To determine whether injection of air via feeding tube before taking radiographs improves radiological assessment of its position.

In the study group (n=153), air was injected via gastric feeding tube before taking a radiograph. The tube position on radiographs was compared with a blinded control group (n=381) with no injection of air.

The definition of exact gastric tube position was possible in 95% of the study group compared with 78% in the control group (p<0.001).

Injection of air before taking a radiograph significantly improves the definition of exact gastric feeding tube position in neonates.

Cases of SIA delivered during January 1990 to December 2006 notified to 20 EUROCAT registers formed the population-based case series. Prevalence over time was estimated using multilevel Poisson regression, and heterogeneity between registers was evaluated from the random component of the intercept.

In total 1133 SIA cases were reported among 5126, 164 registered births. Of 1044 singleton cases, 215 (20.6%) cases were associated with a chromosomal anomaly. Of 829 singleton SIA cases with normal karyotype, 221 (26.7%) were associated with other structural anomalies. Considering cases with normal karyotype, the total prevalence per 10 000 births was 1.6 (95% CI 1.5 to 1.7) for SIA, 0.9 (95% CI 0.8 to 1.0) for duodenal atresia and 0.7 (95% CI 0.7 to 0.8) for jejunoileal atresia (JIA). There was no significant trend in SIA, duodenal atresia or JIA prevalence over time (RR=1.0, 95% credible interval (CrI): 1.0 to 1.0 for each), but SIA and duodenal atresia prevalence varied by geographical location (p=0.03 and p=0.04, respectively). There was weak evidence of an increased risk of SIA in mothers aged less than 20 years compared with mothers aged 20 to 29 years (RR=1.3, 95% CrI: 1.0 to 1.8).

This study found no evidence of a temporal trend in the prevalence of SIA, duodenal atresia or JIA, although SIA and duodenal atresia prevalence varied significantly between registers.

Case-control study embedded in an epidemiological survey over a 2-year period.

Throughout 2009, every paediatric department in Germany was asked to report cases of unexplained SID or S-ALTE in term infants with a 10-min Apgar score ≥8 to the Surveillance Unit for Rare Pediatric Conditions. Throughout 2010, the inclusion criteria were extended to infants ≥35 week gestational age and those where an explanation for the deterioration had been found. For each unexplained case, hospitals were asked to fill in a questionnaire for 3 (near-)term controls with good postnatal adaptation at the age (in minutes) when the event had occurred in the case under study.

Of the 85 cases reported, 34 fulfilled the entry criteria; of these, two were near-term newborns and, in three cases, a cause had been identified for the event. For the 31 cases with unknown cause for the event (13 males; mean (SD) gestational age 38.9 (1.7) week), the authors gathered 93 controls (51 male infants; 38.9 (1.4) week). As significant risk factors for S-ALTE and SID, the authors could identify primipara (OR 6.22; 95% CI 2.11 to 18.32) and potentially asphyxiating position (OR 6.45; 95% CI 1.22 to 34.10).

Close observation of newborns seems necessary, particularly in primipara; a potentially asphyxiating position should be avoided.

A retrospective cohort study comparing the incidence of IVH in very premature infants with thrombocytopaenia (platelet count <150x10⁹/l) admitted between 2007 and 2008 to two neonatal intensive care unit in The Netherlands. The restrictive platelet-transfusion unit (N=353 infants <32 weeks gestation) transfused only in case of active haemorrhage and a platelet count <50x10⁹/l. The liberal-transfusion unit (N=326 infants <32 weeks gestation) transfused according to predefined platelet count thresholds. Primary outcome was the incidence and severity of IVH in infants with thrombocytopaenia in both units.

The number of infants with thrombocytopaenia that received a platelet transfusion was significantly lower in the restrictive-transfusion unit compared with the liberal-transfusion unit, 15% (21/145) versus 31% (41/141), (p<0.001). The incidence of IVH in infants with thrombocytopaenia in the restrictive-transfusion and liberal-transfusion units was 30% (44/145) and 29% (41/141), respectively (p=0.81). The incidence of severe IVH (grade 3 or 4) in the restrictive-transfusion and liberal-transfusion units was 8% (12/145) and 11% (16/141), respectively (p=0.38).

In the restrictive-transfusion unit, the rate of platelet transfusions was significantly lower, but the incidence and severity of IVH was similar to the liberal-transfusion unit.

Prospective observational study.

Peripheral-muscle NIRS was performed in the first week of life. Tissue-oxygenation index (TOI), mixed venous oxygenation (SvO₂), fractional oxygen extraction (FOE), haemoglobin flow (Hbflow), oxygen delivery (DO₂) and oxygen consumption (VO₂) were assessed. Blood samples were taken within 3 h of the NIRS measurements.

Cardiocirculatory stable term and preterm neonates with infection-related and infection-unrelated CRP elevations >10 mg/l were compared with neonates without CRP elevation. The two groups were matched for gestational and postnatal age.

33 neonates with CRP elevation (gestational age 37.7±2.9 weeks) were compared with 33 controls (gestational age 37.3±2.9 weeks). In neonates with CRP elevation, TOI (68.9±6.6%), SvO₂ (66.9±7.3%) DO₂ (39.2±16.1 µmol/100ml/min) and VO₂ (10.9±3.4 µmol/100ml/min) were significantly lower compared with controls (TOI 72.9±3.8%, SvO₂ 70.2±4.7%, DO₂ 48.8±18.4 µmol/100ml/min, VO₂ 12.3±3.8 µmol/100ml/min). There was no significant difference in any other NIRS or routine haemodynamic parameter between the two groups.

Inflammatory processes with CRP elevation cause impaired peripheral oxygenation and perfusion in neonates even when routine haemodynamic variables are still normal. NIRS might offer a new non-invasive tool for the early recognition and diagnosis of infectious and non-infectious inflammatory processes.

Administrative health records of live infants born between January 1, 1997, and December 31, 2000 with 3 years follow-up data (N=35733) were linked. First, diagnoses of morbidities were compared between late-preterm and term infants using Cox's proportional hazards models. Healthcare costs expressed as mean total costs and cost ratios, accrued following initial hospital discharge after birth, were also examined.

