Less invasive surfactant administration (LISA) is an effective, minimally invasive technique of administering surfactant to infants with respiratory distress syndrome. While termed less invasive, LISA still requires airway instrumentation with direct laryngoscopy, thus may be considered painful. However, the issue of whether or not to routinely sedate infants for LISA remains contentious, with significant variation in practice between centres. Proponents for giving pharmacological analgesia and/or sedation predominantly focus on patient comfort during the procedure. However, those who favour non-pharmacological measures of pain management focus on the potential for procedural success without the risk of adverse events, such as respiratory depression and potentially the need for escalation to intubation, which may occur with pharmacological agents. The neonatal population who may benefit from LISA is varied. Due to this variety in presentation type, gestational age, and unit experience, there is a need to provide an individualized, tailored approach to sedation and analgesia for these infants. Using a blanket approach to sedation will lead to infants being exposed to sedative medications on the assumption of potential distress, rather than in response to signs of actual distress. This places the infant at risk of the adverse reactions, potentially without them ever having needed the beneficial effect of the medications. This seems an unnecessary risk. This article explores the ethical arguments pertaining to analgesia and sedation during the LISA technique, concluding that a standardized approach to the usage of pharmacological sedation is undesirable. Moreover, we maintain that procedural analgesia and sedation should be based on individualized, infant-centred assessment, rather than on a rigid, standardized approach.

There is a premium placed on the maintenance of our privacy and confidentiality as individuals in society. For a productive and functional doctor–patient relationship, there needs to be a belief that details divulged in confidence to the doctor will be kept confidential and not disclosed to the wider public. However, where the information disclosed to the doctor could have implications for the safety of the wider public, for example disclosures with potential criminal implications, or have serious consequences for another individual, as is the case in genetic medicine, should doctors feel confident about breaching confidentiality? This essay firstly explores the legal rulings regarding cases in which confidentiality has been breached where there was risk of significant harm to others following the patient’s disclosure, and secondly, focusing on the evolving legal position with regard to confidentiality in contexts where information sharing would be beneficial to others, for example the evolving case of the implications of genetic diagnosis on families (eg, ABC v St George’s Healthcare NHS Trust; 2017).

Globally, there is a lack of adherence to the WHO definition of live birth. This is leading to untenable ethical inconsistencies due to significant variation in which infants are being acknowledged and registered as alive. If an infant is not registered as alive, there can be no acknowledgement of their rights as a child, and there are subsequent implications for worldwide child health resources and funding. Being alive should not be a quality that is geographically determined. This paper explores the differing definitions that are used regarding live birth and the ethical and practical implications for infants, their families and child health worldwide.

Fungal organisms pose a life-threatening risk to vulnerable premature infants. In this review, all cases of fungal sepsis in a large tertiary neonatal unit over the last 10 years (2008-2018) in premature neonates (<30 weeks gestation) were reviewed. This time frame spanned a change in prophylaxis policy from fluconazole to nystatin in 2012. The most common fungal organism causing sepsis was Candida albicans in 80% of cases and Candida parapsilosis in 13%. All fungal organisms cultured were fully sensitive; no resistant cases were seen in the last 10 years. Encouragingly, rates of infection were static (between 0 and 3 cases/year) over the last 10 years, despite the unit’s policy for antifungal prophylaxis changing from fluconazole to nystatin in 2012.

No abstract