Objective To examine the impact of a change in the empiric gentamicin dose from 5 mg/kg every 24h to 5 mg/kg every 36h on target drug concentration achievement in neonates with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia. Study Design Gentamicin drug concentrations in neonates with HIE receiving therapeutic hypothermia were examined during two time periods in a retrospective chart review. During the initial treatment period (November 2007 to March 2010; n=29), neonates received gentamicin 5 mg/kg every 24h (Q24h period). During the second treatment period (January 2011 to May 2012; n=23), the dose was changed to 5 mg/kg every 36h (Q36h period). Cooling criteria and protocol remained the same between treatment periods. Gentamicin drug concentrations including achievement of target trough concentrations (<2 mg/L) were compared between treatment periods. Individual Bayesian estimates of gentamicin clearance were also compared. Result Neonates with an elevated trough concentration >2 mg/L decreased from 38% to 4% with implementation of a Q36h dosing interval (P<0.007). The mean gentamicin trough concentration was 2.0 ± 0.8 mg/L during the Q24h period and 0.9 ± 0.4 mg/L during the Q36h period (P<0.001). Peak concentrations were minimally impacted (Q24h 11.4 ± 2.3 mg/L vs. Q36h 10.0 ± 1.9 mg/L; P=0.05). The change in gentamicin trough concentration could not be accounted for by differences in gentamicin clearance between treatment periods (P=0.9). Conclusion A 5 mg/kg every 36h gentamicin dosing strategy in neonates with HIE receiving therapeutic hypothermia improved achievement of target trough concentration <2 mg/L while still providing high peak concentration exposure.

The EXCO test (ASTM G 34) is widely used to predict long-term exfoliation corrosion of high strength aluminum alloys in seacoast and other service environments. Recent experience has shown that the EXCO test does not always accurately predict the resistance of 7X50 and 2024 products processed to different degrees of resistance to exfoliation. The test also severely underestimates resistance to exfoliation of 2090-T8 products. For 7X50 alloys, the standard EXCO test is too corrosive for materials in T7 types tempers. This unrealistic corrosion occurs during the first 24 h of the test, during which time the solution is highly acidic, starting at pH 0.4 and gradually stabilizing at pH 3.2. Tests in a preconditioned EXCO solution, prepared by exposing a piece of 7150 plate in fresh EXCO solution for 24 h to eliminate the period of low pH, showed better correlation with atmospheric test results. Subsequent chemical analyses of this preconditioned solution led to a modified EXCO solution capable of distinguishing the different levels of resistance to exfoliation that are inherent in the three commercial tempers (T6, T76, and T74). This modified solution contains 600 mg/L of aluminum ion plus 4M (142 g/L) chloride and 0.6M (37.2 g/L) nitrate concentrations, and has a pH of 3.2. When conducted at a temperature of 52°C, the modified EXCO solution accurately reflected the performance of 2090 and 2024 alloys in a seacoast atmosphere.

Background and aims If infants fail to initiate spontaneous breathing after birth, international guidelines recommend positive pressure ventilation (PPV). However, mask PPV remains challenging with leakage occurring commonly. Despite a variety of available facemasks, none has been systemically studied in newborn infants. We aimed to determine if using a Fisher and Paykel (FP) round facemask would reduce mask leak compared to using a Laerdal round facemask during mask PPV in preterm infants.Methods From April to September 2013, at the Royal Alexandra Hospital, newborn infants. Results Fifty-eight preterm infants (n = 29 in each group) were enrolled; mean±SD gestation 28 ± 3 weeks; birth weight 1210 ± 448 g, 30(52%) male, 39(67%) born by caesarean section. Apgar scores at 1 and 5 min were 5 ± 3 and 7 ± 2, respectively. Infants randomised to the FP facemask and Laerdal facemask had similar mask leak (37 ± 17% vs. 33 ± 12%, respectively, p = 0.30) and tidal volume (7.3 ± 3.0 mL/kg vs. 6.9 ± 2.7 mL/ kg, p = 0.73) during PPV. There were no significant differences in ventilation rate, inflation time or airway pressures between groups. Conclusions The use of either facemask during PPV in the delivery room yields similar mask leak. Background and aims Endotracheal intubation is a mandatory skill for neonatal trainees. However, inexperienced trainees have success rates <50%. We compared intubations supervised by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view. Methods RCT (ANZCTR# 12613000159752) at The Royal Women's Hospital, Melbourne. Eligible intubations were those performed orally, in infants without facial or airway anomalies, in the delivery room or in NICU, by trainees with <6 months experience. Intubations were randomised to videolaryngoscope screen visible to the instructor (intervention) or covered (control). Primary outcome was first attempt intubation success rate confirmed by colorimetric detection of expired CO 2 . A sample size of 206 provided 80% power to detect a 20% difference in success rates (50% vs. 70%). Background Continuous Renal Replacement Therapies (CRRT) are the treatment of choice for critically ill children with Acute Renal Injury. Hypotension after starting CRRT is frequent but there are no studies that have analysed their incidence and importance. Patients and methods A prospective, observational study was performed including critically ill children treated with CRRT between October 2009 and December 2013. Hemodynamic data and connection characteristics were collected before, during and 60 min after CRRT circuit connection. Hypotension with the connection was defined as a decrease in mean arterial pressure >20% from baseline and/or intravenous fluid expansion and/or if increase in vasopressors was required. Results 161 connections in 36 children (median age 18.8 months) were analysed. 28 patients (77.8%) were in the postoperative period of cardiac surgery, 94% on mechanical ventilation and 86.1% with vasopressors. T...

Purpose: To investigate the impact of custom‐made build‐up caps for two different diode detectors in robotic radiosurgery radiation fields with variable collimator (IRIS) for collimator scatter factor (Sc) measurement. Methods: Two acrylic caps were custom‐made to fit our SFD or PFD (IBA Dosimetry, Germany) diode detectors. The two caps have thicknesses of 1.5 and 5 cm, corresponding to the dmax of the 6 MV CyberKnife and a depth beyond electron contamination, respectively. A watertank (Blue Phantom, IBA Dosimetry) was used to position the detector at 80 cm source‐to‐detector distance. Measurements were performed with the SFD and PFD, with and without the build‐up caps, for all 12 clinical IRIS settings ranging from 5 to 60 mm. Result: As expected, the biggest discrepancy was found in the smallest (5mm) IRIS field size. The Sc factor with 5 cm build‐up cap was 6.6% lower than that without build‐up using the SFD detector while the PFD differed by 13%. However, when the 1.5 cm build‐up cap was used, the largest difference (4%) was found using the 10 mm IRIS field size using the SFD while the maximum discrepancy using the PFD was still using the 5 mm IRIS field size (7.6%). For IRIS field sizes larger than 10 mm, maximum discrepancies were less than 1.3% and 3.7% for SFD and PFD, respectively. Conclusion: Sc measurement data are critical components in advanced algorithms for treatment planning, such as Monte Carlo, in order to calculate the dose accurately. After incorporating build‐up caps, we discovered differences of up to 6.6% and 13% in Sc factors in the SFD and PFD detectors, respectively, when compared against in‐air measurements without build‐up caps. These are significant differences and were obtained with IRIS settings routinely used for clinical treatment.