Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants.

OBJECTIVE: To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants. STUDY DESIGN: Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence. RESULTS: The percent time within the target range was higher during A-FiO2 compared with M-FiO2 control. This effect was more pronounced in the lower SpO2 target range (62 ± 17% vs 54 ± 16%, P < .001) than in the higher SpO2 target range (62 ± 17% vs 58 ± 15%, P < .001). The percent time spent below the target or in hypoxemia (SpO2 <80%) was consistently reduced during A-FiO2, independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO2 >98%) was only reduced during A-FiO2 when targeting the lower SpO2 range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO2 control. CONCLUSIONS: A-FiO2 control improved SpO2 targeting across different SpO2 ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support. TRIAL REGISTRATION: ISRCTN 56626482.

THE CONSEQUENCES OF FAILING ELECTIVE NONINVASIVE RESPIRATORY SUPPORT AS COMPARED TO IMMEDIATE INTUBATION: A POPULATION STUDY OF VERY LOW BIRTH WEIGHT NEONATES.

INTRODUCTION: Elective noninvasive respiratory support has become common. However, many neonates fail this procedure and they may require intubation. The aim of this study was to determine the relative outcome of very low birth weight neonates who failed noninvasive respiratory support compared to those that were initially intubated and mechanically ventilated. MATERIAL AND METHODS: We accessed the database of every neonate who received respiratory support in 18 hospitals in the central region of Poland and examined the records for a 7-year period. The evaluation encompassed 1667 neonates with very low birth weight who were potential candidates for elective noninvasive respiratory support. Three prospective primary outcome measures were assessed using logistic regression to control for differences in baseline risk. We also examined the length of respiratory support corrected for EGA. RESULTS: After controlling for significant baseline factors, we found that there was no statistically significant difference in mortality, severe retinopathy of prematurity (ROP) orsevere bronchopulmonary dysplasia (BPD) between infants failing noninvasive respiratory support and those electively intubated. However, their mortality and severe ROP were significantly higher than in those successfully treated with noninvasive respiratory support. Additionally, there was no difference in the length of mechanical ventilation or the length of all respiratory support between those that failed noninvasive support and those that were electively intubated. CONCLUSION: Our study suggests that in those preterm infants who are at a higher risk of failing noninvasive ventilation there is no compelling reason to administer elective intubation and mechanical ventilation immediately after birth. It seems that efforts should rather be made towards the implementation of the optimal non-invasive respiratory support.

USING THE AUTOMATED FIO2- SPO2 CONTROL IN NEONATAL INTENSIVE CARE UNITS IN POLAND. A PRELIMINARY REPORT.

AIM: Analysis of the way in which a new method of implementing the automated control of oxygen therapy during respiratory support is applied in newborns with respiratory failure. MATERIAL, METHODS AND RESULTS: The AVEA-CLiO2 ventilator with automated FiO2- SpO2 control was used in our study of 121 newborns conducted between February 2014 and January 2015 in five neonatal intensive care units. A web-based database was used to gather information entered concurrently with using the FiO2- SpO2 control system. This included demographics, clinical status, clinical indications, as well as objective and subjective experience. Among the 121 newborns 94 were preterm and 27 were near-term (33-36 hbd). The primary indication for using the system was "routine management" of FiO2 during respiratory support and it was generally initiated within the first 2 days of life. Many of the newborns were managed with the system for more than a week. The control range was usually 90%-95% SpO2, though sometimes it was lower or wider. The control range was not related to the newborn's maturity or indication for use. The perception of more "frequent and persistent" SpO2 alarms was lower when the alarms were set loosely. There were no reports of the system not working effectively. CONCLUSIONS: We expect this first report of the routine use of automated FiO2- SpO2 control to be useful not only to other centers in Poland but also to all those adopting this important new technology. Our registry continues and we expect to have an update when we have experience with 1000 infants. Carefully controlled trials are also needed to refine the optimum use of automated FiO2- SpO2 control and to quantify its impact on neonatal outcomes.

Automated FiO2-SpO2 control system in neonates requiring respiratory support: a comparison of a standard to a narrow SpO2 control range.

