Surgical management of patent ductus arteriosus in pre-term infants - a british paediatric surveillance study.

BACKGROUND: This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 - 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome. RESULTS: Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge. CONCLUSION: This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.

Neonatal pulse oximetry screening: a national survey.

AIM: Studies suggest that universal pulse oximetry (PO) screening of all neonates before hospital discharge improves the detection rate of congenital heart disease (CHD). The aim is to survey the use of Pulse Oximetry (PO) screening in UK. METHODS: A telephone interview was conducted between late 2009 to mid-2010 of all maternity units using a standardised questionnaire. RESULTS: 209(93%) of 224 responding units did not routinely use PO. Among the 15 that performed PO, 5 measured pre and post ductal saturations, 9 measured only post-ductal saturations, and 1 measured only pre-ductal saturations. There were differences in the values used to trigger further investigation, ranging from <94% to <96% and/or difference of > 2-3% between pre and post-ductal saturations. When saturations were abnormal, 13 units performed echocardiography locally. In addition to an echocardiogram, 2 units performed chest x-ray (CXR); 2 units performed electrocardiogram (ECG) and 2 units performed both CXR and ECG. CONCLUSION: Only a minority of hospitals across the UK use PO to supplement the postnatal examination with inconsistent practice. National guidelines should be developed if PO screening is implemented with an agreed management plan if abnormal results are obtained.

Electrocardiogram screening of deaf children for long QT syndrome: are we following UK national guidelines?

INTRODUCTION: Jervell-Lange-Nielsen syndrome is characterised by congenital deafness and a long QT interval on electrocardiography. AIM: (1) To survey UK national practice regarding electrocardiography screening of deaf children referred to cochlear implant centres, performed to evaluate for prolonged QT interval as recommended by national guidelines, and (2) to review local practice. METHODS: Data were collected via a questionnaire sent to all UK cochlear implant centres, and via review of the medical records of a local cochlear implant centre database. RESULTS: Eight (42 per cent) of the 19 cochlear implant centres surveyed performed electrocardiographic screening. Thirteen cases of long QT syndrome were reported in seven centres, with two related deaths. In our local cochlear implant centre, 14 (7.1 per cent) of 193 children had abnormal electrocardiograms; one definite long QT syndrome case and 13 borderline cases were identified. CONCLUSION: Despite clear national guidelines for electrocardiographic screening of deaf children, there is wide variation in practice. Our local practice of performing investigations, including electrocardiography, during magnetic resonance imaging sedation has been very successful. Electrocardiograms should be reviewed by trained clinicians, and corrected QT intervals should be calculated manually.

Ultrasonographic determination of neonatal spinal canal depth.

OBJECTIVE: To determine by ultrasound (US) the spinal canal depth (SCD) in neonates and subsequently establish a nomogram and simple formula for calculating this distance. DESIGN: 116 US measurements were performed by two investigators in 105 neonates at the L3/4 intervertebral space. Both anterior and posterior spinal canal depth were measured and mid-spinal canal depth (MSCD) calculated. Measurements of intra- and interobserver variability were also performed. RESULTS: A clear relationship was found between body weight (W, kg) and all SCD measurements in neonates. In particular, MSCD = 2.2 W + 6.89 mm (R(2) correlation coefficient 0.76), approximated by 2 W + 7 mm. CONCLUSION: SCD measurements are easily determined by US in neonates, with good correlation between weight and MSCD.

Bacterial endocarditis in a child with haemophilia B: risks of central venous catheters.

The use of central venous catheters may be complicated by thrombosis and infection. We report a case of a needle-phobic 5-year-old boy with factor IX deficiency, in whom a portacath was inserted owing to poor compliance with prophylactic treatment. Within a week, he developed a Staphylococcus aureus line infection that was treated with a 2-week course of intravenous antibiotics. One month later he presented with nonspecific symptoms and blood cultures again grew S. aureus. An echocardiogram revealed a large vegetation adherent to the tricuspid valve, confirming the diagnosis of bacterial endocarditis. His clinical course was further complicated by the development of pulmonary emboli. Medical treatment with intravenous antibiotics led to a successful resolution of the endocarditis and pulmonary emboli with a favourable long-term outcome.