The three most common reasons for hospitalisation in late-preterm and term infants were acute bronchitis, otitis media and pneumonia. The most frequent reasons for physician visits included acute upper respiratory infections, otitis media and bronchiolitis. The highest HR were detected for chronic bronchitis 1.64 (1.13–2.39), hearing loss 1.56 (1.14–2.15) and bacterial diseases 1.28 (1.09–1.49). The mean total cost for late-preterm infants during the first 2 years of life was $2568 CAD compared with $1285 CAD for term infants, cost ratio =1.99 (95% CI 1.90 to 2.09). In the third year of life, the cost ratio reduced to 1.46 (95% CI 1.39 to 1.54).

Late-preterm infants are at higher risk of specific morbidities compared with term infants. Their mean total costs fall from almost double that of term infants during the first 2 years of life, to just 46% greater in the third year of life.

In this prospective observational study, left ventricular output (LVO) was simultaneously measured by EV (LVO_ev) using Aesculon and by echocardiography (LVO_echo) in healthy term neonates during the first 2 postnatal days. To determine the agreement between the two methods, we calculated the bias (mean difference) and precision (1.96xSD of the difference). As LVO_echo has its own limitations, the authors also calculated the ‘true precision’ of EV adjusted for echocardiography as the reference method.

The authors performed 115 paired measurements in 20 neonates. LVO_ev and LVO_echo were similar (534±105 vs 538±105 ml/min, p=0.7). The bias and precision of EV were –4 and 234 ml/min, respectively. The authors found the true precision of EV to be similar to the precision of echocardiography (31.6% vs 30%, respectively). There was no difference in bias and precision between the measurements obtained in patients with or without a haemodynamically significant patent ductus arteriosus.

EV is as accurate in measuring LVO as echocardiography and the variation in the agreement between EV and echocardiography among the individual subjects reflects the limitations of both techniques.

Retrospective observational study.

Neonates >37 weeks gestation born between 2003 and 2010 in two hospitals.

Off-line analysis of prolonged continuous multichannel video-EEG recordings was performed independently by two experienced encephalographers. Comparison between the recorded electrographic seizure burden in non-cooled and cooled neonates was assessed. Data were treated as non-parametric and expressed as medians with interquartile ranges (IQR).

One hundred and seven neonates with HIE underwent prolonged continuous multichannel EEG monitoring. Thirty-seven neonates had electrographic seizures, of whom 31 had EEG recordings that were suitable for the analysis (16 non-cooled and 15 cooled). Compared with non-cooled neonates, multichannel EEG monitoring commenced at an earlier postnatal age in cooled neonates (6 (3–9) vs 15 (5–20) h)and continued for longer (88 (75–101) vs 55 (41–60) h). Despite this increased opportunity to capture seizures in cooled neonates, the recorded electrographic seizure burden in the cooled group was significantly lower than in the non-cooled group (60 (39–224) vs 203 (141–406) min). Further exploratory analysis showed that the recorded electrographic seizure burden was only significantly reduced in cooled neonates with moderate HIE (49 (26–89) vs 162 (97–262) min).

A decreased seizure burden was seen in neonates with moderate HIE who received cooling. This finding may explain some of the therapeutic benefits of cooling seen in term neonates with moderate HIE.

Outcomes were assessed using a parental questionnaire, including the Health Utilities Index (HUI-3) to assess functional impairment, and specific medical and behavioural outcomes. Educational outcomes for children in England were explored using national standardised tests. Multiple logistic regression was used to explore independent associates of NEC within the cohort.

The authors obtained data for 119 (77%) of 157 children following proven or suspected NEC and compared their outcomes with those of the remaining 6496 children. NEC was associated with an increase in risk of neonatal death (OR 14.6 (95% CI 10.4 to 20.6)).

At 7 years, NEC conferred an increased risk of all grades of impairment. Adjusting for confounders, risks persisted for any HUI-3 defined functional impairment (adjusted OR 1.55 (1.05, 2.29)), particularly mild impairment (adjusted OR 1.61 (1.03, 2.53)) both in all NEC children and in those with proven NEC, which appeared to be independent. No behavioural or educational associations were confirmed. Following NEC, children were more likely to suffer bowel problems than non-NEC children (adjusted OR 3.96 (2.06, 7.61)).

The ORACLE Children Study provided opportunity for the largest evaluation of school age outcome following neonatal NEC and demonstrates significant long-term consequences of both gut function (presence of stoma, admission for bowel problems and continuing medical care for gut-related problems) and motor, sensory and cognitive outcomes as measured using HUI-3.

A population-based, longitudinal study.

The national child mortality surveillance network.

Population of the 79 surveillance counties.

IMR, leading causes of infant death and the RR of IMR.

The IMR in coastal, inland and remote regions declined by 72.4%, 62.9% and 58.2%, respectively, from 1996 to 2008. Compared with the coastal region, the RR of IMR were 1.7 (95% CI 1.6 to 1.9), 1.9 (95% CI 1.7 to 2.0) and 1.8 (95% CI 1.6 to 2.0) for inland region and 2.6 (95% CI 2.4 to 2.7), 3.2 (95% CI 3.0 to 3.5) and 3.1 (95% CI 2.7 to 3.4) for the remote region during 1996–2000, 2001–2005 and 2006–2008, respectively. The regional disparities existed for both male and female IMRs. The postneonatal mortality showed the highest regional disparities. Pneumonia, birth asphyxia, prematurity/low birth weight, injuries and diarrhoea were the main contributors to the regional disparities. There were significantly more infants who did not seek healthcare services before death in the remote region relative to the inland and coastal regions.

The results indicated persistent existence of regional disparities in IMR in rural China. It is worth noting that regional disparities in IMR increased in the remote and coastal regions during 2001–2005 in rural China. These disparities remained unchanged during 2006–2008. The results indicate that strategies to reduce mortality caused by pneumonia, birth asphyxia and diarrhoea are keys to reducing IMR.

This prospective, observational study was performed from April 2007 until June 2009 among 315 infants born <32 weeks of gestation. Postnatal CMV infection was diagnosed by CMV PCR on urine collected at term-equivalent age. In CMV-positive infants, congenital infection was excluded. The authors compared the clinical and demographic data, feeding pattern and cUS results of infected and non-infected patients. Logistic regression analysis was performed.

In 39 of 315 infants, the diagnosis of postnatal CMV infection has been made. The majority of CMV-infected infants (33/39.85%) did not develop any symptoms of CMV infection. The most important, independent risk factors of postnatal CMV infection were non-native Dutch maternal origin (OR 9.6 (95% CI 4.3 to 21.5)) and breast milk (OR 13.2 (95% CI 1.7 to 104.5)). The risk of infection significantly increased in infants with lower gestational age (GA) (OR 0.7 (95% CI 0.5 to 0.9)). Lenticulostriate vasculopathy (LSV) was significantly more often present in infants with CMV infection (OR 4.1 (95% CI 1.9 to 8.8)).