BACKGROUND: Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues of training, but also the realities of staffing levels and demands. The potential for automatic control is becoming a reality. Results from the evaluation of different systems have been promising and our own experience encouraging. METHODS: This study was conducted in two tertiary level newborn nurseries, routinely using an automated FiO2-SpO2 control system (Avea-CLiO2, Yorba Linda CA, USA). The aim of this study was to compare the performance of the system as used routinely (set control range of 87-93% SpO2), to a narrower higher range (90-93%). We employed a 12-hour cross-over design with the order of control ranges randomly assigned for each of up to three days. The primary prospectively identified end points were time in the 87-93% SpO2 target range, time at SpO2 extremes and the distribution of the SpO2 exposure. RESULTS: Twenty-one infants completed the study. The infants were born with a median EGA of 27 weeks and studied at a median age of 17 days and weight of 1.08 kg. Their median FiO2 was 0.32; 8 were intubated, and the rest noninvasively supported (7 positive pressure ventilation and 6 CPAP). The control in both arms was excellent, and required less than 2 manual FiO2 adjustments per day. There were no differences in the three primary endpoints. The narrower/higher set control range resulted in tighter control (IQR 3.0 vs. 4.3 p < 0.001), and less time with the SpO2 between 80-86 (6.2% vs. 8.4%, p = 0.006). CONCLUSIONS: We found that a shift in the median of the set control range of an automated FiO2-SpO2 control system had a proportional effect on the median and distribution of SpO2 exposure. We found that a dramatic narrowing of the set control range had a disproportionally smaller impact. Our study points to the potential to optimize SpO2 targeting with an automated control system.

A multicenter randomized controlled trial comparing effectiveness of two nasal continuous positive airway pressure devices in very-low-birth-weight infants.

OBJECTIVE: Many studies suggest nasal continuous positive airway pressure is an effective and relatively complication-free means of respiratory support in premature infants. However, only limited data exist regarding the practical aspects of nasal continuous positive airway pressure delivery, including the best way to provide the positive airway pressure. DESIGN: Our aim was to compare the results of treatment using two different nasal continuous positive airway pressure devices: variable flow Infant Flow and constant flow nasal continuous positive airway pressure in two different groups of very-low-birth-weight infants in a multicenter randomized controlled trial. The indication groups were elective to avoid intubation and weaning from mechanical ventilation. SETTING: Twelve leading tertiary care neonatal centers in Poland. PATIENTS: Among 276 infants (weighing between 750-1500g, with a gestational age ≤32 wks) enrolled, 51% were randomized to receive Infant Flow and 49% to receive constant flow nasal continuous positive airway pressure. MEASUREMENTS AND MAIN RESULTS: Treatment success (i.e., no need for intubation/reintubation) occurred in 75% of our patients with a nonstatistically significant advantage seen with Infant Flow. The incidence of severe nasal complications and necrotizing enterocolitis were statistically significantly lower in the infants treated with Infant Flow. In our study, factors associated with elective nasal continuous positive airway pressure failure were birth weight ≤1000 g, gestational age ≤28 wks, clinical risk index for babies score >1, and PaO(2)/FIO(2) ratio of <150. Only birth weight ≤1000 g was associated with weaning failure. CONCLUSIONS: We found fewer severe nasal complications but no statistically significant advantage in treatment success in infants assigned to Infant Flow nasal continuous positive airway pressure compared with those assigned to constant flow nasal continuous positive airway pressure treatment. Significant risk factors of treatment failure include small size, maturity, and severity of respiratory distress syndrome.

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.

Comparative study of clinical characteristics of amniotic rupture sequence with and without body wall defect: further evidence for separation.

