Temperature probe placement in very preterm infants during delivery room stabilization: an open-label randomized trial.

BACKGROUND: Variation in practice exists for temperature probe positioning during stabilization of very preterm infants (<32 weeks gestation). We explored the influence of temperature probe sites on thermoregulation. METHODS: An open-label, stratified, balanced, parallel, randomized trial was conducted. Inborn infants were randomly assigned temperature probe to the axilla or to the upper back. The primary outcome was normothermia (local range: 36.8-37.3 °C and World Health Organization (WHO) range: 36.5-37.5 °C) at admission to the neonatal intensive care unit. RESULTS: Between 1 November 2018 and 4 July 2022, 178 infants were randomly assigned to one of the two sites (n = 89 each), 175 included in the final analysis. Normothermia (local range) was achieved for 39/87 infants (44.8%) assigned to the upper back compared to 28/88 infants (31.8%) assigned to the axilla [risk difference:13%; 95% CI -1.3-27.3]. Normothermia (WHO range) was achieved for 78/87 infants (89.7%) assigned to the upper back compared to 70/88 infants (79.6%) assigned to the axilla [risk difference:10.1%; 95% CI -0.5-20.7]. No infant recorded temperatures >38 °C or developed skin injury. CONCLUSIONS: In very preterm infants, upper back site was equally effective as the axilla in maintaining normothermia, with no increase in adverse events. CLINICAL TRIAL REGISTRATION: The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000293965). IMPACT: Substantial variation in practice exists for the site of securing a temperature probe during delivery room stabilization of very preterm infants and the influence of temperature probe site on thermoregulation remains unknown. In this study, upper back site was equally effective as the axilla in maintaining normothermia, with no increase in adverse events. Clinicians could adopt upper back site for maintaining normothermia. This study may contribute data to future international participant data prospective meta analysis of randomized controlled trials worldwide on temperature probe positioning in very preterm infants, increasing translation of research findings to optimize thermoregulation and clinical outcomes.

Vein of Galen aneurysm.

BACKGROUND: AV malformation of the vein of Galen, also known as vein of Galen aneurysm, is an intracranial anomaly characterised by a midline, high flow lesion with a complex vascular architecture. It compromises less than 1% of all cerebral arteriovenous malformations seen in adults and children. Timely diagnosis of the malformation is of importance particularly during the perinatal period due to the large systemic shunting within the fetal brain potentially leading to cardiac failure, hydrops and perinatal death. METHOD: Case Report: In this report, we present a case that had an increased nuchal translucency of 6 mm at 12 weeks gestation (karyotype normal), nuchal oedema of 12 mm noted at morphology scan and subsequently diagnosed with vein of Galen malformation at 32 weeks on a follow up scan. It was evaluated further with 3D power Doppler imaging modality. 3D power Doppler imaging provided us with improved images of the malformation in utero which was helpful for characterising the vascular anatomic features of the lesion before planned delivery and neonatal treatment. RESULTS: The patient was followed up with antenatal ultrasounds. There was no evidence of hydrops. She delivered a live healthy infant weighing 2.8 kg by elective caesarean section at 39 weeks. The child is now five and half years old and has undergone embolisation twice. CONCLUSION: We present a case illustrating use of Power Doppler imaging in a vein of Galen malformation. Prenatal diagnosis and endovascular treatment in the early neonatal period is important in preventing heart failure and resultant mortality in vein of Galen aneurysm.

Late diagnosis of hepatic mesenchymal hamartoma and placental mesenchymal dysplasia.

Placental mesenchymal dysplasia (PMD) is a rare condition characterised by placental enlargement, oedematous villi and multiple anechoic cysts. Hepatic mesenchymal hamartoma (HMH) is a benign proliferation of mesenchymal tissue, commonly seen in infants below the age of 2. We report the case of a 28 years old female who was noted to have a fetus with a well-circumscribed cyst on the liver, suggestive of HMH and a large, thickened placenta, with multiple anechoic cysts, consistent with PMD during the third trimester. There were no other structural abnormalities and at 38 weeks she underwent an induction of labour with normal vaginal delivery of a live female infant. While the aetiology is poorly understood, the increased incidence of HMH with PMD and the morphological similarities of the changes seen in both the placenta and liver, suggests a possible common developmental mechanism. There are only 12 other cases of this concurrent pathology in the literature and only one of these had resulted in a term delivery, and ours is the second one to date.