Resuscitation practices for infants in the NICU, PICU and CICU: results of a national survey

OBJECTIVE

Infants requiring resuscitation at birth are resuscitated using neonatal resuscitation guidelines. Sometime after birth, resuscitation practice must transition to pediatric guidelines. There is no evidence on when this transition should occur. The objective of this study was to describe infant resuscitation practices in Neonatal Intensive Care Units (NICUs), Pediatric Intensive Care Units (PICUs) and Cardiac Intensive Care Units (CICUs).

STUDY DESIGN

An electronic survey was sent to medical directors of NICUs, PICUs and CICUs in the U.S. The survey examined resuscitation practices, and preference for use of neonatal or pediatric guidelines, for different postnatal ages, clinical scenarios and etiologies of arrest.

RESULTS

A total of 152 responses were received, including 118 NICUs, 19 PICUs and 15 CICUs. The majority of NICU responders used greater than 28 days as the time to change from neonatal to pediatric guidelines. The majority of PICU and CICU transitioned to pediatric guidelines immediately after birth. Pediatric guidelines were preferred in the PICU and CICU regardless of the arrest etiology. NICU responders favored pediatric guidelines only if the arrest was cardiac.

CONCLUSIONS

Our results suggest that infants are resuscitated using neonatal guidelines in the NICU and pediatric guidelines in the PICU and CICU, even if they are the same age and have the same etiology of arrest. There is no agreement on the time to change from neonatal to pediatric guidelines. Further research comparing the outcomes of infants resuscitated in these different units could inform future guideline refinement.

The role of stereopsis (three-dimensional vision) in dentistry: review of the current literature

Clinical dental work is placing increasing demands on a clinician's vision as new techniques that require fine detail become more common. High hand-eye coordination requires good visual acuity as well as other psychological and neurological qualities such as stereopsis. Stereopsis (three-dimensional vision) is the highest form of depth perception obtained by visual disparity of images formed in the retinas of two eyes. It is believed to confer functional benefits on everyday tasks such as hand-eye coordination. Although its role in depth perception has long been established, little is known regarding the importance of stereopsis in dentistry. This article reviews the role of stereopsis in everyday life and the available literature on the importance of stereopsis in dentistry.

Macrosomia and haemodynamic instability may represent risk factors for subcutaneous fat necrosis in asphyxiated newborns treated with hypothermia

AIM

To identify additional risk factors other than asphyxia and hypothermia in newborns developing subcutaneous fat necrosis (SCFN).

METHODS

We conducted a prospective cohort study of all term asphyxiated newborns treated with hypothermia from 2008 to 2015. The presence and location of SCFN were recorded at the time of discharge or at follow-up visits. To identify the risk factors for developing SCFN, we compared the perinatal characteristics of those newborns who developed SCFN with those who did not.

RESULTS

The newborns developing SCFN had significantly higher birthweights compared with those newborns who did not develop SCFN. Among the newborns with a birthweight equal or superior to the 90th percentile, those who developed SCFN had a significantly higher use of inotropic support and higher maximum troponin levels during their initial hospitalisation.

CONCLUSION

A higher birthweight represented an independent risk factor for developing SCFN in asphyxiated newborns treated with hypothermia. When macrosomia is present, other risk factors related to haemodynamic instability during the initial hospitalisation may also increase the risk of developing SCFN.

Introgression of chromosome segments from multiple alien species in wheat breeding lines with wheat streak mosaic virus resistance

Pyramiding of alien-derived Wheat streak mosaic virus (WSMV) resistance and resistance enhancing genes in wheat is a cost-effective and environmentally safe strategy for disease control. PCR-based markers and cytogenetic analysis with genomic in situ hybridisation were applied to identify alien chromatin in four genetically diverse populations of wheat (Triticum aestivum) lines incorporating chromosome segments from Thinopyrum intermedium and Secale cereale (rye). Out of 20 experimental lines, 10 carried Th. intermedium chromatin as T4DL*4Ai#2S translocations, while, unexpectedly, 7 lines were positive for alien chromatin (Th. intermedium or rye) on chromosome 1B. The newly described rye 1RS chromatin, transmitted from early in the pedigree, was associated with enhanced WSMV resistance. Under field conditions, the 1RS chromatin alone showed some resistance, while together with the Th. intermedium 4Ai#2S offered superior resistance to that demonstrated by the known resistant cultivar Mace. Most alien wheat lines carry whole chromosome arms, and it is notable that these lines showed intra-arm recombination within the 1BS arm. The translocation breakpoints between 1BS and alien chromatin fell in three categories: (i) at or near to the centromere, (ii) intercalary between markers UL-Thin5 and Xgwm1130 and (iii) towards the telomere between Xgwm0911 and Xbarc194. Labelled genomic Th. intermedium DNA hybridised to the rye 1RS chromatin under high stringency conditions, indicating the presence of shared tandem repeats among the cereals. The novel small alien fragments may explain the difficulty in developing well-adapted lines carrying Wsm1 despite improved tolerance to the virus. The results will facilitate directed chromosome engineering producing agronomically desirable WSMV-resistant germplasm.