Search

Aim Methods Results Conclusion Evaluate the additional burden of centralised neonatal care on families of extremely preterm infants cared for away from their planned hospital of birth.Retrospective cohort study using national data for infants 23+0 to 27+6 weeks of gestation admitted for neonatal care from 2011 to 2016. The number of transfers on the first day of life (potential maternal–infant separation), time away from the maternal booking hospital (BH) and distance from the maternal residence were quantified.Of 14 719 included infants, 2803 (19%) underwent postnatal transfer on the first day of life. A total of 8622 (59%) infants were cared for away from their BH for a median of 39 days (interquartile range [IQR] 15–69), 30% spending >60 days away over a median of two episodes (range 1–12). Median return road travelling distances for parents to their local BH was 13 km (IQR 8–26), but this increased to 74 km (IQR 32–148) for those cared for in a non‐BH.Centralised neonatal care improves infant outcomes but introduces additional burdens on the families of extremely preterm infants cared for away from their BH. Additional support, including accommodation and financial aid, could help minimise the impact on these families, facilitate family integrated care and improve parental wellbeing. [ABSTRACT FROM AUTHOR]

This article discusses a study on sound levels in the neonatal intensive care unit (NICU) and during neonatal inter-hospital transport. The authors used a mannequin model to investigate the effectiveness of passive and active noise cancellation in each setting. The study found that the original analysis underestimated the efficacy of the incubator as a barrier to noise and the efficacy of active noise-cancelling headphones. Additionally, the study suggests that the occlusion effect, where occlusion of the ear amplifies low-frequency bone-conducted sound, may be a relevant consideration for sound attenuation during neonatal transport. Further research is needed to improve the experimental model. [Extracted from the article]

Aim: A device for newborn heart rate (HR) monitoring at birth that is compatible with delayed cord clamping and minimises hypothermia risk could have advantages over current approaches. We evaluated a wireless, cap mounted device (fhPPG) for monitoring neonatal HR.Methods: A total of 52 infants on the neonatal intensive care unit (NICU) and immediately following birth by elective caesarean section (ECS) were recruited. HR was monitored by electrocardiogram (ECG), pulse oximetry (PO) and the fhPPG device. Success rate, accuracy and time to output HR were compared with ECG as the gold standard. Standardised simulated data assessed the fhPPG algorithm accuracy.Results: Compared to ECG HR, the median bias (and 95% limits of agreement) for the NICU was fhPPG -0.6 (-5.6, 4.9) vs PO -0.3 (-6.3, 6.2) bpm, and ECS phase fhPPG -0.5 (-8.7, 7.7) vs PO -0.1 (-7.6, 7.1) bpm. In both settings, fhPPG and PO correlated with paired ECG HRs (both R2  = 0.89). The fhPPG HR algorithm during simulations demonstrated a near-linear correlation (n = 1266, R2  = 0.99).Conclusion: Monitoring infants in the NICU and following ECS using a wireless, cap mounted device provides accurate HR measurements. This alternative approach could confer advantages compared with current methods of HR assessment and warrants further evaluation at birth. [ABSTRACT FROM AUTHOR]

The centralisation of neonatal intensive care in recent years has improved mortality, particularly of extremely preterm infants, but similar improvements in morbidity, such as neurodevelopmental impairment, have not been seen. Integral to the success of centralisation are specialised neonatal transport teams who provide intensive care prior to and during retrieval of high-risk neonates when in-utero transfer has not been possible. Neonatal retrieval aims to stabilise the clinical condition and then transfer the neonate during a high-risk period for patient. Transport introduces the hazards of noise and vibration; acceleration and deceleration forces; additional handling and temperature fluctuations. The transport team must stabilise the infant fully prior to transport as when on the move they are limited by space and movement to effectively attend to clinical deterioration. Inborn infants have better neurodevelopmental outcome compared with the outborn and aetiology of this seems to be multifactorial with the impact of transport itself during critical illness, remaining unclear. To improve the neurological outcomes for transported infants, it seems imperative to integrate the advancing intensive care neuromonitoring tools into the transport milieu. This review examines current inter-hospital transport neuromonitoring and how new modalities might be applied to the neurocritical care delivered by specialist transport teams. [ABSTRACT FROM AUTHOR]

