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Erdeve O, Okulu E, Tunc G, Celik Y, Kayacan U, Cetinkaya M, Buyukkale G, Ozkan H, Koksal N, Satar M, Akcali M, Aygun C, Ozkiraz S, Zubarioglu U, Unal S, Turgut H, Mert K, Gokmen T, Akcan B, Atasay B, Arsan S. An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation. PLoS One 2019; 14:e0217768. [PMID: 31181092 PMCID: PMC6557483 DOI: 10.1371/journal.pone.0217768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To achieve gas exchange goals and mitigate lung injury, infants who fail with conventional ventilation (CV) are generally switched to high-frequency oscillatory ventilation (HFOV). Although preferred in many neonatal intensive care units (NICUs), research on this type of rescue HFOV has not been reported recently. METHODS An online registry database for a multicenter, prospective study was set to evaluate factors affecting the response of newborn infants to rescue HFOV treatment. The study population consisted of 372 infants with CV failure after at least 4 hours of treatment in 23 participating NICUs. Patients were grouped according to their final outcome as survived (Group S) or as died or received extracorporeal membrane oxygenation (ECMO) (Group D/E). Patients' demographic characteristics and underlying diseases in addition to their ventilator settings, arterial blood gas (ABG) analysis results at 0, 1, 4, and 24 hours, type of device, ventilation duration, and complications were compared between groups. RESULTS HFOV as rescue treatment was successful in 58.1% of patients. Demographic and treatment parameters were not different between groups, except that infants in Group D/E had lower birthweight (BW) (1655 ± 1091 vs. 1858 ± 1027 g, p = 0.006), a higher initial FiO2 setting (83% vs. 72%, p < 0.001), and a higher rate of nitric oxide exposure (21.8% vs. 11.1%, p = 0.004) in comparison to infants who survived (Group S). The initial cut-offs for a successful response on ABG were defined as pH >7.065 (OR: 19.74, 95% CI 4.83-80.6, p < 0.001), HCO3 >16.35 mmol/L (OR: 1.06, 95% CI 1.01-1.1, p = 0.006), and lactate level <3.75 mmol/L (OR: 1.09%95 CI 1.01-1.16, p = 0.006). Rescue HFOV duration was associated with retinopathy of prematurity (p = 0.005) and moderate or severe chronic lung disease (p < 0.001), but not with patent ductus arteriosus or intraventricular hemorrhage, in survivors (p > 0.05). CONCLUSION Rescue HFOV as defined for this population was successful in more than half of the patients with CV failure. Although the response was not associated with gestational age, underlying disease, device used, or initial MV settings, it seemed to be more effective in patients with higher BW and those not requiring nitric oxide. Initial pH, HCO3, and lactate levels on ABG may be used as predictors of a response to rescue HFOV.
