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  1. Article: Very Low Birth Weight Outcomes and Admission Temperature: Does Hyperthermia Matter?

    Brophy, Hannah / Tan, Gaik Min / Yoxall, Charles William

    Children (Basel, Switzerland)

    2022  Volume 9, Issue 11

    Abstract: National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the ... ...

    Abstract National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the relationships between admission temperature and outcomes in very low birth weight (VLBW) babies in a unit with low rates of hypothermia and a higher rate of hyperthermia. This was an observational study based on routinely collected data including demographics, admission temperature, survival and major morbidity outcomes. Subjects were 1104 consecutive inborn VLBW babies admitted to a Neonatal Intensive Care Unit in United Kingdom between 2010 and 2017. Results: 155 (14%) of babies were hypothermic (<36.5 °C) with only 21 (1.9%) < 36 °C, and 254 (23%) of babies were hyperthermic (>37.5 °C). The rate of major abnormality on cranial ultrasound scan was increased in the hyperthermic babies compared to the normothermic babies (37/239 (15.5%) vs. 54/601 (9%), relative risk (95% CI) 1.723 (1.166 to 2.546), p = 0.006). There was no difference in survival or other major morbidity in the hyperthermic babies compared to the normothermic babies. There was no association between hypothermia and survival or any major morbidity, although this probably reflects the low power of the study given the low rates of significant hypothermia. Higher admission temperature was associated with an increase in the risk of major cranial ultrasound abnormality using multiple logistic regression analysis (p = 0.007) with an increased odds ratio (95% CI) of 1.48 (1.11 to 1.97) for each degree of increase. We conclude that admission hyperthermia is independently associated with an increased risk of preterm brain injury. It is not possible to state whether this is a causative association, or whether the association is a consequence of a shared aetiology of perinatal infection.
    Language English
    Publishing date 2022-11-07
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2732685-8
    ISSN 2227-9067
    ISSN 2227-9067
    DOI 10.3390/children9111706
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Safety and efficacy of Transwarmers in preterm resuscitation.

    Brophy, Hannah / Yoxall, Charles William

    Archives of disease in childhood. Fetal and neonatal edition

    2019  Volume 105, Issue 4, Page(s) 455–456

    MeSH term(s) Equipment Design ; Equipment Failure ; Humans ; Hypothermia/prevention & control ; Incubators, Infant ; Infant, Newborn ; Neonatology ; Resuscitation/instrumentation
    Language English
    Publishing date 2019-11-08
    Publishing country England
    Document type Letter
    ZDB-ID 2007331-8
    ISSN 1468-2052 ; 1359-2998
    ISSN (online) 1468-2052
    ISSN 1359-2998
    DOI 10.1136/archdischild-2019-318292
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Outcomes of Femoral Arterial Catheterisation in Neonates: A Retrospective Cohort Study.

    Turner, Lucy / Alexopolou, Vasiliki / Tawfik, Hanin Tawfik Mohammed / Silva, Monica / Yoxall, Charles William

    Children (Basel, Switzerland)

    2022  Volume 9, Issue 8

    Abstract: Background: To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ... ...

    Abstract Background: To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ischaemic injury.
    Methods: Retrospective survey of data relating to all episodes of FAC insertion in a single neonatal intensive care unit over a 12 year period up to 2020.
    Results: 146 FACs were inserted into 139 babies with a median (interquartile range) gestation and birth weight of 27 (24 to 37) weeks and 1092 (682 to 2870) g. Impaired limb perfusion occurred in 32 (22%). This was transient and recovered with no injury in 26 of the 32. There was an increased risk of impaired limb perfusion in babies with lower weight at the time of insertion; from 5.7% in babies over 3000 g to 34.7% in babies under 1000 g (relative risk 6.1 (1.5 to 24.6)). Six babies (4%) had ischaemic injury. Risk factors for ischaemic injury included weight below 1000 g (four cases), pre-existing partial arterial obstruction (two cases), concerns about limb perfusion prior to FAC insertion (two cases) and a delay in removing the FAC after recognition of the poor perfusion (five cases). Two clinicians inserted 71 (50%) FACs and had no associated injuries.
    Conclusions: FAC can be used in neonates, although there is a risk of ischaemic injury, particularly in very small babies. Our data can be used to inform decisions about patient selection for this procedure.
    Language English
    Publishing date 2022-08-20
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2732685-8
    ISSN 2227-9067
    ISSN 2227-9067
    DOI 10.3390/children9081259
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Maintaining Normothermia in Preterm Babies during Stabilisation with an Intact Umbilical Cord.

