Duration of anaemia during the first week of life is an independent risk factor for retinopathy of prematurity.

AIM: This study evaluated the correlation between retinopathy of prematurity (ROP), anaemia and blood transfusions in extremely preterm infants. METHODS: We included 227 infants born below 28 weeks of gestation at King Edward Memorial Hospital, Perth, Australia, from 2014-2016. Birth characteristics and risk factors for ROP were retrieved, and anaemia and severe anaemia were defined as a haemoglobins of <110 g/L and <80 g/L, respectively. Logistic regression was used for the analysis. RESULTS: Retinopathy of prematurity treatment was needed in 11% of cases and the mean number of blood transfusions (p < 0.01), and mean number of weeks of anaemia (p < 0.001) and of severe anaemia (p < 0.05), had positive associations with ROP cases warranting treatment. In the multivariate logistic regression analysis, the best-fit model of risk factors included anaemic days during first week of life, with an odds ratio (OR) of 1.46% and 95% confidence interval (CI) of 1.16-1.83 (p < 0.05), sepsis during the first 4 weeks of life (OR 3.14, 95% CI 1.10-9.00, p < 0.05) and days of ventilation (OR 1.03, 95% CI 1.01-1.06, p < 0.05). CONCLUSION: The duration of anaemia during the first week of life was an independent risk factor for ROP warranting treatment and preventing early anaemia may decrease this risk.

Using a modified Seldinger technique is an effective way of placing femoral venous catheters in critically ill infants.

AIM: Femoral venous catheters (FVCs) provide multilumen access in critically ill infants with difficult venous access. This study reports our experiences of using a modified Seldinger technique to insert FVCs in our neonatal unit. METHODS: This was a retrospective case series of 34 infants who had FVCs inserted using the modified Seldinger technique during a 4-year period. RESULTS: The median (range) post-natal age and weight at the time of insertion were 66 days (1-314) and 3080 g (865-8000). The FVC remained in situ for a median duration of 21 days (1-63). There were nine infants who died while the FVC remained in situ. The FVCs were removed from four infants due to complications. In three cases, they became dislodged, and in one case, the line became blocked. In 16 infants, the FVC was removed when it was no longer required and one infant was transferred out of the unit with the FVC in situ. Transient venous congestion of the distal limb occurred in four infants. In one infant, the FVC was accidently placed in the femoral artery and removed without complications. CONCLUSIONS: Femoral venous catheter insertion using a modified Seldinger technique appeared to provide alternate and immediate central venous access in critically ill infants.

Global myocardial function is compromised in infants with pulmonary hypertension.

AIM: Persistent pulmonary hypertension of the newborn is a serious clinical entity with significant mortality and long-term morbidity. The objective was to study the profile of myocardial function, especially diastolic function, in term infants with pulmonary hypertension treated with nitric oxide. METHODS: Unit electronic database was accessed to identify infants ≥34 weeks gestation who were administered nitric oxide for pulmonary hypertension over the last 6 years. Medical records and archived echocardiographic images were retrieved. Those with no echocardiogram on the day of administration of nitric oxide, concomitant congenital heart disease or ≥2 weeks of age at the time of nitric administration were excluded. RESULTS: Low biventricular outputs were noted in >2/3rd infants. Tricuspid regurgitation was noted in 20/25 (80%) infants, and ductal shunt was bidirectional in the majority of cases. Right ventricular diastolic function was assessed by systolic to diastolic duration ratio; dysfunction was widely prevalent. CONCLUSIONS: A large percentage of infants were haemodynamically severely compromised. This is the first study to detail right ventricular diastolic dysfunction in infants with pulmonary hypertension and highlights the therapeutic role of milrinone, a lusitropic drug with myocardial relaxation properties. Comprehensive evaluation of cardiovascular haemodynamics can optimize clinical care.

Validation of WINROP (online prediction model) to identify severe retinopathy of prematurity (ROP) in an Australian preterm population: a retrospective study.

INTRODUCTION: Retinopathy of prematurity (ROP) is the most common disease leading to blindness in extreme preterm infants. Current screening guidelines recommend frequent eye examinations. There is a dearth of trained ophthalmologists for these frequent screening procedures. The ANZNN neonatal network report (2013) found that only 6.4% of all screened infants had severe ROP and less than half received treatment. WINROP (online prediction model, Sweden) uses the postnatal weight gain (surrogate marker for low insulin-like growth factor IGF-1 and poor retinal vascular growth) to identify ROP requiring treatment and aims to reduce the number of examinations. Our objective was to validate the WINROP model in an Australian cohort of preterm infants. METHODS: Birth weight, gestational age, and weekly weight measurements were retrieved retrospectively along with the final ROP outcomes and plotted on the online WINROP software. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of WINROP were 85.7%, 59.0%, 6.98%, and 99.1% respectively for a cohort of 221 preterm infants (Median birth weight, 1040 g; Gestational age, 27.9 weeks). WINROP alarm was signaled in 42.6% of all infants. WINROP did not signal an alarm in one infant who needed treatment. This infant had intra ventricular hemorrhage grade 3-4 and temporary ventricular dilatation. CONCLUSIONS: This is the first Australian study validating WINROP model. Our findings suggest that it lacked sensitivity to be used alone. However, adjusting the algorithm for the Australian population may improve the efficacy and reduce the number of examinations when used along with the current screening guidelines.