Postnatal CMV infection is an asymptomatic infection among preterm infants. Infants with lower GA are at greatest risk of postnatal CMV infection, especially when fed with fresh breast milk from their non-native Dutch mother. LSV not present at birth but confirmed at term-equivalent age can suggest a postnatal CMV infection.

To examine the trend of survival rates of borderline viable infants over a 10-year-period and to further explore CTC differences.

Population-based, retrospective cohort study.

All nine level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals in Switzerland.

6532 preterm infants with a gestational age (GA) <32 weeks born alive between 1 January 2000 and 31 December 2009.

Trends of GA-specific delivery room and NICU mortality rates and survival rates to hospital discharge were assessed. For CTC comparisons, centre-specific risk-adjusted ORs for survival were calculated in three GA groups: A: 23 0/7 to 25 6/7 weeks (n=976), B: 26 0/7 to 28 6/7 weeks (n=1943) and C: 29 0/7 to 31 6/7 weeks (n=3399).

Survival rates of infants with a GA of 25 completed weeks which had improved from 42% in 2000/2001 to 60% in 2003/2004 remained unchanged at 63% over the next 5 years (2005–2009). Statistically significant CTC differences have persisted and are not restricted to borderline viable infants.

In Switzerland, survival rates of infants born at the limit of viability have remained unchanged over the second half of the current decade. Risk-adjusted CTC outcome variability cannot be explained by differences in baseline demographics or centre case loads.

Data relating to neonatal surgical admissions to a level 3 perinatal centre serving a network with 36 000 births per year collected prospectively over a 5-year period were analysed to identify annual activity. Daily dependency was assessed prospectively over a 6-month period and service costs calculated using existing local tariffs. Admissions from outside the network were excluded from analysis, and allowance was made for refused network admissions.

On average 140 admissions required 2137 cot-days per year. At 80% occupancy, the service requires seven neonatal cots suggesting that there is a national requirement for one neonatal surgical cot per 5000 births. Intensive care, high care (HC) and special care accounted for 37%, 46% and 17% of cot-days, respectively. This equates to an annual service cost of £2m, about £250 000 per 5000 births.

This assessment of the facilities and costs required to provide a neonatal surgical service in a level 3 perinatal centre in the UK may be used to inform network and national commissioning.

Sodium, in paired retrospective samples, measured by the main laboratory and neonatal unit blood-gas (POCT) analysers were compared.

Hypoalbuminaemia (<30 g/l) was present in 1400/2420 paired results. Sodium was higher when measured by laboratory analyser, the difference increased with decreasing albumin; sodium (laboratory – POCT)=7.6 (±1.1)–0.22 (±0.04)xalbumin. A difference >3 mmol/l was present in 31% and consequently underestimated (9.4%) hyponatraemia and overestimated (3.8%) hypernatraemia.

Hypoalbuminaemia is common in sick neonates and monitoring electrolytes using POCT and laboratory analysers frequently yield significantly different results with consequent misclassification. In these patients, measurement of electrolytes by direct ISE (blood-gas analyser) may be more accurate.

Population-based cohort (UK Millennium Cohort Study).

Seven thousand six hundred and fifty children born in 2000–2001 and attending school in England in 2006.

School performance was measured using the foundation stage profile (FSP), a statutory assessment by teachers at the end of the child's first school year. The FSP comprises 13 assessment scales (scored from 1 to 9). Children who achieve an average of 6 points per scale and at least 6 in certain scales are classified as ‘reaching a good level of overall achievement’.

Fifty-one per cent of full term children had not reached a good level of overall achievement; this proportion increased with prematurity (55% in early term, 59% in late preterm, 63% in moderately preterm and 66% in very preterm children). Compared with full term children, an elevated risk remained after adjustment, even in early term (adjusted RR 1.05, 95% 1.00 to 1.11) and late preterm children (adjusted RR 1.12, 95% CI 1.04 to 1.22). Similar effects were noted for ‘not working securely’ in mathematical development, physical development and creative development. The effects of late preterm and early term birth were small in comparison with other risk factors.

Late preterm and early term birth are associated with an increased risk of poorer educational achievement at age 5 years.

Prospective crossover study.

Sixteen infants, median gestational age of 38 (range 34–41) weeks, birth weight of 3.1 (range 1.5–4.1) kg and postnatal age of 5 (range 2–17) days were studied. The infants were receiving time-cycled, pressure-limited ventilation in a continuous mandatory or in a triggered mode.

The infants were studied first without VT (baseline) and then at VT levels of 4, 5 and 6 ml/kg delivered in a random order. After each VT level, the infants were returned to baseline.

The WOB was assessed by measuring the transdiaphragmatic pressure-time product (PTPdi).

One infant became apnoeic at VT of 6 ml/kg. At a VT level of 4 ml/kg, four infants were making such vigorous respiratory efforts that no inflations were delivered. The median PTPdi was higher at a VT level of 4 ml/kg than at 5 ml/kg (p<0.01) or 6 ml/kg (p<0.001). Only at a VT level of 6 ml/kg was the median PTPdi lower than that at baseline (p<0.01).

Low VT levels (4 ml/kg) during VTV increase the WOB in ventilated infants born at term or near term. The results suggest that a VT level of 6 ml/kg could be used to reduce the WOB.

Prospective observational study.

Two tertiary perinatal centres.

Thirty infants, median gestational age 30 (23–34) weeks.

The first five inflations delivered via a face mask and t-piece device were examined using respiratory function monitoring.

Inflation pressures, inflation times and expiratory volumes were recorded and comparison made of inflations during which the infant made an inspiratory effort (active inflation) or did not (passive inflation).

Overall, the median expired tidal volume was 2.5 (0–19.8) ml/kg and was lower for passive (median 2.1 ml/kg, range 0–19.8 ml/kg) compared with active (median 5.6 ml/kg, range 1.2–12.2 ml/kg) inflations (ratio of geometric means 1.85, 95% CI 1.18 to 28%) (p=0.007). Overall, the median face mask leak was 54.5% and was lower for active (34.5%) compared with passive (60.7%) inflations (mean difference in % leak: 12.4%, 95% CI 0.9 to 24%) (p=0.0354). There was a significant positive correlation between the expiratory volumes and the inflation pressures (R2 between subjects 0.19, p=0.04) and a negative correlation between the expiratory tidal volumes and the face mask leaks (R2 between subjects=0.051, p<0.001), but there was no significant correlation between the inflation times and the expiratory tidal volumes.

