Methemoglobinemia can result in severe hypoxia. It has been frequently reported during the use of inhaled nitric oxide, but can occur where nitrate containing medications are used. Glyceryl trinitrate (GTN) patches have been used in the treatment of digital and limb ischemia in prematurely born infants. Little is known about the pharmacokinetics of GTN when incorporated into patches. Studies of other topical forms of nitroglycerine have shown a wide range of absorption. It is likely that the increased permeability of the prematurely born infant's skin would facilitate absorption. We describe the use of GTN patches in two very prematurely born infants used to treat limb/digit ischemia. This resulted in methemoglobinemia and resultant increase in their supplementary oxygen requirements. Removal of the patches was associated with a reduction in their methemoglobin levels and the supplementary oxygen requirements back to baseline levels. In conclusion, routine monitoring of methemoglobin levels should be undertaken when GTN patches are used in very prematurely born infants.

Hemodynamic impairment occurs in up to 80% of infants with neonatal encephalopathy (NE). Not all infants benefit from therapeutic hypothermia (HT); there are some indications that the trajectory of brain injury might be modified by neurologic monitoring and early management over the first 72-hour period. It is also possible that optimizing hemodynamic management may further improve outomes. The coupling between cerebral blood flow and cerebral metabolism is disrupted in NE, increasing the vulnerability of the newborn brain to secondary injury. Hemodynamic monitoring is usually limited to blood pressure and functional echocardiographic measurements, which may not accurately reflect brain perfusion. This review explores the evidence base for hemodynamic assessment and management of infants with NE while undergoing HT. We discuss the literature behind a systematic approach to a baby with NE with the aim to define best therapies to optimize brain perfusion and reduce secondary injury.

Aim To compare in‐hospital mortality and rates of necrotising enterocolitis (NEC), sepsis, IVH and length of invasive respiratory support in preterm infants <36 weeks’ gestation with congenital heart disease (CHD) to matched preterm infants without CHD in a single London centre over 13‐year period. Methods Single‐centre retrospective case‐control study over the 13‐year period from May 2004 to May 2017. Results Two hundred forty‐seven preterm infants with CHD were matched to 494 infants without CHD. Patients with CHD had a significantly increased risk of in‐hospital mortality compared to controls (OR 7.39 (95% CI 4.37–12.5); p < 0.001). Preterm infants with CHD had a higher risk of NEC (OR 2.42 (95% CI 1.32–4.45); p = 0.005), sepsis (OR 1.68 (95% CI 1.23–2.28); p = 0.001) and invasive respiratory support ≥28 days (OR 2.34 (95% CI 1.19–4.58); p = 0.017). Risk of IVH was lower in preterm infants with CHD (OR 0.22 (95% CI 0.11–0.42); p = 0.0001). Conclusion Preterm birth with CHD is associated with a higher risk of in‐hospital mortality, NEC, sepsis and prolonged invasive respiratory support, but a lower risk of IVH compared to matched controls. In‐hospital mortality remains high in moderate‐to‐late preterm infants with CHD.

Despite advances in neonatal intensive care, respiratory morbidities for very low birth weight babies have remained the same.1,2 This is associated with high costs, both to infants and families and in financial terms to the NHS.(Phibbs 2006) There is considerable variation in respiratory management of this vulnerable population across neonatal units. The majority of neonatal units in the United Kingdom contribute neonatal data to a common platform ‘Badger.net’. In this study we aim to pilot extraction of respiratory data from Badger.net from three tertiary units in London to examine the applicability and feasibility of auditing and bench marking routinely collected data.MethodsData were collected for all babies <27 weeks gestational age (GA) for 2013 (January-December). The information was collected from Badger.net, the medical notes were checked for missing data. Data were compared using the Mann Whitney U test.ResultsThe median GA and birth weight (BW) were similar in all units. Only inborn babies from Unit A (a surgical centre) were considered (Table 1). There was a significant difference in the invasive ventilation days in units A and B compared to unit C (p = 0.006 and 0.009 respectively) (Fig 1). The percentage of babies with chronic lung disease at 36 weeks GA did not differ (84%, 88% and 82%, units A, B and C respectively). Babies in unit C were discharged home approximately a week earlier compared to babies in units A and B. The number of babies discharged with home oxygen also varied between units (Table 2). This may reflect the scope and adequacy of locally available community services.Abstract G406(P) Table 1Demographics, ns = non-significantAbstract G406(P) Figure 1Comparison of invasive and non-invasive ventilation days from day 1-28 in all three neonatal unitsAbstract G406(P) Table 2Respiratory outcome, ns = non-significantConclusionBy publishing the respiratory data from three tertiary units in London, we show that these outcomes can be continuously audited by examining routinely collected and readily available data. This methodology will allow other units to audit their own service, benchmark their outcomes and improve standards within their units and across neonatal networks by identifying and sharing good practice. This work is an important ‘proof of concept’, moreover it may be possible to draw further conclusions regarding respiratory management if data are analysed over a longer period.