Maternal and infant outcomes in women with sickle cell disease: a matched cohort study.

OBJECTIVE: Women with sickle cell disease (SCD) have adverse maternal and infant outcomes. Our aim was to determine whether the outcomes of SCD mothers and their infants differed from African or Caribbean women not affected by SCD and whether there were differences between SCD individuals with the haemoglobin SS (HbSS) or haemoglobin SC (HbSC) genotypes. Furthermore, we wished to determine if any differences related to deprivation. DESIGN: A matched cohort study. SETTING: Tertiary perinatal centre in London PATIENTS: 4964 African or Caribbean women without SCD and 148 with SCD. MAIN OUTCOME MEASURES: Mode of delivery, maternal exchange transfusion, birthweight, neonatal unit admission, neonatal death and deprivation indices RESULTS: SCD women were more likely to be delivered by caesarean section (p<0.001) and had babies of lower birthweight (p<0.001). Their infants were no more likely to be admitted to neonatal intensive care unit or suffer a neonatal death. There were no significant differences between the SCD women and those without SCD in their deprivation index or deprivation decile. The women with the HbSS genotype compared to those with the HbSC genotype were more anaemic (p<0.02), required more exchange transfusions (p<0.001) and were more likely to be delivered by caesarean section (p=0.008). The infant outcomes did not differ significantly between the genotypes. CONCLUSIONS: Although, the SCD women, particularly those with the HbSS genotype, had greater morbidity, infant morbidity, and mortality was similar in mothers with the HbSS or HbSC genotypes and those without SCD.

Evaluation of methods of surfactant administration in the delivery suite?

Surfactant administered in the delivery suite might prevent or reduce the severity of subsequent respiratory distress syndrome. This review describes the evidence for surfactant delivery methods with relationship to their relevance in the delivery suite. The techniques include delivery using a thin catheter with the first breath, by the intubation-surfactant extubation procedure, less invasive surfactant administration (LISA) technique, using a laryngeal mask airway (LMA), or by nebulisation. There have been few randomised trials that have evaluated outcomes using these techniques in the delivery suite, and these were early trials. Currently, practitioners favour use of nasal continuous positive airway pressure with early rescue surfactant. Whether prophylactic surfactant given by the LISA technique or other techniques, such as via a LMA in the delivery suite, is more beneficial merits testing. This will require appropriately designed randomised trials with long-term outcomes.

Outcomes following less-invasive-surfactant-administration in the delivery-room.

BACKGROUND: Less invasive surfactant administration (LISA) on the neonatal unit reduces the need for mechanical ventilation and bronchopulmonary dysplasia (BPD). AIMS: To assess the immediate and longer-term efficacy of LISA to prematurely born infants in the delivery-room. STUDY DESIGN: A case control study with inborn historical controls matched for gestational age, birthweight and gender to each LISA infant. SUBJECTS: Infants born between 26+0 weeks and 34+6 weeks of gestational age. OUTCOME MEASURES: Respiratory function monitoring before and after LISA and need for mechanical ventilation within 72 h of birth. RESULTS: Ninety-nine infants, median gestational age of 32+4(range:27+0-34+6) weeks, were prospectively recruited. The respiratory rate and inspired oxygen (FiO2) decreased two minutes after LISA and there was a reduction in the FiO2 requirement at two hours post birth. Compared to historical controls, LISA administration was associated with a reduction in the need for mechanical ventilation within 72 h after birth (20.2% versus 56.6% p < 0.001) the incidence of moderate to severe BPD (8.2% versus 20.2%, p = 0.02) and the median costs of neonatal intensive care stay (£1218 versus £2436, p = 0.03) and total neonatal unit stay (£12,888 versus £17,240, p = 0.04). A high FiO2 in the delivery-room pre-LISA (median 0.75 versus 0.60, p = 0.02) was associated with LISA failure, that is mechanical ventilation within 72 h of birth. CONCLUSIONS: LISA to prematurely born infants in the delivery-room was associated with reductions in the need for mechanical ventilation and costs of care, but was less successful in those with initial, more severe respiratory disease.

The Postnatal Growth and Retinopathy of Prematurity Model: A Multi-institutional Validation Study.

PURPOSE: The G-ROP model was proposed to improve the retinopathy of prematurity (ROP) screening efficiency. It is based on gestational age, birth weight and postnatal weight gain. The current study aimed to validate the G-ROP model's ability to predict ROP in cohorts of premature infants from Egypt and the United Kingdom (UK). METHODS: We retrospectively reviewed the records of preterm infants born between 1st of January and 30th of June 2018 with a known outcome for ROP screening and regular weight measurements until day 39 after birth. We applied the G-ROP model to the study group and calculated the sensitivity of the model for detecting Early Treatment of ROP (ETROP) study type 1 ROP and for any ROP and calculated the reduction of the number of infants requiring ROP screening by the model application. RESULTS: We applied the G-ROP model on 605 infants (504 from Egypt and 101 from the UK). The model successfully predicted all type 1 ROP cases (100% sensitivity) in both cohorts (95% confidence interval [CI], 91.1-100% in the Egyptian cohort and 65.5-100% in the UK cohort). The model reduced the number of infants requiring screening by 14.1% in the Egyptian cohort and 21.8% in the UK cohort. CONCLUSIONS: The G-ROP model was successfully validated for detecting type 1 ROP and in both cohorts from Egypt and the UK.

Respiratory monitoring during less invasive surfactant administration in the delivery suite.

