Umbilical artery eucapnic pH to assess fetal well-being.

Background: Umbilical artery gas results help obstetricians assess fetal well-being during labor and guide screening decisions on eligibility for therapeutic hypothermia (ie, whole-body or head cooling). The accuracy of results, especially for the base deficit on arterial cord gas analysis, in predicting brain injury is questioned. A novel biomarker specifically calculated for fetal acid-base physiology and response to asphyxia-neonatal eucapnic pH as a marker of neonatal metabolic acidosis-has the potential to be an accurate predictor of hypoxic-ischemic encephalopathy.

Eucapnic pH coupled with arterial cord pH improves hypoxic-ischemic encephalopathy prediction.

Objective: To consider the classical use of "pH < 7.0 and/or a base deficiency ≥12 mmol/L" as markers of the risk of neonatal hypoxic-ischemic encephalopathy (HIE), recalling various criticisms of the use of these markers in favor of that of neonatal eucapnic pH, which appears to be a better marker of this risk.

Methods: Fifty-five cases of acidemia with pH < 7.

Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates.

Importance: Cerebral palsy (CP) is the most common abnormality of motor development and causes lifelong impairment. Early diagnosis and therapy can improve outcomes, but early identification of infants at risk remains challenging.

Objective: To develop a CP prognostic tool that can be applied to all term neonates to identify those at increased risk of developing CP.

Assessing shared decision making during antenatal consultations regarding extreme prematurity.

Objective: To assess whether antenatal decisions regarding the neonatal care at birth for extremely preterm infants are more likely to be made when using shared decision-making (SDM)-style consultations compared to standard consultations.

Study Design: In 2015, we implemented a clinical practice guideline promoting SDM use within antenatal consultations in our single-centre university-based perinatal unit. We conducted a prospective cohort study with a retrospective chart review based on data collected from all pregnant women presenting to obstetrical triage between 22 + 0 and 25 + 6 weeks gestation between September 2015 and June 2018.

Antimicrobial utilization in very-low-birth-weight infants: association with probiotic use.

Objective: To examine the association between probiotic use and antimicrobial utilization.

Study Design: We retrospectively evaluated very-low-birth-weight (VLBW) infants admitted to tertiary neonatal intensive care units in Canada between 2014 and 2019. Our outcome was antimicrobial utilization rate (AUR) defined as number of days of antimicrobial exposure per 1000 patient-days.

Vulnerabilities in clinician-parent exchanges and the cascade of communication traps: a review.

This review considers parent-clinician interactions that are associated with vulnerabilities in communication and what we refer to as 'communication traps'. Communication traps are defined by high-stress situations with affect-laden subject matter that can lead to progressively dysfunctional communications/exchanges that are avoidable. While this framework was developed in neonatology, it can be applied to other clinical practices.

Parents' Views to Strengthen Partnerships in Newborn Intensive Care.

Parental involvement in their newborn's neonatal intensive care reduces stress and helps with the parent-child attachment, transition to home, and future development. However, parents' perspectives are not often sought or considered when adapting family-centered care in neonatal intensive care units (NICUs). To identify what parents believe helps or hinders their involvement in their newborn's care when admitted to our Level 3B NICU.

Extremely low gestational age infants: Developing a multidisciplinary care bundle.

Background: Clinical experience in managing extremely low gestational age infants, particularly those born <24 weeks' gestation, is limited in Canada. Our goal was to develop a bedside care bundle for infants born <26 weeks' gestation, with special considerations for infants of <24 weeks, to harmonize and improve quality of care.

Methods: We created a multidisciplinary working group with experience in caring for preterm infants, searched the literature from 2000 to 2019 to identify best practices for the care of extremely preterm infants and consulted colleagues across Canada and internationally.

Pandemic planning: Developing a triage framework for Neonatal Intensive Care Unit.

Although the Covid-19 pandemic has not had a direct impact on neonates so far, it has raised concerns about resource distribution and showed that planning is required before the next crisis or pandemic. Resource allocation must consider unique Neonatal Intensive Care Unit (NICU) attributes, including physical space and equipment that may not be transferable to older populations, unique skills of NICU staff, inherent uncertainty in prognosis both antenatally and postnatally, possible biases against neonates, and the future pandemic disease's possible impact on neonates. We identified the need for a validated Neonatal Severity of Illness Prognostic Score to guide triage decisions.

Medications to manage infant pain, distress and end-of-life symptoms in the immediate postpartum period.

Introduction: Perinatal palliative care (PnPC) is a growing field where healthcare providers from multiple disciplines are supporting families and providing holistic care for their babies with life-limiting illnesses. It is important to have an approach that includes the standardized management of end-of-life symptoms that are anticipated around the time of birth.

