Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western Australia experience.

OBJECTIVE: Comparing the long-term neurodevelopmental and growth outcomes of lower and higher cumulative dexamethasone exposure in preterm infants ventilated for a minimum cumulative duration of 7 days. DESIGN: A retrospective cohort medical chart review of infants born in Western Australia <29 weeks' gestation between January 2007 and May 2016 who were mechanically ventilated >7 days. INTERVENTION: No dexamethasone (controls) or a total cumulative dexamethasone dose of <2 mg/kg (lower) and ≥2 mg/kg (higher). MAIN OUTCOME MEASURES: Long-term disability at 2 and 5 years and growth measurement outcomes at 2 years of age. RESULTS: Dexamethasone was given to 104 infants (66 with cumulative dose <2 mg/kg; 38 with cumulative dose ≥2 mg/kg), and 324 infants were controls. There was no difference in odds of long-term disability in infants with any dexamethasone exposure compared with controls (aOR: 0.90, 95% CI 0.34 to 2.02, p=0.784). No difference in long-term disability was found between the lower and higher groups (p=0.494). The prevalence of cerebral palsy (Gross Motor Functional Classification System level ≥2) between the control, lower and high-dose groups did not differ significantly (5.8% vs 4.0% vs 0%). The higher dose group had lower mean weight z-score (mean effect: -0.83, 95% CI: -1.54 to -0.01, p=0.023), height z-score (mean effect: -0.63, 95% CI: -12.5 to -0.01, p=0.048) and head circumference z-score (mean effect: -0.65, 95% CI: -1.25 to -0.05, p=0.035) compared with controls. CONCLUSIONS: In our cohort, dexamethasone use was not associated with increased odds of long-term disability. Dexamethasone use was associated with lower growth measurements compared with controls.

Incidental Findings on Brain Magnetic Resonance Imaging in Preterm Infants.

BACKGROUND: In recent years, many neonatal intensive care units have adopted the practice of routinely performing brain magnetic resonance imaging (MRI) of extremely preterm (EP) infants at term-equivalent age (TEA). This practice may result in increased identification of incidental findings (IF). OBJECTIVES: To determine the prevalence and clinical significance of incidental findings on routine MRI of EP infants. METHODS: We retrospectively reviewed findings on routine brain MRI on 165 EP infants at TEA (gestation < 28 weeks) admitted between June 2015 and December 2017. RESULTS: Incidental findings were detected in 16/165 (9.7%) infants. This included 9 cases that were clinically significant: 7 (with upper spinal cord abnormalities in 3, a choroid plexus lesion in 1, a pituitary abnormality in 1, and cerebral aqueduct narrowing in 2) required diagnostic intervention, and 2 (1 with an extramedullary arachnoid cyst and 1 with endolymphatic sac dilatation with a hypoplastic cochlear nerve) required diagnostic and therapeutic interventions. The incidental findings in the other 7 cases (a venous anomaly in 2, corpus callosum dysgenesis in 1, an absent septum pellucidum in 2, a frontal scalp mass in 1, and a nasal septum cyst in 1) were not clinically significant. CONCLUSIONS: Incidental findings were not uncommon on routine brain MRI of EP infants at TEA in our cohort. While most were clinically insignificant, some did require further diagnostic and therapeutic interventions. Prospective large studies on the prevalence and clinical significance of incidental findings on routine brain MRI of EP infants at TEA are required for developing evidence-based management plans and for counselling parents.

Applying Performance Frontiers in Operating Room Management: A Tutorial Using Data From an Academic Medical Center.

Although the primary goal of operating room (OR) management is to minimize inefficiencies, it may be difficult for OR managers to track metrics when one extrapolates possible scenarios across every OR on a daily basis. With the ability to visualize the statistical relationships to help simplify the analysis of large datasets, a more elaborate efficiency framework can be established using Pareto optimality (or performance frontiers), a multicriteria framework that includes variables that serve as proxies for a variety of outcomes. Applied to OR management, performance frontiers allow for the evaluation of common and well-understood issues of under- and over-utilized time.