Associations between Red Blood Cell and Platelet Transfusions and Retinopathy of Prematurity.

AIM: The aim of this study is to examine possible associations between the transfusion of RBC or platelets (PLTs) and the development of retinopathy of prematurity (ROP) in infants. METHODS: This retrospective, national, case-control study included all live births in Switzerland between 2013 and 2018. We investigated preterm infants at a gestational age of <28 weeks, who developed higher stage ROP (≥stage 2, n = 178). Each case infant was matched to another of the same sex who did not develop ROP (n = 178, control group). RESULTS: When compared with the control group, we observed higher numbers of RBC transfusions per infant and higher percentages of infants receiving PLT transfusions in the case group. An adjusted logistic regression analysis revealed that both RBC (odds ratio [OR] 1.081, 95% confidence interval [CI] 1.020-1.146) and PLT transfusions (OR = 2.502, 95% CI 1.566-3.998) numbers were associated with ROP development. CONCLUSIONS: Multiple RBC and PLT transfusions are associated with higher stage ROP development. Prospective studies are required to determine their potential as risk factors.

Neonatal red blood cell transfusion practices in Switzerland: national survey and review of international recommendations.

WHAT IS KNOWN ON THE SUBJECT? Red blood cell transfusions are frequently used in the care of newborns, particularly premature infants. Some countries have guidelines regarding preparation, indication and administration of red blood cells in newborns. There are no such guidelines in Switzerland. WHAT DOES THE CURRENT STUDY ADD? This study analysed the results of two national surveys, one among blood transfusion services and the other among neonatal units in Switzerland. The results demonstrate considerable heterogeneity and a lack of “unité de doctrine”. Establishment of national guidelines would be helpful and warranted. AIMS OF THE STUDY: The aim of the study was to analyse Swiss practices in blood transfusion services and neonatal units for the preparation and administration of red blood cells in newborns. METHODS: Two questionnaires were developed and their results analysed. A first questionnaire was developed for the Swiss blood transfusion services and local hospital haematology laboratories, and a second for the neonatal units in Switzerland. RESULTS: 18/25 (72%) of laboratories and 26/29 (90%) of neonatal units performing red blood cell transfusions participated. Responses revealed a lack of consensus for the majority of questions. Differences were found in all steps of the process, from preparation (testing, irradiation, splitting, shelf life and storage of blood bags) to indication and administration (volume, speed, vascular access, patient monitoring) of red blood cells. Forty-six percent of neonatal units stated that they apply internal guidelines. Nevertheless, all but two would welcome the establishment of national recommendations. CONCLUSION: This study confirmed the large variety in neonatal red blood cell transfusion practices in Switzerland. In the absence of clear evidence, national guidelines – as applied in other countries – would foster a common policy among Swiss neonatologists and facilitate the implementation of a national database for future research and comparison with international literature.

Bronchopulmonary dysplasia-impact of severity and timing of diagnosis on neurodevelopment of preterm infants: a retrospective cohort study.

OBJECTIVE: To assess the contribution of the severity of bronchopulmonary dysplasia (BPD) and the time point of its diagnosis to the prediction of neurodevelopmental impairment (NDI) at corrected age of 2 years in preterm infants. DESIGN: Retrospective cohort study. SETTING: Level-III perinatal centre. PATIENTS AND OUTCOME MEASURES: Infants born in 2000-2013 with gestational age <30 weeks. BPD was defined as FiO2 >21% for ≥28 days and its severity classified as mild, FiO2=21%; moderate, FiO2 <30% and severe, FiO2 ≥30% and/or positive pressure support. We applied these criteria at two time points: 36 and 40 weeks' postmenstrual age (PMA). Multivariable regression models were used to estimate the association (OR (95% CI)) between BPD characteristics and NDI defined as cognitive or motor development score <2 SD; severe cerebral palsy; deafness and blindness. RESULTS: Of 610 (81% of cohort) children assessed at 2 years, 357 (58%) had BPD and 98 (16%) had NDI. Neither FiO2 >21% for ≥28 days nor mild or moderate BPD at either 36 or 40 weeks' PMA was associated with NDI, but severe BPD was (at 36 weeks' PMA 5.6 (2.0 to 16.0) and at 40 weeks' PMA 16.6 (4.6 to 59.9)). Infants with severe BPD at both 36 and 40 weeks' PMA had lower mental (mean difference -11.4 (-18.5 to -4.3), -25.7(-35.9 to -15.5), respectively) and motor (-7.8 (-14.9 to -0.6), -20.1(-30.7 to -9.5), respectively), developmental scores than infants without BPD. CONCLUSION: In this cohort, severe BPD was a better independent predictor of NDI at 2 years than mild or moderate BPD. BPD diagnosed at 40 weeks' PMA might allow better identification of infants at highest risk for NDI.

