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[This corrects the article DOI: 10.1371/journal.pone.0232963.].

BackgroundTexas Children's Hospital (TCH) has a 172 bed NICU. TCH NICU employs more than 450 RNs, 50 RTs, 98 NNPs, and over 150 physicians. As a consult center for complex critically ill neonates, many patients have respiratory management via an endotracheal tube (ETT). Proper ETT position is crucial to maintain patients' respiratory and cardiac function. Research shows approximately 20% of children and neonates who experience a UE have cardiovascular collapse requiring CPR or epinephrine. Baseline data showed a mean rate of 3.3 Unplanned Extubations (UE) per 100 ventilator days.ObjectivesReduce the Newborn Center UE rate from 3.3/100 vent days in FY 2014 to 2.64/100 vent days by September 30, 2016.MethodsA multidisciplinary team formed and responded to the problem. Debriefs were initiated by bedside clinicians after every UE to better understand the contributing factors. Using the operational definition from Solutions for Patient Safety, the team reviewed and themed every UE. Identified themes were: Agitation, ETT Depth, Unable to determine, Securement Device, Transfer/holding, and Bundle Compliance.Results33% reduction in UE in a rolling calendar year.ConclusionsOur outcomes identified that the NRP formula can be used as an assessment tool to determine need for an X-ray to check ETT placement and quickly identify ETTs that need adjustment. This has implications for clinical practice to help guide judicious radiation exposure. Ongoing work will be sustainment and growth with the literature (i.e. New NRP formula). With the rich data gained from each UE there are further opportunities for targeted improvement based on theme.Figure 1Unplanned extubation rate.Figure 2Themes for each unplanned extubation.Figure 3UE debrief form.Figure 4Poster for position of ETT.

Aims To investigate maternal and perinatal outcomes for women with singleton pregnancies with polyhydramnios in Tayside. Methods All women diagnosed with polyhydramnios (AFI ≥ 25 cm/deepest pool ≥ 8 cm) between 01/01/13–31/10/13 were included. All women had an ultrasound scan (USS) assessment of fetal anatomy and a random blood sugar assessment as part of routine ante-natal care. Data for obstetric outcomes were collected from the local maternity database (Torex Protos Evolution, v3.5.19). Results 59/3270(1.8%) were diagnosed with polyhydramnios. Median gestation at diagnosis was 34+2weeks (range = 23+4–40+1 weeks). 14/59(23.7%) were associated with diabetes; 5/59(8.5%) had pre-existing diabetes and 9/59(15.3%) had gestational diabetes. 5/59(7%) had perinatal aetiology; 1 case of rhesus isoimmunisation diagnosed at the ante-natal booking visit and 4 congenital abnormalities. 2 congenital abnormalities were diagnosed ante-natally (1 exomphalos, 1 oro-facial cleft). 1 tracheo-oesophageal fistula and 1 case of arthrogryposis multiplex congenita were diagnosed following delivery. 40/59(68%) had idiopathic polyhydramnios. 14/40(35%) resolved on USS. Median gestation at delivery was 39+1weeks (range = 32+6–41+4weeks). Median birth weight was 3480g (range = 1375–4400g). 3/40(7.5%) had pre-term birth. 18/40(45%) had induction of labour (IOL). The median gestation for IOL was 39+1weeks (range=37+1–40+3weeks). 20/40(50%) required caesarean section. 13/20 had planned CS and 7/20 had emergency CS. 4/40(10%) had major post-partum haemorrhage (PPH). 2/40(5%) neonates required NICU admission. Conclusions Idiopathic polyhydramnios is associated with a high rate of obstetric interventions. A diagnosis of polyhydramnios was associated with high rates for induction of labour, operative delivery and major PPH, and also adverse perinatal outcome. This information will be useful to counsel women with polyhydramnios and plan management.

Background Appropriate nutrition and growth are vital components of neonatal care. The most commonly used measures of growth in neonates are weight and head circumference, but these have limitations. Linear growth measurement is the best indicator of dietary adequacy and it most closely relates to lean body mass. There is currently no standardised practice of assessment of length in the neonatal period. Methods We are keen to investigate whether length measurement is being used as a growth parameter for neonates in England. A survey of all tertiary neonatal units in England was conducted in August 2013. Questionnaire completed via phone calls or e mails. 3 main domains were surveyed: practice of measuring length, methods used and barriers to routine practice. Results Response rate was 98% from 43/44 tertiary neonatal units in England. 44% of the units do measure length. Of which, less than half measure at birth/admission but many measure when infants are more stable. Measuring mat/tape and the Leicester incubator scale were the most commonly used equipment. Barriers to not measure were doubts of usefulness and accuracy in 10/23 (43%) and 7/23 (30%) respectively. Conclusion There is no standardised procedure for measuring length in tertiary neonatal units in England. We proposed that there should be a standardised protocol for the assessment of growth during the neonatal period. This should include regular measurements of weight, head circumference and linear growth. Need for further research, training and education are urgent.

