Journal of paediatrics and child health
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J Paediatr Child Health · Oct 2012
Comparative StudyReduction in late-onset sepsis on relocating a neonatal intensive care nursery.
The aims of this study were to compare rates of late-onset sepsis (LOS) in very preterm or very low birthweight infants before and after relocation to a new nursery and to determine risk factors for LOS. ⋯ There was a significant reduction in the severity of LOS in very preterm and/or very low birthweight infants that correlated with the relocation from the old to new nursery. Smaller and more immature infants with percutaneous central catheters were more at risk.
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J Paediatr Child Health · Oct 2012
Case ReportsIntermittent fever, splenomegaly and eosinophilia in a recently resettled African refugee.
We discuss a recently resettled African refugee child with acute schistosomiasis, who presented with fever, hepatosplenomegaly and marked eosinophilia. We outline the differential diagnoses of eosinophilia in the recently resettled refugee and returned traveller and outline the epidemiology and clinical spectrum of schistosomal infection, including controversies in management of acute schistosomiasis.
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The lungs of an extremely preterm infant ≤28 weeks gestation are structurally and biochemically immature and vulnerable to injury from positive pressure ventilation. A lung protective approach to respiratory support is vital, aiming to ventilate an open lung, using the lowest pressure settings that maintain recruitment and oxygenation and avoiding hyperinflation with each tidal breath. ⋯ Many extremely preterm infants have minimal atelectasis and low oxygen requirements in the first days of life, and the ventilatory approach in this case should be one of avoidance of factors including overdistension that are known to contribute to later pulmonary deterioration. From a practical perspective, this means setting positive end-expiratory pressure at the lowest value that maintains oxygenation and restricting tidal volume using a volume-targeted mode of ventilation.
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J Paediatr Child Health · Sep 2012
ReviewTurn and face the strange - ch..ch..ch..changes to neonatal resuscitation guidelines in the past decade.
Resuscitation of newborns has been described since ancient times and is among the most commonly performed emergency medical interventions. The International Liaison Committee on Resuscitation first made recommendations on resuscitation in newborns in 1999. Over the last decade, new research and careful review of the available evidence have resulted in substantial changes to these recommendations - in particular, regarding the assessment of colour, giving supplemental oxygen, suctioning infants born through meconium-stained liquor, confirming endotracheal tube position, the use of pulse oximetry, giving CPAP to premature infants, keeping preterm infants warm using polyethylene wrapping and cooling term infants with encephalopathy. This process has also highlighted the paucity of evidence to support much of the care given to infants in the delivery room and the need for research to refine our techniques.
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J Paediatr Child Health · Sep 2012
ReviewNasal continuous positive airway pressure for respiratory distress in non-tertiary care centres: what is needed and where to from here?
Respiratory distress is one of the commonest reasons for admission to a special care nursery (SCN) affecting between 2.5 and 5.0% of all babies born per year. While most recover with supplemental oxygen, some require transfer to a neonatal intensive care leading to significant family disruption, and financial cost. ⋯ The risk benefit ratio of providing nCPAP in SCNs depends upon many factors including the ability to maintain the skills required and the distance/time to the nearest tertiary centre. Appropriate nurseries should be identified with the aim of supporting them in the provision of nCPAP in a safe manner.