Children with pyelonephritis and meningitis can feasibly receive OPAT. Age, treatment duration and fever influence this decision. None of these should be barriers to OPAT, and the cost savings support change in practice.

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BackgroundEffective lung protective ventilation requires reliable, real-time estimation of lung volume at the bedside. Neonatal clinicians lack a readily available imaging tool for this purpose.ObjectiveTo determine the ability of lung ultrasound (LUS) of the dependent region to detect real-time changes in lung volume, identify opening and closing pressures of the lung, and detect pulmonary hysteresis.MethodsLUS was performed on preterm lambs (n=20) during in vivo mapping of the pressure-volume relationship of the respiratory system using the super-syringe method. Electrical impedance tomography was used to derive regional lung volumes. Images were blindly graded using an expanded scoring system. The scores were compared with total and regional lung volumes, and differences in LUS scores between pressure increments were calculated.ResultsChanges in LUS scores correlated moderately with changes in total lung volume (r=0.56, 95% CI 0.47-0.64, p<0.0001) and fairly with right whole (r=0.41, CI 0.30-0.51, p<0.0001), ventral (r=0.39, CI 0.28-0.49, p<0.0001), central (r=0.41, CI 0.31-0.52, p<0.0001) and dorsal (r=0.38, CI 0.27-0.49, p<0.0001) regional lung volumes. The pressure-volume relationship of the lung exhibited hysteresis in all lambs. LUS was able to detect hysteresis in 17 (85%) lambs. The greatest changes in LUS scores occurred at the opening and closing pressures.ConclusionLUS was able to detect large changes in total and regional lung volume in real time and correctly identified opening and closing pressures but lacked the precision to detect small changes in lung volume. Further work is needed to improve precision prior to translation to clinical practice.

BackgroundManagement of pneumothorax in neonates requiring retrieval poses unique challenges, including decision to insert an intercostal catheter (ICC). We aimed to report the proportion and characteristics of neonates transported with and without ICC insertion and the incidence of deterioration in neonates transported with pneumothorax.MethodsA retrospective cohort study of neonates transported with pneumothorax between 2016 and 2020 in Victoria, Australia. Univariate analysis was performed on patient and clinical characteristics, followed by multivariate analysis to identify risks independently associated with ICC insertion.Results174 neonates were included. Mean (SD) gestational age (GA) was 37.5 (2.8) weeks. Eighty-two neonates (47%) had ICC inserted. On multivariate analysis, risk factors independently associated with ICC insertion were mechanical ventilation (MV) preceding retrieval team arrival (OR 12, 95% CI 3.1 to 46.6, p<0.001) and radiographical mediastinal shift (MS) (OR 6.2, 95% CI 2.4 to 16.2, p<0.001). Increasing GA is negatively associated with ICC insertion (OR 0.66, 95% CI 0.5 to 0.8, p<0.001). No significant difference in incidence of deterioration between the ICC group and the no-ICC group was observed (8.5% vs 5.4%, p=0.55). Ninety-five neonates were treated with needle aspiration (NA); 40 (42%) subsequently avoided ICC insertion. Twelve (13%) neonates transported without ICC had insertion within 24 hours following transport.ConclusionMany neonates with pneumothorax are transported without ICC, with low incidence of deterioration and ICC insertion within 24 hours after transport. More than a third of neonates managed with NA avoided ICC insertion. The likelihood of ICC insertion is increased by lower GA, MV prior to retrieval team arrival and radiographical MS.