Early outcomes from a new regional programme for the surgical management of hypoplastic left heart syndrome.

Background: Early survival and quality of outcome after surgery for hypoplastic left heart syndrome (HLHS) are influenced by patient-specific factors, the quality of surgery and perioperative care. Some skills are common to the care of other complex neonatal presentations but integrating this expertise is a key challenge for new programmes. We began offering surgery for HLHS from 2006 and provided a regional service from January 2009 and report early outcomes.

Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

Aim: To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload.

Methods: A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload.

Which high-risk infants should we follow-up and how should we do it?

Early detection of neurodevelopmental delay and appropriate intervention has been associated with improved academic and social outcomes. Identifying those who are at high risk and might benefit is not straightforward. Approximately 2% of infants are admitted to a neonatal intensive care unit after birth and these babies are known to be at high risk of developmental impairment.

Early developmental outcomes following major noncardiac and cardiac surgery in term infants: a population-based study.

Objective: To ascertain developmental differences between term infants after major noncardiac surgery and cardiac surgery compared with healthy control infants in New South Wales, Australia.

Study Design: This prospective population-based cohort study enrolled infants between August 1, 2006, and December 31, 2008, who required major noncardiac surgery within the first 90 days of life. Developmental outcomes were compared in these children, cohorts of term infants requiring cardiac surgery, and healthy controls.

Ethical advocacy based on caring: a model for neonatal and paediatric nurses.

Advocacy has been identified as an ideal in nursing practice. National codes (Australian Nursing and Midwifery Council) and professional standards (Australian College of Neonatal Nurses) state that nurses are to respect their patients' autonomous choices and act as their advocates. This responsibility includes acting as advocates for the needs and welfare of patients, for the profession of nursing and for the interests of colleagues in nursing.

Challenges in conducting prospective research of developmentally directed care in surgical neonates: a case study.

Background: Evaluation is fundamental to evidence-based practice. Due to practical constraints inherent in real-world clinical environments, however, innovations in clinical practice are often implemented without rigorous research. We set out to evaluate the effectiveness of developmentally directed care in surgical neonates using a randomised controlled trial with a Newborn Individualized Care and Assessment Program (NIDCAP) intervention.

Infant well-being following neonatal cardiac surgery.

Aims And Objectives: To investigate infant well-being as measured by feeding and sleeping and parental support following discharge from the NICU in infants following major cardiac surgery.

Background: Infant feeding and sleeping have been identified as two of the most important concerns reported by parents. These concerns have been reported anecdotally for infants who have undergone cardiac surgery in the neonatal period.

Early developmental outcome of infants with infantile hypertrophic pyloric stenosis.

Purpose: The study aimed to compare the developmental outcome of infants with infantile hypertrophic pyloric stenosis (IHPS) who underwent pyloromyotomy with healthy control infants in New South Wales (NSW), Australia.

Methods: Infants diagnosed with IHPS requiring surgical intervention were enrolled prospectively between August 1, 2006, and July 31, 2008. Healthy control infants were enrolled in the same period.

Early development of children with major birth defects requiring newborn surgery.

Aim: To describe neurodevelopmental outcomes of neonates following cardiac or non-cardiac surgery for major birth defects.

Methods: From 1 June 2002 to 31 July 2004, infants born ≥ 33 weeks gestation who underwent major birth defect surgery were enrolled prospectively. Infants were assessed at a mean corrected age of 24 months (standard deviation (SD) = 8 months, range 18-36 months) using the Bayley Scales of Infant Development: Second Edition.

Closing the evidence-practice gap for newborn pain using clinical networks.

Aim: The Australian New Zealand Neonatal Network undertook a project to close the evidence practice gap for the management of newborn pain in neonatal units within Australia. The aim was to establish a process for using evidence to support practice change and in doing so close the existing practice evidence gap for newborn pain.

Method: An implementation model using a clinical network with state facilitators, local champions and project teams was used in 24 tertiary units and six district hospitals throughout Australia.

Congenital central hypoventilation syndrome: four families.

