Fifteen-minute consultation: Baby with jaundice in the first 2 weeks of life.

There are multiple causes of jaundice in the first 2 weeks of life. The aim of this article is to help explain what these causes are and why they occur. It discusses how to focus on the history, examination and investigations in such cases. Initial management will vary depending on the clinical context; as such, this article also outlines the initial management of the most common scenarios.

Predicting the duration of supplemental home oxygen in prematurely-born infants at discharge from neonatal care.

BACKGROUND: Discharge home of preterm infants on supplemental oxygen has significant healthcare, parental psychological and financial implications, but the potential ability of clinical parameters at discharge to predict the duration of home oxygen has not been previously examined. AIMS: To use clinical and epidemiological parameters available at discharge to predict the duration of home oxygen therapy. STUDY DESIGN: Retrospective observational cohort study with a primary and a validation cohort. SUBJECTS: Seventy one infants born <32 completed weeks of gestational age, born between 1/1/2013-1/1/2020 at King's College Hospital NHS Foundation trust and discharged home on supplemental oxygen were studied. OUTCOME MEASURE: Duration of home oxygen therapy. RESULTS: In a primary cohort of 52 infants with a median (IQR) gestational age of 26.4 (25.0-28.1) weeks and birth weight of 0.81 (0.69-0.96) kg, the duration of home oxygen was four (3-7) months (range: 1-22 months). The postmenstrual age (adjusted p = 0.001) and oxygen flow at discharge (adjusted p = 0.046) were independently associated with the duration of home oxygen therapy. In a validation cohort of 19 infants, the correlation coefficient between the calculated and the observed duration of home oxygen was 0.62, p = 0.005 and the coefficient of determination was 0.38. CONCLUSIONS: Infants discharged home on higher oxygen flows and at a greater postmenstrual age require a longer duration of home oxygen therapy and these parameters can be used to predict the duration of home oxygen therapy.

Comparison of NICE Guideline CG149 and the Sepsis Risk Calculator for the Management of Early-Onset Sepsis on the Postnatal Ward.

INTRODUCTION: The NICE guideline CG149 has increased the number of well infants receiving antibiotics for suspected early-onset sepsis (EOS). The Kaiser Permanente sepsis risk calculator (SRC) has safely and dramatically reduced investigations and antibiotics for suspected EOS in the USA. This study evaluates the current management of suspected EOS against the NICE guideline CG149 and the SRC. METHODS: This study is a prospective, multicentre, observational study across 13 neonatal units in London. Infants were born between June and August 2019 at ≥34 weeks gestation and commenced on antibiotics for suspected EOS and cared for on postnatal/transitional care wards. Data were prospectively recorded: risk factors, clinical indicators, investigations, and results. Outcome measures included the following: (1) incidence of EOS and (2) proportion of infants recommended for antibiotics by NICE versus theoretical application of SRC. RESULTS: 1,066/8,856 (12%) infants on postnatal/transitional care wards received antibiotics, 7 of whom had a positive blood culture (group B Streptococcus = 6 and Escherichia coli = 1), making the EOS incidence 0.8/1,000 infants. Six hundred one infants had data for SRC analysis, which recommended "antibiotics" or "blood culture" for 130/601 (21.6%) infants using an EOS incidence of 0.5/1,000 versus 527/601 (87.7%) if NICE was applied. CONCLUSIONS: Currently, 12.0% of infants on postnatal/transitional care wards receive antibiotics for suspected EOS. The SRC could dramatically reduce antibiotic use, but further prospective studies are required to evaluate safety of SRC implementation.