Archives of Disease in Childhood - Fetal and Neonatal Edition最新文献

Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis and meningitis in the UK, with an incidence of around 0.9 per 1000 live births. Early-onset disease usually results from vertical transmission during delivery, while late-onset disease is also acquired through postnatal exposures. GBS disease presents as sepsis, meningitis or pneumonia and leads to death in 6% of affected infants and long-term neurodevelopmental impairment in up to a third of survivors. The current UK prevention strategy of risk-based intra-partum antibiotic prophylaxis has several limitations, including lack of impact on disease burden in infants without associated risk factors and on late-onset disease. Ongoing studies of universal antenatal GBS screening and GBS maternal immunisations, along with a new British Paediatric Surveillance Unit surveillance study to provide updated epidemiological data will help to guide policy and practice.

Objective: To determine the impact of early rapid saline bolus during resuscitation on (1) time to achieve return of spontaneous circulation (ROSC), and (2) systemic haemodynamics, oxygenation, myocardial stress markers and pulmonary oedema.

Design: Randomised controlled trial.

Setting: Lamb delivery suite.

Subjects: Term lambs in haemorrhagic, asphyxial cardiac arrest.

Interventions: Fetal lambs were exsanguinated (~45 mL/kg) followed by umbilical cord occlusion to arrest. After 5 min of asystole, ventilation was followed by coordinated chest compressions. Asystolic lambs were randomised to epi-first (intravenous epinephrine, 0.02 mg/kg and if no ROSC, a 10 mL/kg saline bolus over 5 min), or bolus-first (10 mL/kg saline bolus over 2 min and if no ROSC, followed by intravenous epinephrine). Haemodynamics and blood gases were monitored.

Results: In the epi-first group, none of the lambs achieved ROSC after epinephrine; ROSC occurred in 11/11 lambs during or immediately after saline bolus. In the bolus-first group, none of the lambs achieved ROSC with bolus alone and 8/9 lambs had ROSC after epinephrine. Mean time to ROSC from start of resuscitation was shorter in epi-first (4.9±1.3 vs 6.6±0.9 min, p=0.004), but time to ROSC from the time of epinephrine administration was shorter with bolus-first (86±43 vs 40±21 s, p=0.004). The fetal heart rate did not change significantly despite fetal blood loss.

Conclusions: Our findings support current neonatal resuscitation guidelines of intravenous epinephrine followed by a bolus in neonates with suspected hypovolaemic arrest. Early saline bolus delays epinephrine and ROSC. Careful clinical assessment of haemodynamics in the post-resuscitation phase is critical.

Objective: To evaluate whether combining abdominal ultrasound with radiography improves diagnostic accuracy and surgical risk stratification in neonates with suspected necrotising enterocolitis (NEC) compared with radiography alone.

Design, setting and patients: Prospective cohort pilot study conducted in two tertiary neonatal intensive care units. Sixty-seven neonates with suspected NEC underwent concurrent abdominal radiography and ultrasound assessments. Imaging studies were independently reviewed by masked investigators using pre-specified criteria to classify each study as reassuring or non-reassuring.

Main outcome measures: The main outcome measure was the need for surgical intervention. Imaging data were analysed using unsupervised k-means clustering (k=2): logistic regression-testing associations with surgery and principal component analysis (PCA)-to identify imaging features most contributing to group separation.

Results: Ultrasounds were reassuring in all cases subsequently diagnosed with non-NEC, that is, feeding intolerance, whereas most radiographs in this group were non-reassuring. Clustering based on radiographs alone did not significantly discriminate surgical risk (58.8% vs 39.4%; p=0.11). Combined model (radiograph+ultrasound) produced two distinct clusters with significantly different surgical rates (78.3% vs 34.1%; OR 6.96, 95% CI 2.29 to 24.58). PCA highlighted complex ascites, absent peristalsis and abnormal bowel perfusion as key discriminating features.

Conclusion: Combining abdominal ultrasound with radiography improved the identification of neonates at high surgical risk from NEC, in our pilot study. A reassuring ultrasound reliably identified infants with feeding intolerance, suggesting potential to reduce unnecessary transfers and treatments. Larger multicentre studies are needed to validate these findings and inform development of a unified multimodal imaging score for NEC diagnosis.

Objective: To describe changes in early respiratory support for infants born at <30 weeks' gestational age (GA) in England and Wales.

Design: Retrospective cohort study using data from the National Neonatal Research Database of all infants born at <30 weeks GA, admitted to neonatal units in England and Wales from 2016 to 2021.

Main outcome measures: Methods of respiratory support used in the delivery room and days 1 and 7 of care were determined. Success of the initial non-invasive respiratory support strategy was assessed by any use of mechanical ventilation in the first 7 days of care.

Results: 24 107 babies were included. Use of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) as the highest method of respiratory support for stabilisation increased during the study period (CPAP: 17.3% to 28.8%; HFNC: 0% (first recorded in 2016) to 0.7%). CPAP use increased in the most preterm (<25 weeks GA; 0.7% to 4.8%), the extremely preterm (<28 weeks GA; 7.2% to 17.5%) and the very preterm (28-29 weeks GA; 29.3% to 44.1%) cohorts. Among those initially stabilised with non-invasive ventilation in this study, 2763 (48.0%) infants required mechanical ventilation in the first week.

Conclusions: In England and Wales, use of non-invasive respiratory support for initial stabilisation has increased among babies born at <30 weeks GA. 48% of those stabilised with non-invasive ventilation required mechanical ventilation in the first week. A higher quality evidence base for interventions that reduce mechanical ventilation could improve respiratory management in this population.

Preterm birth affects around 7-8% of pregnancies in the UK. There are immunological consequences of preterm birth, epidemiological differences in infectious diseases in the preterm population and differences in immunity after vaccination, both following immunisations received in pregnancy and following vaccines administered to infants themselves. There are also often increased concerns about the side effects experienced by preterm infants following vaccination. It is important that health care professionals and parents are fully informed about the specific issues of vaccination in this group.