The expired tidal volume, inflation pressures and times during the first five inflations during resuscitation were variable. The expired tidal volumes were significantly greater if the infant inspired during the inflation.

In a prospective study, proximal, middle and tip segments of PCVLs indwelling for more than 24 h in term and preterm infants were sent for culture at line removal. Definite CRS was considered as a positive peripheral blood culture plus any line segment growing the same organism in an infant with clinical signs of sepsis.

189 lines were removed from 143 neonates: 142 (75%) were from well infants and 47 (25%) were from neonates with suspected clinical sepsis. The overall CRS rate was 7.9% (15 of 189 line episodes). In well infants, bacterial colonisation rates were significantly higher for proximal segments than for tips (p=0.004). Comparative rates of segmental culture positivity and their positive predictive values for definite CRS were similar for all segments. The diagnosis of CRS was not improved beyond a sole line tip culture by additional middle or proximal segmental cultures or by combinations of the three segments.

In well infants, the proximal segments of PCVLs were more often colonised than line tips, but in clinically septic infants preferential culture of proximal or middle segments or combinations of the three segments did not permit better prediction of definite CRS than the culture of the line tip alone. Further studies prior to antibiotic therapy are indicated in babies with suspected CRS.

Prospective surveillance study.

There were 159 episodes of sepsis (81 urban and 77 rural) affecting 158 babies. Gram negative bacilli caused 117 infections (68%) and predominated at both centres in both early and late sepsis. Klebsiella pneumoniae was the commonest organism, causing 61 infections (38.3%). In early sepsis (0–2 days), non-fermenting gram negative bacilli caused 42.1% of infections at the urban centre; there were no cases of early Group B Streptococcus sepsis. Late onset sepsis was mainly caused by gram negative bacilli at both centres. Multi-drug resistance of over 80% of early-onset gram negative organisms to ampicillin, third generation cephalosporins and gentamicin indicates that these multi-resistant organisms are almost certainly circulating widely in the community. The overall mortality from early sepsis was 27.3% (9 of 33) and from late sepsis was 26.2% (33 of 126). Gram negative bacilli caused all deaths from early sepsis and 87.5% of deaths from late sepsis.

This study shows that multi-drug resistant gram negative bacilli are a major cause of early and late neonatal sepsis in India and are almost certainly widespread in the community.

The authors asked 24 participants (consultants, fellows and nurses) to administer positive pressure ventilation to a modified leak-free, term newborn manikin using a self-inflating bag (SIB) and a Neopuff T-piece device. Recordings were made before and after the participants were informed about their percentage of mask leak and asked to correct this. Airway pressure and flow were measured using a Florian monitor, and the force applied to the head was measured using a concealed custom-made load cell weighing scale.

There were no differences in the mean (SD) force applied to the head between devices used and before or after the attempt to correct the mask leak (SIB before 2215 (892) and after 2195 (989) g; Neopuff before 1949 (957) and after 2028 (909) g). There was a large variation in force with both devices before and after the attempt (coefficient of variation: SIB before 40% and after 45%; Neopuff before 50% and after 45%). There was no correlation between mask leak and the difference in force used before and after the attempt to correct the mask leak using both devices.

During mask ventilation of a manikin, the authors observed that large forces were exerted on the head with either an SIB or a Neopuff, but these forces did not increase during the attempt to minimise the mask leak.

Double-blind randomised controlled trial.

Tertiary level neonatal intensive care unit (NICU).

Eighty mothers expressing breast milk for their infants (mean gestational age 28 weeks) based in NICU and the amounts expressed fell short of the prescribed target.

Mothers were randomised to receive domperidone or metoclopramide for 10 days (10 mg three times a day).

Total milk volume daily for up to 10 days before the medication, 10 days during the trial and up to 10 days after medication. Adverse side effects were also recorded.

Mothers produced more milk in the domperidone group and achieved a mean of 96.3% increase in milk volume (mean increase/pretrial volume) compared with a 93.7% increase for metoclopramide. After adjusting for the amount of milk produced prior to medication, the mean amount of milk produced while taking medication for those on domperidone was 31.0 ml/24 h (95% CI –5.67 to 67.6) greater than the mean for those on metoclopramide. Seven mothers taking metoclopramide reported side effects and three taking domperidone; a further eight women (of 29) who had a follow-on prescription for metoclopramide also reported side effects.

Oral domperidone and metoclopramide increased the volume of milk produced by mothers who are expressing to feed their babies in NICU. There were small differences in milk output between the two medications and in the incidence of side effects, but the differences were non-significant.

Prospective, randomised controlled study.

Tertiary neonatal intensive care unit.

The study enrolled 80 preterm infants with gestational age ≤28 weeks, birth weight <1000 g, postnatal age 48 to 96 h, and had echocardiographically confirmed significant PDA. Seventy extremely low birthweight (ELBW) preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h.

The success rate and the safety of the drugs in ELBW preterm infants were the major outcomes.

PDA closure rate was significantly higher with oral ibuprofen (83.3% vs 61.7%) after the first course of the treatment (p=0.04). Although the primary closure rate was marginally higher in the oral ibuprofen group, the need for a second course of ibuprofen during the whole hospitalisation was similar between groups: 11 of 36 in oral versus 15 of 34 in intravenous groups (p=0.24) because of a higher reopening rate in the oral group. In addition to no increase in side effects with oral ibuprofen use, the need for postnatal steroid use for chronic lung disease was significantly lower in oral ibuprofen group (p=0.001).

Oral ibuprofen is as effective as intravenous ibuprofen for PDA closure even in ELBW infants.

The authors measured the time to wash out CO2 from a 45-ml test lung using end-tidal CO₂ monitor (ETCO₂). The test lung was filled with 100% CO₂, then ventilated using VG at VT ranging from DS+2 ml to DS–1.5 ml. With ventilation, ETCO₂ declined exponentially as CO₂ was washed out, the rate being proportional to VT – effective instrumental DS. The time from initiation of ventilation to threshold of accurate detection was determined in triplicate.

