a single CRP value for proven sepsis was 64% (95% CI 53 to. 59) with a positive predictive value of only 14% (95% CI 11 to. 17).45 However, if serial CRP values remain normal, there is a low likelihood of infection with a negative predictive value of nearly 100%46 The 2021 NICE guidelines recommend use of.
What’s new in the management of neonatal early-onset sepsis?
The expert guidelines highlighted in this review provide an evidence-based framework for approaching at-risk infants and allow for a more limited and standardised approach to antibiotic use. While these guidelines have significantly reduced antibiotic utilisation worldwide, optimally each unit would individualise their approach to early onset sepsis (EOS) based on the neonatal population they ...
Untangling the physiology and pathophysiology of neonatal …
Hypoglycaemia remains one of the leading causes of term admission to neonatal units. Significant time is expended by clinical teams in managing infants at risk of hypoglycaemia. Challenges remain in differentiating physiological falls in glucose concentrations from a potentially preventable cause of brain injury. The current evidence for distinguishing physiological from pathological ...
Neonatal high-frequency oscillatory ventilation: where are we now?
High-frequency oscillatory ventilation (HFOV) is an established mode of respiratory support in the neonatal intensive care unit. Large clinical trial data is based on first intention use in preterm infants with acute respiratory distress syndrome. Clinical practice has evolved from this narrow population. HFOV is most often reserved for term and …
Understanding the principle biophysics concepts of pulmonary …
Pulmonary surfactant (PS) is a lipid-protein complex essential to stabilise the delicate structure of mammalian alveoli along with successive compression-expansion respiratory cycles. To do so, surfactant reduces dramatically surface tension at the air-liquid interface, an activity that depends critically on a proper lipid composition and the presence of some specific surfactant proteins. Lack ...
Management and investigation of neonatal encephalopathy: 2017 …
This review discusses an approach to determining the cause of neonatal encephalopathy, as well as current evidence on resuscitation and subsequent management of hypoxic-ischaemic encephalopathy (HIE). Encephalopathy in neonates can be due to varied aetiologies in addition to hypoxic-ischaemia. A combination of careful history, examination and the judicious use of investigations can help ...
Supporting all breaths versus supporting some breaths during ...
Background National Institute for Health and Clinical Effectiveness (NICE), UK, guideline published in 2019 recommends the use of volume-targeted ventilation (VTV). It recommends synchronised intermittent mandatory ventilation (SIMV) over the modes that support-all-breaths, for example, assist control ventilation (ACV). We conducted a systematic review and meta-analysis of the studies ...
Neonatal jaundice in infants born at 37 weeks: is NICE treating too ...
Neonatal jaundice affects approximately 60% of term and 80% of preterm infants within the first week of life. Gestation-based treatment threshold graphs by the National Institute of Health and Care Excellence are used to guide jaundice management in the UK.1 NICE treatment thresholds at 37-week gestation are much lower compared with ≥38 weeks and also when compared with the previous and ...
Neonatal thrombocytopenia: causes and management
Neonatal thrombocytopenia is a common clinical problem. Thrombocytopenia presenting in the first 72 hours of life is usually secondary to placental insufficiency and caused by reduced platelet production; fortunately most episodes are mild or moderate and resolve spontaneously. Thrombocytopenia presenting after 72 hours of age is usually secondary to sepsis or necrotising enterocolitis and is ...
Trends in the incidence and management of hypoxic-ischaemic ...
Objective Hypoxic-ischaemic encephalopathy (HIE) remains a leading cause of neonatal mortality and neurodisability. We aimed to determine the incidence of HIE and management patterns against national guidelines. Design Retrospective cohort study using the National Neonatal Research Database. Setting Neonatal units in England and Wales. Patients Infants 34–42 weeks gestational age (GA) with a ...