Our data confirm that impaired renal function is strongly associated with high SGCs. Reduced body temperatures do not affect the clearance of gentamicin.

Introduction The utility of mucous fistula refeeding (MFR) in neonates with short bowel syndrome is widely debated. Our purpose is to review MFR and outline methods, reported complications, and clinical outcomes (survival, weight gain, dependence on parenteral nutrition [PN], and time to enteral autonomy). Materials and Methods We performed a MEDLINE literature search and reference review from January 1980 to May 2020 for terms (“mucous fistula re-feeding” or “enteral re-feeding”) and neonates. We included studies that utilized conventional MFR in the neonatal period. Non-English language articles were excluded. Results We identified 11 relevant articles. Internationally, there was no consensus on methods of MFR. A total of 197 neonates underwent MFR. Within a single study, four neonates developed major complications; however, the procedure was well tolerated without major complications in 10 of the 11 studies. A mortality of nine patients during MFR highlights the burden of disease within the study population; however, of these, only one was directly attributable to MFR. Minor complications were seldom quantified. Three studies demonstrated a higher rate of weight gain and shorter PN support versus controls. Neonates who underwent MFR had lower chance of anastomotic leak and quicker progression to full feed after reversal versus controls. The influence of microorganisms in MFR was only investigated in one study. Conclusion Current evidence suggests benefits of MFR; however, an international consensus is yet to be reached on the optimal method. A large prospective study investigating the influence of MFR on the enteric system is required.

AimsBilious vomiting in the newborn is a potentially life threatening emergency. Malrotation, a disorder of abnormal intestinal rotation and fixation, predisposes newborns to midgut volvulus. Plain abdominal films and upper gastrointestinal contrast studies form the mainstay of radiological diagnosis. 1) To determine the incidence of surgical pathology in newborns with bilious vomiting referred to a regional paediatric surgical centre.2) To assess the predictive value of radiological investigations MethodsA total of one hundred and fourteen infants referred for radiological assessment on the day of presentation were identified from the regional radiological database (October 2006–April 2008). Exclusion criteria included abdominal wall defects, congenital cardiac conditions, congenital anomalies and vomiting beyond the neonatal period. A total of 23 infants were excluded. All infants had plain abdominal films and upper gastrointestinal contrast studies. In addition, five infants had abdominal ultrasonography.Results18.6% (17/91) of newborns presented with intestinal pathology, of which all 17 required surgery. Thirteen newborns (14.2%) had malrotation (seven had additional midgut volvulus), two had a duodenal web, one each had colonic pneumatosis and intussusception. Plain films and clinical examination did not suggest malrotation in the positive cases. Upper gastrointestinal contrast studies diagnosed malrotation in eleven cases, equivocal diagnosis of malrotation in two cases with midline duodenojejunal junction and a diagnosis of duodenal web in a further two cases. The predictive value of upper gastrointestinal contrast studies in diagnosing malrotation was 85%. Ultrasonography secured the diagnosis of midgut volvulus based on the “whirlpool sign”, in the two equivocal cases with midline duodenojejunal junction and this was confirmed during surgery. All thirteen cases had a Ladd's procedure. None had ischaemic bowel.ConclusionThe incidence of malrotation in our population is less than previously reported, probably because our regional policy dictates that all infants with a single bilious vomit require specialist investigation. This study confirms that clinical examination and plain abdominal films have no predictive value in diagnosing midgut volvulus. The study also confirmed that upper gastrointestinal contrast studies, in combination with ultrasound improves the predictive value in diagnosing surgical pathology.

Background Cerebellar haemorrhage in preterm infants has become a focus of attention, as it is associated with neurodevelopmental sequelae and mortality. With regard to neurodevelopmental sequelae, cerebellar haemorrhage may play a role in the cognitive, learning and behavioural dysfunctions known to affect survivors of preterm birth. Aim To investigate the incidence, risk factors and outcomes of preterm infants with cerebellar haemorrhage in a large tertiary Neonatal Intensive Care Unit. Methods All the infants over the period of 4 years from Jan 2009 to Dec 2012 with cerebellar haemorrhage were identified from radiology database. All the cases were diagnosed by cranial ultrasound from mastoid fontanelle view Results 10 cases of cerebellar haemorrhage were identified. Incidence 13 per 1000 less than 30 weeks gestation live births. The gestation at birth range from 23+2 to 28weeks. Birth weight range from 520grams to 1190grams except one case. Abstract PC.07 Table Male: Female 7:3 Age at diagnosis Day 1 to Day 5 IVH 6/10 (60%) Chorioamnionitis 2/10 (20) RDS 10/10 (100%) Hypotension 7/10 (70%) Anaemia 7/10 (70%) Thrombocytopenia 3/10 (30%) DIC 8/10 (80%) Mortality 6/10 (60%) Conclusion In our study cerebellar haemorrhage is predominantly seen in extreme preterm infants. It is very uncommon, but diagnosis will help in predicting the long term outcome. It is associated with high mortality.

St Michael's NICU (StMH) provides pre and postoperative care for all newborns with an ante/postnatal diagnosis of congenital diaphragmatic hernia (CDH) in South-West England. A consistent care bundle is followed for antenatal diagnoses: delivery at StMH, sedation and muscle relaxation at birth, elective intubation, high frequency oscillatory ventilation (HFOV), inotropic support, pulmonary vasodilators and delayed surgery. ECMO is only considered for reversible pulmonary hypertension when conventional management fails. Objectives To review clinical management and evaluate survival/morbidity in infants with CDH over a 12 year period. Methods A retrospective case note review of all CDH cases managed at StMH(1998–2010). A review of the South-West Congenital Anomaly Register. Results 79 cases were identified, including 45 identified antenatally. 16 (20%) had additional major malformations/genetic syndromes; 2 lethal. Overall survival was 60/79(76%). The anomaly register identified 4 additional CDH deaths in local hospitals for this population. 100% of infants delivered at StMH received the full care bundle (91% received HFOV). No cases received ECMO. 10/79(12.6%) had pneumothoraces. 13/60(21%) of survivors required additional oxygen at 28 days of life and 3/60(5%) were discharged on oxygen. Domiciliary oxygen was not required for any infant delivered at StMH (where the complete care bundle was followed). Conclusion Our survival rate compares favourably with recent large published series and is not significantly biased by ‘hidden mortality’ in the South-West Region. Pneumothorax and chronic lung disease rates are significantly lower than recently published studies using HFOV. Our consistent approach delivers favourable survival rates with a low pulmonary morbidity burden in survivors.