Effect of Bias Gas Flow on Tracheal Cytokine Concentrations in Ventilated Extremely Preterm Infants: A Randomized Controlled Trial.

Background: The objective of this study was to determine whether ventilator bias gas flow affects tracheal aspirate (TA) cytokine concentrations in ventilated extremely preterm infants.

Methods: This is a randomized controlled trial in a tertiary neonatal unit in New Zealand. Preterm infants (<28 weeks' gestation/<1,000 g) requiring intubation in the first 7 days after birth were randomized to bias gas flows of 4 or 10 L/min.

Changed ophthalmic workload following introduction of digital retinal photography for retinopathy of prematurity screening.

Background: ROP screening is vital in care of premature infants but is considered burdensome, difficult and time consuming for ophthalmologists. This study assessed the reduction in workload following the introduction of nurse-led WFDRI to a large neonatal nursery.

Methods: We report a retrospective audit of 628 infants screened for ROP in the years 2010, 2013 and 2019 at the Royal Women's Hospital, Victoria.

Higher Rates of Retinopathy of Prematurity after Increasing Oxygen Saturation Targets for Very Preterm Infants: Experience in a Single Center.

Randomized trials of oxygen saturation target ranges for extremely preterm infants showed increased survival but increased retinopathy of prematurity with higher compared with lower target ranges. In our center, changing from a target range of 88%-92% to 91%-95% has been associated with increased rates and severity of retinopathy of prematurity.

Randomized controlled trial of oxygen saturation targets in very preterm infants: two year outcomes.

Objective: To assess whether an oxygen saturation (Spo2) target of 85%-89% compared with 91%-95% reduced the incidence of the composite outcome of death or major disability at 2 years of age in infants born at <28 weeks' gestation.

Study Design: A total 340 infants were randomized to a lower or higher target from <24 hours of age until 36 weeks' gestational age. Blinding was achieved by targeting a displayed Spo2 of 88%-92% using a saturation monitor offset by ±3% within the range 85%-95%.

Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences.

Background: Preterm infants ≤32 weeks' gestation are increasingly being managed on continuous positive airway pressure (CPAP), without prior intubation and surfactant therapy. Some infants treated in this way ultimately fail on CPAP and require intubation and ventilation.

Objectives: To define the incidence, predictors and consequences of CPAP failure in preterm infants managed with CPAP from the outset.

Fluid recovery during lung lavage in meconium aspiration syndrome.

Unlabelled: Lung lavage using two aliquots of 15 mL/kg of dilute surfactant was performed in 30 ventilated infants with severe meconium aspiration syndrome (MAS). Mean recovery of instilled lavage fluid was 46%, with greater fluid return associated with lower mean airway pressure at 24 h and a shorter duration of respiratory support.

Conclusion: Recovery of instilled lavage fluid is paramount in effective lung lavage in MAS and must be afforded priority in the lavage technique.

High bias gas flows increase lung injury in the ventilated preterm lamb.

Background: Mechanical ventilation of preterm babies increases survival but can also cause ventilator-induced lung injury (VILI), leading to the development of bronchopulmonary dysplasia (BPD). It is not known whether shear stress injury from gases flowing into the preterm lung during ventilation contributes to VILI.

Methods: Preterm lambs of 131 days' gestation (term = 147 d) were ventilated for 2 hours with a bias gas flow of 8 L/min (n = 13), 18 L/min (n = 12) or 28 L/min (n = 14).

Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure.

Objective: To evaluate the applicability and potential effectiveness of a technique of minimally-invasive surfactant therapy (MIST) in preterm infants on continuous positive airway pressure (CPAP).

Methods: An open feasibility study of MIST was conducted at two sites. Infants were eligible for MIST if needing CPAP pressure ≥7 cm H(2)O and FiO(2) ≥0.

Improvement in mortality of very low birthweight infants and the changing pattern of neonatal mortality: the 50-year experience of one perinatal centre.

Aim: Neonatology is a relatively new sub-specialty so we aimed to review survival data in the context of advances in neonatal care.

Method: Review of neonatal survival for very low birthweight babies over the last 50 years.

Results: In the data collected from a single tertiary neonatal unit, survival for babies 501-1000 g improved from below 10% in 1959 to over 60% in 2009.

Improved neonatal survival and outcomes at borderline viability brings increasing ethical dilemmas.

With improvements in neonatal intensive care over the past five decades, the limits of viability have reduced to around 24 weeks' gestation. While increasing survival has been the predominant driver leading to lowering the gestation at which care can be provided, these infants remain at significant risk of adverse long-term outcomes including neuro-developmental disability. Decisions about commencing and continuing intensive care are determined in partnership with parents, considering the best interests of the baby and the family.