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Affiliation(s)
- Omer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Okulu
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Gaffari Tunc
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Yalcın Celik
- Division of Neonatology, Department of Pediatrics, Mersin University School of Medicine, Mersin, Turkey
| | - Ugur Kayacan
- Division of Neonatology, Department of Pediatrics, Mersin University School of Medicine, Mersin, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, University of Health Sciences, Kanuni Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Buyukkale
- Department of Neonatology, University of Health Sciences, Kanuni Training and Research Hospital, Istanbul, Turkey
| | - Hilal Ozkan
- Division of Neonatology, Department of Pediatrics, Uludag University School of Medicine, Bursa, Turkey
| | - Nilgun Koksal
- Division of Neonatology, Department of Pediatrics, Uludag University School of Medicine, Bursa, Turkey
| | - Mehmet Satar
- Division of Neonatology, Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
| | - Mustafa Akcali
- Division of Neonatology, Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
| | - Canan Aygun
- Division of Neonatology, Department of Pediatrics, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Servet Ozkiraz
- Neonatal Intensive Care Unit, Medicalpark Hospital, Gaziantep, Turkey
| | - Umut Zubarioglu
- Department of Neonatology, University of Health Sciences, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sezin Unal
- Department of Neonatology, University of Health Sciences, Etlik Zubeyde Hanim Maternity Training and Research Hospital, Ankara, Turkey
| | - Hatice Turgut
- Division of Neonatology, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Kurthan Mert
- Neonatal Intensive Care Unit, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Tulin Gokmen
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Barıs Akcan
- Division of Neonatology, Department of Pediatrics, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Begum Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Griffin JB, Jobe AH, Rouse D, McClure EM, Goldenberg RL, Kamath-Rayne BD. Evaluating WHO-Recommended Interventions for Preterm Birth: A Mathematical Model of the Potential Reduction of Preterm Mortality in Sub-Saharan Africa. Glob Health Sci Pract 2019; 7:215-227. [PMID: 31249020 PMCID: PMC6641817 DOI: 10.9745/ghsp-d-18-00402] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/13/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm birth, a leading cause of neonatal mortality, has the highest burden in low-income countries. In 2015, the World Health Organization (WHO) published recommendations for interventions to improve preterm outcomes. Our analysis uses the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model to evaluate the potential effects that WHO-recommended interventions could have had on preterm mortality in sub-Saharan Africa in 2015. METHODS We modeled preterm birth subconditions causing mortality (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, birth asphyxia, and low birth weight). For each subcondition, models were populated with estimates of WHO-recommended intervention prevalence, case fatality, coverage, and efficacy. Various scenarios modeled improved coverage of single and combined interventions compared with baseline. RESULTS In 2015, approximately 500,000 neonatal deaths due to preterm birth occurred in sub-Saharan Africa. Single interventions with the greatest impact on preterm mortality included oxygen/continuous positive airway pressure (44,000 lives saved), cord care (38,500 lives saved), and breastfeeding (30,200 lives saved). Combined with improved diagnosis/transfer to a hospital, the impact of interventions showed greater reductions in mortality (oxygen/continuous positive airway pressure, 134,100 lives saved; antibiotics, 28,600 lives saved). Combined interventions had the greatest impact. Together, hospital delivery with comprehensive care for respiratory distress syndrome saved 190,600 lives, and comprehensive thermal care, breastfeeding, and prevention/treatment for sepsis saved 94,400 lives. CONCLUSION In 2015, WHO-recommended interventions could have saved the lives of nearly 300,000 infants born preterm in sub-Saharan Africa. Combined interventions are necessary to maximize impact. Mathematical models such as MANDATE can estimate effects on health outcomes to allow health officials to prioritize implementation strategies.
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Affiliation(s)
| | - Alan H Jobe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Beena D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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153
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Manley BJ, Arnolda GRB, Wright IMR, Owen LS, Foster JP, Huang L, Roberts CT, Clark TL, Fan WQ, Fang AYW, Marshall IR, Pszczola RJ, Davis PG, Buckmaster AG. Nasal High-Flow Therapy for Newborn Infants in Special Care Nurseries. N Engl J Med 2019; 380:2031-2040. [PMID: 31116919 DOI: 10.1056/nejmoa1812077] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nasal high-flow therapy is an alternative to nasal continuous positive airway pressure (CPAP) as a means of respiratory support for newborn infants. The efficacy of high-flow therapy in nontertiary special care nurseries is unknown. METHODS We performed a multicenter, randomized, noninferiority trial involving newborn infants (<24 hours of age; gestational age, ≥31 weeks) in special care nurseries in Australia. Newborn infants with respiratory distress and a birth weight of at least 1200 g were assigned to treatment with either high-flow therapy or CPAP. The primary outcome was treatment failure within 72 hours after randomization. Infants in whom high-flow therapy failed could receive CPAP. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome, with a noninferiority margin of 10 percentage points. RESULTS A total of 754 infants (mean gestational age, 36.9 weeks, and mean birth weight, 2909 g) were included in the primary intention-to-treat analysis. Treatment failure occurred in 78 of 381 infants (20.5%) in the high-flow group and in 38 of 373 infants (10.2%) in the CPAP group (risk difference, 10.3 percentage points; 95% confidence interval [CI], 5.2 to 15.4). In a secondary per-protocol analysis, treatment failure occurred in 49 of 339 infants (14.5%) in the high-flow group and in 27 of 338 infants (8.0%) in the CPAP group (risk difference, 6.5 percentage points; 95% CI, 1.7 to 11.2). The incidences of mechanical ventilation, transfer to a tertiary neonatal intensive care unit, and adverse events did not differ significantly between the groups. CONCLUSIONS Nasal high-flow therapy was not shown to be noninferior to CPAP and resulted in a significantly higher incidence of treatment failure than CPAP when used in nontertiary special care nurseries as early respiratory support for newborn infants with respiratory distress. (Funded by the Australian National Health and Medical Research Council and Monash University; HUNTER Australian and New Zealand Clinical Trials Registry number, ACTRN12614001203640.).