BACKGROUND: Amniotic rupture sequence (ARS) is a disruption sequence presenting with fibrous bands, possibly emerging as a result of amniotic tear in the first trimester of gestation. Our comparative study aims to assess whether there is a difference in the clinical pattern of congenital limb and internal organ anomalies between ARS with body wall defect (ARS-BWD) and ARS without BWD (ARS-L). METHODS: Among 1,706,639 births recorded between 1998 and 2006, 50 infants with a diagnosis of ARS were reported to the Polish Registry of Congenital Malformations. The information on 3 infants was incomplete, thus only 47 cases were analyzed. These infants were classified into groups of ARS-L (38 infants) and ARS-BWD (9 infants). RESULTS: The ARS-BWD cases were more frequently affected by various congenital defects (overall p < 0.0001), and in particular by urogenital malformations (p = 0.003). In both groups, limb reduction defects occurred in approximately 80% of cases; however, minor and distal limb defects (phalangeal or digital amputation, pseudosyndactyly, constriction rings) predominated in the ARS-L group (p = 0.0008). The ARS-L group also had a higher frequency of hand and upper limb involvement. CONCLUSIONS: This observation suggests that amniotic band adhesion in ARS-L takes place at a later development stage. Although limited by a small sample size, our study contributes to the growing evidence that both ARS entities represent two nosologically distinct conditions.

Introduction of Infant Flow nasal continuous airway pressure as the standard of practice in Poland: the initial 2-year experience.

OBJECTIVE: The aim of this prospective study was to evaluate whether a change in the standard of newborn care for respiratory insufficiency by widely introducing more aggressive use of nasal continuous airway pressure (nCPAP) and including Infant Flow technology would result in satisfactory outcomes. DESIGN: Prospectively defined analysis. SETTING: Fifty-seven secondary and tertiary care neonatal centers in Poland. PATIENTS: Patients were 1,299 newborns. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We carried out a prospectively defined analysis of 1,299 newborns included in the program between August 1, 2003, and April 30, 2005. The inclusion criterion was the occurrence of symptoms of respiratory failure irrespective of its etiology. Respiratory support was provided with the use of the Infant Flow Advance Driver. The analysis was made on data from prospectively designed questionnaires completed following each infant's treatment. Infants were placed into categories based on clinical indication for use. The primary end point was avoiding tracheal intubation. A high rate of acceptance of the new practice was observed across the substantial demographic and clinical diversity of newborns. Tracheal intubation was avoided in 78% of infants treated electively with nCPAP. Of those being weaned from mechanical ventilation, 61.2% were successfully weaned. Related complications were low (1.4% pneumothorax, 12% nasal injuries). CONCLUSIONS: The new method of nCPAP with Infant Flow was adopted as standard practice in Poland. We monitored its safety and effectiveness over a 2-yr period and found it to be safe and effective as implemented. Additional research is still needed to determine the optimum patient population, strategy for use, and devices.

[Microdialysis: its application in experimental and clinical studies of disturbances in tissue metabolism]. / Mikrodializa--zastosowanie metody w badaniach eksperymentalnych i klinicznych zaburzen metabolizmu tkanek.

Homeostasis of human and animal organisms and its disturbance are explored mainly by evaluating metabolic substrates and metabolite concentrations and their changes under different clinical conditions. This review describes a method of tissue biochemistry monitoring by analysis of extracellular fluid dialysate. Microdialysis not only provides information about the general disturbances of the body, but allows insight into the local metabolism of tissues and organs. It can be applied both in experimental conditions (e.g. animal neurophysiology) and in clinical practice (episodes of brain ischemia, glycemic disturbances, pharmacodynamic studies). The technique of microdialysis is relatively simple and is based on microdialysis probe implantation into the studied organ or tissue, followed by measurement of the obtained samples of extracellular fluid dialysate. During the last twenty years, microdialysis probes have been inserted into different part of the living organism: brain, skeletal muscles, subcutaneous adipose tissue, transplanted tissues (myocutaneous flap) and organs (liver), tendons, skin, breast gland, lungs, heart muscle, intestines, and body cavities. The possibility of frequent sampling (every 20-60 minutes) and measuring the concentrations of glucose, glycerol, lactates, and pyruvates with a bedside analyzer in an average time of 2-3 minutes is considered a great advantage of this method. Microdialysis gives many opportunities for a better understanding of how living organisms are functioning, but it requires cautious application and validation in clinical observations in order to make standards and recommendations (diseases and clinical conditions, substances for monitoring, referenced values and trends) for its common medical usage.

