Objective: The objective of this study is to describe the use and complications of peripherally inserted central catheters (PICC) via scalp veins in neonates.
Methods: A retrospective review of ...neonates who had PICCs inserted, between January 2010 and June 2013, in the NICU at Children's and Women's Health Center of British Columbia.
Results: During the study period, 689 PICCs were inserted over a total of 46 728 NICU patient days. The PICC insertion sites were scalp veins (69), upper limb veins (471), and lower limb veins (149). The mean catheter durations were 17 d, 19 d, and 18 d for PICCs inserted through scalp, upper limb, and lower limb veins, respectively. The complication rates were 23%, 23%, and 15% for insertion via scalp, upper, and lower limb veins, respectively. Centrally placed PICCs at the time of insertion were more likely to remain in situ for longer than one week (p < 0.001). The incidence of central line-associated blood stream infection was 4.4, 6.4, and 3.4 per 1000 catheter days, respectively, for scalp, upper, and lower limb PICCs.
Conclusions: Insertion of PICC via the scalp veins are feasible and not associated with higher complication rates compared with insertions via other sites.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a frequently prescribed class of medications in the neonatal intensive care unit (NICU). We aimed to reveal acute kidney injury (AKI) epidemiology in ...NSAID-exposed premature infants admitted to the NICU using a standardized definition and determine the percentage of NSAID-exposed patients with adequate serum creatinine (SCr) monitoring.
This retrospective study compared infants born at ≤34 weeks gestational age who received NSAID for intraventricular hemorrhage prophylaxis (prophylaxis group) or symptomatic treatment for patent ductus arteriosus (PDA; treatment group) between January and December 2014 at a tertiary NICU. All available SCr and 12-h urine output (UO) values were recorded from admission until day seven post-NSAID exposure. AKI incidence was determined using the neonatal modified Kidney Disease Improving Global Outcomes classification, defined as an increase in SCr (i.e., 1.5 fold rise from previous SCr measurement within seven days or 26.5 mmol/L increase within 48 h) or UO < 1 mL/kg/hour, excluding the first 24 h of life.
We identified 70 eligible subjects; 32 received prophylactic NSAIDs, and 38 received indomethacin or ibuprofen for treating symptomatic PDA. AKI incidence for the entire cohort was 23% (16/70). The prophylaxis group had a significantly lower AKI rate than the treatment group (9% vs. 34%; p = 0.014). The treatment group had a higher proportion of infants with adequate SCr monitoring during NSAID treatment than the prophylaxis group (87% vs. 13%, p < 0.001).
NSAID-associated AKI occurred in approximately one-quarter of premature infants overall, and the AKI incidence was higher in infants treated with NSAIDs for the symptomatic treatment of PDA than in those receiving prophylactic treatment during the first day of life. Standardized protocols for monitoring daily SCr and UO after exposure should be implemented for all neonates with NSAID exposure to improve early AKI recognition and management.
Congenital diaphragmatic hernia (CDH) is a major congenital anomaly, resulting from the herniation of abdominal contents into the thoracic cavity, thereby impeding the proper development of the lungs ...and pulmonary vasculature. CDH severity correlates with a spectrum of pulmonary hypoplasia, pulmonary hypertension (PHT), and cardiac dysfunction, constituting the pathophysiological triad of this complex condition. The accurate diagnosis and effective management of PHT and cardiac dysfunction is pivotal to optimizing patient outcomes. Targeted neonatal echocardiography is instrumental in delivering real-time data crucial for the bespoke, pathophysiology-targeted hemodynamic management of CDH-associated PHT.
The patent ductus arteriosus frequently poses a significant morbidity in preterm infants, subjecting their immature pulmonary vascular bed to substantial volume overload. This, in turn, results in ...concurrent hypoperfusion to post-ductal organs, and subsequently alters cerebral blood flow. In addition, treatment has not demonstrated definitive improvements in patient outcomes. Currently, the optimal approach remains a subject of considerable debate with ongoing research controversy regarding the best approach. This article provides a comprehensive review of existing literature.
Flattening filter-free (FFF) x-rays can provide more efficient use of photons and a significant increase of dose rate compared with conventional flattened x-rays, features that are especially ...beneficial for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). The available data on the entrance doses of the FFF photon beams remain limited. The purpose of this study was to investigate the entrance dose of FFF photons in the buildup region and to compare it with that of conventional flattened photons.
A Varian TrueBeam linear accelerator has been in full clinical operation with 6-MV and 10-MV FFF and flattened x-ray photons. Entrance dose at the surface was measured using a parallel plate ionization chamber in a solid water phantom with buildup depth = 0~15 mm for 6X and 0~25 mm for 10X. Different field size (FS) patterns were created in the Eclipse Treatment Planning System by multileaf collimator (MLC) rather than jaws (FS = 2 × 2, 3 × 3, 4 × 4, 6 × 6, and 10 × 10 cm(2) by MLC and jaw size = 2.2 × 2.2, 3.2 × 3.2, 4.2 × 4.2, 6 × 6, and 10 × 10 cm(2)). The smallest FS was about four times larger than the ion chamber dimension. All buildup dose measurements were normalized to FS = 10 × 10 cm(2) at the depth of dose maximum (dmax).
