
Ruben WitloxLeiden University Medical Centre | LUMC · Department of Neonatology
Ruben Witlox
MD PhD
About
40
Publications
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Introduction
I am interested in neonatal and long term follow-up of children born with congenital chylothorax an specially those who were treated with thoraco-amniotic shunts antenatally.
Furthermore I am working on improving alarm management and reducing alarm fatigue in single-room NICU's.
I am also involved in auditing neonatal procedures, especially stabilisation of neonates after birth
Additional affiliations
November 2010 - present
February 2010 - October 2010
January 2007 - January 2010
Publications
Publications (40)
Introduction:
This study aimed to describe the prevalence and risk factors for respiratory complications in monochorionic twins with twin anaemia polycythaemia sequence (TAPS).
Methods:
All neonates diagnosed with postnatal TAPS at our center between 2002 and 2023 were included in this retrospective study. The primary outcome was the prevalence...
Video review (VR) of procedures in the medical environment can be used to drive quality improvement. However, first it has to be implemented in a safe and effective way. Our primary objective was to (re)define a guideline for implementing interprofessional VR in a neonatal intensive care unit (NICU). Our secondary objective was to determine the rat...
Objective
To examine the providers’ perceptions and experiences on implementation of video review (VR) of procedures in the neonatal intensive care unit (NICU).
Design
Qualitative study using semi-structured interviews with neonatal care providers about their experiences with VR. Interviews were audio-recorded, transcribed and thematically analyse...
Fetal hydrops as detected by prenatal ultrasound usually carries a poor prognosis depending on the underlying aetiology. We describe the prenatal and postnatal clinical course of two unrelated female probands in whom de novo heterozygous missense variants in the planar cell polarity gene CELSR1 were detected using exome sequencing. Using several in...
Aim
In 2017, the Leiden University Medical Centre implemented a secondary alarm system using handheld devices to ensure accurate patient monitoring on the single room NICU. Initially, alarms remained active on the handheld devices until one of the caregivers in the alarm chain accepted the alarm. In 2020, a bidirectional communication protocol (BCP...
Virginia Apgar designed the apgar score during a breakfast with colleagues in response to a discussion about the need to evaluate newborns at birth. She scribbled down the score on a piece of paper and the score has been indispensable ever since, not just for reflecting the clinical condition and to indicate whether intervention was needed, but als...
Purpose: The environment of the NICU can be dynamic and emergent. Video-reflection of neonatal interventions gives an objective view on clinical practice. Although video-reflection is increasingly used, it is focused mostly on technical aspects. The focus of video-reflection can also be shifted towards teamwork and context. However, no studies have...
As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video re...
Background
Large amounts of data are collected in neonatal intensive care units, which could be used for research. It is unclear whether these data, usually sampled at a lower frequency, are sufficient for retrospective studies. We investigated what to expect when using one-per-minute data for descriptive statistics.
Methods
One-per-second inspira...
Background:
Obtaining ethically valid consent to participate in delivery room (DR) studies from parents facing an imminent premature birth can be challenging. This study aims to provide insight into parental experiences with and perceptions of consent for DR studies.
Methods:
Semistructured interviews were conducted with parents of very and extr...
Background: Preterm infants are commonly supported with 5–8 cmH 2 O CPAP. However, animal studies demonstrate that high initial CPAP levels (12–15 cmH 2 O) which are then reduced (termed physiological based (PB)-CPAP), improve lung aeration without adversely affecting cardiovascular function. We investigated the feasibility of PB-CPAP and the effec...
Objective:
To perform a temporal and geographical validation of a prognostic model, considered of highest methodological quality in a recently published systematic review, for predicting survival in very preterm infants admitted to the neonatal intensive care unit. The original model was developed in the UK and included gestational age, birth weig...
Objective
The aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic.
Design
Observational prospective single-centre study.
Setting
Neonatal intensive care unit at the Leiden University...
Introduction:
Retinopathy of prematurity (ROP) remains an important cause for preventable blindness. Aside from gestational age (GA) and birth weight, risk factor assessment can be important for determination of infants at risk of (severe) ROP.
Methods:
Prospective, multivariable risk-analysis study (NEDROP-2) was conducted, including all infant...
Objective
To compare the effect of two different automated oxygen control devices on target range (TR) time and occurrence of hypoxaemic and hyperoxaemic episodes.
Design
Randomised cross-over study.
Setting
Tertiary level neonatal unit in the Netherlands.
Patients
Preterm infants (n=15) born between 24+0 and 29+6 days of gestation, receiving in...
Background
Recording of neonatal resuscitation, including video and respiratory parameters, was implemented for research and quality purposes at the neonatal intensive care unit (NICU) of the Leiden University Medical Center, and parents were offered to review the recording of their infant together with a neonatal care provider. We aimed to provide...
Objective
In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25 ⁺⁰ to 24 ⁺⁰ weeks’ gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.
Design
National cohort study, using data from...
Video and physiological parameter recording of neonatal stabilization was implemented at the Neonatal Intensive Care Unit (NICU) of the Leiden University Medical Center. In order to improve documentation and the quality of care provided during neonatal transition, we implemented weekly plenary audits reviewing recordings of neonatal stabilization i...
Background
Automated oxygen control systems are finding their way into contemporary ventilators for preterm infants, each with its own algorithm, strategy and effect.