Trisomy 18 in neonates: prenatal diagnosis, clinical features, therapeutic dilemmas and outcome.

The study aimed to analyse the clinical courses of aggressively treated neonates with cytogenetically confirmed trisomy 18, with special attention focused on the efficiency of prenatal diagnostics, associated malformations, therapeutic dilemmas and outcomes. We investigated retrospectively the data concerning 20 neonates with trisomy 18, admitted to the Neonatal Intensive Care Unit (NICU) in Katowice between January 2000 and February 2005. Their birth weights ranged from 650 g to 2400 g, mean 1812 g; gestational age ranged from 27 to 42 weeks, median 38 weeks. Intrauterine growth retardation was noticed in 90% of neonates. Trisomy 18 was suspected prenatally in 40% of cases. Most (80%) of newborns were delivered by caesarean section (92% of neonates with prenatally unrecognized chromosomal defects, 62% of neonates with trisomy 18 suspicion) and 70% of infants needed respiratory support immediately after birth. Cardiac defects were present in 95%, central nervous system malformations in 65%, severe anomalies of digestive system or abdominal wall in 25% of patients. Nine surgical operations were performed during hospitalization (4 were palliative cardiac surgeries). Six patients (30%) survived the neonatal period and were discharged from the NICU. The median survival of the neonates who died was 20 days. In 4 cases cardiac problems implicated their death; in others, deaths were attributed to multiorgan failure, prematurity and/or infection. Further improvement of efficiency of prenatal ultrasound screening for diagnosis of trisomy 18 in the fetus is necessary. A lack of prenatal diagnosis of trisomy 18 in the fetus results in a high rate of unnecessary caesarean sections in these pregnancies. Despite the aggressive treatment most neonates with trisomy 18 died during the neonatal period. The majority of deaths were attributed to cardiorespiratory and multiorgan failure. Concerning the poor prognosis, prompt karyotyping (using FISH) of clinically suspected trisomy 18 is very important, because many invasive procedures and surgeries may then be avoided.

[Posthaemorrhagic hydrocephalus in newborns--current concepts of formation and treatment possibilities]. / Wodoglowie pokrwotoczne u noworodków --wspólczesne poglady na temat mechanizmów powstawania i mozliwosci leczenia.

Intracranial haemorrhage is still one of major complications of preterm birth. Transfontanel ultrasonographic examination is a recognized method of peri/intraventricular haemorrhage imaging. Haemorrhages are distinguished according to four degrees Papile classification. Early diagnosis of posthaemorrhagic hydrocephalus is a very important task for neonatologist. Traditional clinical symptoms of ventricular expansion are useless criteria for posthaemorrhagic hydrocephalus diagnosis. Early diagnosis of posthaemorrhagic hydrocephalus is possible with ultrasonographic measurement of ventricular size--for example with ventricular index of Levine. There are four mechanisms responsible for posthaemorrhagic hydrocephalus formation: blockage of cerebro-spinal fluid circulation and its absorption, fibrosis and scarring around the medulla and in subarachnoid spaces and endogenic fibrinolytic mechanisms insufficiency. Authors decribe current known and used methods of neonatal and neurosurgical interventions in posthaemorrhagic hydrocephalus, as well as a new method involving drainage, irigation and fibrinolytic therapy (DRIFT), which seems to be promising in clinical neonatal care.

Quicker response results in better SpO2 control - a comparison of 3 FiO2-titration strategies in ventilated preterm infants.