Halving the theoretical ‘alveolar ventilation’ (DS+2 ml to DS+1 ml) only increased the elimination time by 26%, not the 100%, as predicted by conventional physiology. CO₂ washout was less efficient, but still occurred even at VT=DS and VT=DS–1.5 ml. Halving the theoretical ‘alveolar ventilation’ by decreasing respiratory rate from 80 to 40 breaths/min only increased elimination time by 35%, not 100%, as predicted by conventional physiology. Twenty minutes of continuous positive airway pressure prior to ventilation did not alter the elimination time, verifying that CO₂ did not diffuse or leak out of the test lung. Size of the endotracheal tube (ETT; 2.5, 3.0 and 3.5 mm) flow rate (4, 6 and 10 l/min) and inspiratory time (0.25 vs 0.35 s) did not affect the results.

Contrary to conventional physiology, effective CO₂ elimination appears to be possible with VT<DS even at conventional rates. With small ETT a spike of fresh gas likely penetrates through the DS, rather than pushing it ahead.

Retrospective review of medical staff resuscitation assessments over an 8-year period from 2003 to 2010.

A network-lead tertiary neonatal service with over 11 000 deliveries annually.

Neonatal medical staff: junior (speciality trainee(ST) of years 1–3) and senior trainees (ST 4–8 with tier 2 on-call responsibilities).

A standardised criterion-referenced assessment was performed by two NLS instructors. Junior trainee assessment focused on the basic airway skills learnt on an NLS course. Senior trainees demonstrated resuscitation of a baby with meconium-stained liquor, focusing on advanced life support, including intubation of the mannequin.

Assessment outcomes were pass/fail; fails were categorised as algorithm failure, technical skills failure or both. For trainees who failed the first assessment, the outcome of the second assessment following appropriate feedback was recorded.

Two hundred and sixty-two assessments were performed: 160 junior and 102 senior trainees; 98/160 (61%) of junior and 57/102 (56%) of senior trainees passed their first assessment; 69% of junior trainees who failed the first assessment had a second assessment recorded. There was a 79% pass rate at second assessment; 89% of senior trainees who failed a first assessment had a second assessment recorded. There was an 85% pass rate at second assessment. The majority of trainees who failed an assessment had problems with both the resuscitation algorithm and technical skills.

Significant numbers of trainees who have been formally trained in neonatal resuscitation skills previously do not pass the standardised resuscitation assessment, thus require an additional input to maintain their competence in neonatal resuscitation.

Follow-up of 4 to 8 years of two earlier performed randomised controlled trials.

Leiden University Medical Center, University Medical Center Groningen and University Medical Center Utrecht, The Netherlands.

Fifty-four term infants were included when suffering from moderate-to-severe birth asphyxia in two previously performed trials.

Infants either received 40 mg/kg allopurinol (with an interval of 12 h) starting within 4 h after birth or served as controls.

Children, who survived, were assessed with the Wechsler Preschool and Primary Scales of Intelligence test or Wechsler Intelligence Scale for Children and underwent a neurological examination. The effect of allopurinol on severe adverse outcome (defined as mortality or severe disability at the age of 4–8 years) was examined in the total group of asphyxiated infants and in a predefined subgroup of moderately asphyxiated infants (based on the amplitude integrated electroencephalogram).

The mean age during follow-up (n=23) was 5 years and 5 months (SD 1 year and 2 months). There were no differences in long-term outcome between the allopurinol-treated infants and controls. However, subgroup analysis of the moderately asphyxiated group showed significantly less severe adverse outcome in the allopurinol-treated infants compared with controls (25% vs 65%; RR 0.40, 95%CI 0.17 to 0.94).

The reported data may suggest a (neuro)protective effect of neonatal allopurinol treatment in moderately asphyxiated infants.

Observational study.

All infants born in the Stockholm County during 2004–2006 with a gestational age of ≥33 weeks, planned as vaginal delivery, with a normal cardiotocographic recording on admission to hospital and with an Apgar score of <7 at 5 min were included.

Adherence to guidelines for neonatal resuscitation.

Documentation was unsatisfactory in 142 (45%) infants. Other important shortcomings identified were delayed initiation of extensive resuscitation due to late paging or late arrival of attending paediatrician/neonatologist (n=48), and unsatisfactory ventilation related to late intubation and late securing of free airway (n=15).

Substandard care in neonatal resuscitation is not limited to cases of severe asphyxia related to claims for medical malpractice. The overall documentation of neonatal resuscitation needs to be much better to enable accurate and reliable evaluation. Obvious actions to improve standards of care include the paging of skilled personnel at an earlier stage in cases of complicated deliveries and team and skills training in neonatal ventilation.

The authors analysed DTI images of three term infants with acute unilateral cortical arterial ischaemic stroke. Probabilistic tractography was used to define separate thalamic regions of interests (ROIs). The authors evaluated the three eigenvalues (EV) and apparent diffusion coefficient (ADC) values in the ROIs.

The ADC and EV in voxels of ROIs placed within the nuclei corresponding to ischaemic cortex were significantly lower than those in the unaffected contralesional thalamic nuclei.

Our findings support the concept of acute network injury in neonatal stroke. ADC and EV were altered in specific thalamic regions that corresponded to the specific cortical areas affected by the primary ischaemic injury.

Retrospective case-control analysis between drug-exposed and unexposed infants between DRD2 polymorphisms, drug exposure and NAS treatment.

Drug-exposed (n=48) and drug-free (n=49) infants born between March 1999 and December 2006.

Analysis of DNA for the Taq1A, -141Ins/Del and Ser311Cys DRD2 polymorphisms. Drug exposure was determined by antenatal maternal drug and alcohol history. Frequency measures of DRD2 polymorphisms were compared between drug-exposed infants, treatment NAS medication and with control infants.

Tertiary maternity hospital, Sydney, Australia.

All infants were born in a good condition (25.7% <37 weeks gestation). Opiates (methadone and heroin) were used by 45 (93.8%) of drug-exposed mothers. The A2A2 allele was more common in drug-exposed infants (37 (77.0%) versus 23 (46.9%), p=0.003) but the A1A2 allele was more common in control infants (23 (46.9%) versus 4 (8.3%), p=0.00002). The-ins allele was more common in control (39 (79.6%) versus 20 (41.7%), p=<0.01) and unmedicated drug-exposed (14/25 (56%) versus 5/23 (21.7%), p=0.02) infants. The majority of infants (41 (83.7%) controls versus 41 (85.4%), p=1.000) expressed the least common, Ser polymorphism.