    Cleator, Alexander James / Coombe, Emma / Alexopoulou, Vasiliki / Levingston, Laura / Evans, Kathryn / Hurst, Jonathan Christopher / Yoxall, Charles William

    Children (Basel, Switzerland)

    2022  Volume 9, Issue 1

    Abstract: Background: We had experienced an increase in admission hypothermia rates during implementation of deferred cord clamping (DCC) in our unit. Our objective was to reduce the number of babies with a gestation below 32 weeks who are hypothermic on ... ...

    Abstract Background: We had experienced an increase in admission hypothermia rates during implementation of deferred cord clamping (DCC) in our unit. Our objective was to reduce the number of babies with a gestation below 32 weeks who are hypothermic on admission, whilst practising DCC and providing delivery room cuddles (DRC).
    Method: A 12 month quality improvement project set, in a large Neonatal Intensive Care Unit, from January 2020 to December 2020. Monthly rates of admission hypothermia (<36.5 °C) for all eligible babies, were tracked prospectively. Each hypothermic baby was reviewed as part of a series of Plan, Do, Study Act (PDSA) cycles, to understand potential reasons and to develop solutions. Implementation of these solutions included the dissemination of the learning through a variety of methods. The main outcome measure was the proportion of babies who were hypothermic (<36.5 °C) on admission compared to the previous 12 months.
    Results: 130 babies with a gestation below 32 weeks were admitted during the study period. 90 babies (69.2%) had DCC and 79 babies (60%) received DRC. Compared to the preceding 12 months, the rate of hypothermia decreased from 25/109 (22.3%) to 13/130 (10%) (
    Conclusions: It is possible to achieve low rates of admission hypothermia in preterm babies whilst providing DCC and DRC. Using a quality improvement approach with PDSA cycles is an effective method of changing clinical practice to improve outcomes.
    Language English
    Publishing date 2022-01-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2732685-8
    ISSN 2227-9067
    ISSN 2227-9067
    DOI 10.3390/children9010075
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Implementing intact cord resuscitation in very preterm infants: feasibility and pitfalls.

    Hocq, Catheline / Van Grambezen, Aurianne / Carkeek, Katherine / Van Grambezen, Bénédicte / Yoxall, Charles William / Debiève, Frédéric / Piersigilli, Fiammetta / Danhaive, Olivier

    European journal of pediatrics

    2022  Volume 182, Issue 3, Page(s) 1105–1113

    Abstract: The purpose of this study is to evaluate the feasibility of intact cord resuscitation (ICR) in very preterm infants using a custom-equipped mobile resuscitation trolley ( ... ...

    Abstract The purpose of this study is to evaluate the feasibility of intact cord resuscitation (ICR) in very preterm infants using a custom-equipped mobile resuscitation trolley (LifeStart
    MeSH term(s) Infant, Newborn ; Humans ; Pregnancy ; Female ; Infant, Premature ; Feasibility Studies ; Umbilical Cord ; Placenta ; Resuscitation/methods ; Infant, Premature, Diseases ; Constriction
    Language English
    Publishing date 2022-12-28
    Publishing country Germany
    Document type Review ; Journal Article
    ZDB-ID 194196-3
    ISSN 1432-1076 ; 0340-6199 ; 0943-9676
    ISSN (online) 1432-1076
    ISSN 0340-6199 ; 0943-9676
    DOI 10.1007/s00431-022-04776-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart trolley.

    Hoyle, Emily Suzanne / Hirani, Sunaya / Ogden, Sally / Deeming, Jenna / Yoxall, Charles William

    Archives of disease in childhood. Fetal and neonatal edition

    2020  Volume 105, Issue 6, Page(s) 652–655

    Abstract: Aim: To increase the documented use of the Lifestart trolley to allow premature infants' (<32 weeks' gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.: Design: A 13-month quality improvement programme from April ... ...

    Abstract Aim: To increase the documented use of the Lifestart trolley to allow premature infants' (<32 weeks' gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.
    Design: A 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.
    Results: Documented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).
    Implications and relevance: By undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.
    MeSH term(s) Constriction ; Guideline Adherence ; Humans ; Infant, Newborn ; Infant, Premature/blood ; Perinatal Care/methods ; Perinatal Care/standards ; Point-of-Care Systems/standards ; Practice Guidelines as Topic ; Quality Improvement ; Umbilical Cord/blood supply
    Language English
    Publishing date 2020-04-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2007331-8
    ISSN 1468-2052 ; 1359-2998
    ISSN (online) 1468-2052
    ISSN 1359-2998
    DOI 10.1136/archdischild-2019-318636
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The prognostic value of initial blood lactate concentration measurements in very low birthweight infants and their use in development of a new disease severity scoring system.

