Background Little is known about normative ammonia concentrations in extremely low birthweight (ELBW) babies and whether these vary with birth characteristics. We aimed to determine ammonia concentrations in ELBW babies in the first week after birth and relationships with neonatal characteristics and protein intake. Methods Arterial blood samples for the measurement of plasma ammonia concentration were collected within 7 days of birth from ProVIDe trial participants in six New Zealand neonatal intensive care units. Results Three hundred and twenty-two babies were included. Median (range) gestational age was 25.7 (22.7–31.6) weeks. Median (interquartile range (IQR)) ammonia concentration was 102 (80–131) µg/dL. There were no statistically significant associations between ammonia concentrations and birthweight or sex. Ammonia concentrations were weakly correlated with mean total (Spearman’s r s = 0.11, P = 0.047) and intravenous ( r s = 0.13, P = 0.02) protein intake from birth, gestational age at birth ( r s = −0.13, P = 0.02) and postnatal age ( r s = −0.13, P = 0.02). Conclusions Plasma ammonia concentrations in ELBW babies are similar to those of larger and more mature babies and only weakly correlated with protein intake. Currently, recommended thresholds for investigation of hyperammonaemia are appropriate for ELBW babies. Protein intake should not be limited by concerns about potential hyperammonaemia.

The objective of this study was to determine whether the routine use of probiotics was associated with earlier removal of peripherally inserted central catheter (PICC) lines in extremely premature infants born ≤28 weeks' gestation. This study was a retrospective, observational, cohort study in infants born ≤28 weeks gestation in the 2 years before [No Probiotic Group (NPG)] and after [Probiotic Group (PG)] the commencement of the routine use of probiotics (lnfloran®) in a large tertiary neonatal intensive care unit in the North Island of New Zealand. Age at the removal of PICC line in patients whose first PICC lines were inserted before day 14 and remained in-situ for at least 4 days was compared using Kaplan-Meir Survival Analysis on SPSS 22.0®. We studied PICC line infections as a secondary outcome measure. We compared 120 PICC lines in NPG and 130 PICC lines in PG. Mean age at removal was 25.9 [(95% Confidence Intervals (CI)=22.6 - 29.2)] days in NPG and 23.1 (95% CI=20.9 - 25.2) days in PG. The result was independent of birth weight, gender, type of PICC line and age at insertion but related significantly to gestation at birth (p < 0.001). There was no difference in the incidence or the microbiologic profile of PICC line infections between the study groups. PICC lines were removed 2.8 days earlier in infants receiving probiotics (p=0.070), which can have potential benefits with reduced infection and other risks due to earlier removal of PICC lines.

Objective To assess whether an oxygen saturation (Spo(2)) target of 85%-89% compared with 91%-95% reduced the incidence of the composite outcome of death or major disability at 2 years of age in infants born at <28 weeks' gestation.Study design A total 340 infants were randomized to a lower or higher target from <24 hours of age until 36 weeks' gestational age. Blinding was achieved by targeting a displayed Spo(2) of 88%-92% using a saturation monitor offset by +/- 3% within the range 85%-95%. True saturations were displayed outside this range. Followup at 2 years' corrected age was by pediatric examination and formal neurodevelopmental assessment. Major disability was gross motor disability, cognitive or language delay, severe hearing loss, or blindness.Results The primary outcome was known for 335 infants with 33 using surrogate language information. Targeting a lower compared with a higher Spo(2) target range had no significant effect on the rate of death or major disability at 2 years' corrected age (65/167 [38.9%] vs 76/168 [45.2%]; relative risk 1.15, 95% CI 0.90-1.47) or any secondary outcomes. Death occurred in 25 (14.7%) and 27 (15.9%) of those randomized to the lower and higher target, respectively, and blindness in 0% and 0.7%.Conclusions Although there was no benefit or harm from targeting a lower compared with a higher saturation in this trial, further information will become available from the prospectively planned meta-analysis of this and 4 other trials comprising a total of nearly 5000 infants.

BACKGROUND:The clinically appropriate range for oxygen saturation in preterm infants is unknown. Previous studies have shown that infants had reduced rates of retinopathy of prematurity when lower targets of oxygen saturation were used. METHODS:In three international randomized, controlled trials, we evaluated the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks' gestation. Halfway through the trials, the oximeter-calibration algorithm was revised. Recruitment was stopped early when an interim analysis showed an increased rate of death at 36 weeks in the group with a lower oxygen saturation. We analyzed pooled data from patients and now report hospital-discharge outcomes. RESULTS:A total of 2448 infants were recruited. Among the 1187 infants whose treatment used the revised oximeter-calibration algorithm, the rate of death was significantly higher in the lower-target group than in the higher-target group (23.1% vs. 15.9%; relative risk in the lower-target group, 1.45; 95% confidence interval [CI], 1.15 to 1.84; P=0.002). There was heterogeneity for mortality between the original algorithm and the revised algorithm (P=0.006) but not for other outcomes. In all 2448 infants, those in the lower-target group for oxygen saturation had a reduced rate of retinopathy of prematurity (10.6% vs. 13.5%; relative risk, 0.79; 95% CI, 0.63 to 1.00; P=0.045) and an increased rate of necrotizing enterocolitis (10.4% vs. 8.0%; relative risk, 1.31; 95% CI, 1.02 to 1.68; P=0.04). There were no significant between-group differences in rates of other outcomes or adverse events. CONCLUSIONS:Targeting an oxygen saturation below 90% with the use of current oximeters in extremely preterm infants was associated with an increased risk of death. (Funded by the Australian National Health and Medical Research Council and others; BOOST II Current Controlled Trials number, ISRCTN00842661, and Australian New Zealand Clinical Trials Registry numbers, ACTRN12605000055606 and ACTRN12605000253606.).

Background Infections are common complications of neonatal long lines. Heparin has been shown to prolong the effective duration of neonatal long lines and to reduce the ability of bacteria to adhere to foreign surfaces, but the effect of heparin on rates of infection is uncertain. Objective The goal of this study was to evaluate the effect of heparin on the frequency of episodes of catheter-related sepsis (CRS) in infants receiving total parenteral nutrition (TPN) through a neonatal long line. Design/Methods This randomised, controlled, double blind, single-centre clinical trial compared heparin at 0.5 IU/ml with no heparin in TPN infused through a neonatal long line, with episodes of CRS as the primary outcome. Results 210 infants were enrolled (TPN with heparin n=102, TPN without heparin n=108). There was a statistically significant reduction in all episodes of culture-positive CRS in those infants with heparin added to the TPN compared with those without heparin (p=0.04; RR 0.57, 95% CI 0.32 to 0.98; number needed to treat 9, 95% CI 4.6 to 212.4). Conclusions The addition of heparin at 0.5 IU/ml to TPN infused through a neonatal long line reduces the incidence of culture-positive CRS.

A case of congenital malaria in a preterm newborn infant is presented. The case illustrates the difficulty of early diagnosis, and the atypical nature of presentation in a preterm infant.