DRD2 polymorphisms are detectable from DNA obtained from stored blood spots. The –ins allele is more common in control and unmedicated drug-exposed infants. Further study is recommended to explore postneonatal outcomes especially in relation to neuropsychiatric behaviours.

To describe NICU care giver assessments of safety culture, explore variability within and between NICUs on safety culture domains, and test for association with care giver characteristics.

NICU care givers in 12 hospitals were surveyed using the Safety Attitudes Questionnaire (SAQ), which has six scales: teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and working conditions. Scale means, SDs and percent positives (percent agreement) were calculated for each NICU.

There was substantial variation in safety culture domains among NICUs. Composite mean score across the six domains ranged from 56.3 to 77.8 on a 100-point scale and NICUs in the top four NICUs were significantly different from the bottom four (p<0.001). Across the six domains, respondent assessments varied widely, but were least positive on perceptions of management (3%–80% positive; mean 33.3%) and stress recognition (18%–61% positive; mean 41.3%). Comparisons of SAQ scale scores between NICUs and a previously published adult ICU cohort generally revealed higher scores for NICUs. Composite scores for physicians were 8.2 (p=0.04) and 9.5 (p=0.02) points higher than for nurses and ancillary personnel.

There is significant variation and scope for improvement in safety culture among these NICUs. The NICU variation was similar to variation in adult ICUs, but NICU scores were generally higher. Future studies should validate whether safety culture measured with the SAQ correlates with clinical and operational outcomes in NICUs.

A prospective observational study was conducted measuring the time taken by selected nurses to undertake the necessary tasks for babies receiving different levels of care in the Network's six constituent neonatal units. An independent observer was used. The unit and individual's workload was evaluated against BAPM standards. Delays in essential predetermined tasks were recorded. The impact on quantity of care given and on the number of delayed tasks were compared between those with the recommended workload or less and those overstretched.

Between October 2008 and February 2009, 89 nurses were observed caring for 244 neonates over 534 h. 54% of nursing shifts failed to meet BAPM standards. Nurses with workload greater than the BAPM-recommended levels demonstrated a 28% decrease in median time spent on clinical care per baby. 92 (17%) essential tasks were delayed >1 h or not done. Delays/omissions were more likely when BAPM standards were not met (53% vs 40%, p=0.049). In nursing observations without delays/omissions, accommodating for adequate nursing breaks and working in the same area, nurses could cater for no more than 1.2, 1.5 and 2.7 babies in intensive care, high dependency care and special care, respectively.

Understaffing leads to measurable problems including delays to essential treatment and reduced clinical care. BAPM standards are not aspirational and should be regarded as a minimum. Further research on optimising nursing care efficiency with limited nursing resources is necessary.

Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO₂ of 0.15 for 20 min. A ‘failed’ test was defined as oxygen saturation (SpO₂) <90% for at least 2 min.

41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO₂ (median –6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO₂ dropped further during feeding (median –4% in term and –2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002).

Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO₂ of 0.15 leads to a further fall in SpO₂, which is significant but transient.

Retrospective cohort study.

Canadian Neonatal Network data for 2003–2008 were utilised.

Neonates born between 22 and 32 weeks gestation admitted to neonatal intensive care units in Canada.

Survival to discharge without major morbidity defined as survival without severe neurological injury (intraventricular haemorrhage grade 3 or 4 or periventricular leukomalacia), severe retinopathy (stage 3 or higher), necrotising enterocolitis (stage 2 or 3) or chronic lung disease.

Of the 17 148 neonates who met the eligibility criteria, 65% survived without major morbidity. Sex and GA at birth were significant predictors. Birth weight (BW) had a significant but non-linear effect on survival without major morbidity. Although maternal information characteristics such as steroid use, improved the prediction of survival without major morbidity, sex, GA at birth and BW for GA predicted survival without major morbidity almost as accurately (area under the curve: 0.84). The graphical tool based on the models showed how the GA and BW for GA interact, to enable prediction of outcomes especially for small and large for GA infants.

This graphical tool provides an improved and easily interpretable method to predict survival without major morbidity for very preterm infants at the time of birth. These curves are especially useful for small and large for GA infants.

To evaluate pharmacokinetic parameters of oral ibuprofen in preterm infants.

Plasma ibuprofen levels were determined at various time points, and pharmacokinetic profiles were calculated after a single dose of 10 mg/kg of oral ibuprofen. The rate of ductal closure, adverse effects and patients' clinical course were recorded.

The authors studied 13 preterm infants (mean gestational age±SD 27.8±2.4 weeks, mean birth weight 1052±443 g). PDA closure was obtained in all patients after a single dose. Ibuprofen levels were detectable 1 h after administration, peaked after 8 h and remained in a relative plateau until 24 h postadministration. Area under the curve (AUC)0->24 was higher than levels reported with intravenous treatment. No adverse effects were observed.

Oral administration of ibuprofen in very preterm infants is associated with excellent absorption and a high AUC0->24, and may be an alternative to intravenous administration.

Photographs of normal, acholic and indeterminate infant stools were shown to paediatric professionals who have regular contact with jaundiced babies at three London teaching hospitals. Each stool was classified as ‘healthy’ or ‘suspect’.

One-third of the stools were not correctly identified by physicians and nurses.

Experienced professionals often do not recognise stool colour associated with biliary obstruction. The authors propose that stool colour cards similar to those used in Japan and Taiwan may improve early detection of hepatobiliary disease at a minimal cost.

Randomised controlled trial.

One tertiary and two regional neonatal units in public hospitals in Queensland, Australia.

182 preterm infants born with a birth weight less than 1600 g, who were at least 48 h old; had not required ventilation or continuous positive airways pressure within the last 48 h; were medically stable with no oxygen requirement, or significant apnoea or bradycardia; did not require phototherapy; and were enterally fed with an intake (breast milk/formula) of at least 60 ml/kg/day.

Transfer into an open cot at 1600 or 1800 g.

The primary outcomes were temperature stability and average daily weight gain over the first 14 days following transfer to an open cot.

90 infants in the 1600 g group and 92 infants in the 1800 g group were included in the analysis. Over the first 72 h, more infants in the 1800 g group had temperatures <36.4°C than the 1600 g group (p=0.03). From post-transfer to discharge, the 1600 g group had more temperatures >37.1°C (p=0.02). Average daily weight gain in the 1600 g group was 17.07 (SD±4.5) g/kg/day and in the 1800 g group, 13.97 (SD±4.7) g/kg/day (p=<0.001).