    Phillips, Louise A / Dewhurst, Chris J / Yoxall, Charles William

    Archives of disease in childhood. Fetal and neonatal edition

    2011  Volume 96, Issue 4, Page(s) F275–80

    Abstract: Objectives: To investigate the predictive value of the Clinical Risk Index for Babies (CRIB) score in current practise, the predictive value of blood lactate concentrations ([L]) and to develop a new clinical scoring system for very low birthweight ( ... ...

    Abstract Objectives: To investigate the predictive value of the Clinical Risk Index for Babies (CRIB) score in current practise, the predictive value of blood lactate concentrations ([L]) and to develop a new clinical scoring system for very low birthweight (VLBW) babies.
    Methods: The predictive ability of CRIB, [L] and the development of the new score was based on retrospective data collected from all inborn VLBW babies born between March 2001 and February 2004 in a tertiary neonatal unit. Predictive ability was determined from area under the receiver operator curve (AUC). A new score was developed and validated with a second cohort of VLBW babies.
    Results: 408 babies were studied in the development cohort and 275 in the validation cohort. AUC for CRIB was 0.933 (95% CI 0.897-0.969). Initial [L] was significantly higher in babies who died than in those who survived (median (range) 9.2 (1.26-21.1) vs 3.64 (0.67- 17.9) mmol/l, p<0.0001) as was the highest [L] in the first 12 h (10.2 (3.37-26) vs 3.84 (1.05-20.7) mmol/l, p<0.0001). A new score was developed using; highest [L], gestation and the presence of life-threatening malformation. AUC for the new score was 0.918 (95% CI 0.876-0.961) in the development cohort and 0.859 (95% CI 0.805-0.913) in the validation cohort.
    Conclusions: CRIB score retains its predictive ability for mortality in VLBW babies. Early hyperlactataemia is a predictor of death in VLBW babies. The new score appears to perform as well as CRIB but requires fewer data items.
    MeSH term(s) Biomarkers/blood ; Birth Weight/physiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight/blood ; Lactic Acid/blood ; Male ; Prognosis ; Severity of Illness Index
    Chemical Substances Biomarkers ; Lactic Acid (33X04XA5AT)
    Language English
    Publishing date 2011-07
    Publishing country England
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 2007331-8
    ISSN 1468-2052 ; 1359-2998
    ISSN (online) 1468-2052
    ISSN 1359-2998
    DOI 10.1136/adc.2010.185793
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Randomised trial of cord clamping and initial stabilisation at very preterm birth.

    Duley, Lelia / Dorling, Jon / Pushpa-Rajah, Angela / Oddie, Sam J / Yoxall, Charles William / Schoonakker, Bernard / Bradshaw, Lucy / Mitchell, Eleanor J / Fawke, Joe Anthony

    Archives of disease in childhood. Fetal and neonatal edition

    2017  Volume 103, Issue 1, Page(s) F6–F14

    Abstract: Objectives: For very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care.: Design: Parallel group randomised (1:1) trial, using sealed opaque numbered envelopes.: Setting: Eight UK tertiary ... ...

    Abstract Objectives: For very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care.
    Design: Parallel group randomised (1:1) trial, using sealed opaque numbered envelopes.
    Setting: Eight UK tertiary maternity units.
    Participants: 261 women expected to have a live birth before 32 weeks, and their 276 babies.
    Interventions: Cord clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and immediate neonatal care after clamping.
    Main outcome measures: Intraventricular haemorrhage (IVH), death before discharge.
    Results: 132 women (137 babies) were allocated clamping ≥2 min and neonatal care cord intact, and 129 (139) clamping ≤20 s and neonatal care after clamping; six mother-infant dyads were excluded (2, 4) as birth was after 35
    Conclusions: This is promising evidence that clamping after at least 2 min and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed.
    Trial registration: ISRCTN 21456601.
    MeSH term(s) Adult ; Cerebral Intraventricular Hemorrhage/etiology ; Cerebral Intraventricular Hemorrhage/prevention & control ; Constriction ; Female ; Gestational Age ; Humans ; Infant ; Infant Death/etiology ; Infant Death/prevention & control ; Infant, Newborn ; Infant, Premature, Diseases/etiology ; Infant, Premature, Diseases/prevention & control ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal/methods ; Male ; Pregnancy ; Premature Birth/diagnosis ; Premature Birth/therapy ; Time-to-Treatment ; Treatment Outcome ; Umbilical Cord/surgery
    Language English
    Publishing date 2017-09-18
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2007331-8
    ISSN 1468-2052 ; 1359-2998
    ISSN (online) 1468-2052
    ISSN 1359-2998
    DOI 10.1136/archdischild-2016-312567
    Database MEDical Literature Analysis and Retrieval System OnLINE

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