Background: Congenital central hypoventilation syndrome (CCHS) is a rare condition that usually presents soon after birth and is potentially life-shortening if not treated. The defining abnormality is hypoventilation during sleep which requires life-long treatment with artificial ventilation. This syndrome may also be associated with generalised dysfunction of the autonomic nervous system and a sub-group with associated Hirschsprung's disease.

Developmental outcomes following major surgery: what does the literature say?

Relative to the wealth of information in the medical literature regarding developmental outcome for infants who have had cardiac surgery available, few studies specifically detail how those who have undergone major surgery grow and develop. The few published studies tend to be disease specific, making their results difficult to translate to a more general setting. As mortality for most infants who require surgery in infancy continues to decrease, the focus for researchers and clinicians should be on how these children will grow and develop.

Mother-child interaction and child developmental capacities in toddlers with major birth defects requiring newborn surgery.

Background: Evidence exists of the important role of the mother-child relationship in child development, yet with the exception of prematurity, little is known of the impact of biologic risk on this relationship.

Aims: We investigated the quality of the mother-child interaction in association with early development in toddlers who had newborn surgery for major birth defects.

Methods: Ninety-three toddlers (Mean age=24.

Endobronchial polyp in a neonate.

Respiratory distress in the neonate with collapse/hyperinflation of the lung can be because of a number of causes, which includes extraluminal, parenchymal and endobronchial lesions. Endobronchial tumour and polyps as the cause of collapse/hyperinflation in newborns are quite rare. We report a case of preterm newborn with respiratory distress secondary to endobronchial inflammatory granuloma and discuss the relevant issues in diagnosis and management.

Traumatic bleeding at birth treated with Factor VII.

We report 36 week gestation twins born following a traumatic delivery. Twin 2 had profuse haemorrhage where haemostasis was achieved with recombinant Factor VIIa (rFVIIa - NovoSeven;Novo Nordisk A/S, Bagsvaerd, Denmark).

Stabilising the newborn for transfer - basic principles.

Background: Rural general practitioners involved in obstetric service delivery may have occasion to support the sick or premature newborn requiring transfer. This should be achievable for short periods of time in most rural hospitals.

Objective: This article discusses the planning priorities, and the equipment and skills required for care of the sick or premature newborn.

A population-based study of the outcome after small bowel atresia/stenosis in New South Wales and the Australian Capital Territory, Australia, 1992-2003.

Purpose: The purpose of the study was to describe the incidence, epidemiology, and survival of infants with small bowel atresia/stenosis in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia.

Methods: A population-based cohort study was conducted of infants diagnosed with small bowel atresia/stenosis in NSW and the ACT from 1992 to 2003. Data were obtained from the prospectively collated NSW and ACT Neonatal Intensive Care Units' data collection.

Neonatal nasal obstruction and a single maxillary central incisor.

We present two neonates with nasal obstruction because of anterior choanal stenosis (congenital nasal pyriform aperture stenosis). An associated single maxillary central incisor was also shown on computed tomography imaging in the neonatal period. These midline anomalies are recognized minimal manifestations (microforms) of holoprosencephaly.

Adventitious knot formation complicating catheterization of the infant bladder.

Bladder catheterization is a common technique employed in obtaining urine for culture, monitoring urine output and for diagnostic radiological procedures. We present two cases of knot formation in male infants catheterized with a 5 gauge feeding tube. We discuss avoidance, recognition and management of this complication.

The value of a CT-guided fine needle aspirate in infants with lung abscess.

Objective: To describe the range of pathogens isolated from a lung abscess in infants less than one year of age. To assess the role of direct culture from the abscess.

Methods: The two index cases were managed in 2002.

Involvement of alpha-4 integrins in allergic airway responses and mast cell degranulation in vivo.

Antibodies against integrins have been shown to inhibit allergic airway responses. The purpose of this study was to test the hypothesis that the beta1 integrin, very late antigen-4 (VLA-4), is involved in mast cell activation triggered by allergen exposure in sensitized animals. To do this we studied Brown Norway rats that were sensitized to ovalbumin (OA; 1 mg subcutaneously) using Bordetella pertussis as an adjuvant.