[Thermal comfort in preterm babies. Infra-red colour thermography findings. Preliminary report]. / Ocena komfortu cieplnego u noworodków urodzonych przedwczesnie przy uzyciu metody termografii w podczerwieni - doniesienie wstepne.

OBJECTIVE: To assess the thermal comfort of clinically stable neonates with normal body temperature by using infra-red colour thermography (THY). MATERIAL AND METHODS: 32 babies were enrolled in the study. The axillary temperature was maintained in the range 36.6-37.0 degrees C and the air temperature in the incubator remained within the neutral range according to Hey and Katz. Temperature distribution was measured by THY The abdomen and foot skin temperature, as well as the difference between both parameters were recorded. Thermal comfort for THY was defined as a difference between core and peripheral temperatures (Deltat) in the range of 1 to 2 degrees C. RESULTS: Thermal comfort defined according to THY criterion was fulfilled only in 12 patients (37.5%). We found Deltat< 1 degree C in 14 patients (43.8%), and Deltat>2 degrees C in 6 patients (6.3%). Thermal comfort defined by standard care varied from founded by THY p<0.0001. High foot temperature >or=35.0 degrees C in THY was found as a determinant for Deltat< 10 degrees C. Multivariate logistic regression analysis found gestational age <30 weeks to be connected with the risk of hyperthermia [odds ratio 8.4 (95% Cl 1.2-61.2). CONCLUSIONS: We concluded that there is a risk for hyperthermia in prenaturely, immature babies when nursed in standard neutral temperature. Infra-red colour thermography gives additional information which can be used for further studies on determination of optimal thermal comfort in newborn.

[Evaluation of sick neonates' medical interventions in maternity units before transport to reference centres]. / Ocena jakosci przygotowania chorego noworodka w macierzystym oddziale noworodkowym do transportu miedzyszpitalnego.

BACKGROUND: Interhospital transfer of the sick neonate should be an integral part of neonatal intensive care. However, it is essential that the referring hospital is able to provide the appropriate standard of care from birth up to the point of transfer. OBJECTIVE: To evaluate the quality of medical interventions before interhospital transport of sick neonates. MATERIAL AND METHODS: Retrospective study based on review of all transport records of530 neonates who were transported at the Neonatal Intensive Care Unit (NICU) in 2006. The examined variables included medical interventions in the maternity unit and transport team interventions before and during the transport. RESULTS: During the study period there was as a total of 530 transfers to Neonatology Departments, 325 of them (61.32%) were transferred to the NICU and 205 (38.68%) to the Special Care Unit. Within the group of neonates transported to the NICU, 51 (15.7%) infants had hypothermia, 65 (20%) had no venous access before the transport. The most common form of respiratory therapy was oxygen therapy (89 (27.4%) neonates), followed by mechanical ventilation (65 (20%) and NCPAP ventilation (50 (15.4%) infants). As a result of transport team interventions the number of children with hypothermia decreased to 27 (8.3%). Peripheral intravenous devices were inserted in 52 (16%) neonates. The number of infants transported on mechanical ventilation increased to 115 (35.4%), 56 (17.2%) babies received NCPAP and 53 (16.3%) were on supplemental oxygen. The highest number of transport team interventions was found in the group of extremely low birth weight infants. CONCLUSIONS: Inadequate medical preparation of sick neonates in maternity hospital for interhospital transport was the reason for the high incidence of transport team interventions before moving the neonate to the NICU.

Usefulness of the Apgar score: a national survey of Polish neonatal centers.

INTRODUCTION: The paper discusses the reliability of the Apgar score for evaluating newborns, particularly its usefulness in assessing the state of preterm or full term newborns born with hypoxia. AIM: The paper provides a sum-up of the opinions on usefulness and reliability of the Apgar score given by doctors from 255 NICUs. MATERIAL AND METHODS: Data for the analysis were gathered by means of a questionnaire opinion poll sent to 158 primary referral centers, 71 secondary referral centers and 26 tertiary referral centers. Respondents answered questions about value of the Apgar score assessment (highly valuable, limited value, always reliable), as well as overrating and underrating children born in good overall condition and children born with clinical and biochemical indicators of hypoxia. In the group of prematurely born babies, the data concerning newborns with very low (VLBW) and extremely low birth weight (ELBW) were analyzed separately RESULTS: 88.5% neonatologists claimed the use of the Apgar score in assessing newborn condition to be of little value and only 11.5% found this indicator useful and reliable. CONCLUSIONS: According to the majority of Polish neonatologists, Apgar score is not reliable in the assessment of term and preterm hypoxic newborns.

Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years.