Short courses of dual-strain probiotics appear to be effective in reducing necrotising enterocolitis.

AIM: Prophylactic probiotics to reduce necrotising enterocolitis (NEC) are mostly given for at least 28 days or until discharge. We describe the effects of a shorter duration dosing strategy. METHODS: Retrospective cohort study of neonates (birthweight 400-1500 g) in three neonatal intensive care units in Switzerland and Germany that embarked on probiotic prophylaxis given for 10 or 14 days, employing a fixed combination (Lactobacillus acidophilus plus Bifidobacterium infantis, each 10(9) CFU/day) licensed as a drug in Switzerland. Probiotics were initiated upon discontinuation of antibiotics, or on day 1-3 in infants without antibiotics. Repeat probiotic courses were given whenever antibiotics had been instituted and were discontinued. RESULTS: Birthweight and gestational age were similar in the two 24-month pre- and postimplementation cohorts. NEC rates fell from 33 of 633 (5.2%) to 8 of 591 infants alive at three days (1.4%; risk ratio (RR) 0.26, 95% confidence interval (CI) 0.12-0.55). The drop in NEC was significant both for infants of 400-999 g (6.4% to 2.5%) and 1000-1500 g birthweight (4.4% to 0.6%). Mortality was 5.1% (32/633) without, as opposed to 3.5% (21/591) with probiotics, respectively (RR 0.69, 95% CI 0.41-1.19). CONCLUSION: Short courses of a dual-strain probiotics appear to be effective in reducing NEC.

Higher multiple births in Switzerland: neonatal outcome and evolution over the last 20 years.

QUESTION UNDER STUDY: The study has following objectives: 1) to determine the incidence of higher-order multiple births from 2005 to 2008 in Switzerland and its evolution over the last twenty years, and 2) to analyse the neonatal outcome and its change over the last two decades. METHODS: Data on higher-order multiple births were retrospectively obtained from Swiss obstetric and neonatal hospitals and compared with results from the first two national surveys. RESULTS: The incidence of higher-order multiple births was 35.3/100,000 live births for triplets, 0.7/100,000 for quadruplets and 0.3/100,000 for quintuplets. All newborns were premature with a median gestational age of 32 1/7 weeks for triplets, 29 2/7 weeks for quadruplets and 28 4/7 weeks for quintuplets. 94% of triplets and all quadruplets and quintuplets survived the neonatal period. Over the last two decades, the incidence of quadruplet and quintuplet births has fallen, while that of triplet births has risen by 40%. The perinatal mortality of triplets has decreased and the neonatal morbidity, mainly respiratory distress, has remained constant. CONCLUSION: Higher-order multiple births have a high morbidity that has not improved over the last two decades. The incidence of higher-order multiple births is still increasing, which demonstrates that reproductive medicine in Switzerland is not yet sufficiently controlled and monitored.

Malposition of feeding tubes in neonates: is it an issue?

