Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations.

AIM: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. METHODS: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. RESULTS: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7). CONCLUSION: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

Hypertriglyceridaemia in extremely preterm infants receiving parenteral lipid emulsions.

BACKGROUND: Lipid emulsions (LE) are routinely administered as part of parenteral nutrition in neonates. There is a wide variation in clinical practice of plasma triglyceride monitoring during LE therapy. Our aim was to evaluate the incidence of hypertriglyceridaemia (Plasma triglyceride > 2.8 mmol/L) and its association with mortality and major morbidities in extremely preterm infants on parenteral nutrition. METHODS: A retrospective review of 195 infants < 29 weeks gestation. Lipid emulsion was commenced at 1 g/kg/day soon after birth and increased by 1 g/kg daily up to 3 g/kg/day and continued until the infant was on at least 120 ml/kg/day of enteral feeds. Plasma triglyceride concentrations were measured at each increment and the lipid emulsion dosage was adjusted to keep plasma triglyceride concentrations ≤2.8 mmol/L. RESULTS: Hypertriglyceridemia was noted in 38 neonates (32.5% in 23-25 weeks and 16.1% in 26-28 weeks). Severe hypertriglyceridemia (> 4.5 mmol/L) was noted in 11 infants (10.0% in 23-25 weeks and 4.5% in 26-28 weeks). Hypertriglyceridemia was associated with an increase in mortality (unadjusted OR 3.5; 95% CI 1.13-10.76; 0.033) and severe retinopathy of prematurity (unadjusted OR 4.06; 95% CI 1.73-9.59; 0.002) on univariate analysis. However, this association became non-significant in multivariate analysis with adjustment for gestation and birthweight. CONCLUSIONS: Hypertriglyceridemia is common in extremely preterm infants receiving parenteral lipid emulsions. Regular monitoring and prompt adjustment of lipid intake in the presence of hypertriglyceridemia, minimising the length of exposure to hypertriglyceridemia, may mitigate potential consequences.

[Health promotion and inpatient rehabilitation. Long-term effects of education in patients with coronary heart disease]. / Gesundheitsförderung durch eine stationäre Rehabilitation. Langzeiteffekte von Schulungsmassnahmen bei Patienten mit koronarer Herzkrankheit.

BACKGROUND AND PURPOSE: The most important goals in the rehabilitation of patients with a coronary heart disease (CHD) include the diagnosis and treatment of risk factors, health promotion, and education. The knowledge on and awareness of cardiovascular risk factors is an important precondition for a high patient compliance. Former studies on patients in cardiologic departments of hospitals showed no effect of health promotion and education on patients' knowledge on risk factors, presumably because of the setting in acute therapy. Therefore, the possible effects of health promotion and education on the knowledge of patients were studied in the setting of an inpatient rehabilitation. METHODS: Over 1 year, 426 patients, admitted to an inhospital rehabilitation, were questioned on the first and last day of their stay using a validated instrument ("Bochumer Bewertungsbogen-Kardiovaskuläre Risikofaktoren" [BBKR], Table 1). 1 year after discharge, the same questionnaire was sent to the surviving 423 patients. Of these, 267 patients (63.1%) answered. The average age was 64.3 years (standard deviation [SD] 11.3). Demographic data and clinical history are summarized in Table 2. RESULTS: For most of the known risk factors of CHD, the number of patients mentioning them significantly increased during the observation period. On the day of admittance, only 59.2% mentioned diabetes mellitus as a risk factor compared to 74.6% 1 year after discharge. Especially patients with a CHD improved their knowledge on their disease (Figure 1). Education and number of rehabilitations in the past had an influence on the knowledge of interviewed patients on the day of admittance. Especially elderly patients had an increase in knowledge, indicated by a higher score in the questionnaire (Table 3). Participation in patients' self-help meetings within the observation time had no influence on the knowledge. Patients with known hypertension or hyperlipoproteinemia and overweight patients could increase knowledge on the cardiovascular risk of their disease (Figure 2). CONCLUSION: The results of this query document the lack of knowledge on cardiovascular risk factors of patients before rehabilitation. Especially the results of patients with a diagnosed (and treated) CHD after an inpatient stay in an acute hospital in the past were surprising. The stationary rehabilitation is an appropriate measure to improve this knowledge. It can be used for secondary prevention. The raise in knowledge was evident 1 year after discharge; a long-term effect of health education during stationary rehabilitation is likely.