INTRODUCTION: The impact of SpO2 target ranges (TR) has been carefully studied; however, reports suggest a wide variation among infants and centres in maintaining the intended range. Little is known about the effectiveness of different approaches to manual control. Auto-SpO2 controllers are now available which show promise. OBJECTIVE: The aim was to compare two different protocol-driven manual strategies with different response requirements to each other, and a faster automated system (AveaCLiO2, Yorba Linda, CA, USA). MATERIALS AND METHODS: In a crossover design, each of the three FiO2/SpO2 approaches was implemented in three randomly assigned consecutive 2.5-hour runs. The two manual strategies (Attentive and Observational) were implemented by a trained operator. The primary endpoints were time in 1) SpO2 TR, 2) < 80% SpO2 and 3) >98% SpO2. RESULTS: Fifteen studies were completed. All three approaches resulted in good control, with time in the target range >60%. CLiO2 use reflected reduced exposure at the two SpO2 extremes. Post hoc analysis determined that the differences were more marked in the infants with more frequent desaturations. Likewise, in this group, the Attentive strategy performed better than the Observative. CONCLUSIONS: All three approaches provided excellent control of SpO2 in infants with infrequent desaturations, significantly better than typical routine care. In hard to manage infants with frequent desaturations, faster response appeared to result in better control. The potential of automating the tedious error prone FiO2 adjustment offers significant promise. If manual titration of FiO2 is to remain the usual method of care, additional studies are needed to identify optimal approaches.

[The genetic basis of childhood nephrotic syndrome]. / Podloze genetyczne zespolów nerczycowych u dzieci.

Great progress has been made of late in understanding the mechanisms of proteinuria, the structure and function of the slit diaphragm, and the genetic background of congenital nephrotic syndromes in new borns and infants. This paper presents recent achievements of molecular genetics in unraveling the causes of inherited disorders, e.g. Finnish-type nephrotic, Denys-Drash and Frasier's syndromes, as well as sporadic focal-segmental glomerulosclerosis. A change in the routine policy used in evaluating the causes of childhood nephrotic syndrome is discussed.

[Intestinal colonization of newborns treated in intensive care units by multiple drug resistant microorganisms]. / Zasiedlanie wieloopornymi drobnoustrojami szpitalnymi przewodu pokarmowego noworodków leczonych w oddzialach intensywnej terapii.

The aim of the study was to examine the digestive tract colonisation of the newborns by multiple drug resistant bacteria during hospitalization. On the day of admission, after 5 days of hospitalization and at the day of discharge swabs from the anus of the 31 newborns hospitalized in OITiPN were taken and cultured on nutrient and selective media for staphylococci, enterococci, gram negative bacilli and fungi. Susceptibility to antibiotics of bacteria was determined, with giving attention to such resistance mechanisms as: methicillin resistant staphylococci (MRS), high level aminoglycoside resistant (HLAR) and vancomycin resistant enterococci (VRE) and the production of extended spectrum beta-lactamases (type ESBL) by gram negative bacilli. On the day of admission in 7 newborns methicillin resistant staphylococci (MRSCN) were grown in 24 no multiple drug resistant bacteria were found. Among those in 23 already after 5 days of hospitalization, colonization by multiple drug resistant strains was determined: coagulase-negative methicillin resistant staphylococci (MRSCN) were found in 16 children, strains of enterococci (HLAR) in 3 newborns and gram negative ESBL (+) bacilli also in 3 cases. On the day of discharge from hospital (after 13-141 days) in 23 out of 24 newborns enteric tract colonization by multiple drug resistant strains was assessed. In the enteric tract of 3 newborns hospitalized up to 2 weeks coagulase-negative methicillin resistant staphylococci (MRSCN) and/or HLAR enterococci were found; gram negative bacilli that produce ESBL appeared in newborns hospitalized for longer than 14 days. They were isolated in 12 out of 21 newborns. Forming of the enteric tract bacterial flora of the long hospitalized newborns depends on the time of hospitalization as well as on the used therapy.

[The intensity of metabolic acidosis and serum lactate concentrations in relation to illness severity evaluated by SNAP in newborns admitted to intensive care unit]. / Ocena nasilenia kwasicy metabolicznej i stezenia mleczanów w zaleznosci od stanu klinicznego okreslonego w skali SNAP u noworodków przyjmowanych do oddzialu intensywnej terapii.

