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

Introduction: Intubation is most often performed electively by anaesthetists in controlled conditions in operating theatres. In neonates, however, it is most often performed by neonatologists or paediatricians in urgent circumstances in the neonatal intensive care unit (NICU) or delivery room (DR). Neonatal intubation is a difficult skill to learn and maintain, and success rates are suboptimal both in the NICU and DR. Video laryngoscopy (VL) has the potential to increase intubation success and safety as it may offer a better view of the airway, which can be shared by the intubator and other clinicians.

Objectives: To compare the efficacy and safety of using VL to direct laryngoscopy (DL) for intubation of neonates in the NICU and DR.

Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL up to August 2024 without language restrictions.

Selection criteria: Randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs or cross-over trials that compared VL to DL for intubation of neonates outside of the neonatal operating theatre.

Main results: VL improves first attempt intubation success rates, 849 intubations (RR 1.46, 95% CI 1.21 to 1.75), with a number needed to treat (NNT) of 6.

Conclusions: VL improves intubation success rates without increasing adverse events and should be the standard of care for neonatal intubations in the NICU and DR.

Objective: To conduct a systematic review of barriers and facilitators to the practice of neonatal Family Integrated Care (FICare) from the perspective of healthcare professionals (HCPs).

Design: A systematic search strategy was developed to identify qualitative studies exploring neonatal HCPs' views of any of the principles of FICare. Six literature databases (CINAHL, (Cumulated Index in Nursing and Allied Health Literature) Embase, Medline, PsycINFO, Scopus, Web of Science) were searched using the terms Healthcare Professionals, Neonatal, Environment, FICare, Education, Well-being, Culture, Partnership and Empowerment. Studies meeting the inclusion criteria were thematically analysed.

Results: 11032 titles and abstracts and 85 full-text papers were screened. Thirty-seven studies met the inclusion criteria and reported interviews with 1243 HCPs, predominantly nurses. Three themes were synthesised in relation to barriers and facilitators: (1) 'advocacy and acknowledgement', whereby HCPs are expected to advocate for the emotional and mental health of the whole family, not solely the baby's needs; (2) 'belief and behaviour', whereby the degree to which FICare is practised is dependent on HCPs' belief in its benefits in relation to other activities; (3) 'conditions and consistency', whereby a lack of space, resources, policy and consistent practice of FICare created apathy and contradictory approaches to care.

Conclusion: Although HCPs see value in FICare, successful implementation is multifactorial and requires the expectation to deliver FICare to be aligned with resourcing at the hospital, team and individual levels. Shifting the practice paradigm to FICare remains challenging for some HCPs. Greater understanding of HCPs' views on barriers, facilitators and how FICare practice impacts individuals is required.

Objective: To investigate the effect of alcohol-impregnated port protectors (AIPPs) on neonatal central line-associated bloodstream infection (CLABSI) rates.

Design: A quality improvement study.

Setting: A tertiary neonatal unit in the UK.

Patients: Babies >72 hours of age with a central line.

Intervention: AIPPs were applied to intravascular access ports not allocated for fluid infusion from March 2018 to February 2020. Daily audits were performed for 3 months postimplementation, with quarterly audits thereafter.

Main outcome measures: CLABSI rates were calculated preimplementation and postimplementation with a 3-month washout period (March-May 2018). Logistic regression was used to analyse the risk of CLABSIs between periods, adjusting for important differences between cohorts.

Results: There was no difference in overall CLABSI rates per 1000 central lines days between the preimplementation and postimplementation periods (5.5 vs 6.6, p=0.5). However, rates of CLABSI involving confirmed pathogens rather than coagulase-negative Staphylococcus (CoNS) were higher postimplementation (0.5 vs 2.7, p=0.012). After adjusting for birth weight, gestational age at birth, gender, central line duration and length of stay, there were no significant differences in the overall risk of CLABSI between the two periods (OR 1.05, 95% CI 0.57 to 1.91, p=0.886) or the risk of CLABSI involving pathogens (OR 3.54 95% CI 0.77 to 16.06, p=0.102) or CoNS (OR 0.76 95% CI 0.39 to 1.46, p=0.406).

Conclusions: AIPPs did not result in reduced CLABSI rates. The use of AIPPs cannot currently be recommended.

Objective: To evaluate growth of the triceps surae muscle over the first 12 months of life in neonatal intensive care unit (NICU) graduates compared with typically developing (TD) infants.

Design: Longitudinal, prospective study.

Participants: Sixty-one infants, n=24 TD (15 male) and n=37 NICU graduates designated as intermediate-risk (NICU-IR; n=14, 9 male) or higher-risk (NICU-HR; n=23, 11 male) based on additional risk factors (including <28 weeks gestational age; <1000 g; neonatal encephalopathy; abnormal neuroimaging; small for gestational age).

Outcome measures: Sequential assessments at corrected ages 3, 6 and 12 months of muscle volume (freehand three-dimensional ultrasound) and gross motor development (Peabody Developmental Motor Scale-2, Gross Motor Quotient (GMQ)). Linear mixed models analysed muscle volume trajectories.

Results: Triceps surae growth trajectories differed significantly by group (p<0.001). Between 3 and 12 months, triceps surae increased on average by 18.1 cm³ (95% CI 16.1 to 20.2 cm³), 13.3 cm³ (10.6 to 16.0 cm³) and 12.5 cm³ (10.5 to 14.6 cm³) in TD, NICU-IR and NICU-HR infants, respectively. Soleus was significantly smaller at 6 and 12 months for both NICU groups, and lateral gastrocnemius was smaller at 12 months for NICU-HR (p<0.001). At 12 months of age, 8% of NICU infants and 30% of the TD infants were walking, the GMQ was >90 in all TD infants, and all but 5 (14%) NICU infants. Muscle volumes at 12 months were positively associated with both gestational age and birth weight.

