BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line‐associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs.OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI.METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter‐related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols.RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days.CONCLUSION: A multidisciplinary evidence‐based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter‐related bloodstream infections among low‐birth‐weight infants.

Background: In the recent years, a new treatment modality, high-flow nasal cannulae (HFNC) has become widely used despite limited systematic evaluation. Objective: To survey the attitudes and practices in academic neonatal units in the United States

We present a case of fetal diagnosed by ultrasound. Clinical aspects of this patient and the differential diagnosis of early neonatal seizures are discussed. A diagnosis of fetal seizures confirmed by ultrasonography is a rare event. Review of the literature shows only four cases of documented fetal seizures. This report describes a case of fetal seizures diagnosed in utero, its management, and the neonatal outcome. We also discuss the differential diagnosis.

The hemodynamic effects produced by continuous positive airway pressure (CPAP) and continuous negative extrathoracic presure (CNEP) of 4 and 8 cm H2O were compared in 8 normal, spontaneously breathing piglets. Arterial blood gases and hemodynamic measurements were obtained before and during CPAP and CNEP of 4 and 8 cm H2O. CPAP 8 cm H2O and CNEP 8 cm H2O produced significant increases (p < 0.01) in PaO2 from baselines 76 ± 3 to 85 ± 3 and 77 ± 4 to 85 ± 3 mm Hg, respectively. No significant changes occurred in PaCo2 or cardiac index, except during CPAP 8 cm H2O [38 ± 1 to 44 ± 2 mm Hg (p < 0.05) and 376 ± 30 to 330 ± 30 ml/kg/min (p < 0.05), respectively]. During CPAP of 4 cm H2O, significant increases occurred in mean right atrial pressure (Pra) (2.1 ± 0.3 to 3.3 ± 0.4 mm Hg; p < 0.01), left ventricular end-diastolic pressure (LVEDP) (2.8 ± 0.4 to 3.7 ± 0.3 mm Hg; p < 0.01), and mean pulmonary artery pressure (Ppa) (12.9 ± 0.8 to 15.1 ± 0.8 mm Hg; p < 0.01). CPAP of 8 cm H2O produced marked increases in Pra (2–1 ± 0.2 to 4.9 ± 0.7 mm Hg; p < 0.01), LVEDP (2.7 ± 0.5 to 4.5 ± 0.4 mm Hg; p < 0.01) and Ppa (12.8 ± 0.8 to 17.7 ± 0.6 mm Hg; p < 0.01). In contrast, CNEP of 8 cm H2O produced decreases in Pra (2.1 ± 0.2 to 1.3 ± 0.3 mm Hg; p < 0.01), LVEDP (2.6 ± 0.5 to 1.7 ± 0.4 mm Hg; p < 0.01), and Ppa (12.9 ± 1.0 to 11.4 ± 1.0 mm Hg; p < 0.01). CNEP in contrast to CPAP produced an improvement in oxygenation while decreasing vascular pressures and maintaining cardiac output near basal levels. These data support clinical experience which suggests a beneficial effect of CNEP in the treatment of patients with increased pulmonary vascular resistance and pulmonary hypertension.