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

Objective: To evaluate the clinical impact of nasal mask ventilator-delivered positive pressure ventilation (PPV) versus face mask manual T-piece resuscitator PPV during resuscitation of preterm neonates.

Design: We conducted a pre-post cohort study in a tertiary neonatal unit, comparing consecutive neonates born 25^0/7-28^6/7 weeks of gestational age (GA) who received PPV ≤10 min after birth, before and after changing the approach during resuscitation from face mask manual T-piece resuscitator PPV (epoch 1, April 2018-April 2020) to nasal mask ventilator-delivered PPV (epoch 2, May 2020-February 2022). The association between birth epoch and the primary outcome of emergent intubation (EI) during resuscitation was examined by multivariable logistic regression and inverse probability of treatment weighting models. Additional outcomes compared between epochs were rates of advanced resuscitation, and early (≤7 days) and late (>7 days) prematurity-related morbidities.

Results: Of 545 eligible births, 336 (62%) received PPV; 176 (58%) in epoch 1 and 160 (66%) in epoch 2. Neonates in epoch 1 had lower GA (26.7 (25.9-27.9) vs 27.4 (26.0-28.1) weeks; p=0.02) but similar birth weight (900 (730-1060) vs 880 (740-1085) g; p=0.53). Neonates in epoch 2 had lower rates of EI (16% vs 44%; p<0.001) and less use of post-resuscitation invasive ventilation (22% vs 59%; p<0.001). After accounting for confounders, nasal mask ventilator-delivered PPV remained associated with lower odds of EI (adjusted OR 0.23 (95% CI 0.13 to 0.42)). Secondary outcomes were similar between groups.

Conclusion: Nasal mask ventilator-delivered PPV may reduce EI during resuscitation of preterm neonates. Our observations support a large trial of nasal mask ventilator-delivered PPV in this context.

Objective: To assess the association between histological chorioamnionitis without maternal clinical symptoms and neurodevelopmental disabilities at age 5 years in children born very preterm.

Design: French national prospective population-based cohort study, EPIPAGE-2 (Etude épidémiologique sur les petits âges gestationnels).

Setting: All births from 22 to 34 weeks of gestational age in France in 2011 were eligible.

Population: Infants born alive between 24⁺⁰ and 31⁺⁶ weeks following preterm labour (PTL) or preterm premature rupture of membranes (PPROMs).

Exposure: Histological chorioamnionitis without maternal clinical symptoms, also called isolated histological chorioamnionitis, was defined as the presence of neutrophils in the chorionic plate, excluding clinical chorioamnionitis.

Main outcome measures: Neurodevelopmental disabilities, a composite outcome including cerebral palsy, developmental coordination disorders, sensory impairment, developmental cognitive deficiencies or behavioural difficulties. These assessments were comprehensive, standardised and conducted by trained neuropsychologists and paediatricians at age 5 years.

Results: Among 1296 children alive at 5 years of age, 486 (36.3%) were born in a context of isolated histological chorioamnionitis. Overall, 47% vs 33.6% of children exposed and not exposed to isolated histological chorioamnionitis had mild neurodevelopmental disabilities, and 13.8% vs 13.3% had moderate-to-severe neurodevelopmental disabilities. After multiple imputation and multivariable analysis, isolated histological chorioamnionitis was found not to be associated with the occurrence of mild or moderate-to-severe neurodevelopmental disabilities (adjusted OR: 1.0, 95% CI: 0.7 to 1.4 and 0.9, 0.6 to 1.2).

Conclusion: We did not find any association between isolated histological chorioamnionitis and neurodevelopmental disabilities at age 5 years in children born very preterm after PTL or PPROM.

Background: Skin antisepsis is one of the most important bundle measures to decrease central line-related bloodstream infections (CRBSIs). However, in the neonatal population, the use of alcoholic chlorhexidine is limited by the risk of skin lesions.

Objective: We hypothesised that skin antisepsis with alcohol-based 2% chlorhexidine instead of aqueous 2% chlorhexidine could reduce the incidence of CRBSI without increasing skin complications.

Design: We conducted a double cohort study comparing two periods of 3 years, first using aqueous and second using alcohol-based chlorhexidine, leaving a 1-year washout interval between them. In extremely preterm infants, aqueous chlorhexidine was used during the first week of life in both periods.

Results: A total of 1783 patients and 2493 episodes of central line catheter were analysed. There were no statistically significant differences in clinical and demographic data from infants in both periods. There was a significant reduction in the pooled incidence density of CRBSI in the second compared with the first period (4.03 vs 9.05 episodes/1000 central line days, OR 0.45 (95% CI 0.29 to 0.68)). The overall absolute risk reduction was 0.039 (95% CI 0.023 to 0.056) and the number needed to treat was 25. A similar but not significant reduction of the small number of CRBSI was observed in extremely preterm infants within the first week of life OR 0.43 (95% CI 0.134 to 1.379). No statistically significant differences in skin lesions were observed between periods, making erythema the most common injury(5.1% vs 4.2%).