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Affiliation(s)
- Brett J Manley
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Gaston R B Arnolda
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Ian M R Wright
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Louise S Owen
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Jann P Foster
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Li Huang
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Calum T Roberts
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Tracey L Clark
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Wei-Qi Fan
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Alice Y W Fang
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Isaac R Marshall
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Rosalynn J Pszczola
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Peter G Davis
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
| | - Adam G Buckmaster
- From the Newborn Research Centre and Neonatal Services, Royal Women's Hospital (B.J.M., L.S.O., P.G.D.), the Departments of Obstetrics and Gynaecology (B.J.M., L.S.O., P.G.D.) and Paediatrics (W.Q.F.), University of Melbourne, and Clinical Sciences, Murdoch Children's Research Institute (B.J.M., L.S.O., P.G.D.), Parkville, VIC, the University of New South Wales (G.R.B.A.) and the Sydney Medical School-Sydney Nursing School, University of Sydney (J.P.F.), Sydney, the Australian Institute of Health Innovation, Macquarie University, Sydney (G.R.B.A.), Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW (I.M.R.W.), Western Sydney University, Penrith, NSW (J.P.F.), Ingham Institute, Liverpool, NSW (J.P.F.), the Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC (L.H.), Monash Newborn, Monash Children's Hospital, and the Department of Paediatrics, Monash University, Clayton, VIC (C.T.R.), Monash Newborn, Monash Health, Dandenong, VIC (T.L.C.), the Department of Paediatrics, Northern Hospital, Epping, VIC (W.Q.F.), Box Hill Hospital, Eastern Health, Box Hill, VIC (A.Y.W.F.), Women's and Children's Services, Barwon Health, Geelong, VIC (I.R.M.), the Department of Neonatology, Western Health, St. Albans, VIC (R.J.P.), the Department of Paediatrics, Central Coast Local Health District, Gosford, NSW (A.G.B.), and the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (A.G.B.) - all in Australia
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154
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Abstract
Introduction Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. Methods This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 - March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. Results Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75+84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05+2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71+3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of 38% to 62% whereas 24 (39%) babies required mechanical ventilation and other modalities. Conclusions This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.
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Affiliation(s)
- Sunil Raja Manandhar
- Department of Pediatrics, Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal
- Correspondence: Dr. Sunil Raj a Manandhar, Department of Pediatrics, Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal. , Phone: +977-9803812218
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155
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Abstract
Respiratory support is frequently required during neonatal transport. This review identifies the various modalities of respiratory support available during neonatal transport and their appropriate clinical uses. The respiratory equipment required during neonatal transport and appropriate safety checks are also reviewed. In addition, we discuss potential respiratory emergencies and how to respond to them to decrease the risk of complications during transport and improve health outcomes.
