Neonatal end of life care in a tertiary care centre in Canada: a brief report / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To describe the processes followed by a neonatal team engaging parents with respect to end of life care of babies in whom long term survival was negligible or impossible; and to describe feedback from these parents after death of their child.</p><p><b>METHODS</b>A retrospective review was conducted of health records of neonates who had died receiving palliative care over a period of 5 years at a tertiary neonatal centre. Specific inclusion criteria were determined in advance that identified care given by a dedicated group of caregivers.</p><p><b>RESULTS</b>Thirty infants met eligibility criteria. After excluding one outlier an average of 4 discussions occurred with families before an end of life decision was arrived at. Switching from aggressive care to comfort care was a more common decision-making route than having palliative care from the outset. Ninety per cent of families indicated satisfaction with the decision making process at follow-up and more than half of them returned later to meet with the NICU team. Some concerns were expressed about the availability of neonatologists at weekends.</p><p><b>CONCLUSIONS</b>A compassionate and humane approach to the family with honesty and empathy creates a positive environment for decision-making. An available, experienced team willing to engage families repeatedly is beneficial. Initiating intensive care with subsequent palliative care is acceptable to families and caregivers.</p>

Effects of nosocomial infection trends on neonatal outcomes in preterm infants <33 weeks of gestational age in Canadian NICUs / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To characterize recent trends of nosocomial infection (NI) among preterm infants admitted to Canadian Level 3 NICUs during 2008-2012, and its association with neonatal outcomes.</p><p><b>METHODS</b>A retrospective observational cohort study was performed including infants born <33 weeks gestational age and admitted to 24 NICU sites participating in the Canadian Neonatal NetworkTM during 2008-2012. NICU sites were classified into three groups according to their baseline NI rates in 2008 [Low NI group (≤14%), Medium NI group (14.1%-19%) and High NI group (>19%)], and NICU sites were also classified according to their NI trend during 2008-2012 (decreased, null and increased). Trends in NI were further examined for each baseline-NI group. Trends for a composite outcome indicating mortality or severe morbidities (intraventricular hemorrhage grades≥3 or periventricular leukomalacia, retinopathy of prematurity stages≥3, bronchopulmonary dysplasia or necrotizing enterocolitis stages≥2) were examined for each baseline-NI and trend-NI NICU site groups using multivariable logistic regression analyses adjusted for potential confounders.</p><p><b>RESULTS</b>Baseline high NI group showed significantly decreased trends in NI rates, while for with medium or low baseline NI groups showed no significant trends in NI rates. The composite outcome (mortality during NICU stay or any severe neonatal morbidity such as intraventricular hemorrhage grades 3-4, periventricular leukomalacia, retinopathy of prematurity stages 3-5, bronchopulmonary dysplasia and necrotizing enterocolitis stages 2-3) decreased significantly for sites with decreased (OR=0.89, 95% CI=0.85-0.93) or null (OR=0.94, 95% CI=0.90-0.98) NI trends, but no significant trends in the composite outcome were detected for sites with increased NI rates.</p><p><b>CONCLUSIONS</b>The neonatal outcome is possibly influenced by NI rates and trend. The trend in the mortality and the risk of bronchopulmonary dysplasia, retinopathy of prematurity stage≥3 and intraventricular hemorrhage>2 were significantly decreased for sites with decreased NI trend, suggesting that these improved outcomes may be associated with effort to decrease NI rate.</p>

Children hospitalized with respiratory syncytial virus infection in Saskatchewan pediatric tertiary care centers, 2002-2005 / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To describe the epidemiology and severity of illness of children hospitalized with respiratory syncytial virus (RSV) infection, including those who received palivizumab prophylaxis, at Royal University Hospital (RUH), Saskatoon and Regina General Hospital (RGH) from July 2002 to June 2005.</p><p><b>METHODS</b>Children hospitalized for ≥ 24 hours with laboratory-confirmed RSV infection were enrolled, and their health records were retrospectively reviewed for patient demographics and referral patterns, use of palivizumab prophylaxis, severity of infection (length of hospitalization, need for and duration of pediatric intensive care and mechanical ventilation) and outcome of infection.</p><p><b>RESULTS</b>A total of 590 children (324 males) were hospitalized over the three years. The median chronological age at admission was 5.3 months, and median hospital stay was 4.0 days. Gestational age at birth was ≥ 36 weeks in 82.4% of patients. RSV disease severity was mild to moderate in 478 patients (81.0%) and severe in 110 (18.6%). Thirty-nine patients (6.6%) required pediatric intensive care unit admission, for a median of 5.0 days. Twenty-two of these patients (56%) were mechanically ventilated for a median of 6.0 days. Two children died, not attributed to RSV infection. Twenty-two patients had received palivizumab prophylaxis before hospital admission, with 18 completing at least 2 of the monthly doses. Most of these children (17/22) had mild to moderate illness.</p><p><b>CONCLUSIONS</b>RSV causes significant morbidity in Saskatchewan, affecting predominantly term infants. The majority of illness is mild to moderate. Some patients who have received palivizumab may still develop significant RSV disease.</p>

