Category: Procedures

Recorded maternal voice reduces pain

In a single-center randomized trial in preterm infants undergoing a heel lance, infants who were exposed to a recording of their mother’s voice during the procedure had lower pain scores (using the Premature Infant Pain Profile) and less of a…

Burden of venipuncture pain in the NICU

A prospective study of 495 neonates from 16 NICUs in France showed that the mean (SD) number of venipunctures was 3.8 (2.8) for all neonates, and 4.1 (2.9) for neonates less than 33 weeks. The range was 1-19 for all neonates…

Videolaryngoscopy for intubation

A single-center randomized trial compared intubation of neonates (in the delivery room or in the NICU) by trainees using a videolaryngoscope where the screen was visible to the instructor in the intervention group and invisible in the control group. The…

Inserting umbilical catheters: birth weight vs body measurement

A randomized trial from one center compared the percentage of umbilical catheters that were accurately placed when the catheter was placed using a birth-weight based formula for calculating the insertion depth versus using a graph based on shoulder-umbilicus length. There was…

Facial recognition software to detect neonatal pain

To study whether computerized recognition of facial expressions can accurately detect neonatal pain, researchers from Brazil obtained nearly 6000 facial images from 30 neonates in the resting state and when undergoing painful procedures. These images were then analyzed by computer…

Umbilical venous catheters – often misplaced

A retrospective analysis of 51 neonates with an umbilical venous catheter in place compared the location of the catheter tip as assessed on radiographs with assessment by targeted neonatal echocardiography (TNE). Almost 40% of the UVCs were inside the heart…

The value of bedside ultrasound

Point-of-care (bedside) ultrasound is increasingly being recommended as a valuable diagnostic and assessment tool in pediatric practice. Its use is growing rapidly in pediatric emergency medicine, critical care, and neonatology. It can aid in the performance of invasive procedures, focus…

Central venous catheter-related thrombi detected by routine ultrasound

An observational study assessed the frequency of thrombi related to central venous catheters. Any central venous catheter in place for longer than 14 days was studied with ultrasound surveillance twice a week. Around 1300 catheters were studied, and 10% of…

Intranasal midazolam for delivery room intubation

A case series from France reports on the use of intranasal midazolam as pre-medication for intubation of preterm infants to administer surfactant soon after birth. Twenty-seven infants with a median gestation of 29 weeks were studied. Infants were monitored using pain…

Stylets for intubation

An unblinded randomized study from Australia compared endotracheal intubations (by residents or fellows in the delivery room or in the NICU) performed with and without a stylet. The overall success rate on the first attempt was between 50 – 60%.…

Revised UVC insertion formula

An observational (pre-post) study compared insertion of umbilical venous catheters using the Shukla formula ((3 x birthweight in kg + 9)/2)+1 cms to insertion using a formula where the 1 was not added, i.e., ((3 x birthweight in kg)+9)/2). The…

Propofol for neonatal intubation

A case series from the Netherlands describes 62 intubations where propofol was used for premedication in neonates 24 – 44 weeks. A starting dose of 2 mg/kg was insufficient in about two-thirds of infants, who required additional doses. Fifteen percent…

Extravasation injuries: prevention and treatment

A survey of 26 NICUs in Australia and New Zealand describes the practices in place in those units to prevent and treat intravenous catheter-related extravasation injuries. Methods to prevent peripheral IV extravasations included frequent observation of the site, ensuring visibility of…

Posthemorrhagic hydrocephalus: management patterns

In this study from the Hydrocephalus Clinical Research Network, data were analyzed from 110 neonates consecutively treated for post-hemorrhagic hydrocephalus in preterm infants. Almost two-thirds of the patients underwent a temporizing procedure such as a ventricular reservoir or a subgaleal…

Catheter-related sepsis in ELBW infants

In a retrospective cohort study from Canadian NICUs of babies less than 29 weeks gestation or less than 1000 grams birth weight who had a percutaneously placed central venous catheter, around 20% of babies developed catheter-related sepsis. The rate of…