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Affiliation(s)
- Gillian Brennan
- The University of Chicago Comer Children's Hospital, Chicago, IL
| | - Jill Colontuono
- The University of Chicago Comer Children's Hospital, Chicago, IL
| | - Christine Carlos
- The University of Chicago Comer Children's Hospital, Chicago, IL
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156
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Abstract
PURPOSE This evidence-based practice project evaluated the efficacy of a respiratory algorithm administered by specially trained transition nurses on the reduction of preventable NICU admissions for infants experiencing mild respiratory distress during transition. DESIGN A retrospective chart review compared a cohort of newborn admission rates for seven months before and seven months after initiation of a respiratory algorithm. SAMPLE Records of infants were included if they were born >35 weeks' gestation, had documented mild respiratory distress after birth, required <48 hours of noninvasive respiratory support, and had a length of stay less than four days. RESULTS Ninety-six infants (before n = 34, after n = 62) were included. Before implementation of the respiratory algorithm, infants requiring noninvasive respiratory support were admitted to the NICU. Following implementation of the algorithm, NICU admissions for mild respiratory distress significantly decreased (86 percent), despite a concurrent increase in maternal acuity.
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157
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Bamat N, Fierro J, Wang Y, Millar D, Kirpalani H. Positive end-expiratory pressure for preterm infants requiring conventional mechanical ventilation for respiratory distress syndrome or bronchopulmonary dysplasia. Cochrane Database Syst Rev 2019; 2:CD004500. [PMID: 30820939 PMCID: PMC6395956 DOI: 10.1002/14651858.cd004500.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Conventional mechanical ventilation (CMV) is a common therapy for neonatal respiratory failure. While CMV facilitates gas exchange, it may simultaneously injure the lungs. Positive end-expiratory pressure (PEEP) has received less attention than other ventilation parameters when considering this benefit-risk balance. While an appropriate PEEP level may result in clinical benefits, both inappropriately low or high levels may cause harm. An appropriate PEEP level may also be best achieved by an individualized approach. OBJECTIVES 1. To compare the effects of PEEP levels in preterm infants requiring CMV for respiratory distress syndrome (RDS). We compare both: zero end-expiratory pressure (ZEEP) (0 cm H2O) versus any PEEP and low (< 5 cm H2O) vs high (≥ 5 cm H2O) PEEP.2. To compare the effects of PEEP levels in preterm infants requiring CMV for bronchopulmonary dysplasia (BPD). We compare both: ZEEP (0 cm H2O) vs any PEEP and low (< 5 cm H2O) versus high (≥ 5 cm H2O) PEEP.3. To compare the effects of different methods for individualizing PEEP to an optimal level in preterm newborn infants requiring CMV for RDS. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase, and CINAHL to 14 February 2018. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA We included all randomized or quasi-randomized controlled trials studying preterm infants born at less than 37 weeks' gestational age, requiring CMV and undergoing randomization to either different PEEP levels (RDS or BPD); or, two or more alternative methods for individualizing PEEP levels (RDS only). We included cross-over trials but limited outcomes to those from the first cross-over period. DATA COLLECTION AND ANALYSIS We performed data collection and analysis according to the recommendations of the Cochrane Neonatal Review Group. We used the GRADE approach to assess the quality of evidence for prespecified key clinically relevant outcomes. MAIN RESULTS Four trials met the inclusion criteria. Two cross-over trials with 28 participants compared different PEEP levels in infants with RDS. Meta-analysis was limited to short-term measures of pulmonary gas exchange and showed no differences between low and high PEEP.We identified no trials comparing PEEP levels in infants with BPD.Two trials enrolling 44 participants compared different methods for individualizing PEEP in infants with RDS. Both trials compared an oxygenation-guided lung-recruitment maneuver (LRM) with gradual PEEP level titrations for individualizing PEEP to routine care (control). Meta-analysis showed no difference between LRM and control on mortality by hospital discharge (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.17 to 5.77); there was no statistically significant difference on BPD, with an effect estimate favoring LRM (RR 0.25, 95% CI 0.03 to 2.07); and a statistically significant difference favoring LRM for the outcome of duration of ventilatory support (mean difference -1.06 days, 95% CI -1.85 to -0.26; moderate heterogeneity, I2 = 67%). Short-term oxygenation measures also favored LRM. We graded the quality of the evidence as low for all key outcomes due to risk of bias and imprecision of the effect estimates. AUTHORS' CONCLUSIONS There continues to be insufficient evidence to guide PEEP level selection for preterm infants on CMV for RDS or BPD. Low-quality data suggests that selecting PEEP levels through the application of an oxygenation-guided LRM may result in clinical benefit. Well-conducted randomized trials, particularly to further evaluate the potential benefits of oxygenation-guided LRMs, are needed.