Medically stable, preterm infants can be transferred to open cots at a birth weight of 1600 g without any significant adverse effects on temperature stability or weight gain.

ACTRN12606000518561 (http://www.anzctr.org.au).

A randomised, double-blind controlled trial was conducted.

Royal Victoria Hospital, a tertiary neonatal intensive care unit in Montreal, Canada.

Stable spontaneously breathing premature infants with birth weights less than 1500 g or gestation of 30 weeks and less.

During the eye examination, all infants were swaddled, received oral sucrose and topical anaesthetics. Control group infants received a mixture of 50% oxygen and 50% nitrogen (n=18) administered by nasal cannula, while the intervention group received EMONO (50% oxygen and 50% N₂O).

Pain was assessed by the premature infant pain profile (PIPP).

The mean PIPP score at speculum insertion in the control group (8.4, 95% CI 7.6 to 9.3) was comparable with the EMONO group (8.5, 95% CI 7.3 to 9.8) with a p value of 0.94. There were no significant differences in heart rate or saturation between the two groups. EMONO inhalation was tolerated without any measured side effects.

EMONO does not produce any additional pain relief over currently used measures during ROP screening eye examinations. Systematically combining pharmacological and non-pharmacological treatment modalities appears to be the best option until newer treatments are proven effective.

NCT00623220

10 Neonatal Intensive Care Units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia.

Retrospective analysis of prospectively collected data as part of NICUs' data collection in NSW and ACT.

Premature infants born at 22⁺⁰ to 31⁺⁶ weeks' gestation between January 1997 and December 2006 and admitted to one of the 10 NICUs in NSW and ACT.

Actuarial day-by-day survival to discharge from NICU.

Survival to discharge after initiation of neonatal intensive care ranges from 30.0% at 23 weeks' gestation to 98.8% at 31 weeks. Actuarial day-by-day survival increased across all gestations. This improvement was most notable among the babies who were born <26 weeks gestation.

Preterm infants who survive the first few postnatal days have considerable chances of long-term survival. It is important to revise the information stored regarding chances of survival so it covers chances at regular intervals, especially after the first few days of life.

Mothers who entered the repeated dose of antenatal steroids (ACTORDS) trial were randomised to additional weekly steroid or placebo. Infant occipital-frontal head circumference, weight and crown-heel length were measured at birth and weekly for 4 weeks or until discharge, whichever was later. Lower leg length was measured using a knemometer daily for the first week, then thrice weekly.

Of 145 babies studied (77.5% of the ACTORDS study infants from this centre), 70 were exposed to repeated antenatal steroids and 75 to placebo. There were no significant differences in prerandomisation demographic and pregnancy data. The mean gestational age at ACTORDS entry was 28.7 weeks and at birth was 31.4 weeks. The mean birth weight was 1618 g. There were no significant differences in postmenstrual age, weight, length or head circumference, nor in z-scores for these measurements, at birth, 4 weeks or discharge.

In the first 2 weeks after birth, babies in both groups showed a decrease in z-scores for weight and length. After week 2, growth improved in both groups but babies exposed to repeat antenatal corticosteroids grew more rapidly, as measured by weight gain, increasing head circumference and increasing lower leg length knemometry. This rapid growth was most apparent around weeks 3–5 after birth.

Babies exposed to weekly doses of repeat antenatal corticosteroids demonstrate postnatal growth acceleration 3–5 weeks after birth.

De-identified perinatal and neonatal outcome data for 10 267 infants were examined. There were 8629 (84.0%) Caucasian, 922 (9.0%) Asian, 439 (4.3%) indigenous, 127 (1.2%) Polynesian and Maori (PAM) and 150 (1.5%) infants of other maternal ethnicities (excluded from study). Caucasians were the referent for all comparisons.

Infants of indigenous mothers were less likely to receive antenatal steroids and three times as likely to be born in non-tertiary hospitals (OR 3.28, 95% CI 2.59 to 4.16, p<0.001). PAM infants were more likely to have Apgar scores <7 at 5 min of age (1.76, 95% CI 1.16 to 2.67, p<0.01). Asian infants had lower birth weight (mean±SD 44.7±27.9, p<0.001) and head circumference percentiles (47.8±29.0, p<0.001), were more likely to be small for gestational age (1.53, 95% CI 1.25 to 1.88, p<0.001), less likely to have hyaline membrane disease (0.78, 95% CI 0.68 to 0.90, p<0.001) but had a higher risk of severe retinopathy of prematurity (1.52, 95% CI 1.11 to 2.07, p<0.01). Ethnicity did not influence infant mortality.

Neonatal growth characteristics and morbidity but not mortality are influenced by maternal ethnicity. Of concern is the risk of low Apgar scores in PAM infants and non-tertiary births of indigenous infants. Review of perinatal care for certain vulnerable ethnic populations is recommended due to the rapidly changing ethnic compositions of many countries around the world.

To determine the cost effectiveness of more frequent red blood cell transfusions (high-Hb threshold) compared with less frequent transfusions (low-Hb threshold) in ELBW infants.

The authors performed an economic evaluation using patient-level data collected during the PINT randomised trial. The authors measured comprehensive costs from a third-party payer's perspective over a time horizon from birth through 18–21 months corrected age.

The average total cost in the high-Hb threshold group was CAN$149 767 compared with CAN$150 227 in the low-Hb threshold group (difference of CAN$460, p=0.96). Cost-effectiveness analysis estimated savings of CAN$6879 for every additional infant surviving without severe NDI. There was a 48% chance that the high-Hb threshold reduced costs while improving outcome and a 90% chance that it would be cost effective at a willingness-to-pay threshold of CAN$250 000 per additional survivor without severe NDI. Post-hoc analysis defining cognitive delay as MDI score <85, instead of <70, revealed savings in the high-Hb threshold group of CAN$4457 per additional survivor without NDI. Results were robust to deterministic sensitivity analyses.

A high-Hb threshold for transfusion, as measured in ELBW PINT study infants through 18 months corrected gestational age, may be an economically appealing intervention. The estimates were associated with moderate statistical uncertainty that should be targeted in larger, future studies.

76 premature infants <30 weeks gestation were enrolled between January 2001 and August 2004. They were examined at 4 and 9 months corrected ages, and at 18 months, 3–4 years and 5–6 years. EEGs performed in the neonatal period were analysed by two neurologists blind to the child's outcome.

