I believe I am the only ex 24 weeker that not only survived, but also works within neonatology, as a Junior Sister. I am using myself as a case study as I feel it is important for professionals to see somebody with an exceptional outcome.
Neonatologists have often commented that ‘The next time I consider whether to resuscitate a 23 weeker, I’ll think of you’.
Aside from being born at 23+6 weeks, 27 years ago, I am a surviving twin.
I required PIPs of up to 35, needing HFOV post PDA ligation. I was diagnosed with severe BPD, however a lung function test in February 2023 showed no evidence of CLD and total lung capacity of 98%- is CLD truly chronic?
I underwent cryotherapy at 6 weeks old, suffered many infections and had 6 pneumothoracies. I narrowly avoided amputation due to an arterial block. I lost my hearing aged 3 due to a vaccine trial for RSV.
Remarkably, I achieved A*AA at A Level & First Class Honours degree and returned to work on the unit I was born on. I contributed to The Butterfly Project and the NeoWonder Study. I am passionate about the long-term effects of prematurity. In 2021, I underwent vocal chord surgery to improve my voice quality from repeated intubations. A lot has changed in the last three decades, things they did on me was trial and error to see what would work. My outcome is far from what was predicted, providing a truly unique story.

Background
Moderate to late preterm (MLP) infants are at risk of adverse outcomes. Brain function can be measured using electroencephalography (EEG). Inter-burst intervals (IBI) are a specific feature of quiet sleep (QS) and a marker of brain maturation. Changes in background pattern in QS occur with advancing gestational age (GA).
Aim
This study aims to describe IBI features of MLP infants at 36 weeks postmenstrual age (PMA)
Methods
Quantitative EEG (qEEG) analysis was performed using an adapted IBI detection algorithm. Five quantitative features of IBI were extracted (maximum IBI length, median IBI length, IBI variability, number of IBIs/minute and percentage of epoch that was IBI) for each infant.
Results
The median (IQR) features of IBI features of MLP infant (n=60|) were: IBI maximum length 6.89(5.97-7.86) secs, median length 3.00(2.60-3.27) secs, IBI length variability 2.49(2.00-2.90) secs, number of IBIs per minute 5.58(4.81-5.88) and percentage IBI 32.90(24.68-39.02) %. With the exception of IBI median length, IBI values decreased with advancing PMA except (p=0.02-0.08). All IBI features were significantly longer/higher for infants nursed in incubators. Infants from multiple pregnancies had longer IBI length maximum (p=0.030), and IBI length variability (p=0.043) than infants from singleton pregnancies.
Conclusion
For the first time, we have described detailed quantitative features of IBIs in QS of the MLP infant with a normal developmental outcome at 18 months PMA. This normative data can be used in future studies of infants at risk of abnormal development. Automated analysis may be a useful pre-discharge screening tool for all preterm infants.

Background:
Advances in prenatal screening enable planned deliveries at hospitals with specialized cardiac and neonatal care, improving neurodevelopmental outcomes in neonates. In October 2021, the Yorkshire and Humber Congenital Heart Disease Network developed a guideline aimed at providing guidance on the timing and location of delivery for babies with antenatal diagnosis of CHD.

Objectives:
We aimed to assess compliance with the guideline and evaluate the extent of improvement in delivery practices that have been implemented in accordance with the guideline.

Methods:
We conducted a retrospective audit examining a period of 6 months before and 6 months after the guideline publication.
This review was carried out in the cardiac centre using electronic patient records and the local data provided by regional paediatricians with cardiology interests.

Results:
There were 166 live births of babies with CHD in the region.

Before the guideline:
- Cardiac Centre: median gestational age was 38+2(30+6–40+0).
- Local: median gestational age was 38+0(32+4–41+0).
- 8% of babies were delivered outside their planned delivery destination.
- 100% of planned palliation was achieved locally.

After the guideline:
- Cardiac Centre: median gestational age was 38+3(27+0–40+1).
- Local: median gestational age was 38+1(26+5–40+4).
- 5% of babies were delivered off-pathway.
- 80% of planned palliation was achieved locally.

Conclusion:
There was a 1-day increase in median gestational age at birth and improvement in the number of babies born off-pathway following the guideline. Obstetric emergencies and parental wishes were drivers of off-pathway deliveries. Good communication, counselling and reassurance could improve off-pathway deliveries.

Team-working, collaboration and clear communication between obstetric, neonatal, and paediatric surgical teams are critical to achieving optimal outcomes in gastroschisis management. A national cohort study of all surgical units in the UK and Ireland identified primary closure as the optimal management for simple gastroschisis. Neonates with silo placement take longer to achieve feeds, prolonged TPN, delayed discharge, and increased complication rates.
A 10-year retrospective audit in RBHSC identified a higher rate of staged gastroschisis repair; 66% of patients requiring silo placement, compared to 45% national average.

Aims:
Create an interprofessional simulation programme to achieve optimal delivery stabilisation, bowel wrapping and clear communication amongst the MDT with the overall goal of improving primary closure rates and outcomes.

A gastroschisis model was created using vegan sausage-casings, jelly, and food colouring. The programme focuses on; team education, delivery room preparation, resuscitation and bowel wrapping. Following a lecture and demonstration participants were given a scenario, asked to prepare equipment, allocate roles and stabilise the new-born. Pre and post-feedback was collected and course adapted using a PDSA cycle. A post-course video for gastroschiosis resuscitation was created; available for anyone to reference at any time.

Pre-simulation; 56% had no previous training or clinical experience and 78% didn't feel confident providing delivery-room stabilisation. 100% felt the training improved their confidence of gastroschisis stabilisation and all would recommend this course to their peers.

Simulation-based MDT training is a channel for the acquisition and maintenance of clinical skills and is crucial to improving the management of complex neonatal conditions.