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Affiliation(s)
- Nicolas Bamat
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of PennsylvaniaDivision of Neonatology and Center for Pediatric Clinical Effectiveness34th Street and Civic Center BoulevardPhiladelphiaUSA19104
| | - Julie Fierro
- Children's Hospital of PhiladelphiaDivision of Pulmonary MedicinePhiladelphiaUSA
| | - Yifei Wang
- Guangdong General Hospital, Guangdong Academy of Medical SciencesDepartment of Pediatrics106 Zhongshan Second RoadGuangzhouChina510080
| | - David Millar
- Royal Jubilee Maternity ServiceRegional Neonatal Intensive Care UnitRoyal Maternity HospitalGrosvenor RoadBelfastUKBT12 6BB
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158
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Bashir T, Murki S, Kiran S, Reddy VK, Oleti TP. 'Nasal mask' in comparison with 'nasal prongs' or 'rotation of nasal mask with nasal prongs' reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial. PLoS One 2019; 14:e0211476. [PMID: 30703172 PMCID: PMC6355017 DOI: 10.1371/journal.pone.0211476] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings. Methods In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study. Results Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value <0.0001]. Median maximum nasal injury score was significantly less in Mask continue group as compared to Prong continue group and Rotation group [Injury Score 0 (IQR 0–1) vs. Injury Score 3 (IQR 2–5) vs. Injury Score 1 (IQR 0–2), p value = <0.0001] respectively. The proportion of infants failing nCPAP was similar across the three groups. Conclusion nCPAP with nasal masks significantly reduces nasal injury in comparison with nasal prongs or rotation of nasal prongs and nasal masks. However, the type of interface did not affect the nCPAP failure rates.
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Affiliation(s)
- Tanveer Bashir
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
- * E-mail:
| | - Sai Kiran
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
| | | | - Tejo Pratap Oleti
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
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159
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Anwaar O, Hussain M, Shakeel M, Ahsan Baig MM. Outcome Of Use Of Nasal Continuous Positive Airway Pressure Through Infant Flow Drivers In Neonates With Respiratory Distress In A Tertiary Care Hospital In Pakistan. J Ayub Med Coll Abbottabad 2018; 30:511-555. [PMID: 30632326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Nasal continuous positive pressure has been used for management of respiratory distress in neonates in various conditions as a primary modality. Objective of the study is to evaluate the frequency of improved outcome and complications of use of nasal CPAP through infant flow drivers in neonates with respiratory distress. The study was conducted from 2nd April 2017 to 2nd October 2017 in neonatal intensive care unit of Allama Iqbal Memorial Teaching Hospital Sialkot. METHODS All neonates with respiratory distress fulfilling the clinical criteria (Neonates with gestational age 28 weeks to 40 weeks having clinical signs of respiratory distress classified according to down score (tachypnea, grunting, decreased air entry, cyanosis, recessions), neonates having pc02 <60 mmhg, neonates having x-ray findings consistent with respiratory distress syndrome (RDS), Transient tachypnea of newborn (TTN) and pneumonia) were included in the study. Nasal CPAP was used at variable settings. Outcome, complications, indications, associated diseases and hospital stay along with other baseline characteristics were assessed. Success was defined as improvement of the respiratory distress as assessed by down score, maintenance of SPO2 above 90% in room air after weaning from CPAP for about consecutive 4 hours and normalization of blood gases while the failure as need for mechanical ventilation. RESULTS Total 60 neonates were included in the study. Mean weight was 2113.3±580.32 g while mean gestational age was 33.35±2.59 weeks. Total 52 (86.7%) babies were successfully weaned off from nCPAP while only 8 (13.3%) neonates required mechanical ventilation. Main indication of use of CPAP was RDS (65%). No complications were observed in 73.3% babies while 26.7% had complications of which nasal deformities accounted for 20% and abdominal distension for 6.37%. CONCLUSIONS Nasal CPAP can be safely and easily used as primary support for neonates with respiratory distress even in resource limited developing countries. It reduces the need for mechanical ventilation and thus hospital stay.
