Background Medical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. For this, peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting. Purpose Difficult PICC guidewire removal is understood to cause catheter damage, causing luminal rupture or possible breakage of the catheter or guidewire itself. The aim of this study was to assess and compare the incidence of therapy failures with use of a preflush fluid using normal saline (NSS) versus a diluted lipid solution (DLS) prior to device insertion, to assist with guidewire removal and prevent unnecessary catheter damage. Method and setting A retrospective, observational study was performed in the Neonatal Intensive Care Unit (NICU) of the Women’s Wellness and Research Centre, Hamad Medical Corporation, Qatar. This single site study included 507 neonates who required intravenous therapy administered via a PICC during the study period. Results Results demonstrated the use of a diluted lipid solution preflush (DLS) resulted in significantly lesser failures, when compared with the control group (NSS). This highlights a clinical significance after adjusting for day of insertion, gestational age, birth weight and catheter type. Conclusion DLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in neonatal patients in the NICU. The risk for development of maintenance-related complications leading to premature device removal decreased significantly if the DLS preflush was used. During the study period, no complications related to the use of a lipid preflush solution were identified. Implications for practice and research This may be the first study published investigating and supporting guidewire removal enhancement by using a diluted lipid/saline preflush solution. When the requirement for vascular access is most pertinent in the neonate, using a diluted lipid preflush may provide an effective method to assist in guidewire removal to prevent malposition and vascular device complications in the neonatal population.

Neonatal hyperglycemia is a common metabolic disorder seen in very low birth weight (VLBW) and critically ill newborns. Hyperglycemia is a recognized cause for mortality and morbidity in the neonatal period. Incidence in preterm infants is around 45%–80%. The mechanism of increased risk of hyperglycemia in preterm infants is not well understood, but different possible mechanisms have been reported. Plasma glucose values more than 180–200 mg/dl (10–11.1 mmol) are of concern as this can lead to complications. Hyperglycemia was found to predispose to severe intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and increased mortality. It is important to recognize and manage this condition early to avoid serious complications. Multiple etiologies with different management strategies are mentioned in the literature. Here, we discuss a complete understanding on practical management of hyperglycemia and we propose a simplified practical approach for the diagnosis and management of neonatal hyperglycemia.

Background: Caring about ELBW newborns at the limit of viability is demanding with a high rate of mortality and long-term morbidity. Society expectations become high and persistent while health care coast inside NICU is very high. Objective: The purpose of this study is to examine the short-term survival (till discharge) of extremely low birth weight (ELBW) newborns at limits of viability 23–26 weeks gestation (WG) age in a large tertiary maternity hospital. Methods: A population-based retrospective study of babies born at 23–26 WG age over 3 years period. Results: Over the study period 2016 to mid-2018, a total of 283 ELBW newborns were delivered in our institute. Of those, 250 were admitted to NICU (88%). The number of newborns who survived till discharge from NICU was 174 (61.5%) while the rate of delivery room death was 33 newborns (11.75%). The survival rates during 2016–2018 period were 35%, 64%, 73%, and 81.4% for 23, 24, 25, and 26 WG respectively. 76 newborns (26.9%) of NICU admissions died before discharge. Most deaths occurred during the first two weeks of life (64%). The main cause of death inside the NICU during the first 2 weeks was respiratory failure, followed by infection. Conclusion: Counseling Parent using local data become more convincing and reflecting local experience. Short term survival rate of ELBW is comparable to those reported in the literature. The first two weeks are very crucial where the mortality rate is highest.

Background: Medical management of neonates is often predicated upon safe and reliable vascular access which may be related to physiological monitoring, medical treatment, supportive therapy and diagnostic or procedural purposes. For this, peripherally inserted central catheters (PICCs) are deemed safe to provide vascular access and infusion related therapy in the neonatal intensive care setting. Purpose: PICCs are associated with a reduced incidence of complications compared to short peripheral catheters. Despite a reduced complication rate, the impact for the patient has to be considered severe. Difficult PICC guidewire removal during the insertion procedure is known to cause catheter damage, resulting in leakage or breakage of the catheter itself. The aim of this study was to assess and compare the incidence of therapy failure related to the use of preflush fluids (normal saline (NSS) versus diluted lipid solution(DLS)) used before PICC guidewire removal. Method and Setting: This was a retrospective observational study and performed on the Neonatal Intensive Care Unit (NICU) of the Women’s Wellness and Research Centre, Hamad Medical Corporation, Qatar. The single site study included 507 neonates who required intravenous therapy. Results: The results show that the use of a diluted lipid preflush resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight and catheter type.Conclusion: DLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in patients admitted to the NICU. The risk for the development of maintenance-related complications leading to premature removal of the device, decreased significantly if the preflush DLS was used. During the study period no known complications related to the used lipid solution were identified. Implications for Practice and Research: This study is the first of its kind ever published in international literature and supports the enhancement of guidewire removal by using a diluted lipid preflush. When the requirement for vascular access is most pertinent, using a diluted lipid preflush is a safe and effective method to remove the guidewire in order to facilitate long-term vascular access amongst the neonatal population.