Background Intrapartum monitoring aims to identify fetal acidaemia. The fetal acidaemia threshold, reliably accountable for neonatal morbidity, or mortality, is less clear. The International Cerebral Palsy and American Congress of Obstetrics and Gynaecology task force, suggests: “pH <7 …. provides sufficient evidence to blame acute intrapartum events for the neonatal condition”. Objective We analysed early neonatal outcomes in babies born with an arterial pH ≤7.1, from paired umbilical cord gases. Method Retrospective case notes audit at Kingston hospital maternity unit, involving 30 singleton live neonates, between 01/01/2012–31/12/2012. Neonatal outcomes were assessed using: 5 min APGAR scores <7, need for resuscitation and neonatal unit (NNU) admissions. Results Median arterial pH was 7.07, interquartile range 7.00–7.09. Neonates with an arterial pH 6.80–7.02 demonstrated; 100% resuscitation requirements and NNU admission; with 25% APGARs at 5 min <7. Above an arterial pH 7.02; absolute risk for resuscitation was 50%; 36.36% required NNU admission and 9.09% had APGARs at 5 min <7. No ideal arterial pH was identified for good neonatal outcomes. We compared our results against a large cohort study;¹ their threshold pH for adverse neurological outcomes was 7.10 and the ‘ideal’ cord pH 7.26–7.30. Conclusion Overall, our results suggest an unpredictable association between acidaemia and adverse early neonatal outcomes, with a pH >7.02. Highlighting the multifactorial nature of predicting neonatal outcome; which if better understood, will improve interpretation of intrapartum monitoring. Reference Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51,519 consecutive validated samples

The cover image is based on the article  Pcolce2 overexpression promotes supporting cell reprogramming in the neonatal mouse cochlea  by Changling Xu et al.,  https://doi.org/10.1111/cpr.13633 . image

Omphalocele is very disturbing problem in infants with more complication and trouble theraphy that the lesion covered with nylon paper and late repair. This problem so exposed very difficult management and therapy TPN and the intestine are exposed long time out of abdomen and nylon covered can teared so patients stayed long time in hospital.so presentation of new technic with early repair and soft cover is nessessary .For this from 3yrs ago the 10 neonate are surgeried with dual mesh.with initial repair of omphalocele in supine position that one edge of foam like mesh is sutured to abdominal wall and other soft edge overlied omphalocele contents with skin flap covered all them finally and two lateral cisor was done and in 1–3 yrs f/u the all 10 neonate that the oldest 3yrs old and youngest 6mo old nowadays are in health. This way is easy, safe with less TPN and hospital staying and more best results. The dual mesh was been same with abdominal wall without any complication. The study was done prospective and with dual mesh and CT scan 16 slice in control of them was done. The dual mesh was been same with abdominal wall.

The objective of our study is to assess the prevalence of infectious perinatal risk situations in the delivery maternity room in Souissi hospital in Rabat, Morocco. Materials and Methods A prospective study about all infants born in maternity Souissi (Rabat) during one year: from first January to 31 December 2010. We included all newborns symptomatic or not at birth and whose mothers have at least one infectious case histories from the following: rupture of membrane ≥ 12 hours, chorioamnionitis, urinary tract infection and/or genital, fever ≥ 38°c before or in early labor. Results On a total of 14792 live births, 1602 newborns were prone to a risky infection (10.83%). Prolonged rupture of membranes showed 1341 cases including 59 newborns were premature. The duration of the rupture was between 12 and 24 hours in 44.30% of cases, between 24 and 48 hours in 44, 37% of cases and more than 48 hours in 11.33% of cases. On 133 cases of chorioamnionitis (10.67%) 129 newborns were full-term and 7 were premature. The obstetric decision was caesarean section delivery in 25.78% of cases. 4.74% of newborns had respiratory distress with a single case of death in the first hours of life. 4.50% were preterm and 8.86% were hypotrophy. Hospitalization was required from the outset in 1059 cases among which 133 were hospitalized. For other patients an inflammatory report was requested. The were followed as outpatients.