Influence of nutrition provision during the first two weeks of life in premature infants on adolescent body composition and blood pressure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Adequate nutrition is paramount for premature infants. Longitudinal information is scant on the effects of early nutrition and later growth. The purpose of this study was to determine the influence of early energy and protein provision in premature infants on adolescent body composition and blood pressure.</p><p><b>METHODS</b>In 2007-2008 we obtained data from 36 male (12.3±1.7 years) and 25 female (11.5±1.8 years) adolescents born preterm at <34 weeks gestation (range 23-34 weeks) between October 1st 1989 and December 31st 1995 (birth weight <1850 g). The adolescents were divided into groups depending on infant intake mode (enteral vs parenteral), energy provision (<70 kcal/kg/d and ≥70 kcal/kg/d) and protein provision (>2.5 g/kg/d for ≥5 days and >2.5 g/kg/d for <5 days) during the first 14 days of life.</p><p><b>RESULTS</b>After controlling for birth weight and biological maturity, adolescents who received ≥70 kcal/kg/d during infancy were significantly taller (163±11 cm vs. 156±11 cm) and heavier (58±16 kg vs. 49±16 kg) than adolescents who received <70 kcal/kg/d. There were no significant differences in systolic and diastolic BP and total percent body fat between the two groups.</p><p><b>CONCLUSIONS</b>Our data suggests that higher infant energy provision appears to be related to adolescent size, it does not appear to contribute to adverse risk factors such as higher systolic BP or increased body fat.</p>

Prevention of respiratory syncytial viral infections in late preterm infants / 中国当代儿科杂志

RSV prophylaxis is not routine in infant born 33 to 35 weeks gestation. Risk scoring tool can be utilized to identify infants that have significant chance for hospitalization. Premature birth is a leading cause of infant mortality and chronic pulmonary morbidity, therefore prevention of RSV hospitalization though immune prophylaxis in late preterm infants appears attractive.

Noninvasive respiratory support in neonates: a brief review / 中国当代儿科杂志

In the era of gentle ventilation and open lung strategy noninvasive ventilatory support in neonates has gained momentum and its use in nurseries around the world is also increased. This paper reviews various modalities of non-invasive respiratory support in some details and its relevance in the recent evidence based use. Continuous positive airway pressure (CPAP) is a mode of ventilatory assistance in which positive pressure is delivered to the airway throughout the respiratory cycle. It is also referred to as continuous distending pressure (CDP) or positive end expiratory pressure (PEEP) when applied through a ventilator along with intermittent mandatory ventilation (IMV). It has been proven over the years to be an effective mode of ventilatory support and as such has gained widespread use in the management of a variety of neonatal respiratory diseases. It is relatively cheap and easy to apply and certainly feasible for routine use in underdeveloped world. Besides improving oxygenation CPAP often functions as an airway stabilizer of the trachea thus helping to decrease the frequency of neonatal apneas, particularly the obstructive variety. There is good to fair quality supportive evidence from several studies that the use of primary CPAP can reduce the need for intubation and mechanical ventilation in infants less than 32 weeks gestation. In this review, we will attempt to describe different delivery devices and pressure generating systems and discuss different ways in which CPAP can be applied. Although it is unclear that primary use of CPAP can reduce overall neonatal mortality and morbidity it is becoming increasingly clear that early CPAP use is less invasive, baby friendly and decreases the need and frequency of the use of surfactants. Besides, clinical indications for CPAP, its advantages and limitations will also be explored. CPAP adjuncts such as nasal intermittent positive pressure ventilation (NIPPV) and infant flow driver will also be discussed.

Vitamin D intake in young children with acute lower respiratory infection / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To determine if vitamin D intake is associated with acute lower respiratory infections (ALRI) in children.</p><p><b>METHODS</b>The vitamin D intakes of children younger than 5 years of age admitted to hospital with either bronchiolitis or pneumonia were compared to an unmatched control group of the same age without respiratory infection. Caregivers of 197 children completed a questionnaire collecting information on demographic variables, ALRI risk factors and diet. Associations of ALRI with vitamin D intake and other ALRI risk factors were determined.</p><p><b>RESULTS</b>The mean vitamin D intake of children with ALRI was 48 IU/kg/d compared to 60 IU/kg/d in the control group. When controlling for age, ethnicity, socio-economic status, northern residence, breastfeeding, immunizations and smoking contact, children with a vitamin D intake of less than 80 IU/kg/d were greater than 4 times more likely to have ALRI compared to children with a vitamin D intake exceeding 80 IU/kg/d (OR=4.9; 95%CI: 1.5-16.4).</p><p><b>CONCLUSIONS</b>A higher vitamin D intake than currently recommended might be needed to offer protection against diseases such as ALRI. Increased vitamin D supplementation could have important public health consequences, as bronchiolitis and pneumonia are the most common reasons for hospitalization in young children. (Full English version will be available online at www.amepc.org/tp.).</p>

Neonatal seizures: diagnosis and management / 中国当代儿科杂志

The recognition of epileptic seizures in newborns is challenging as neonates exhibit a variety of paroxysmal motor phenomena, some epileptic but others not. The distinction, frequently requiring video-EEG monitoring, is crucial for management. Causes are often multi-factorial, specific to country/region, and change over time. Hypoxia-ischemia and infection are still common in both developed and developing countries. Venous and arterial strokes are being increasingly recognized. Treatable conditions, including inborn errors of metabolism, must be anticipated and considered early in the course. Etiology is the principal determinant of outcome. Management is based on uncontrolled studies and expert opinions. Information on neonatal seizures is reviewed, and suggestions for management provided. Phenobarbital remains the first anti-epileptic drug of choice, worldwide. Pharmacogenetic information and hepatic or renal dysfunction will influence doses of all drugs. The toxicity of excipients present in intravenous medicines should be kept in mind, especially when infusions are given to critically ill neonates. Therapeutic trials with pyridoxine or ideally pyridoxal phosphate, folinic acid and biotin should be considered early, if seizures are intractable. The management of electrographic seizures without clinical seizures needs critical study. When anti-epileptic drug treatment is required, maintenance should be for a short duration if seizures are of an acute symptomatic nature.