The mean follow-up was 5.6 years. 25 infants had normal neurological development and all EEGs were normal for 22 of these. 36 others had developmental disabilities (7 motor sequelae and 29 delayed psychomotor development). Of 187 EEGs, 43 were dysmature, 13 disorganised, 2 displayed electrical seizures without clinical manifestations and 15 showed other abnormal features. Dysmaturity was the predominant EEG pattern in newborns with severe or moderate sequelae and was persistent on several EEGs in 12 of these. In contrast, only three infants with normal development had a dysmature pattern on one EEG. All infants with a disorganised pattern had cognitive sequelae, and two had cerebral palsy. The sensitivity of EEG regarding psychomotor outcome was 83.3%, the specificity was 88% and the positive predictive value was 90.9%.

Very preterm neonates remain at high risk of neurological sequelae and EEG is a sensitive method for assessing neuromotor and cognitive prognosis. A dysmature pattern was the predominant EEG characteristic in infants who developed severe or moderate impairment. Early postnatal tracing is useful but additional recordings are generally necessary to detect high-risk newborns.

Observational study.

Neonatal Unit, Middlemore Hospital, Auckland, New Zealand.

30 preterm infants <30 weeks' gestational age.

Cord clamping was immediate in 17 infants and delayed by 30–45 s in 13.

Infants in the two groups did not differ significantly in terms of gestational age, gender or use of antenatal steroids. Median flow in the SVC in the first 24 h was significantly higher in the group with delayed clamping (median 91 ml/kg/min; IQR 81–101) compared with 52 ml/kg/min (IQR 42–100) in the immediate clamping group (p=0.028). Fewer infants in the delayed group had low flow (1 compared with 9; p=0.017). All three infants with intraventricular haemorrhage (IVH) (of any grade) had low flow.

Blood flow in the SVC was higher in infants where delayed cord clamping was performed. The relationship of IVH, low flow and timing of cord clamping requires further study.

32 mothers and their singleton term neonates selected as small for gestational age (st-SGA=8) or appropriate for gestational age (st-AGA=24).

Nitric oxide, high-sensitive C reactive protein (hs-CRP), uric acid, blood lipids and protein levels were analysed in maternal and cord blood.

Applying customised criteria yielded 16 ct-AGA, 13 ct-SGA and 3 ct-LGA (large for gestational age) babies. Both st-SGA and ct-SGA babies had higher nitric oxide and hs-CRP levels. Their mothers had lower albumin fractions. st-SGA babies also had higher triglyceride and cholesterol levels. ct-LGA babies and mothers had higher uric acid levels, and the mothers had higher triglyceride levels.

Customised growth criteria better identify babies submitted to unfavourable intrauterine environments. The authors suggest that combined with maternal biochemistry, these growth criteria can be used to screen for adverse fetal programming.

Six neonatal intensive care units (NICUs).

762 neonates admitted to six NICUs during a 28-month observational study for whom at least one serum sample was taken on admission.

Positive and negative predictive values at different PCT cut-off levels.

The overall probability of an NS was doubled or more if PCT was >0.5 ng/ml. In very-low-birth-weight (VLBW) infants, a cut-off of >2.4 ng/ml gave a positive predictive value of NS near to 50% with a probability of a false-positive diagnosis of NS in about 10% of the patients.

In VLBW neonates, a serum PCT value >2.4 ng/ml prompts early empirical antibiotic therapy, while in normal-birth-weight infants, a PCT value ≤2.4 ng/ml carries a low risk of missing an NS.

Retrospective review of routinely collected patient data.

14 out-born infants were referred for cooling during a 12-month period. Nine infants were managed with the servo-controlled system during transport. Cooling was commenced in all infants before 6 h of life. Median time from team arrival to the infant having a temperature in the target range (33–34°C) was 45 min. Median temperature during transfer was 33.5°C (range 33–34°C). Temperature on arrival at the cooling centre ranged from 33.4°C to 33.8°C.

Servo-controlled cooling during transport is feasible and provides an optimal level of thermal control.

To assess the reliability of linear sonographic cerebellar vermis measurement.

Cranial ultrasounds of 110 infants ranging from 24 to 41 weeks' gestation were retrospectively reviewed. Cerebellar vermian height, craniocaudal diameter and superior and inferior vermis widths were independently measured on the first midline sagittal image by three neonatal sonologists of varying experience. Interobserver and intraobserver reliability were calculated using the intraclass correlation coefficient (ICC) (2 way mixed model, SPSS V.15.0).

61 images were technically adequate. Interobserver ICCs (95% CI) were: cerebellar vermian height 0.88 (0.82 to 0.92); craniocaudal diameter 0.91 (0.86 to 0.94); superior vermis width 0.84 (0.77 to 0.89); inferior vermis width 0.92 (0.89 to 0.95). Intraobserver ICCs were similar.

With adequate images, linear ultrasound measurements of cerebellar vermis are reliable.

Left and right ventricular peak systolic (S'), early diastolic (E') and late diastolic (A') myocardial velocities were measured using TDI alongside standard echocardiography (including peak diastolic atrioventricular flow, E). E/E' ratio was calculated for both ventricles.

UK neonatal intensive care unit.

43 neonates were prospectively recruited into three groups: term (n=16), preterm (30–36 weeks, n=12) and very preterm (<30 weeks, n=15).

Myocardial velocities increased with increasing gestation. Right ventricular velocities were significantly greater than left. E/E' ratio decreased with increasing gestation. Left E/E' ratio was higher than right in each group.

TDI is feasible in preterm neonates and enables the acquisition of myocardial velocities. With increasing gestation, higher myocardial velocities and lower E/E' ratios were found. The addition of TDI to standard neonatal echocardiography may provide additional information about cardiac function.

Prospective study from 1 July 2006 to 30 June 2007. Data on mother–child pairs were collected for every syphilis seropositive mother.

Maternal syphilis seroprevalence at delivery was 0.17%. 207 infants were born to 203 syphilis seropositive mothers. In 25 newborns it was possible to diagnose congenital syphilis (20/100 000 live births). Maternal risk factors included age <20 years, no antenatal care and no adequate treatment. The infected babies were more often preterm or weighed <2000 g at birth.

Many syphilis seropositive mothers were foreign born but the risk of an infected newborn was not higher in foreign-born than in Italian seropositive women. The significant factors were lack of antenatal screening and inadequate maternal treatment.

Syphilis is a re-emerging infection in Italy. Prevention strategies should include antenatal serological tests for all pregnant women and treatment for infected mothers.