Conclusion: Reduced soleus growth from 3 to 12 months led to a 25% smaller triceps surae muscle at 12 months in NICU graduates.

Objective: To compare neurodevelopmental outcomes in extremely preterm (EPT) children born across two epochs in Sweden.

Design and setting: Nationwide population-based cohorts of infants born at 22-26 weeks' gestation in 2004-2007 (Cohort 1) and 2014-2016 (Cohort 2), comprising 1606 live births. Survivors were assessed at 2-2.5 years' corrected age using the same protocol design.

Main outcome: The primary outcome was neurodevelopmental impairment (NDI), defined as a composite of moderate-severe cerebral palsy (CP), visual or hearing deficits, or moderate-severe cognitive, language or motor impairment assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III). For children not assessed with Bayley-III, NDI was defined as moderate-severe speech delay, general developmental delay or categories of CP, vision and hearing impairment. Outcomes were compared using logistic regression to evaluate differences between cohorts and perinatal and socioeconomic risk factors.

Results: Of 1188 eligible survivors, 1062 (89.3%) were assessed (mean gestational age (GA) 24.8 weeks; 54.9% male). The prevalence of moderate-severe NDI at 22, 23, 24, 25 and 26 weeks' gestation was 60% vs 52%, 51% vs 51%, 34% vs 42%, 27% vs 32% and 17% vs 24% in Cohorts 1 and 2, respectively. Overall prevalence did not differ significantly (27% vs 35%; adjusted OR (AOR) 1.2, 95% CI 0.94 to 1.6). Among 724 (68%) children assessed with Bayley III, Cohort 2 had higher rates of cognitive delay (21.6% vs 11.3%; AOR 1.8, 95% CI 1.1 to 3.4) and language delay (40.9% vs 16.1%; AOR 3.3, 95% CI 1.4 to 4.1). Low GA and maternal country of birth outside the Nordic region were the strongest predictors of NDI and cognitive delay, the latter association confined to Cohort 2.

Conclusion: Although survival of EPT infants in Sweden has improved, long-term neurodevelopmental outcomes have not. The root causes of failed improvements in long-term outcomes for EPT infants are complex and need further clarification.

Background: Ketones and lactate may contribute towards overall cerebral fuel availability in term infants, yet the availability of such cerebral fuels in very preterm infants is unclear. We undertook a prespecified substudy to explore ketone and lactate concentrations in the first week of life in infants recruited to the REACT trial (real-time continuous glucose monitoring in the newborn): an international multicentre randomised controlled trial of 182 very low birth weight infants investigating the use of continuous glucose monitoring in glycaemic care.

Methods: Ketone and lactate measurements were prospectively collected over the first week of life using the Nova Biomedical point-of-care meter. A longitudinal analysis was undertaken to explore lactate and ketone concentration trends across time and their relationships with blood glucose, baseline demographics, nutritional support and insulin treatment.

Results: Data were available for 168 infants (85 females) including 2902 blood glucose, 2084 ketone and 2017 lactate samples. The mean (SD) gestational age was 27.4 (2.0) weeks. Lactate concentrations were higher initially, with mean (SD) 1.72 (1.26) mmol/L on day 2 and lowered to 1.19 (1.1) mmol/L on day 7. Ketone concentrations remained consistently low at 0.1 mmol/L. Neither simultaneous blood glucose concentrations, macronutrient intake nor receipt of insulin was consistently related to ketone or lactate concentrations.

Conclusion: In this cohort of very preterm infants, there were persistently low concentrations of ketones and relatively higher concentrations of lactate throughout the first week of life. Future research should evaluate changes in these metabolites during episodes of acute hypoglycaemia or hyperglycaemia over more prolonged periods of neonatal intensive care.

Objective: To explore families' experiences of hypoxic ischaemic encephalopathy (HIE) care in the National Health Service (NHS) and the impact of HIE on families.

Design: Semistructured interviews (n=28) sampled to maximise variation, were conducted with parents of infants (born 2010-2024) who underwent therapeutic hypothermia for HIE. Data were analysed with reflexive thematic analysis.

Setting: Parents were recruited from across the UK, covering 84.6% (11/13) of the UK's regional neonatal networks, known as Operational Delivery Networks.

Findings: Three themes with eight subthemes were generated from the interview data. (1) The life-changing diagnosis of HIE: Parents described loss of stability and opportunity to parent, ongoing mental turmoil, and how the diagnosis led to transformation. (2) Balancing hope with facts: Parents opened up on how treasured their child is, the tension between hope and loss they experienced, and feelings of being kept in the dark. (3) Struggling to meet their child's needs: Parents outlined deficiencies in care infrastructure and battling disability-based discrimination.

Conclusions: This study highlights the profound and life-changing impact of HIE on families. Parents described cherishing their children and experiencing personal growth. However, many also characterised how challenges were intensified by disability-based discrimination, poor communication and gaps in support across health, education and social care systems.To prevent further trauma and to support family well-being, this work identifies priority improvement areas. Embedding trauma-informed care, strengthening transparent and sensitive communication around prognostic uncertainty, and improving care coordination will help families feel seen, heard and supported throughout their journey.