Management of pneumothorax in neonatal retrieval: a retrospective cohort study.

BACKGROUND: Management of pneumothorax in neonates requiring retrieval poses unique challenges, including decision to insert an intercostal catheter (ICC). We aimed to report the proportion and characteristics of neonates transported with and without ICC insertion and the incidence of deterioration in neonates transported with pneumothorax. METHODS: A retrospective cohort study of neonates transported with pneumothorax between 2016 and 2020 in Victoria, Australia. Univariate analysis was performed on patient and clinical characteristics, followed by multivariate analysis to identify risks independently associated with ICC insertion. RESULTS: 174 neonates were included. Mean (SD) gestational age (GA) was 37.5 (2.8) weeks. Eighty-two neonates (47%) had ICC inserted. On multivariate analysis, risk factors independently associated with ICC insertion were mechanical ventilation (MV) preceding retrieval team arrival (OR 12, 95% CI 3.1 to 46.6, p<0.001) and radiographical mediastinal shift (MS) (OR 6.2, 95% CI 2.4 to 16.2, p<0.001). Increasing GA is negatively associated with ICC insertion (OR 0.66, 95% CI 0.5 to 0.8, p<0.001). No significant difference in incidence of deterioration between the ICC group and the no-ICC group was observed (8.5% vs 5.4%, p=0.55). Ninety-five neonates were treated with needle aspiration (NA); 40 (42%) subsequently avoided ICC insertion. Twelve (13%) neonates transported without ICC had insertion within 24 hours following transport. CONCLUSION: Many neonates with pneumothorax are transported without ICC, with low incidence of deterioration and ICC insertion within 24 hours after transport. More than a third of neonates managed with NA avoided ICC insertion. The likelihood of ICC insertion is increased by lower GA, MV prior to retrieval team arrival and radiographical MS.

Outcomes after Introduction of Minimally Invasive Surfactant Therapy in Two Australian Tertiary Neonatal Units.

OBJECTIVE: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units. STUDY DESIGN: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records. RESULTS: There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation. CONCLUSIONS: MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.

Implementation of dextrose gel in the management of neonatal hypoglycaemia.

AIM: The aim of this study was to evaluate dextrose gel in the management of neonatal hypoglycaemia in the postnatal wards at an Australian tertiary level perinatal centre. METHODS: An audit was performed before and after implementation of dextrose gel. Pre-implementation, neonatal hypoglycaemia was managed with feed supplementation alone, and dextrose gel was used in addition to feed supplementation in the post-implementation phase. Outcomes included admission to neonatal intensive care unit (NICU) for management of hypoglycaemia, proportion of neonates who achieved normoglycaemia (defined as blood glucose ≥2.6 mmol/L, with no clinical signs after one or two treatment attempts) and proportion of neonates with hypoglycaemia recurrence after normoglycaemia and one or two treatment attempts. RESULTS: NICU admission for treatment of hypoglycaemia reduced significantly post-implementation of dextrose gel (29/100 (29%) vs. 14/100 (14%), P = 0.01). No significant difference was seen in the proportion of neonates achieving normoglycaemia (71/100 (71%) vs. 75/100 (75%), P = 0.52), but hypoglycaemia recurrence was higher in the post-implementation group (22/71 (31%) vs. 37/75 (49%), P = 0.02). CONCLUSIONS: Dextrose gel is effective in the management of neonatal hypoglycaemia in the postnatal ward setting, reducing admission to NICU and mother-infant separation.