Enteral feeding practices in very preterm infants: an international survey.

Objective: To evaluate enteral feeding practices in neonatal units in different countries and on different continents.

Design: A web-based survey of 127 tertiary neonatal intensive care units in Australia, Canada, Denmark, Ireland, New Zealand, Norway, Sweden and the UK.

Results: 124 units (98%) responded.

Does more protein in the first week of life change outcomes for very low birthweight babies?

Background: Following publication of revised recommended nutrient intakes (RNI) for infants <1500 g, our intravenous nutrition (IVN) solutions were reformulated to deliver RNI in a restricted volume to ensure additional non-nutritional fluids did not detract from nutritional intake. An audit was performed to determine whether these changes achieved RNI and influenced growth, clinical or neurodevelopmental outcomes.

Methods: Two cohorts of 40 infants <1500 g were identified from a prospectively maintained database: babies born before and after reformulation of the IVN solutions.

Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome.

Objective: To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS).

Study Design: We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung.

Ventilator gas flow rates affect inspiratory time and ventilator efficiency index in term lambs.

Background: Despite increasing survival in the smallest preterm infants, the incidence of chronic lung disease has not decreased. Research into ventilatory strategies has concentrated on minimising barotrauma, volutrauma and atelectotrauma, but little attention has been paid to the role of bias gas flow rates and the potential for rheotrauma or shear stress injury. Ventilated preterm infants frequently receive relatively high gas flow rates.

The reliability of 2D and colour Doppler ultrasound in localising longline position.

Background: The position of percutaneously inserted central venous catheters (longlines) in neonates is critical, as malpositioned longlines are associated with potentially fatal complications.

Aim: To determine if cardiac ultrasound (two-dimensional (2D) and colour Doppler) is useful in evaluating longline position, when compared with the position identified by contrast radiography.

Setting: Single level 3 neonatal unit.

AP-ROP in an infant with minimal oxygen exposure.

Retinopathy of prematurity (ROP) is a multifactorial disease affecting the developing retinal vasculature and remains an important cause of blindness in very preterm infants. Rush disease, or aggressive posterior ROP (AP-ROP), progresses rapidly to stage 5 disease without exhibiting the classical course that includes stages 1-3. We describe an infant with minimal exposure to oxygen who developed AP-ROP that led to bilateral retinal detachments and a poor visual outcome, despite following current recommended screening guidelines.

Does retrograde diastolic flow in the descending aorta signify impaired systemic perfusion in preterm infants?

High-volume systemic-to-pulmonary ductal shunting occurs frequently in preterm infants and is indicated by diastolic flow reversal in the descending aorta (DAo). We studied the relationship between ductal diameter, diastolic DAo reversal, and left ventricular output (LVO); and superior vena caval (SVC) flow (upper body perfusion) and DAo flow (lower body perfusion) in preterm (<31 wk) infants. Echocardiographic assessments were performed at 5, 12, 24, and 48 h postnatal age (80 infants, median gestation 28 wk, 1060 g).

Survey of the management of neonatal hyperglycaemia in Australasia.

Aim: Hyperglycaemia is a common problem in very low birthweight (VLBW) preterm neonates and has been associated with an increase in intraventricular haemorrhage and mortality. There are few data to guide clinicians on the best range of blood glucose levels to aim for when treating hyperglycaemic preterm babies with insulin. The aim of this study was to survey all Australasian tertiary neonatal intensive care units for their current practice in the definition and management of neonatal hyperglycaemia to aid in the design of a randomised controlled trial of the effect of tight glycaemic control on long-term outcome in VLBW babies.

Early low cardiac output is associated with compromised electroencephalographic activity in very preterm infants.

Low cerebral blood flow in preterm infants has been associated with discontinuous electroencephalography (EEG) activity that in turn has been associated with poor long-term prognosis. We examined the relationships between echocardiographic measurements of blood flow, blood pressure (BP), and quantitative EEG data as surrogate markers of cerebral perfusion and function with 112 sets of paired data obtained over the first 48 h after birth in 40 preterm infants (24-30 wk of gestation, 510-1900 g at delivery). Echocardiographic measurements of right ventricular output (RVO) and superior vena caval (SVC) flow were performed serially.

Digital imaging does not improve localization of percutaneously inserted central lines in neonates.

Objective: To determine whether the use of digital imaging improves the localization of percutaneously inserted central (PIC) line tips compared to standard radiographs, with contrast being used in both cases.

Methods: Digital radiographs taken for localization of PIC lines between October 2002 and September 2003 were identified from the neonatal database. Two reporters independently reviewed the radiographs and stated (i) whether the tip could confidently be seen and (ii) the position.