The pelvic radiograph in children with cerebral palsy (CP) can inform the degree of hip displacement by calculation of the migration percentage. However, concerns have arisen about the reliability of this measurement. The present study examined the reliability of radiographic assessment of displacement and the importance of positioning and reporting experience. Two pelvic radiographs, taken at least an hour apart, were performed in 20 children (total 40 hips) in the standard position by a trained paediatric radiographer. Children (13 males, seven females) were aged 30 months to 10 years with severe bilateral spastic CP in Gross Motor Function Classification System levels IV ( n=10) and V ( n=10). The migration percentage of each hip was measured on two occasions 3 months apart by two experienced radiologists independently. Comparisons of migration percentage were made in three ways by (1) the same observer at the same time, (2) the same observer 3 months apart, and (3) different observers 3 months apart. Migration percentage (mean [SD]) was (1) 3.2% (3.5), (2) 3.3% (3.2), and (3) 3.7% (3.8) respectively. Reliable measures of migration percentage can be obtained with correct positioning and if reported by suitably experienced radiologists, making this a valid surveillance method. Clinical decisions can be made taking into account an expected error in hip displacement measurements. [ABSTRACT FROM AUTHOR]

Maternal diet during pregnancy can program an offspring's risk of disease in later life. Obesity adversely alters renal and adipose tissue function resulting in chronic kidney disease and insulin resistance, respectively, the latter associated with dysregulation of the unfolded protein response (UPR). In view of the current obesity epidemic, we explored the combined effects of in utero early- to midgestational nutrient restriction and postnatal obesity on the UPR in ovine juvenile offspring. Nutrient restriction was coincident with fetal kidney development but prior to exponential adipose tissue deposition. Nutrient restricted (NR) and normal diet (control) offspring were exposed to an obesogenic environment throughout adolescence, resulting in similar degrees of juvenile obesity. NR offspring showed enhanced adipose tissue dysregulation characterized by activation of the UPR, perturbed insulin signaling, and marked inflammation, as demonstrated by increased abundance of crownlike structures and proinflammatory genes. Conversely, in renal tissue NR offspring had marked attenuation of cellular stress and inflammation evident as reduced activation of the UPR, down-regulation of proinflammatory genes, and less histological damage. In conclusion, obesity-related activation of the UPR can be determined by the in utero nutritional environment, demonstrating organ-specific effects dependent on the developmental phase targeted within the fetus. [ABSTRACT FROM AUTHOR]

Background: Maternal nutrient restriction (NR) during pregnancy can induce obesity and insulin resistance in the offspring but the mechanisms remain unclear. Increasing adiposity is associated with adipose tissue macrophage accumulation and inflammation predisposing to the metabolic syndrome. Aims: To determine the effects of maternal NR on the expression of key genes implicated in this process. Those juveniles exposed to late NR develop insulin resistance and increased adiposity (Gardner 2005). Methods: 17 singleton bearing sheep received either 100% metabolisable energy (ME) throughout pregnancy (controls), and 50% ME from days 0 to 30 (Early NR) or days 110 to 147 (Late NR). At 1 year perirenal adipose tissue (PAT) was analysed for the mRNA expression of CD68 (macrophage marker), toll-like receptor 4 (TLR4) and IL-6. Results: Weight at birth and 1 year were not different between the groups. Irrespective of maternal diet, TLR4 correlated with IL-6 and CD68 (R²=0.92 and 0.69, P<0.0001). Conclusions: Maternal NR induces macrophage accumulation and inflammation within adipose tissue of offspring and in late NR results in insulin resistance and increased adiposity. [ABSTRACT FROM AUTHOR]