Blood pressure intervention levels in preterm infants: pilot randomised trial.

OBJECTIVE: To examine the feasibility of a trial allocating different blood pressure (BP) intervention levels for treatment in extremely preterm infants. DESIGN: Three-arm open randomised controlled trial performed between February 2013 and April 2015. SETTING: Single tertiary level neonatal intensive care unit. PATIENTS: Infants born <29 weeks' gestation were eligible to participate, if parents consented and they did not have a major congenital malformation. INTERVENTIONS: Infants were randomised to different levels of mean arterial BP at which they received cardiovascular support: active (<30 mm Hg), moderate (

Newborn infants with bilious vomiting: a national audit of neonatal transport services.

OBJECTIVE: The precautionary approach to urgently investigate infants with bilious vomiting has increased the numbers referred to transport teams and tertiary surgical centres. The aim of this national UK audit was to quantify referrals and determine the frequency of surgical diagnoses with the purpose to inform the consequent inclusion of these referrals in the national 'time-critical' data set. METHODS: A prospective, multicentre UK-wide audit was conducted between 1 August, 2015 and 31 October, 2015. Term infants aged ≤7 days referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at 7 days after transfer were collected by the local teams and transferred anonymously for analysis. RESULTS: Sixteen teams contributed data on 165 cases. Teams that consider such transfers as 'time-critical' responded significantly faster than those that do not classify bilious vomiting as time-critical. There was a surgical diagnosis in 22% cases, and 7% had a condition where delayed treatment may have caused bowel loss. Most surgical problems could be predicted by clinical and/or X-ray findings, but two infants with normal X-ray features were found to have a surgical problem. CONCLUSION: The results support the need for infants with bilious vomiting to be investigated for potential surgical pathologies, but the data do not provide evidence for the default designation of such referrals as 'time-critical.' Decisions should be made by clinical collaboration between the teams and, where appropriate, swift transfer provided.

Can early-onset nonoliguric hyperkalemia be predicted in extremely premature infants?

Hyperkalemia is common soon after birth in extremely premature infants and often occurs in the absence of oliguria or renal failure. Our objective was to examine the early biochemical indicators, clinical risk factors, and incidence of early-onset nonoliguric hyperkalemia in a cohort of extremely premature infants. We studied clinical and biochemical data from 154 consecutive premature infants < or = 28 weeks of gestation admitted to a tertiary neonatal unit over a 3-year period. Hyperkalemia (> 7 mmol/L) was found in 33 (21%) of patients during the first 4 days of life, with peak potassium levels occurring at 3 days of age. Hyperkalemic patients had similar birthweight, gestation, creatinine and sodium levels as normokalemic infants, but they had higher phosphate and urea levels, with lower calcium levels. The combination of a high phosphate (> 2.0 mmol/L) and a high potassium (> 5.6 mmol/L) within 6 hours of birth predicted later development of hyperkalemia, with a positive likelihood ratio of 8.3 (post-test probability, 70%). Potassium level of < 5.6 mmol/L at birth indicates subsequent hyperkalemia is unlikely (likelihood ratio, 0.25; post-test probability, 4%). Mildly elevated potassium and phosphate levels within 6 hours after birth may be useful in predicting the development of early-onset hyperkalemia.