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Affiliation(s)
- Osama Anwaar
- Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot, Pakistan
| | - Mudassar Hussain
- Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot, Pakistan
| | - Maria Shakeel
- Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot, Pakistan
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160
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Vail B, Morgan MC, Spindler H, Christmas A, Cohen SR, Walker DM. The power of practice: simulation training improving the quality of neonatal resuscitation skills in Bihar, India. BMC Pediatr 2018; 18:291. [PMID: 30176831 PMCID: PMC6122678 DOI: 10.1186/s12887-018-1254-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, neonatal mortality accounts for nearly half of under-five mortality, and intrapartum related events are a leading cause. Despite the rise in neonatal resuscitation (NR) training programs in low- and middle-income countries, their impact on the quality of NR skills amongst providers with limited formal medical education, particularly those working in rural primary health centers (PHCs), remains incompletely understood. METHODS This study evaluates the impact of PRONTO International simulation training on the quality of NR skills in simulated resuscitations and live deliveries in rural PHCs throughout Bihar, India. Further, it explores barriers to performance of key NR skills. PRONTO training was conducted within CARE India's AMANAT intervention, a maternal and child health quality improvement project. Performance in simulations was evaluated using video-recorded assessment simulations at weeks 4 and 8 of training. Performance in live deliveries was evaluated in real time using a mobile-phone application. Barriers were explored through semi-structured interviews with simulation facilitators. RESULTS In total, 1342 nurses participated in PRONTO training and 226 NR assessment simulations were matched by PHC and evaluated. From week 4 to 8 of training, proper neck extension, positive pressure ventilation (PPV) with chest rise, and assessment of heart rate increased by 14%, 19%, and 12% respectively (all p ≤ 0.01). No difference was noted in stimulation, suction, proper PPV rate, or time to completion of key steps. In 252 live deliveries, identification of non-vigorous neonates, use of suction, and use of PPV increased by 21%, 25%, and 23% respectively (all p < 0.01) between weeks 1-3 and 4-8. Eighteen interviews revealed individual, logistical, and cultural barriers to key NR skills. CONCLUSION PRONTO simulation training had a positive impact on the quality of key skills in simulated and live resuscitations throughout Bihar. Nevertheless, there is need for ongoing improvement that will likely require both further clinical training and addressing barriers that go beyond the scope of such training. In settings where clinical outcome data is unreliable, data triangulation, the process of synthesizing multiple data sources to generate a better-informed evaluation, offers a powerful tool for guiding this process.