Some authors questioned the prognostic value of indicators of metabolic acidosis (pH, HCO3, BE). On the other hand, the elevated serum lactates are considered to be sensitive markers of anaerobic metabolism in peripheral tissues with significant predictive value. The aim of the study was to analyse the relationship between SNAP index and serum lactates as well as the markers of metabolic acidosis in newborns treated in intensive care unit (ICU). 173 newborns up to the 72 hour of life admitted to the ICU were enrolled into the study. Mean birth weight was 2045 +/- 808 grams, mean gestational age--35 +/- 4 weeks. SNAP (evaluated on the first day of hospitalization) ranged from 0 to 41 points, with the mean value of 9 points. Based on the SNAP, the study group was divided into four subgroups: 0-8 points, 9-16 points, 17-24 points and more than 24 points. Observations were prolonged up to the 48 hour of hospital stay, with at least one measurement of serum lactates, blood gases and calculation of the anion gap. Elevated serum lactates were found even with the SNAP as low as 8 points, but significantly high concentration of lactates was observed in newborns with more than 24 points. Uncompensated metabolic acidosis was found in newborns with more than 9 points in SNAP. Any relationship was found between the SNAP at admission and HCO3 concentration or anion gap. Serum lactates correlated much better with the clinical status of the newborn in comparison to markers of metabolic acidosis (pH, HCO3, BE).

[Neonatal intensive care unit--therapeutical success and what next?]. / Pacjenci oddzialu intensywnej terapii noworodka--sukces terapeutyczny i co dalej?

The increasing number of successfully treated newborns with disturbances of the adaptive period can measure effectiveness of neonatal intensive care units (NICU). The authors summarized some health problems of the former NICU patients. Central nervous system (CNS) of the premature, especially low (LBW) and very low birth weight (VLBW) infant, is in serious danger of improper development. The lack of neurological disturbances in early infancy does not exclude further pathological events and such patients require long-term observation and follow-up. High-risk newborns are of great need of precise imaging and diagnosis of CNS, which should be performed before discharge. Early stimulation and developmental care program are the crucial points in the management of newborns with neurological abnormalities. Sensorial problems, especially the rate of vision and hearing impairments, can be significantly reduced when prophylactic schedule is applied. Both, etiological factors leading to respiratory insufficiency and some iatrogenic effects of the therapy, can influence respiratory system. Symptoms of different intensity--from sneezing caused by nasal mucous membrane edema to the severe forms of bronchopulmonary dysplasia (BPD)--may last for a long time and influence the child's general condition. The surgical closure of Botall's duct (persistent ductus arteriosus--PDA) usually normalizes the circulatory system. In serious heart defects or isolated shunt-type defects, the compensation of the circulatory system can easily be disturbed. Digestive tract problems belong to the two main groups: first--connected with the prematurity and immature interstitial functioning (necrotizing enterocolitis, digestive and absorption abnormalities, hepatic cholestasis), and second--caused by congenital defects requiring immediate surgical intervention. Despite different types of the diseases, the treatment and care have to be focused on necessary for the growing organism, optimal nutrients and calories uptake. Disturbances of social development, improper behavior, adaptation and emotional problems are mainly presented in VLBW patients and those with organic defects of the central nervous system.

[The post-hospital care of the newborn and infant with disturbances of the adaptation period]. / Opieka poszpitalna nad noworodkiem i niemowleciem po przebytych zaburzeniach okresu adaptacyjnego.

Medical care of the newborn or infant discharged from the neonatal intensive care unit is difficult and requires close co-operation between the primary care pediatrician and the team of specialists. The authors are trying to collect the rules of pediatric guidance of the high-risk patients to help in practical approach to such children and highlight the issues requiring special attention. The newborn should be discharged with precisely described plan of following treatment and controls. Despite careful discussion with parents on child's clinical status, many questions and daubts appear as sooll as the infant arrives home. All these problems have to be explained by the primary care pediatrician. Defining the subgroup of special care patients on the basis of perinatal and adaptive period risk factors can protect them from being "overseen" (the steadily progressing deterioration or problems occurring in the course of development). On the other hand, some non-typical symptoms are normal for these special patients and should be taken into consideration in the following evaluation of the development and recognition of changes in clinical condition. The attention is drawn to the meaning of corrected age and its use in growth monitoring and psychomotor development, and also the carefulness in recognizing mental psychomotor disability. Other problems, like early neurodevelopmental stimulation program, feeding difficulties, immunization questions and the care of children with chronic diseases are also discussed.

[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.