Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants.

Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life.

Method: This is a retrospective medical records review of 23 -28 weeks' gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens.

Variation between Clinician-Recorded and Downloaded Invasive Blood Pressure in Extremely Preterm Infants.

Objective: This study aimed to examine the variation between clinician-recorded and continuously downloaded invasive blood pressure (BP).

Study Design: Prospective study where invasive BP data were downloaded every 10 seconds for the first week of life. Hourly clinician-recorded BP was recorded.

Common carotid artery blood flow volume in extremely preterm infants.

Aim: The aim of this study was to determine carotid blood flow volume, a surrogate for cerebral blood flow, using Doppler ultrasound in extremely preterm infants.

Methods: In infants <29 weeks, right common carotid artery flow volume (RCCAF) was calculated from vessel diameter and intensity-weighted mean velocity measured using Doppler ultrasound on days 1 and 3. In addition, left ventricular output (LVO), ductus arteriosus characteristics and invasive mean arterial blood pressure (MABP) were obtained.

A realistic flow phantom model of the carotid artery in preterm infants for training and research.

Introduction: Cerebral blood flow is increasingly monitored in preterm infants. Doppler ultrasound of the carotid artery is a widely available method but is operator dependent. Our aim was to design and produce a realistic flow phantom model of the carotid artery of preterm infants.

Blood pressure intervention levels in preterm infants: pilot randomised trial.

Objective: To examine the feasibility of a trial allocating different blood pressure (BP) intervention levels for treatment in extremely preterm infants.

Design: Three-arm open randomised controlled trial performed between February 2013 and April 2015.

Setting: Single tertiary level neonatal intensive care unit.

Does antibiotic choice for the treatment of suspected late-onset sepsis in premature infants determine the risk of developing necrotising enterocolitis? A systematic review.

Background: Necrotising enterocolitis (NEC) is a significant cause of infant morbidity and mortality, disproportionately affecting those of extreme prematurity and/or very low birth weight. A number of risk factors have been identified, including an association between the use of antibiotics, and the subsequent development of NEC.

Aim: This review sought to address whether the choice of antibiotic(s) used to treat infants with suspected late-onset sepsis (LOS) influences the risk of developing NEC.

Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants.

Aim: To determine whether early echocardiographic ductal parameters identified infants who subsequently received medical or surgical treatment of the patent ductus arteriosus (PDA).

Methods: Infants <29 weeks had PDA size in 2D and colour, flow velocity and patterns obtained on days 1 and 3. Infants were followed up to identify those subsequently receiving treatment for symptomatic PDA by clinicians who were unaware of scan results.

Investigation of EEG Activity Compared with Mean Arterial Blood Pressure in Extremely Preterm Infants.

Background: Cerebral electrical activity in extremely preterm infants is affected by various factors including blood gas and circulatory parameters.

Objective: To investigate whether continuously measured invasive mean arterial blood pressure (BP) is associated with electroencephalographic (EEG) discontinuity in extremely preterm infants.

Study Design: This prospective observational study examined 51 newborn infants born <29 weeks gestation in the first 3 days after birth.

Newborn infants with bilious vomiting: a national audit of neonatal transport services.

Objective: The precautionary approach to urgently investigate infants with bilious vomiting has increased the numbers referred to transport teams and tertiary surgical centres. The aim of this national UK audit was to quantify referrals and determine the frequency of surgical diagnoses with the purpose to inform the consequent inclusion of these referrals in the national 'time-critical' data set.

Methods: A prospective, multicentre UK-wide audit was conducted between 1 August, 2015 and 31 October, 2015.

Comparison of Passive and Servo-Controlled Active Cooling for Infants with Hypoxic-Ischemic Encephalopathy during Neonatal Transfers.

 The recent availability of servo-controlled cooling equipment on transport makes it possible to commence active cooling at the referral unit for infants with hypoxic-ischemic encephalopathy. This study aimed to compare the temperature and transfer variables in passively and actively cooled babies.  This is a retrospective cohort study comparing two groups-passively cooled (July 2011 to August 2012) versus actively cooled group (September 2012 to June 2013), following introduction of active hypothermia using servo-controlled cooling mattress by the London Neonatal Transfer Service (NTS).

Antibiotic treatment duration and prevention of complications in neonatal Staphylococcus aureus bacteraemia.

Background: In adults with Staphylococcus aureus bacteraemia, short duration of effective antibiotic treatment is associated with increased risk of complications and recurrence. The optimum duration of treatment for neonates is unknown and practice varies widely.

Aim: To relate the duration of treatment of neonatal S.

