Simple and accurate formula to estimate umbilical arterial catheter length of high placement.

OBJECTIVE: The present study aimed to derive the new simple, reliable, and accurate formula based on a body measurement parameter and not on reference graphs, to determine umbilical arterial catheter length of high placement, between the sixth to tenth thoracic vertebral (T6-T10) levels. Accuracy among a variety offormulas was also examined. MATERIAL AND METHOD: A prospective recruitment of 40 babies who had an umbilical arterial catheter placed in the NICU, Thammasat University Hospital was studied Insertional length for high placement was measured. The body measurement parameters were measured twice on each patient to indicate their reliability properties. Three individual umbilical arterial lengths, from umbilical ring to anatomical points of T6, T8, and T10 levels accordingly, were estimated by verifying the catheter tip against those anatomical points on chest and abdominal radiograph. Correlation coefficient (r) between each parameter and the umbilical arterial length to the T8 level was calculated. RESULTS: Suprasternal notch to superior iliac spine length (SSSL) was the selected parameter to derive a new formula because of high reliability coefficient of 0.964, high correlation to the umbilical arterial length to the T8 level (r = 0.906), and its simplicity to measure. The accuracy of the 'SSSL' to position the catheter tip at T6-T10 was 90%. CONCLUSION: The SSSL is simple and accurate for predetermination of the umbilical arterial catheter length to position the catheter tip at T6-T10. It can be an alternative formula, especially where birth weight and total body length are not available.

Survival and outcome of very low birth weight infants born in a university hospital with level II NICU.

OBJECTIVES: Determine the survivals, neonatal outcomes to hospital discharge, and perinatal risks of death among VLBW infants born in the Thammasat University Hospital. MATERIAL AND METHOD: This was a retrospective longitudinal study. Data were colleted from medical charts of all neonates with a gestational age of more than 25 weeks and birth weight of less than 1500 grams, who were born in Thammasat University Hospital for a 3-year period between July 1st, 2003 and June 30th, 2006. Antenatal history, perinatal data, and neonatal outcome until hospital discharge were extracted and analyzed. RESULTS: Seventy-eight neonates with a birth weight between 600-1485 grams were analyzed. Survival rate of very-low-birth-weight (VLBW) infants and extremely-low-birth-weight (ELBW) infants were 81% and 52% respectively. Respiratory distress syndrome (RDS) was the major cause of death. Major morbidity was found in 35% of survived infants to hospital discharge. Unfavorable outcome was documented in infants with a birth weight < 750 grams. Perinatal risks of mortality among VLBW infants included no use of antenatal steroids (p = 0.015), gestational age of <28 weeks (p = 0.012), ELBW (p < 0.001), congenital abnormalities (p = 0.002), Apgar score at 5 minute <5 (p = 0.019), needed endotracheal intubation in the delivery room (p < 0.001), and first temperature at NICU < 35.0 degrees C (p = 0.023). CONCLUSION: Overall survival and outcome among very-low-birth-weight infants born in Thammasat University Hospital is acceptable. The mortality and morbidity in extremely-low-birth-weight infants remained high. A continuing audit of these measures should be encouraged.