NEONATAL OUTCOMES FOLLOWING LATE PRETERM BIRTH

Physiological vital sign reference ranges for well late preterm newborns calculated during a typical two-hour newborn period between 2 hours and 7 days of life

Objectives To calculate 95% reference ranges for heart rate, respiratory rate, oxygen saturation, temperature and blood pressure for well late preterm newborns between 34+0/7 and 36+6/7 weeks of gestation during typical neonatal behaviour. Approach A single site, prospective cohort study in a major Australian quaternary hospital between February and September 2019. A total of 120 late preterm newborns had their heart rate, respiratory rate and oxygen saturation measurements recorded every two seconds for up to two hours with unconditional 95% reference ranges determined using a linear mixed model with random intercept for total standard deviation calculation including repeated measures. Temperature and blood pressure measurements were collected twice - at the start and conclusion of the data recording period, with weighted 2.5th and 97.5th percentiles calculated using the mean value. Main results A total of 364,577 heart rate, 365,208 respiratory rate, 360,494 peripheral oxygen saturation, and 240 temperature and blood pressure values were obtained. The 95% reference ranges were: heart rate 102 - 164 bpm; respiratory rate 15 - 67 rpm; oxygen saturation 94 - 100%; temperature 36.4 - 37.6°C; systolic blood pressure 51 - 86 mmHg; diastolic blood pressure 28 - 61 mmHg; mean arterial pressure 35 - 68 mmHg. Significance Seven vital sign references ranges were reported for the late preterm population during a typical newborn period (such as crying, sleeping, feeding, awake and alert, and during nappy hygiene cares); internal and external validation should be completed prior to clinical use. Cut off points for escalation of care have previously been generalised to all newborns irrespective of gestational age which may result in over-treatment or a delay in recognising subtle signs of deterioration.

Are there interventions that improve breastfeeding and the use of breast milk in late preterm infants?

To answer the clinical question 'Among late preterm infants are there any interventions that improve the rates of breastfeeding and the use of breast milk compared with current practice?'. MEDLINE via Ovid, Embase via Ovid, the Maternity and Infant Care Database and the Cochrane Library were searched for relevant articles. Articles were excluded if they did not discuss specific interventions to improve breastfeeding, for example, if they only commented on factors such as age, race and education. Articles were also excluded if they were not specific to the late preterm infant population. A total of 516 articles were found and screened by title and abstract independently by two reviewers. The full text of 17 articles was independently reviewed. The reference lists of these full-text articles were screened, and 14 abstracts were subsequently reviewed. The final analysis included three studies. There is limited high-quality research evidence for interventions to improve breastfeeding in late preterm infants. In the absence of robust academic research, clinical practice should be guided by clinical expertise and involve a multidisciplinary team, including qualified lactation consultants. While it seems reasonable for hospitals to support interventions that improve breastfeeding in term infants, managing late preterm infants as healthy term infants without additional specialist support may result in high breastfeeding failure rates among late preterm infants.

Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review

INTRODUCTION

Forty per cent of global child deaths occur in the neonatal period. Low and middle income countries need effective and simple methods to improve hospital-based neonatal care. Bubble continuous positive airway pressure (CPAP) may have a role in improving the quality of respiratory support in hospitals in low and middle income countries.

AIM

To examine the evidence for the efficacy and safety of bubble CPAP in neonates with respiratory distress in low and middle income settings.

METHOD

A systematic search (1946-March 2014) was performed of Pubmed, Ovid MEDLINE, Web of Science, Google Scholar and the references of relevant articles. Articles meeting inclusion criteria (CPAP for respiratory distress in infants <28 days of age in hospitals in low and middle income countries) were assessed using Grading of Recommendations, Assessment, Development and Evaluation and Newcastle-Ottawa Quality Assessment Scale methodology. Outcomes included need for mechanical ventilation, complications and mortality.

RESULTS

In three studies, the initial use of bubble CPAP compared with oxygen therapy, followed by mechanical ventilation if required, reduced the need for mechanical ventilation by 30%-50%. In another three trials comparing bubble CPAP with ventilator CPAP, mortality and complication rates were similar, while meta-analysis of CPAP failure in these same trials showed a lower failure rate in the bubble CPAP groups (p <0.003).

CONCLUSIONS

There is evidence that bubble CPAP is safe and reduces the need for mechanical ventilation. Further research into the efficacy of bubble CPAP in low-income and middle-income countries is needed.