Relevance: Alcohol-based 2% chlorhexidine as a skin antiseptic could reduce the incidence of CRBSI in neonates without producing an increase in skin lesions.

Background: Children born with congenital diaphragmatic hernia (CDH) are at risk of poor developmental outcomes. This study aimed to clarify the motor and functional characteristics of school-age CDH survivors and identify perinatal factors associated with motor function deficits.

Methods: Motor function was comprehensively assessed in CDH survivors aged 6-10 years (CDH group, n=24) and in age- and sex-matched controls (n=72). Assessments included physical activity time, grip strength, the five times sit-to-stand test, one-leg standing time, 6 min walking distance and gait ability using a three-dimensional gait analysis. In the CDH group, correlations between perinatal factors and motor function outcomes were analysed.

Results: In the CDH group, all children had isolated CDH. Three were extracorporeal membrane oxygenation (ECMO) treated and 21 were non-ECMO treated. The CDH group exhibited shorter stature, lower weight and reduced physical activity time than the controls. They also showed significantly lower grip strength, longer five times sit-to-stand test time, shorter one-leg standing time and decreased 6 min walking distance. No significant differences were found between the two groups regarding walking speed, step length or Gait Deviation Index. Within the CDH group, a higher observed-to-expected lung area-to-head circumference ratio (o/e LHR) was positively correlated with better grip strength.

Conclusions: School-age survivors of CDH are at risk of impaired motor function. Particularly, grip strength measurement is crucial for those born with a low o/e LHR. Implementing follow-up and intervention programmes focused on improving limb muscle strength, balance, and endurance, and promoting adequate physical activity may enhance motor function.

Objectives: Standardised reporting of outcomes in neonatal palliative and/or end-of-life care would facilitate comparison of practice and lead to more informed decisions about practice. We systematically reviewed evidence evaluating outcomes currently used to characterise the clinical provision of palliative and/or end-of-life care in neonatal settings.

Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken using Ovid Medline, Ovid Embase, OVID PsycINFO, OVID MIDIRIS and EBSCOhost CINAHL. No date or language restrictions were used. Studies were included if they measured or reported outcomes related to the clinical practice of neonatal palliative care in a neonatal unit.

Results: Of 7998 records identified through database searching, 20 articles were included. Identified studies were retrospective chart reviews. No studies used standardised outcomes and all used proxy outcome measures. Results were organised according to the WHO domains of paediatric palliative care. All studies (n=20) reported documentation of physical symptoms and functional status (physical domain); six documented parental emotional and support needs (psychological domain); four reported sibling support and wider family presence (social and cultural domain), and three reported support from spiritual services (spiritual domain).

Conclusion: Despite neonatal death accounting for the largest category of child death under 5 years of age, there are no standardised outcomes from which to characterise or develop clinical practice. Developing a core outcome set for neonatal palliative and end-of-life care would ensure that services can be compared using reliably collected and collated data and help advance care in this area.

Objective: To ascertain the sociodemographic and geographical determinants of exclusive and no mother's own milk (MOM) feeding for infants <34 weeks' gestational age (GA) in England and Wales.

Study design: Retrospective cohort study using the National Neonatal Research Database (2016-2022). We calculated unadjusted and mutually adjusted ORs for exclusive and no MOM feeding throughout an infant's neonatal stay, by maternal age group, ethnicity and deprivation quintile. Neonatal Operational Delivery Network and unit were included as random effects, and the adjusted models included other potential confounders such as gestational age and mode of delivery.

Results: Among the 90 730 infants, 11 962 (13.2%) were exclusively MOM fed, while 9018 (9.9%) never received MOM. The odds of exclusive MOM feeding increased with decreasing maternal social deprivation (OR for least deprived vs most deprived quintile 2.16, 95% CI 2.01 to 2.33), while the odds of no MOM decreased (OR 0.33, 95% CI 0.30 to 0.36). The odds of exclusive MOM feeding were lower for Asian/Asian-British mothers compared with white mothers (OR 0.88, 95% CI 0.82 to 0.95). The odds of never receiving MOM were lower for Black, Asian and mixed ethnicities compared with white mothers. Infants of mothers aged 26-35 years had the highest odds of exclusive MOM feeding. There was a geographical variation in feeding practices with a north-south divide in the prevalence of never receiving MOM. There was a significant variation in feeding practices between neonatal units.

Conclusion: Provision of MOM to preterm infants in England and Wales is associated with maternal sociodemographic characteristics.