Good repeatability was demonstrated and surface dose increased linearly with FS for both flattened and FFF photons. The entrance dose of the FFF photons was modestly larger than that of the corresponding flattened photons for both 6X and 10X for different FS ranging from 2 × 2 cm(2) to 10 × 10 cm(2).
The FFF photons have a higher entrance dose than that of the corresponding flattened photons for FS smaller than 10 × 10 cm(2). However, the difference is not substantial and may be clinically insignificant.
Excessive antimicrobial use is associated with adverse neonatal outcomes. In our cohort of 27,163 infants born at <33 weeks gestational age, the first week after birth accounted for the highest rates ...of antimicrobial use, and variability across sites persisted after adjustment for patient characteristics correlated with illness severity.
Fluid management in newborns undergoing surgery can be challenging due to difficulties in accurately assessing volume status in context of high fluid needs perioperatively and postoperative ...third-space fluid loss. Fluid overload can be associated with an increase in neonatal morbidity and mortality.
Our objective was to determine the burden of fluid overload and to evaluate their associations with adverse effects among infants undergoing abdominal surgery at a tertiary perinatal center.
Patients from our Neonatal Intensive Care Unit who underwent abdominal surgery from January 2017 to June 2019 were included in this retrospective cohort study. Fluid balance was assessed based on the maximum percentage change in body weight at 3- and 7-postoperative days.
Sixty infants were included, with a median interquartile range gestational age (GA) of 29 25-36 weeks and birth weight of 1240 721-2871 grams. The median daily actual fluid intake was significantly higher than the prescribed fluid intake in the first 7 postoperative days (163 vs. 145 mL/kg, p < .01). The median maximum change of body weight by postoperative days 3 and 7 were 6% 3-13 and 11% 5-17, respectively. A 1% increase in weight within the first 3 postoperative days was associated with a 0.6-day increase for invasive ventilatory support (p = .012). The correlation was still significant after adjusting for GA (p = .033).
Fluid overload within the first 3 postoperative days was associated with an increase in ventilator support among infants. Careful attention to fluid management may affect the optimization of outcomes for newborns undergoing abdominal surgery.
Antenatal corticosteroids reduce respiratory morbidity in preterm infants, but their use during late preterm gestation (34-36 weeks) is limited because their safety for longer-term child ...neurodevelopment is unclear. We sought to determine if fetuses with higher probability of exposure to antenatal corticosteroids had increased rates of prescriptions for attention-deficit/hyperactivity disorder (ADHD) medication in childhood, using a quasiexperimental design that better controls for confounding than existing observational studies.
We identified 16 358 children whose birthing parents were admitted for delivery between 31 + 0 (31 weeks, 0 days) and 36 + 6 weeks' gestation in 2000-2013, using a perinatal data registry from British Columbia, Canada, and linked their records with population-based child ADHD medication data (2000-2018). We used a regression discontinuity design to capitalize on the fact that pregnancies presenting for delivery immediately before and immediately after the clinical cut-off for antenatal corticosteroid administration of 34 + 0 weeks' gestation have very different levels of exposure to corticosteroids, but are otherwise similar with respect to confounders.
Over a median follow-up period of 9 years, 892 (5.5%) children had 1 or more dispensations of ADHD medication. Children whose birthing parents were admitted for delivery just before the corticosteroid clinical cut-off of 34 + 0 weeks' gestation did not appear to be more likely to be prescribed ADHD medication than those admitted just after the cut-off (rate ratio 1.1, 95% confidence interval CI 0.8 to 1.6; 1.3 excess cases per 100 children, 95% CI -2.5 to 5.7).
We found little evidence that children with higher probability of exposure to antenatal corticosteroids have higher rates of ADHD prescriptions in childhood, supporting the safety of antenatal corticosteroids for this neurodevelopmental outcome.
To evaluate the short-term outcomes of implementing a care bundle emphasizing frequent hemodynamic assessments by echocardiography in neonates with congenital diaphragmatic hernia (CDH).
This was a ...retrospective cohort study of infants with CDH admitted to a quaternary perinatal unit from January 2013 to March 2021. The primary composite outcome was defined as mortality or use of extracorporeal membrane oxygenation or need for respiratory support at discharge.
We identified 37 and 20 CDH infants in Epoch I and II, respectively. More patch repairs (50% vs. 21.9%, p = 0.035) and echocardiograms (64-8 vs. 10-5, p = 0.003) were performed in Epoch II. While there were no differences in the primary outcome, there was a reduction in mortality in Epoch II (0% vs. 27%, p = 0.01).
With the implementation of a CDH care bundle with an emphasis on hemodynamic assessment, we demonstrated a significant reduction in mortality.
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