Inter-rater reliability of amplitude-integrated EEG for the detection of neonatal seizures.

BACKGROUND: Amplitude-integrated electroencephalogram (aEEG) is being used increasingly for seizure detection in neonates. However, data regarding inter-rater reliability among neonatologists for the use of aEEG for the detection of neonatal seizures is lacking. METHODS: Term and late-preterm infants at risk of seizures were monitored simultaneously with 24-h video-electroencephalography (vEEG) and aEEG. vEEG was interpreted by an experienced neurologist. Five neonatologists with experience in aEEG interpretation from four different neonatal units interpreted aEEG recordings independently. The Brennan and Prediger kappa coefficient and Intra-class Correlation Coefficients (ICC) were used to assess inter-rater reliability between the neonatologists. RESULTS: Thirty-five infants at risk of seizure with gestational age at birth 35-42 weeks were recruited for the study after informed parental consent. vEEG detected seizures in seven infants with a total of 169 individual seizure episodes. Neonatologists detected seizures in 10 to 15 infants on aEEG. The sensitivities for the detection of individual seizures by neonatologists ranged from 18% to 38%. The inter-rater reliability for detection of: individual seizure was "fair" (kappa = 0.37; 95% CI: 0.32-0.42), infant with seizure was "moderate" (kappa = 0.60; 95% CI: 0.44-0.75), duration of individual seizure (ICC: 0.22; 95% CI: 0.18-0.28) and total duration of seizures in an infant (ICC: 0.46; 95% CI: 0.30-0.63) was "poor". The neonatologists missed 77-90% of the duration of seizures. CONCLUSION: The inter-rater reliability of aEEG for the detection of neonatal seizures was suboptimal. Even when interpreted by experienced and trained clinicians, seizure detection with aEEG has limitations and can miss large number and duration of seizures.

Screening for retinopathy of prematurity (ROP) using wide-angle digital retinal photography by non-ophthalmologists: a systematic review.

Retinopathy of prematurity (ROP) is one of the leading and preventable causes of blindness. The investigation of choice for diagnosing ROP is binocular indirect ophthalmoscope (BIO) done by ophthalmologists. Since the number of ophthalmologists available to do BIO examination is limited, especially in developing countries, there is a need for an alternate, cheap, reliable and feasible test. Telemedicine imaging with Digital Retinal Photography (DRP) is one such alternate diagnostic test which can be performed easily by non-ophthalmologists, with adequate training. Our objective was to conduct a systematic review to evaluate the accuracy of DRP performed by trained personnel (non-ophthalmologists) in diagnosing clinically significant ROP. Medline, EMBASE, CINAHL and Cochrane databases were searched independently by two authors. Eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. Six were included in the review (three prospective; N=120, three retrospective; N=579). Studies had methodological limitations on QUADAS-2. Because of the heterogeneity of studies, data could not be pooled to derive single-effect size estimates for sensitivity and specificity. The included studies reported sensitivity of 45.5-100% with the majority being more than 90%; specificity 61.7-99.8% with the majority being more than 90%, positive predictive value 61.5-96.6% and negative predictive value of 76.9-100% for diagnosing clinically significant ROP. We conclude that diagnostic accuracy of DRP must be established in prospective studies with adequate sample size where DRP is compared against the simultaneously performed BIO examination.

Neonatal presentation of chromosome 9q33.2-q34.3 duplication.

Partial terminal duplication of chromosome 9 is a rare anomaly that is known to be associated with specific dysmorphic features. While having common characteristics, these patients also have inconsistent phenotypic features. These inconsistent features may be attributed to the length and the region of the duplicated segment of chromosome 9. We discuss a case of an infant with similar physical features to those previously reported including dysmorphology of the craniofacial region, hands and feet. However we also describe findings of malrotation and renal anomalies. Microarray demonstrated duplication of 9q33.2-q34.3 with normal parental karyotyping. This is the first reported case of duplication of this specific region of chromosome 9q and the phenotypic presentation represents a new constellation of clinical findings.