Reduced utility of serum IGF-1 levels in predicting retinopathy of prematurity reflects maternal ethnicity.

Aims: To validate known risk factors and identify a threshold level for serum insulin-like growth factor 1 (IGF-1) in the development of severe retinopathy of prematurity (ROP) in an ethnically diverse population at a tertiary neonatal unit, 2011-2013.

Methods: A prospective cohort masked study was conducted. Serum IGF-1 levels at 31, 32 and 33 weeks were measured and risk factor data collected including gestational age (GA), birth weight (BW), absolute weight gain (AWG) and maternal ethnicity.

Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort.

Unlabelled: Bilious vomiting in a neonate may be a sign of intestinal obstruction often resulting in transfer requests to surgical centres. The aim of this study was to assess the use of clinical findings at referral in predicting outcomes and to determine how often such patients have a time-critical surgical condition (eg, volvulus, where a delay in treatment is likely to compromise gut viability).

Methods: 4-year data and outcomes of all term newborns aged ≤7 days with bilious vomiting transferred by a regional transfer service were analysed.

Development of maternal and neonatal composite outcomes for trials evaluating management of late-onset pre-eclampsia.

Objective: Pre-eclampsia is associated with significant maternal and neonatal complications, and delivery is often expedited to minimise complications. For randomised trials evaluating interventions in women with late-onset (>34 weeks) mild to moderate pre-eclampsia, no single outcome has been identified to be the most clinically important. Existing composite outcomes with more than one clinically relevant endpoint to evaluate interventions in pre-eclampsia provide limited justification for selection of the components.

Feeding infants below 29 weeks' gestation with abnormal antenatal Doppler: analysis from a randomised trial.

Objective: To describe feeding and gastrointestinal outcomes in growth-restricted infants <29 weeks' gestation and to determine the rate of feed advancement which they tolerate.

Design: Analysis of prospectively collected data from a randomised feeding trial, the Abnormal Doppler Enteral Prescription Trial (ADEPT).

Setting: 54 neonatal units in the UK and Ireland.

A toolkit for monitoring hospital-acquired bloodstream infection in neonatal intensive care.

Objective: In neonatal intensive care units (NICUs), monitoring hospital-acquired bloodstream infection (BSI) is critical to alert clinicians to variations in the incidence of infection between units and over time. We demonstrate a toolkit of monitoring techniques that account for case mix and could be implemented using routinely available clinical data. This toolkit could enable quality of care comparisons between hospitals to facilitate the sharing of improved practices.

Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial.

Background: Growth-restricted preterm infants are at increased risk of developing necrotizing enterocolitis (NEC) and initiation of enteral feeding is frequently delayed. There is no evidence that this delay is beneficial and it might further compromise nutrition and growth.

Methods: Infants with gestation below 35 weeks, birth weight below the 10th centile, and abnormal antenatal umbilical artery Doppler waveforms were randomly allocated to commence enteral feeds "early," on day 2 after birth, or "late," on day 6.

Risk-adjusted comparisons of bloodstream infection rates in neonatal intensive-care units.

Comparisons of bloodstream infection (BSI) rates between neonatal intensive-care units (NICUs) should take into account differences in babies' vulnerability and invasive procedures that can introduce infection. Our aim was to investigate which risk factors recorded in routine records should be adjusted for when NICUs are compared. This was a retrospective cohort study using routine records for two London NICUs.

Levels of periodontal pathogens in neonatal gastric aspirates and possible maternal sites of origin.

Maternal periodontal infection has been recognized as a risk factor for preterm and low birthweight infants. It is suspected that pathogens causing periodontal disease may translocate to the amniotic cavity and so contribute to triggering an adverse pregnancy outcome. This study aimed to determine levels and proportions of periodontal bacteria in neonatal gastric aspirates obtained from complicated pregnancies and the respective maternal oral and vaginal samples using a quantitative polymerase chain reaction approach, and also to determine the origin of the neonate's bacteria by sequence comparisons between the three sites.

Identification of bacteria and potential sources in neonates at risk of infection delivered by Caesarean and vaginal birth.

Neonatal gastric aspirates (NGA) are routinely screened in UK hospitals to investigate fetal/neonatal infections associated with cases of adverse pregnancy outcome (APO). The aim of this study was to describe and compare the microbiology of NGA from Caesarean and vaginal deliveries using molecular methods, and to evaluate other possible clinical and non-clinical variables that may have determined the presence of the bacteria in the samples. The value of using NGA and molecular methods to investigate potential pathogens associated with the risk of early infection was also evaluated.