TVR as a measure of the degree of constriction of a PDA is associated with other echocardiographic criteria for a haemodynamically significant PDA. A low TVR (signifying a poorly constricted duct) is associated with echocardiographic features of a significant left to right shunt, and vice versa. Further research is required to determine the usefulness of the TVR in predicting closure or likely continuing patency of a PDA and the need for treatment.

Reference ranges for the linear dimensions of the intracranial ventricles in preterm neonates.

AIMS: To establish normal ranges, in preterm infants < 33 weeks' gestation, for measurements of the lateral, third, and fourth ventricles and to assess intra-observer and inter-observer reliability. To assess the effect of head position during scanning on lateral ventricle size. To determine whether sex influences ventricle size. METHODS: A prospective study involving infants < 33 weeks' gestational age (GA) at birth. Cranial ultrasound scans were done during the first 3 days of life. Linear dimensions of the anterior horn width and thalamo-occipital distance of the lateral ventricles, the width of the third ventricle, and the width and length of the fourth ventricle were measured. Measurements were plotted against GA and reference ranges produced. All measurements were tested for intra-observer and inter-observer reliability. Head position and sex differences were studied. RESULTS: 120 infants with known GA (23(+1) to 32(+6) weeks) had their intracranial ventricles measured. Reference ranges obtained were-anterior horn width: 0-2.9 mm; thalamo-occipital distance: 8.7-24.7 mm; third ventricle width: 0-2.6 mm; fourth ventricle width: 3.3-7.4 mm; fourth ventricle length: 2.6-6.9 mm. Dependent and non-dependent lateral ventricles did not differ significantly in size. There was no clinically significant difference in ventricular size between sexes. CONCLUSIONS: Reference ranges for the measurement of the intracranial ventricles in preterm infants from 23 to 33 weeks' GA are provided and can be used in the diagnosis and assessment of ventricular enlargement in preterm infants. All measurements have good intra-observer and inter-observer reliability. Head position at the time of scanning does not influence the asymmetry of the lateral ventricular measurements. The infant's sex does not influence ventricular size.

Infant to staff ratios and risk of mortality in very low birthweight infants.

OBJECTIVES: To assess the effect that infant to staff ratios, in the first three days of life, have on the survival to hospital discharge of very low birthweight infants (<1500 g), having adjusted for initial risk and unit workload. DESIGN: In a retrospective analysis of a cohort of patients, the number of infants per nurse per shift were averaged for the first three days after admission and related to risk of mortality by logistic regression analysis. Infant to staff ratio was divided into terciles of low (1.16-1.58), medium (1.59-1.70), and high (1.71-1.97) infants per staff member. SUBJECTS: 692 very low birthweight infants admitted to the Intensive Care Nursery, Royal Women's Hospital, Brisbane over a four year period from January 1996 to December 1999. MAIN OUTCOME MEASURES: Survival to hospital discharge, adjusted for initial risk using the Clinical Risk Index for Babies (CRIB) score, and adjusted for unit workload using dependency scores. RESULTS: There were 80 deaths among the 692 babies analysed for the study period. The odds of mortality, adjusted for initial risk and infant dependency scores (unit workload), were improved by 82% when an infant/staff ratio of greater than 1.71 occurred, suggesting improved survival with the highest infant/staff ratio. The low and medium staffing levels corresponded with similar odds ratios for mortality. CONCLUSIONS: Infants exposed to higher infant to staff ratios have an improved adjusted risk of survival to hospital discharge.

Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants.

BACKGROUND: Tracheal gas insufflation (TGI) is a technique where a continuous flow of gas is instilled into the lower trachea during conventional mechanical ventilation. TGI can improve carbon dioxide removal with lower ventilation pressures and smaller tidal volumes, potentially decreasing secondary lung injury and chronic lung disease (CLD). OBJECTIVES: To assess whether, in mechanically ventilated neonates, the use of tracheal gas insufflation reduces mortality, CLD and other adverse clinical outcomes without significant side effects. SEARCH STRATEGY: Searches were made of MEDLINE 1966 to December 2001, CINAHL 1982 to December 2001, the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2001) and conference and symposia proceedings. SELECTION CRITERIA: Randomised controlled trials (RCT) that include newborn infants who are mechanically ventilated, and compare TGI during conventional mechanical ventilation (CMV) with CMV alone. Primary outcomes - mortality, CLD and neurodevelopmental outcome; secondary outcomes - air leak, intraventricular haemorrhage, periventricular leukomalacia, duration of mechanical ventilation, duration of respiratory support, duration of oxygen therapy, duration of hospital stay, retinopathy of prematurity, immediate adverse effects. DATA COLLECTION AND ANALYSIS: Each reviewer assessed eligibility, trial quality and extracted data separately. Study authors were contacted for additional information if necessary. MAIN RESULTS: Only one small study was found to be eligible. This study found no evidence of effect on mortality, CLD or age at first extubation. The total duration of ventilation was 9.3 days shorter in the TGI group (95% CI from 15.7 to 2.9 days shorter). The age at complete weaning from ventilation was 26 days shorter in the TGI group (95% CI from 46 to 6 days shorter). There was no evidence of effect on the total duration of respiratory support, oxygen therapy or hospital stay. REVIEWER'S CONCLUSIONS: There is evidence from a single RCT that TGI may reduce the duration of mechanical ventilation in preterm infants - although the data from this small study do not give sufficient evidence to support the introduction of TGI into clinical practice. The technical requirements for performing TGI (as performed in the single included study) are great. There is no statistically significant reduction in the total duration of respiratory support or hospital stay. TGI cannot be recommended for general use at this time.

Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome.

BACKGROUND: Acute lung injury (ALI), and acute respiratory distress syndrome (ARDS), are syndromes of severe respiratory failure. Adults with ALI or ARDS have high mortality and significant morbidity. Partial liquid ventilation (PLV) may be better (i.e., cause less lung damage) for these patients than other forms of respiratory support. Uncontrolled studies in adults have shown improvement in gas exchange and lung compliance with partial liquid ventilation. OBJECTIVES: To assess whether partial liquid ventilation reduces morbidity and mortality in adults with ALI or ARDS. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2004; MEDLINE (1966 to May 2004); and CINAHL (1982 to May 2004); intensive care journals and conference proceedings; reference lists and unpublished literature. SELECTION CRITERIA: Randomized controlled trials which compared partial liquid ventilation with other forms of ventilation, in adults (16 years old or greater) with ALI or ARDS, reporting one or more of the following: mortality; duration of mechanical ventilation, respiratory support, oxygen therapy, stay in the intensive care unit, or stay in hospital; infection; long term cognitive impairment or health related quality of life; long term lung function; or cost. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated the quality of the relevant studies and extracted the data from the included studies. MAIN RESULTS: Problems with the inadequacy of the primary report of the one included study do not allow us to report any quantitative results for patients with ALI or ARDS. The only outcome we considered to be of clinical significance and reported for all enrolled patients (i.e., patients with ALI and ARDS and less severe respiratory insufficiency) was 28 day mortality. There was no statistically significant difference between groups for this outcome with a relative risk for 28 day mortality in the PLV group of 1.15 (95% confidence intervals of 0.64 to 2.10). REVIEWERS' CONCLUSIONS: There is no evidence from randomized controlled trials to support or refute the use of partial liquid ventilation in adults with ALI or ARDS; adequately powered, high quality randomized controlled trials are still needed to assess its efficacy. Clinically relevant outcome measures should be assessed (especially mortality at discharge and later, duration of respiratory support and hospital stay, and long term cognitive and quality of life outcomes) and the studies should be published in full.