Areas Covered: A need was identified to develop medication orders for the initial pharmacological management of symptoms at end-of-life for infants with life-limiting conditions intended for use outside of an intensive care setting.

Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants.

Introduction: Having an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home.

Evaluating parental perceptions of written handbooks provided during shared decision making with parents anticipating extremely preterm birth.

Objective: To explore parental perceptions of written handbooks provided to them during antenatal counseling for anticipated extremely preterm birth.

Study Design: This study involved a prospective convenience sample of parents anticipating delivery between 22 weeks + 0 days and 25 weeks + 6 days gestation. The antenatal counseling involved a shared decision-making process.

Umbilical artery carbon dioxide decreases the risk for hypoxic-ischaemic encephalopathy.

Aim: An accurate biomarker for metabolic acidosis at birth is needed. Our aims were to investigate the link between umbilical artery pCO and the risk for hypoxic-ischaemic encephalopathy (HIE) and to compare false-negative screen results in newborn infants with HIE using three umbilical artery blood gas biomarkers.

Methods: From a cohort of newborn infants ≥35 weeks born in Ottawa, Canada, between January 2007 and December 2016, we highlighted those with HIE or who died.

Risk factors for re-hospitalization following neonatal discharge of extremely preterm infants in Canada.

Objective: Survivors of extremely preterm birth are at risk of re-hospitalization but risk factors in the Canadian population are unknown. Our objective is to identify neonatal, sociodemographic, and geographic characteristics that predict re-hospitalization in Canadian extremely preterm neonates.

Methods: This is a retrospective analysis of a prospective observational cohort study that included preterm infants born 22 to 28 weeks' gestational age from April 1, 2009 to September 30, 2011 and seen at 18 to 24 months corrected gestational age in a Canadian Neonatal Follow-Up Network clinic.

Neonatal cord blood eucapnic pH: A potential biomarker predicting the need for transfer to the NICU.

Introduction: The best biomarker for neonatal metabolic acidosis (NMA) and its related complications is still a matter of debate. Umbilical artery (Ua) cord pH is not sufficiently specific, as is lactatemia, while base deficit is considered to offer no added value. From a physiological point of view, the calculated neonatal eucapnic pH is a more specific marker for neonatal metabolic acidosis and may be a better predictor of birth complications of hypoxic origin, because complications related to asphyxia are always preceded by neonatal depression leading to a transfer to a neonatal intensive care unit (NICU) for close monitoring.

Comparisons between umbilical cord biomarkers for newborn hypoxic-ischemic encephalopathy.

Background: Cord blood umbilical artery (Ua) pH, base deficit (BD), and pH eucapnic Blickstein/Green-50 may mislead clinicians to identify newborns at risk for hypoxic-ischemic encephalopathy. Neonatal eucapnic pH (pH euc-n Racinet-54) may be a comprehensive alternative. The goal of the study is to compare the predictive performance of these four biomarkers for the combined primary outcome of hypoxic-ischemic encephalopathy/death.

Umbilical artery base deficit/excess: sailing blindly in a thick fog.

Assessing the wellbeing of newborns at birth with base deficit (BD)/base excess(BE) is well anchored in clinicians' practice. However, clinicians may not fully understand the concepts behind BD and the concerns regarding the validity of BD results provided by the hospital laboratory. These concerns are linked to the inconsistencies between the equations to calculate BD, and that these equations do not consider the aspects of acid-base physiology at birth.

Shared decision making during antenatal counselling for anticipated extremely preterm birth.

Objectives: To explore health care providers' (HCPs) perceptions of using shared decision making (SDM) and to identify facilitators of and barriers to its use with families facing the anticipated birth of an extremely preterm infant at 22 to 25 weeks gestational age.

Study Design: Qualitative descriptive study design: we conducted interviews with 25 HCPs involved in five cases at a tertiary care centre and completed qualitative content analysis of their responses.

Results: Nine facilitators and 16 barriers were identified.

Catch the moment: The power of turning mistakes into 'precious' learning opportunities.

We developed a series of small group workshops that aim to facilitate communication during very challenging ethically sensitive scenarios within a Neonatal-Perinatal Medicine (NPM) postgraduate curriculum at the University of Ottawa. These workshops are called Scenario-Oriented Learning in Ethics (SOLE). This educational intervention aims to focus attention on the learner's needs and to help them recognize, define, and view each communicative or behavioural mistake as an occasion to achieve a personal-defined learning goal in a controlled environment free of judgement.