OBJECTIVES: Accurate tube placement of orogastric and nasogastric feeding tubes in neonates is important to ensure safe and effective enteral feeding. Errors in placement and position of feeding tubes are described in literature, but there is little evidence of the exact prevalence of improperly placed tubes, especially in neonates. MATERIALS AND METHODS: To evaluate the prevalence of improperly placed feeding tubes, we reviewed 381 consecutive radiographs and defined the position of the feeding tubes. RESULTS: We found that in 41% of the placements, the optimal position of the feeding tubes was achieved, whereas overall 59% of the feeding tubes had been placed incorrectly. CONCLUSIONS: There is a need for both better rules to measure the distance between nose (lips) and the body of the stomach and improved methods to confirm correct tube position in neonates.

Pulse oximetry screening for congenital heart defects in Switzerland: most but not all maternity units screen their neonates.

QUESTIONS: In Switzerland, the screening of neonates for congenital heart defects (CHD) by using pulse oximetry (PO) on the first day of life was recommended in 2005. We assessed the current practice of Swiss maternity units regarding PO screening to define the actual screening rate in Switzerland and to detect possible difficulties in the implementation of this screening. METHODS: This descriptive study was conducted by means of a standardized questionnaire that was sent to all Swiss maternity units. RESULTS: The response rate was 100%. 76% of the units perform regular PO screening and, on the basis of the number of births for 2007, this means that 85% of newborns in Switzerland undergo screening. Although units which do not perform PO screening include every category of maternity unit, the screening is performed to a significantly lower extent in birthing centres than in hospitals (p <0.001). The number of unscreened neonates was 5398 within small units (<1000 births per year) while it was 6137 within large units (>1000 births per year). The main reasons for not performing PO screening are financial factors and the belief that clinical signs are sufficient for the detection of CHD. CONCLUSIONS: Greater effort is needed to implement a nationwide PO screening program for CHD. Special attention should be paid to birthing centres given their limited capacity to treat newborns with critical CHD.

The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: size matters.

OBJECTIVE: We sought to analyze the effect of patent ductus arteriosus diameter on treatment success in premature neonates. METHODS: Among 537 consecutive neonates born between 1985 and 2005 with a diagnosed patent ductus arteriosus, 201 premature patients (<35 weeks' gestation) treated for a hemodynamically significant patent ductus arteriosus were retrospectively reviewed. Two groups were compared: group MED (n = 154; successful treatment with indomethacin) and group FAIL (n = 47; failure of medication to reduce the patent ductus arteriosus diameter to hemodynamic insignificance). RESULTS: After unsuccessful medical treatment, 33 patients required surgical patent ductus arteriosus closure, 12 died before further possible treatment, and 2 were discharged home without clinical symptoms but with an open patent ductus arteriosus. Mean patent ductus arteriosus diameter in the FAIL group (2.8 +/- 0.9 mm) was significantly larger than that in the MED group (2.4 +/- 0.6 mm, P < .01). Assisted respiration time (ventilation plus continuous positive airway pressure) before patent ductus arteriosus closure was longer in the FAIL group (20 days) than in the MED group (9 days, P < .001) but was similar after patent ductus arteriosus closure. By using an index of patent ductus arteriosus diameter squared/birth weight (in square millimeters per kilogram), a cutoff value of less than 9 mm2/kg correctly predicts medical patent ductus arteriosus closure in 87.5% of patients. Values of greater than 9 mm2/kg correctly predict medication failure in 41.5% of patients. CONCLUSIONS: In preterm babies requiring surgical patent ductus arteriosus closure, longer respiration times reflect a delay while attempting medical treatment, but respiration time is equally short between groups after shunt elimination. Medical treatment, although a valid first option, is likely to fail with larger patent ductus arteriosus diameters and lower birth weights. Unwarranted assisted respiration and corresponding hospital stay might be shortened by earlier surgical referral for patent ductus arteriosus closure in preterm babies with a patent ductus arteriosus index of greater than 9 mm2/kg.