Background: Congenital infections are associated with a wide spectrum of clinical symptoms, including lenticulostriate vasculopathy (LSV). Objective: To determine the relationship between LSV and... Show moreBackground: Congenital infections are associated with a wide spectrum of clinical symptoms, including lenticulostriate vasculopathy (LSV). Objective: To determine the relationship between LSV and congenital infections, as diagnosed by TORCH serology and viral culture for cytomegalovirus (CMV). Methods: All neonates with LSV admitted to our neonatal intensive-care unit from 2004 to 2008 were included in the study. Results of maternal and neonatal TORCH testing were evaluated. Results: During the study period, cranial ultrasound scans were performed in 2,088 neonates. LSV was detected in 80 (4%) neonates. Maternal and/or neonatal serological TORCH tests were performed in 73% (58/80) of cases. None of the mothers or infants (0 of 58) had positive IgM titres for Toxoplasma, rubella, CMV or herpes simplex virus. Additional urine culture for CMV was performed in 38 neonates. None of the infants (0 of 38) had a positive CMV urine culture test. Conclusions: Routinely applied efforts to diagnose congenital infections in cases presenting with LSV have a poor yield. Routine TORCH screening in neonates with LSV cases should only be regarded as mandatory once well-designed studies demonstrate a clear diagnostic benefit. Copyright (C) 2009 S. Karger AG, Basel Show less
Objectives To evaluate mask technique during simulated neonatal resuscitation and test the effectiveness of training in optimal mask handling. Study design Seventy participants (consultants,... Show moreObjectives To evaluate mask technique during simulated neonatal resuscitation and test the effectiveness of training in optimal mask handling. Study design Seventy participants (consultants, registrars and nurses) from neonatal units were asked to administer positive pressure ventilation at a flow of 8 l/min and a frequency of 40-60/min to a modified leak free, term newborn manikin (lung compliance 0.5 ml/cm H2O) using a Neopuff T-piece device. Recordings were made (1) before training, (2) after training in mask handling and (3) 3 weeks later. Leak was calculated. Obstruction (tidal volume <60% of optimal tidal volume) and severe obstruction (<30% of optimal tidal volume) were calculated when leak was minimal. Results For the 70 participants, median (IQR) leak was 71% (32-95%) before training, 10% (5-37%) directly after training and 15% (4-33%) 3 weeks later (p<0.001). When leak was minimal, gas flow obstruction was observed before, directly after training and 3 weeks later in 46%, 42% and 37% of inflations, respectively. Severe obstruction did not occur. Conclusions Mask ventilation during simulated neonatal resuscitation was often hampered by large leaks at the face mask. Moderate airway obstruction occurred frequently when effort was taken to minimise leak. Training in mask ventilation reduced mask leak but should also focus on preventing airway obstruction. Show less
OBJECTIVE: Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need... Show moreOBJECTIVE: Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need respiratory support in the NICU, but international resuscitation guidelines do not stipulate use of this therapy during stabilization at birth. We aimed to investigate the effect of humidified and heated gas on admission temperature in preterm infants who require respiratory support at birth. METHODS: Two cohorts of very preterm infants born at <= 32 weeks' gestational age in the Leiden University Medical Center were compared prospectively before (the "cold" cohort) and after (the "heated" cohort) introduction of the use of heated and humidified gas during respiratory support at birth (continuous positive airway pressure or intubation). The primary outcome was the infant's rectal temperature at admission in the NICU. RESULTS: There was a difference in the mean (SD) rectal temperature between the cold and heated cohorts (35.9 [0.6] vs 36.4 [0.6], respectively; P < .0001). Normothermia (36.5 degrees C-37.5 degrees C) occurred less often in the cold cohort than in the heated cohort (12% vs 43%; P < .0001). There was no difference in occurrence of mild hypothermia (36.0 degrees C-36.4 degrees C) between groups (33% vs 35%; not significant). Moderate hypothermia (<36.0 degrees C) occurred more often in the cold cohort (53% vs 19%; P < .001). CONCLUSIONS: The use of heated and humidified air during respiratory support in very preterm infants just after birth reduced the postnatal decrease in temperature. Heating and humidifying the gas during stabilization merits additional investigation. Pediatrics 2010; 125: e1427-e1432 Show less
Weiden, S. van der; Steggerda, S.J.; Pas, A.B.T.; Vossen, A.C.T.M.; Walther, F.J.; Lopriore, E. 2010
Background: Congenital infections are associated with a wide variety of clinical symptoms, including subependymal cysts (SEC). Objective: To determine the co-occurrence of SEC and congenital... Show moreBackground: Congenital infections are associated with a wide variety of clinical symptoms, including subependymal cysts (SEC). Objective: To determine the co-occurrence of SEC and congenital infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture. Methods: We performed a retrospective study of all neonates admitted to our neonatal intensive care unit from 1998 to 2009 in whom SEC were detected on cranial ultrasound and TORCH serologic tests and/or CMV urine cultures were performed. Results: Fifty-nine neonates fulfilled the inclusion criteria. TORCH serologic tests were performed in 69% (41/59) of cases. Urine CMV culture was performed in 68% (40/59) of cases. None of the neonates tested positive for IgM Toxoplasma gondii, Rubella and Herpes simplex virus. Positive CMV IgM titers and/or a positive urine CMV culture were detected in 2% (1/59) of neonates. Conclusion: The co-occurrence of TORCH congenital infections in infants with SEC is rare. Routine TORCH screening in neonates with SEC does not seem warranted. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Show less
This study compares the methods of Dunn and Shukla in determining the appropriate insertion length of umbilical catheters. In July 2007 we changed our policy for umbilical catheter insertions from... Show moreThis study compares the methods of Dunn and Shukla in determining the appropriate insertion length of umbilical catheters. In July 2007 we changed our policy for umbilical catheter insertions from the method of Dunn to the method of Shukla. We report our percentage of inaccurate placement of umbilical-vein catheters (UVCs) and umbilical-artery catheters (UACs) before and after the change of policy. In the Dunn-group, 41% (28/69) of UVCs were placed directly in the correct position against 24% (20/84) in the Shukla-group. The position of the catheter-tip of UVCs in the Dunn-group and the Shukla-group was too high in 57% (39/69) and 75% (63/84) of neonates, respectively. UACs in the Dunn-group were placed directly in the correct position in 63% (24/38) compared to the Shukla-group in 87% (39/45) of cases. The position of the catheter-tip of UACs in the Dunn-group and the Shukla-group was too high in 34% (13/38) and 13% (6/45) of neonates, respectively. In conclusion, the Dunn-method is more accurate than the Shukla-method in predicting the insertion length for UVCs, whereas the Shukla-method is more accurate for UACs. Show less