BACKGROUND: Preterm infants who develop posthemorrhagic ventricular dilatation (PHVD) have a high risk of cognitive and motor disability. No clinical intervention has been proven to reduce neurodevelopmental disability in such infants. We investigated whether drainage, irrigation, and fibrinolytic therapy (DRIFT), which aims to lower pressure, distortion, free iron, and cytokines, reduces death or severe disability in PHVD. METHODS: We randomly assigned 77 preterm infants with PHVD to either DRIFT or standard treatment (ie tapping off cerebrospinal fluid to control excessive expansion). Severe disability was assessed at 2 years' corrected age and included severe sensorimotor disability and cognitive disability (<55 on the Bayley Mental Development Index). RESULTS: Of 39 infants assigned to DRIFT, 21 (54%) died or were severely disabled versus 27 of 38 (71%) in the standard group (adjusted odds ratio 0.25 [95% confidence interval: 0.08-0.82]). Among the survivors, 11 of 35 (31%) in the DRIFT group had severe cognitive disability versus 19 of 32 (59%) in the standard group (adjusted odds ratio: 0.17 [95% confidence interval: 0.05-0.57]). Median Mental Development Index was 68 with DRIFT and <50 with standard care. Severe sensorimotor disability was not significantly reduced. CONCLUSIONS: Despite an increase in secondary intraventricular bleeding, DRIFT reduced severe cognitive disability in survivors and overall death or severe disability.

[Aims and methodology of the Polish National programme for Standardisation of Clinical Practices in Neonatology and Paediatric Intensive Care. Edition 2007/2008]. / Cele i metodologia Ogólnopolskiego Programu Definiujacego i Standaryzujacego Praktyki Kliniczne w Neonatologii oraz Intensywnej Terapii Dzieciecej z uwzglednieniem dzieci urodzonych z mala i bardzo mala masa urodzeniowa ciala. Edycja 2007/2008.

In this paper we outline the aims and methods of the Polish National Programme for Standardisation of Clinical Practice in Neonatology and Paediatric Intensive Care, with special reference to infants with low and extremely low birth weight. The aim of this Programme is to adjust the diagnostic and therapeutic procedures to the latest guide lines and recommendations. The first stage consisted of a national level survey in order to identify the diversity of procedures implemented in Medical University Clinical Departments, Neonatology Units and Paediatric Intensive Care Units. The survey also served to confront the legitimacy of the used procedures with the current clinical knowledge and research. It is planned to repeat the survey 24 months after the implementation of the latest recommendations with the aim to assess the impact of the Programme on clinical practice. Partial stages of the Programme were started since 2006. The survey is coordinated by an independent statistics unit. The recommendations are developed on published standards.

[Recommended treatment of apnea in premature infants. A review based on literature and own experience]. / Leczenie bezdechów u noworodków przedwczesnie urodzonych - zalecenia opracowane na podstawie danych z pismiennictwa i doswiadczen wlasnych.

The authors reviewed the literature concerning different methods of treatment of apnea in premature infants. The authors consider that, apart from pharmacological treatment, noninvasive respiratory support methods play an important role in the prevention and treatment of newborns with apnea. The aim of the study is to present current recommendations concerning the principles of prevention and treatment of apnea in premature infants. The compiled recommendations are based on the data from literature and from the authors' own experiences.

[Current neonatal resuscitation practices in Polish neonatal units - national survey]. / Stan przygotowania pod wzgledem merytorycznym i organizacyjnym oddzialów neonatologicznych o róznym stopniu referencji do prowadzenia resuscytacji noworodka po urodzeniu.

AIM: We surveyed current neonatal resuscitation practices in Polish neonatal units to determine the factors, relevant to improving practices in this area. MATERIAL AND METHODS: The study was performed within the framework of the National Standardization Programme on Neonatal Practices and Procedures in 2007. An 11 question survey included questions concerning the frequency of neonatal resuscitation, type of procedure performed during resuscitation ie.: medicaments and oxygen administration, umbilical vein catetherisation, equipment availability, resuscitation of extremely preterm babies. The survey included also questions concerning problems in resuscitation and their causes. 420 questionnaires were sent out and 274 were returned completed (65.2% response rate). 266 units providing delivery room resuscitation were included in the study. RESULTS: Neonatal resuscitation procedures were needed significantly more frequently in the centres of the highest degree reference (p<0.001). There were also marked differences between the centres according to the frequency of umbilical vessels catetherisation and availability of the necessary medical equipment. In 44.6% of neonatal units, resuscitated newborns are successfully ventilated with room air. However, in 23.5% of the surveyed units, 100% oxygen is used for ventilation. The finding of great importance is that 30.7% of neonatal units stated the need for a trained resuscitator to attend a high risk pregnancy delivery and to resuscitate asphyxiated newborns. CONCLUSIONS: There are substantial differences in neonatal resuscitation practices in different neonatal centres. These findings should stimulate appropriate authorities to start an educational programme to establish suitable polices in newborn resuscitation.

[Delivery room resuscitation with room air and oxygen in newborns. State of art, recommendations]. / Zastosowanie tlenu i powietrza w resuscytacji noworodka po urodzeniu, aktualne poglady, zalecenia.

