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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Is NIRS monitoring well tolerated in term and preterm neonates?


Background. Near infrared spectroscopy (NIRS) is a new, non-invasive monitoring method in neonates, which has now become part of routine monitoring in many neonatal intensive care units (NICU). New, additional, non-invasive technical monitoring might have an influence on neonatal wellbeing.

Objectives. The aim of the present study was to evaluate the wellbeing of neonates during peripheral and cerebral NIRS monitoring and venous occlusions.

Methods. In the present study, secondary outcome parameters of prospective observational studies with NIRS in term and preterm neonates were analysed. Heart rate (HR), arterial oxygen saturation (SpO2), respiratory rate (RR), mean arterial blood pressure (MABP), pain score and skin condition at four defined time points during NIRS measurements of regional tissue oxygenation were recorded and analysed.

Results. Thirty-six term and preterm neonates were included (gestational age (GA) 36±1 week, 2779±930g birth weight). SpO2 and peripheral tissue oxygenation index (pTOI) increased and HR dropped while RR, mean MABP and pain scores remained unchanged during NIRS measurements. In eight infants, a mildly irritated area of skin was noted where the NIRS sensors had been attached.

Conclusion. Cerebral and peripheral NIRS monitoring and venous occlusions were painless and well tolerated by term and preterm neonates.

Key words: neonates, NIRS, vital signs

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Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support


Extracorporeal membranous oxygenation (ECMO) is a life-saving treatment for paediatric patients with cardiac or respiratory failure of diverse aetiology. ECMO support is implemented only when all other available medications and procedures fail to treat the underlying cause of organ failure. The reason for caution is a high risk of complications, including intravascular haemolysis, bleeding or clot formation, inflammation and sepsis. Platelet count is closely monitored in assessment of bleeding risk associated with ECMO support. Platelets are counted as a parameter of the complete blood count and can be measured using impedance or optical technology. We report a case of severe red blood cell (RBC) fragmentation in a neonate on ECMO in whom erroneously normal platelet counts were obtained by all available automated methods for platelet count in an emergency laboratory. Based on those observations we have implemented an additional procedure for recognising interferences of fragmented and microcytic RBCs that cause spuriously normal platelet counts.

Key words: platelet count, ECMO, fragmented RBC, neonates, analytical interference

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CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?


Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting.

Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC).

Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality.

Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs.

Key words: CRIB, CRIB II, mortality, neonates, outcome, prematurity, scoring system

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Pediatric surgical extracorporeal membrane oxygenation – a case series


Objective. To review demographic and procedural factors and their association with weaning rate and survival from extracorporeal membrane oxygenation (ECMO) in pediatric patients undergoing repair of cardiac malformations.
Methods. The hospital records of children requiring ECMO during cardiac operation due to failure to wean from cardio-pulmonary by pass (CPB) were retrospectively reviewed, and an analysis of variables affecting survival was performed.
Results. Thirty-five pediatric patients between January 1, 2000 and December 31, 2006 required ECMO for cardiopulmonary support during cardiac operations. ECMO survival was 54.3% and was comparable across all age groups. The lowest pH during ECMO treatment was the only predictor of mortality (P = 0.006). No other patient, surgical or anesthetic, factor was associated with either weaning from ECMO or hospital survival.
Conclusions. No clear risk factor could be identified for survival from ECMO in our pediatric patients who underwent cardiac surgery and failed weaning from cardiopulmonary bypass.

Keywords: congenital, cardiopulmonary bypass, infants, neonates, failure to wean for cardiopulmonary bypass, survival

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