Keith James Barrington

Objectives Extremely preterm children may have a prolonged neonatal intensive care unit (NICU) stay. Their parents interact with clinicians both before and after birth. There is little information about parental satisfaction with the information received and what they would want to improve. The objective of this study was to explore parental perspectives regarding their information needs. Methods Over 1 year, parents of children born at Results Among parents (n=248, 98% of parents coming to follow-up), 45% were satisfied. When parents had recommendations, the main themes invoked improving communication about (1) preparing for discharge and life after the NICU in a stepwise, personalised and practical manner (40%), (2) more practical and functional information about being a parent in the NICU during the whole clinical trajectory (35%) and (3) more optimistic conversations with clinicians about the function of babies/families (as opposed to diagnoses) (26%). Conclusion Although half the parents are satisfied with the information received, many recommended improvements in clinician–parent communication, mainly to make it more accessible, personalised, positive and practical.

Objective To determine survival and neurodevelopmental outcomes in the Hypotension in Preterm (HIP) trial. Design Prospective follow-up of infants enrolled in randomised controlled trial. Participants 58 infants born before 28 weeks of gestation with low mean arterial blood pressure. Intervention Random allocation to treatment of low blood pressure values with infusion of dopamine or placebo. Primary outcome Survival without neurodevelopmental impairment to 24 months corrected age (CA). Results The HIP trial stopped early due to logistic and recruitment difficulties. Outcomes were determined for 55 infants (27 in the dopamine group and 28 in the placebo group) at 24 months CA. Survival without impairment was present in 13 (48%) infants in the dopamine group and 7 (25%) infants in the placebo group (OR 2.79 (95% CI 0.89, 8.72); p=0.078). The components of the primary outcome were similarly distributed between the two arms. Mean Bayley composite scores and the frequency of somatic impairments did not differ significantly between groups but infants were shorter and lighter at 2 years of age after dopamine administration. Conclusion In this placebo-controlled trial of the treatment of hypotension in extremely preterm infants, dopamine administration did not increase survival without impairment at 2 years CA. However, the study was not sufficiently powered and a clinically important effect cannot be excluded. The role of inotropic medication in facilitating good outcomes requires further study.

Aim: Umbilical venous catheters (UVC) have been associated with an increased risk of necrotizing enterocolitis (NEC). We aimed to assess the relationship between the type of initial central venous access in preterm infants and NEC.Methods: Using the Canadian Neonatal Network database, we identified preterm infants <30 weeks gestation born between 2014 and 2021 in one of 32 participating centres who had a peripherally inserted central catheter (PICC) as initial vascular access. These infants were matched in a 1:1 ratio based on gestational age, sex and birth weight to infants in two other groups: (i) those who initially had an UVC and (ii) those who had an UVC followed by a PICC.Results: A total of 497 infants were included in this study: 165 in the PICC group, 164 in the UVC group and 165 in the UVC + PICC group. There was no association between the type of initial central venous access and NEC.Conclusion: Although this retrospective study did not find an association between the type of initial central venous access and NEC, larger prospective studies are required to evaluate this association.

Introduction: In neonatology, multiple pregnancies are common. Unfortunately, it is not rare for one baby to die. Communication with parents in these circumstances has been demonstrated to be sub-optimal. Methods: Two educational programs were evaluated with pre- and post-course surveys, questionnaires administered to participants, and audits. Results: In the online Butterfly project (UK; n = 734 participants), all participants reported that the training exceeded or met their expectations, 97% reported they learned new skills, and 48% had already applied them. Participants expressed gratitude in their open-ended answers: “I feel a lot more confident in supporting parents in this situation”. In the Ribbon project (workshop for neonatal clinicians, Quebec; n = 242), 97% were satisfied with the training and reported feeling more comfortable caring for bereaved parents. Knowledge improved pre–post training. Audits revealed that 100% of cases were identified on the incubator and the baby’s/babies’ admission card, all changed rooms after the death of their co-twin/triplet, and all had the name of their co-twin/triplet on the discharge summary. All clinicians (55) knew what the ribbon symbol meant when asked during surprise audits at the bedside. Conclusion: Different educational strategies to optimize communication with families after the perinatal loss of a co-twin are appreciated and have a positive impact.

Objectives Extremely preterm babies have a significant risk of neurodevelopmental impairment (NDI). There has been little investigation regarding the impact of prematurity on families. The objective of this study was to explore parental perspectives regarding the impact of prematurity on themselves/their family. Methods Over 1 year, parents of children born Results Among parents (n=248, 98% participation rate), most (74%) reported that their child’s prematurity had both positive and negative impacts on their life or their family’s life, while 18% reported only positive impacts and 8% only negative impacts. These proportions were not correlated with GA, brain injury, nor level of NDI. The positive impacts reported included: an improved outlook on life, such as gratitude and perspective (48%), stronger family relationships (31%) and the gift of the child (28%). The negative themes were stress and fear (42%), loss of equilibrium due to medical fragility (35%) and concerns about developmental outcomes including the child’s future (18%). Conclusion Parents report both positive and negative impacts after an extremely preterm birth, independent of disability. These balanced perspectives should be included in neonatal research, clinical care and provider education.

Aim: To describe pulmonary important outcomes (PIO) reported by parents of children born extremely preterm.Methods: Over 1‐year, all parents of children aged 18 months–7‐years born n = 285, 98% participation rate), 44% spoke about PIO, invoking 24 themes pertaining to NICU hospitalisation and/or long‐term respiratory health. Some themes had an impact primarily on the child (e.g. exercise limitation), while the majority had an impact on the whole family (e.g. hospital readmissions). None mentioned oxygen at 36 weeks nor bronchopulmonary dysplasia (BPD). The proportion of responses invoking PIO were statistically similar between parents of children with and without BPD, born before or after 25 weeks or with birthweight < or ≥750 g. PIO were more likely to be mentioned in males and among those readmitted for respiratory problems.Conclusion: Parents describe many PIO, most related to the functional impact of lung disease on their child (and family), rather than the diagnosis of BPD itself. Most of these PIO are not primary outcomes in large neonatal trials nor collected in neonatal databases.

Objective To assess the educational and clinical impact of a tiny baby intubation team (TBIT). Study design Retrospective study comparing endotracheal intubation (ETI) performed: pre-implementation of a TBIT (T1), 6 months post-implementation (T2), and 4 years post-implementation (T3). Results Post-implementation (T2), first-attempt success rate in tiny babies increased (44% T1; 59% T2, p = 0.04; 56% T3, p = NS) and the proportion of ETIs performed by residents decreased (53% T1; 37% T2, p = 0.001; 45% T3, p = NS). After an educational quality improvement intervention (prioritizing non-tiny baby ETIs to residents, systematic simulation training and ETI using videolaryngoscopy), in T3 residents’ overall (67% T1; 60% T2, p = NS; 79% T3, p = 0.02) and non-tiny baby ETI success rate improved (72% T1; 60% T2, p = NS; 82% T3, p = 0.02). Conclusion A TBIT improves success rate of ETIs in ELBW infants but decreases educational exposure of residents. Educational strategies may help maintain resident procedural competency without impacting on quality of care.