OBJECTIVE: To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks’ gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS: This retrospective matched cohort study examined data from infants born at <30 weeks’ gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. RESULTS: Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. CONCLUSIONS: There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection.

Background There have been recent concerns regarding the higher rates of spontaneous intestinal perforation (SIP) in preterm infants that have been exposed to intrapartum magnesium sulfate (MgSO4). Objective To assess the association between intrapartum MgSO4 exposure and necrotizing enterocolitis (NEC) and/or SIP in extremely preterm neonates. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born at < 28 weeks' gestation admitted to neonatal units in Canada between 2011 and 2014 were divided into two groups: those exposed antenatally to MgSO4 and those unexposed. Stratified analyses for infants born between 22 and 25 weeks' gestation and those born between 26 and 27 weeks' gestation were conducted. The primary outcome was intestinal injury, identified as either NEC or SIP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Results We compared 2,300 unexposed infants with 2,055 exposed infants. There was no difference in the odds of NEC (9.88% exposed vs. 9.59% unexposed; aOR: 0.92; 95% CI: 0.75–1.14) or SIP (3.4% exposed vs. 3.39% unexposed; aOR: 1.05; 95% CI: 0.75–1.48) between the two groups. Conclusion Antenatal exposure to MgSO4 was not associated with NEC or SIP in extremely preterm infants.

D ear Editor,Blood is a valuable resource that has specific guidance related to its safe and effective use (National Institute for Health and Care Excellence, 2015). In an effort to reduce the number of blood transfusions in our burn patients, we audited and changed our practice guidelines, resulting in a 100% reduction of unnecessary crossmatching investigations, thus increasing resources and reducing costs. Our previous practice guidelines recommended Group and Save (i.e., determining patient blood group [ABO and RhD] and screening for atypical antibodies) as a minimum for all burn patients undergoing operative treatment regardless of burn size. For patients with burns on more than 10% of their body requiring operative treatment, we routinely crossmatched two units of red blood cells and other blood products as considered necessary based on individual patient circumstances.Since implementing these guidelines, we have changed the way we treat burns. We now routinely perform enzymatic debridement (ED) of burns. Enzymatic debridement involves the application of a debriding enzyme in the form of a gel dressing. In many cases, ED can be performed outside of the operating room. The procedure is performed under local, regional, or general anesthesia as needed, and patients tolerate this procedure very well.We retrospectively reviewed 47 patients who were referred to our unit with burns on more than 10% of their total body surface area (TBSA). The patients were grouped according to the percentage of TBSA of their burns: 10%-20% (n = 31), 20%-30% (n = 10), and 30%-40% (n = 6). A total of 12 patients underwent ED, 32 underwent surgical debridement, and three were managed conservatively. Within the ED group, there were eight patients in the 10%-20% TBSA group and four patients in the 20%-30% TBSA group. None of these patients (n = 12) required a blood transfusion. Within the surgical debridement group, there were 20 patients in the 10%-20% TBSA group and

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