BACKGROUND: On the neonatal unit less invasive surfactant administration (LISA) reduces BPD and the need for mechanical ventilation. AIMS: To evaluate the feasibility of LISA in the delivery suite and to undertake respiratory function physiological monitoring before and after LISA. STUDY DESIGN: A prospective, observational cohort study was undertaken. A LISA simulation training programme was delivered. Then, LISA was undertaken in infants with respiratory distress maintained on continuous positive airway pressure (CPAP) in the delivery suite using videolaryngoscopic guidance without sedation. SUBJECTS: Thirty-eight infants with a median (IQR) gestational age of 31 + 5 weeks (30+3-33+4) and birth weight of 1.61 (1.42-1.90) kg had LISA in the delivery suite. OUTCOME MEASURES: Adverse effects of LISA and whether LISA resulted in changes in tidal and minute volumes, end tidal carbon dioxide (EtCO2) levels and the inspired oxygen concentration (FiO2). RESULTS: Respiratory function monitoring was available for 34 of the infants. LISA occurred at a median (IQR) interval of 18 (15-29) minutes after birth. The most common adverse events were desaturation (44.7%) and surfactant reflux (39.5%), both responded to either temporary suspension of LISA or slowing the speed of surfactant administration. Following LISA, there was a significant reduction in respiratory rate 2 min later (p < 0.001) and in the FiO2 2 h later (p < 0.001). CONCLUSIONS: LISA is feasible in the delivery suite after appropriate training of staff. It can be undertaken without serious adverse effects and results in a reduction in respiratory distress and improvement in oxygenation.

A randomised crossover trial of closed loop automated oxygen control in preterm, ventilated infants.

AIM: To determine whether closed loop automated oxygen control resulted in a reduction in the duration and severity of desaturation episodes and the number of blood gases and chest radiographs in preterm, ventilated infants. METHODS: Infants were studied on two consecutive days for 12 hours on each day. They were randomised to receive standard care (standard period) or standard care with a closed loop automated oxygen control system (automated oxygen control period) first. RESULTS: Twenty-four infants with a median gestational age of 25.7 (range 23.1-32.6) weeks were studied at a median postconceptional age of 27.4 (range 24.3-34.9) weeks. During the automated oxygen control period, there were fewer desaturations that lasted >30 seconds (P = .032) or >60 seconds (P = .002), infants spent a higher proportion of the time within their target SpO2 range during the automated oxygen control period (P < .001), and fewer manual adjustments were made to the inspired oxygen concentration (mean 0.58 vs mean 11.29) (P < .001). There were no significant differences in the number of blood gases (P = .872) or chest radiographs (P = .366) between the two periods. CONCLUSION: Closed loop automated oxygen delivery resulted in fewer prolonged desaturations with more time spent in the targeted oxygen range.

Maternal smoking and cannabis use during pregnancy and infant outcomes.

Background Our aim was to determine the prevalence of tobacco smoking and e-cigarettes and cannabis use during pregnancy, whether these were influenced by ethnicity, and their relationship to perinatal outcomes. Methods A study was carried out in 4465 infants whose mothers delivered during 2017 and 2018. Self-reported maternal smoking, e-cigarette and cannabis use at booking were recorded. Outcome measures were birthweight and head circumference z-scores and admission to the neonatal intensive care unit (NICU). Results Two hundred and five women reported smoking cigarettes (4.7%), five were using e-cigarettes (0.11%) and 106 were using cannabis (2.43%). Women were most likely to smoke if young (15-19 years old) or from a mixed-race or White background. Cigarette smoking was associated with a lower mean z-score for birthweight (-0.587 vs. -0.064) and head circumference (-0.782 vs. -0.157) (both outcomes P < 0.0001). Young, mixed-race women were most likely to be both smoking and using cannabis during pregnancy and their infants had a lower birthweight mean z score (-0.989 vs. -0.587, P = 0.028) and head circumference z score (-1.33 vs. 0.782, P = 0.025) than cigarette use alone. Conclusion Young, mixed-race women were most likely to be both smoking and using cannabis during pregnancy and should be targeted for cessation programmes.

Tidal Volumes and Outcome of Extubation in Mechanically Ventilated Premature Infants.

OBJECTIVES: To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prematurely born infants who were successfully extubated compared with the ones who failed extubation and explore the ability of VT to predict successful extubation. STUDY DESIGN: This is a two-center, prospective, observational, cohort study of ventilated infants born <32 weeks of gestational age (GA) at King's College Hospital and St George's University Hospital, London, United Kingdom between February and September 2018. Expiratory VT was recorded before extubation, and extubation was considered successful if the infants were not reintubated within 72 hours. RESULTS: Fifty-six (29 male) infants with a median (interquartile range) GA of 26 (25-29) weeks were studied. The infants who successfully extubated (N = 36) had a higher GA (27 [25-30] weeks) and VT (7.2 [4.8-9.5] mL) compared with the GA (25 [24-26] weeks) and VT (4.3 [4.0-5.5] mL) of the infants who failed extubation (p = 0.002 and p = 0.001, respectively). VT/kg was not different in infants who successfully extubated compared with the ones who failed extubation (p = 0.643). Following multivariate regression, VT was associated with extubation success (adjusted p = 0.022) and GA was not (adjusted p = 0.167). A VT > 4.5 mL predicted successful extubation with 82% sensitivity and 58% specificity (area under the curve = 0.786). CONCLUSION: Successful extubation was associated with higher unadjusted-for-weight VTs compared with failed extubation, and unadjusted VT predicted extubation outcome with moderate sensitivity and specificity.

Coxsackie encephalitis in a child in Western India.

Enteroviral encephalitis in children has been rarely described from Western India. We describe a 5½-year-old child with Coxsackie encephalitis.