Objective
To provide guidance to clinicians seeking to comprehend automated oxygen control and possibly introduce this technology in their practice.
Method
A narrative review of the...
Purpose
Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods.
Methods
Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1‐1‐2010 to 31‐3‐2013 and P2: 1‐4‐2013 to 31‐12‐2016. Treatment character...
Objective: Evaluate whether weekly audits of neonatal resuscitation using video and physiological parameter recordings improved guideline compliance and documentation in medical records.
Study design: Neonatal care providers of the Neonatal Intensive Care Unit (NICU) of Leiden University Medical Center reviewed recordings of neonatal resuscitation...
The original version of this Article contained an error in the spelling of the author Pleuntje J. van der Sluijs, which was incorrectly given as Eline (P. J.) van der Sluijs. This has now been corrected in both the PDF and HTML versions of the Article.
Purpose:
Several studies have reported diagnostic yields up to 57% for rapid exome or genome sequencing (rES/GS) as a single test in neonatal intensive care unit (NICU) patients, but the additional yield of rES/GS compared with other available diagnostic options still remains unquantified in this population.
Methods:
We retrospectively evaluated...
Introduction:
The aim of this study is to evaluate long-term neurodevelopmental and respiratory outcome after fetal therapy for fetal pleural effusion, congenital cystic adenomatoid malformation, and bronchopulmonary sequestration.
Methods:
Children ≥18 months of age underwent an assessment of neurologic, motor, and cognitive development. Medica...
Aim
To evaluate the short-term neonatal outcome after fetal thoracoamniotic shunt placement for isolated hydrothorax.
Methods
Retrospective evaluation of infants with isolated hydrothorax treated with thoracoamniotic shunt placement at our fetal therapy centre between 2001 and 2016.
Results
In total 48 fetuses were treated with a thoracoamniotic...
Background
Caffeine promotes spontaneous breathing by antagonizing adenosine. We assessed the direct effect of caffeine on respiratory effort in preterm infants at birth.Methods
Thirty infants of 24-30 weeks of gestation were randomized for receiving caffeine directly after birth in the delivery room (caffeine DR group) or later in the neonatal int...
Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant's condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as...
Copy number variations (CNVs) on the short arm of chromosome 19 are relatively rare. We present a patient with a tandem de novo 3.9 Mb duplication of 19p13.12p13.2 and an adjacent 288 kb deletion of 19p13.12. The CNVs were detected by genome wide SNP-array and confirmed by fluorescence in situ hybridization. Mate-pair sequencing revealed two breakp...
Objective Neonatal resuscitation is often retrospectively documented, which can lead to inaccuracy and incomplete recording of delivery room management. In this study, we assessed the accuracy and completeness of neonatal resuscitation documentation in our neonatal intensive care unit.
Methods Recordings of physiological parameters and video data w...
Objectives
To test effectivity of a two-minute training consisting of a few key-points in ventilation using the self-inflating bag (SIB).
Study Design
Experienced and inexperienced caregivers were asked to mask ventilate a leak free manikin using the SIB before and after the training. Mask leak and pressures were measured using respiratory functio...
Congenital lung lesions, mostly congenital cystic adenomatoid malformations (CCAMs) and bronchopulmonary sequestrations (BPSs), are uncommon disorders. Prenatal intervention in severely affected (hydropic) fetuses has drastically improved perinatal survival. Not much is known, however, on the short-term and long-term respiratory and neurodevelopmen...
The widespread availability of high resolution ultrasound equipment and almost universal routine anatomy scanning in all pregnant women in the developed world has lead to increased detection of abnormalities in the fetal thorax. Already in the 1980s, large pleural effusions and significant macrocystic lesions in the fetus were easily detected on ul...
International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing 'adequate' chest excursion lacks objectivity.
It was the aim of this study to test the accuracy in the assessment of 'adequate' chest excursion by measuring intra- and inter-observer variabilit...
To evaluate mask technique during simulated neonatal resuscitation and test the effectiveness of training in optimal mask handling.
Seventy participants(consultants, registrars and nurses) from neonatal units were asked to administer positive pressure ventilation at a flow of 8 l/min and a frequency of 40-60/min to a modified leak free, term newbor...
Neonatal resuscitation guidelines do not specify the gas flow rate during mask ventilation. Aim: Investigating the effect of gas flow rates on pressures, volumes delivered and mask leak.
Flow 5 and 10 liters/min were tested. In study part 1, pressure ranges were measured when ventilating an intubated manikin with a Neopuff®. In study part 2, pediat...
Velamentous cord insertion and vasa previa occur more frequently in monochorionic twin pregnancies than in singleton pregnancies. Both have been linked with poor perinatal outcome due to the increased risk of rupture of the velamentous vessels. We present a case of acute fetal distress in 2 fetuses in a monochorionic twin pregnancy caused by ruptur...
This study compares the methods of Dunn and Shukla in determining the appropriate insertion length of umbilical catheters. In July 2007, we changed our policy for umbilical catheter insertions from the method of Dunn to the method of Shukla. We report our percentage of inaccurate placement of umbilical-vein catheters (UVCs) and umbilical-artery cat...
Bronchopulmonary sequestration (BPS) is sometimes associated with hydrothorax and hydrops in utero. In the absence of fetal hydrops, perinatal outcome is favorable and justifies expectant management. In the presence of fetal hydrops, perinatal outcome is reported to be extremely poor and intervention should be considered. Therapeutic options includ...