The authors present and discuss the current data, concerning delivery room resuscitation with oxygen and room air in neonates. On the ground of the results obtained from literature and the Polish National Survey on Paediatric and Neonatal Intensive Care, 2007/2008 issue, the authors give the following proposals regarding optimal oxygen treatment: 1. there is a need for optimizing tissue oxygenation in order to prevent injury caused by radical oxygen species; 2. newborn resuscitation should be monitored by measuring the haemoglobin saturation - the values above 90%, found in resuscitated newborn within the first minutes of life may be dangerous and cause tissue injury; 3. starting the resuscitation with oxygen concentration lower than 40% and adjusting it according to the effects of the procedure - the less mature infant the lower oxygen concentration at the beginning of resuscitation; 4. heart rate >100/min and SatO2Hb between 70-80% within the first minutes of life should not be an indication for increasing oxygen concentration.

[Weaning newborns from noninvasive ventilation]. / Zasady uwalniania noworodków z wentylacji neinwazyjnej.

The purpose of the study was to propose the recommendations for weaning infants from nasal continuous positive airway pressure (nCPAP) and nasal intermittent positive pressure ventilation (NIPPV). Despite the fact that both methods are commonly used for respiratory insufficiency in infants, detailed recommendations for weaning have not been described so far. The proposed recommendations are based on previously described data and a wide survey conducted among Polish neonatologists and intensive therapy paediatricians.

[Parenteral nutrition in neonatal units: a survey of current practices in Poland]. / Zywienie pozajelitowe w oddzialach neonatologii w Polsce - analiza stosowanych praktyk.

UNLABELLED: The aim of the study was to assess parenteral nutrition methods in neonatal units in Poland. MATERIAL AND METHODS: Large scale questionnaire investigations concerning parenteral nutrition (PN) were carried out in neonatological centres in Poland. The questionnaires were distributed in the year 2007 to 463 wards. Three hundred and two neonatal wards (NW) and pediatric intensive care units (PICU) responded (65.2% response rate). RESULTS: The investigation revealed that only 129 NW (48%) and 27 PICU (96% PICU) of the studied neonatal units (156 centres - 52% of responders) declared PN as a method of treatment. Nutritional teams are rare (20% of NW and 35% PICU) and hospital pharmacy was very rarely involved in preparing nutritional mixtures (11% NW and 22% PICU). More than half of NW and nearly 30% of paediatric intensive care units (PICU) use inappropriately concentrated lipid emulsions. One third of NW do not use obligatory for children (particularly neonates) volumetric infusion pumps. Mean time of umbilical artery access was twice as long as recommended. Majority of centres regard the level of training in parenteral nutrition as insufficient. CONCLUSION: Assessment of parenteral nutrition practices in neonates in Poland revealed that significant number of centres did not follow the recommendations and that there is need for training and organization activities to improve the quality of current PN practices.

[Physicians' attitudes toward pain in newborn infants. Preliminary results of a cross-sectional national survey]. / Postawy lekarza wobec bólu noworodków. Wstepne wyniki ogólnopolskiego badania sondazowego.

BACKGROUND: Since 1980s, the problem of pain experienced by newborns has met with increasing interest both in research work and in clinical practice. It is worth noting that significant progress in neurophysiologic basis of pain and in diagnostic and therapeutic methods have occurred during that time. AIM: This study primarily aims at describing opinions of the doctors who work in the neonatal wards and neonatal intensive care units in Poland regarding the management of pain in newborns. MATERIAL AND METHODS: The respondents of this survey were heads (or persons appointed by them) of 302 neonatal and paediatric intensive care hospital wards, in Poland. The questionnaire prepared for this purpose was used. RESULTS: The respondents demonstrated that essentially they possessed correct knowledge regarding the neurophysiology of pain, the diagnostic and therapeutic methods used in the management of pain in the newborns. The majority of respondents claimed that adequate pain management was used in their daily practice. They felt responsible for the parents' health education concerning the problem of pain in newborns. On the other hand, they complain about the lack of adequate training courses for physicians regarding this subject matter. CONCLUSIONS: It is recommended to organize specialized courses for doctors regarding pain in the newborn, and, in particular, regarding the principles of using opioids in the pain management of newborns.

[Local complications during nasal continuous positive airway pressure method therapy]. / Powiklania miejscowe podczas terapii metoda nosowego ciaglego dodatniego cisnienia w drogach oddechowych.

A review of the current knowledge about local complications during nasal continuous positive airway pressure method therapy in the neonate with respiratory failure is the subject of this article. In the authors' conviction, local damages make up one of the main causes of failure of therapy, or its interruption, especially in the newborn with extremely low birth weight. Apart from review of the literature, the authors describe the causes of the most frequent damages as well as methods of their prevention and treatment, developed during many years of using of this form of ventilation.