Neonatologists and non-vigorous newborns with meconium-stained amniotic fluid (MSAF) in the delivery room: time for hands off?

Lung function evolution in children with old and new type bronchopulmonary dysplasia: a retrospective cohort analysis Abstract Bronchopulmonary dysplasia (BPD) is one of the most important sequelae of premature birth. There is concern that in some patients, lung injuries early in life may have lifelong consequences. In this retrospective observational cohort study, lung function evolution in children with BPD was investigated from childhood to young adulthood. Data from 355 pulmonary function tests (PFT) in 24 patients were analyzed, with a median age at first PFT of 7.6 years and at last PFT 18.2 years. FEV1 and FEV1/FVC were below the 5th percentile in respectively 18 and 13/24 patients. Comparing first and last measurement, there was significant worsening in FEV1 from a mean of 71.3% pred (SD 18.3) to 66.7% pred (SD 21.7) (p < 0.05) and in FEV1/FVC from 85.4% pred (SD 15.2) to 79.8% pred (SD 17.3) (p = 0.01). Evaluation of the individual lung function changes with linear regression showed deterioration in FEV1, FVC, and FEV1/FVC in respectively 17, 13, and 17/24 patients. Total group analysis showed significant deterioration in FEV1 (− 0.7%/year, p = 0.002) and FEV1/FVC (− 0.5%/year, p = 0.01). None of the 11 patients born up to 1990 improved in FEV1 vs 7 of the 13 patients born after 1990 (p = 0.006). Conclusion: This points out to further deterioration of the lung function during childhood in this selected group of children with BPD. What is Known: • Data on longitudinal changes in lung function in children with BPD are scarce. What is New: • In children with BPD at the severe end of the disease spectrum, lung function does not improve over time. On the contrary, in two-thirds of the subjects studied FEV1and FEV1/FVC worsen over time. • Lung function evolution towards adulthood was somewhat more favorable in children born after 1990 compared with those born earlier, probably reflecting improvements in neonatal care in subjects with new type BPD.

Facing the large variety of life-limiting conditions in children Abstract Life-limiting conditions in children in specialized pediatric palliative care (PPC) are manifold. The “Together for Short Lives” (TfSL) association established four disease categories, which represent the most common illness trajectories. Better understanding the palliative care needs and symptoms of children within these TfSL groups will result in improved anticipation of clinical problems and tailored care. During this retrospective single-center cohort study, 198 children, adolescents, and young adults (CAYAs) were in PPC. Mean age at referral was 8.7 years (range 0.0–25.0), mean duration of care 355 days (range 1–2754). One hundred six (53.5%) CAYAs died during the study period. Sixty-five (32.8%) CAYAs were assigned to TfSL-1, 13 (6.6%) to TfSL-2, 49 (24.7%) to TfSL-3, and 71 (35.9%) to TfSL-4. Home visits were conducted on average every 9.6 days in TfSL-1, 18.9 days in TfSL-2, 31.7 days in TfSL-3, and 31.8 days in TfSL-4 (p value < 0.01). Conclusions: Intensity of palliative care significantly differed between the TfSL groups. Neurological and gastrointestinal symptoms were most prominent across all TfSL groups. Symptom cluster analysis showed distinct clusters in TfSL-1 (cluster 1, fatigue/lack of appetite/nausea/somnolence; cluster 2, dyspnea/fear/myoclonus/seizures/spasticity) and TfSL-3/4 (cluster 1, spasticity; cluster 2, all other symptoms). What is Known: • The four TfSL (together for short lives) groups represent the four most common illness trajectories of pediatric palliative care patients. • Better understanding the palliative care needs and symptoms of children within these four TfSL groups will result in improved anticipation of clinical problems and tailored care. What is New: • In our study, TfSL-1 represented the largest individual group of patients, also requiring the most intensive care (defined by the number of visits per days of care). • Symptom cluster analysis revealed distinct symptom clusters in TfSL-1 and TfSL-3/4, which can be used to anticipate clinically common challenges in these patients.

Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre’s experience Abstract This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants’ behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children’s Hospital, Turin, Italy. We analysed the medical records of infants < 12 months whose parents reported they had worrying behaviour during sleep in the period 1 January 2009– 31 December 2015. Regional guidelines suggest performing anamnesis and capillary blood gas analysis in case of apparent life-threatening events. There were 33 males, average age 55 ± 54.37 days. On arrival at the emergency medical service/emergency department 97 % infants were asymptomatic; 61 % patients had a capillary blood gas analysis as suggested by the regional guidelines. A clear acid-base disorder was observed in two infants, asymptomatic at medical evaluation, that had assumed an unsafe sleeping position. Two patients presented recurrence of the episode at 3 months. Conclusions: Most worrying infant behaviour during sleep can be related to paraphysiological phenomena; capillary blood gas analysis and anamnesis are pivotal to identify the cases at risk of fatal events. What is Known: • Events that happen during sleep often frighten the parents of newborns. This fear may be induced by the fact that Sudden Infant Death Syndrome typically occurs during sleep. • This tragic event is unpredictable by any clinical features or findings in instrumental examinations and cannot be prevented with an early resuscitation. What is New: • In our retrospective study, most worrying infant behaviour during sleep can be related to paraphysiological phenomena. • Capillary blood gas analysis and anamnesis collection were crucial to identify the only two life-threatening events.

Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study Abstract This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666–21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068–0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013–8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection. Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates. What is Known: • Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement. • Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited. What is New: • Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants. • Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.