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Affiliation(s)
- Brennan Vail
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA 94158 USA
| | - Melissa C. Morgan
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA 94158 USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
| | - Amelia Christmas
- PRONTO International, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar 80002 India
| | - Susanna R. Cohen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112 USA
| | - Dilys M. Walker
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
- PRONTO International, 1820 E. Thomas Street APT 16, Seattle, WA 98112 USA
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161
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Umoren RA, Gray MM, Schooley N, Billimoria Z, Smith KM, Sawyer TL. Effect of Video-based Telemedicine on Transport Management of Simulated Newborns. Air Med J 2018; 37:317-320. [PMID: 30322635 DOI: 10.1016/j.amj.2018.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/18/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Video-based telemedicine is a reliable tool to assess the severity of respiratory distress in children, increasing the appropriateness of triage and disposition for acutely ill children. Telemedicine simulations may identify patterns in regional transport management and influence attitudes toward telemedicine. METHODS The objective was to determine the effect of videos on simulated neonatal transport care compared with telephone management. Participants received information about a newborn requiring respiratory support by an audio recording and made management decisions based on only that information. Four videos of varying respiratory distress on respiratory support were then shown. After each video, participants again rated patient stability and recommended management. RESULTS Sixteen neonatologists completed the cases. Compared with the telephone call, there were significant differences in ratings of patient stability and confidence in their assessment after watching the videos. When given the same information, participants were less likely to recommend intubation after viewing an infant in mild respiratory distress than after the telephone call (P < .05). Most participants felt that viewing the videos was helpful in formulating their assessment and plan. CONCLUSION Video-based telemedicine simulations influenced the perceived stability of neonates during transport. Viewing the patient increased provider confidence in their assessment and recommendations.
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Affiliation(s)
- Rachel A Umoren
- Neonatal Education and Simulation-Based Training Program, University of Washington, Seattle, WA; Seattle Children's Hospital, Seattle, WA
| | - Megan M Gray
- Neonatal Education and Simulation-Based Training Program, University of Washington, Seattle, WA; Seattle Children's Hospital, Seattle, WA
| | | | - Zeenia Billimoria
- Neonatal Education and Simulation-Based Training Program, University of Washington, Seattle, WA; Seattle Children's Hospital, Seattle, WA
| | | | - Taylor L Sawyer
- Neonatal Education and Simulation-Based Training Program, University of Washington, Seattle, WA; Seattle Children's Hospital, Seattle, WA
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162
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Rocha G, Soares P, Gonçalves A, Silva AI, Almeida D, Figueiredo S, Pissarra S, Costa S, Soares H, Flôr-de-Lima F, Guimarães H. Respiratory Care for the Ventilated Neonate. Can Respir J 2018; 2018:7472964. [PMID: 30186538 PMCID: PMC6110042 DOI: 10.1155/2018/7472964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Américo Gonçalves
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Silva
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Diana Almeida
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Sara Figueiredo
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Susana Pissarra
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Flôr-de-Lima
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Wang Z, Xiang JW, Gao WW, Shen YZ, Zhou WJ, Chen J, Xu F, Yang J. [Comparison of clinical efficacy of two noninvasive respiratory support therapies for respiratory distress syndrome in very low birth weight preterm infants]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:603-607. [PMID: 30111466 PMCID: PMC7389755 DOI: 10.7499/j.issn.1008-8830.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/03/2018] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of nasal intermittent positive pressure ventilation (NIPPV) and heated humidified high flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) among very low birth weight (VLBW) preterm infants. METHODS A total of 89 very low birth weight premature infants with respiratory distress syndrome (RDS) who were randomly administered with NIPPV (n=46) and HHHFNC (n=43) as an initial respiratory support. The incidence of initial treatment failure, the usage of pulmonary surfactant (PS), the parameters of respiratory support treatment and the incidence of complications were compared between the two groups. RESULTS There were no significant differences between the NIPPV and HHHFNC groups in the following items: the rate of intubation within 72 hours, rate of PS use, duration of invasive or non-invasive mechanical ventilation, duration of oxygen therapy, and incidence rates of severe apnea and pneumonia (P>0.05). There were also no significant differences in the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, intracranial hemorrhage, and air leak between the two group (P>0.05). The incidence rate of nose injury in the NIPPV group was higher than that in the HHHFNC group (P<0.05). CONCLUSIONS As an initial respiratory support for very low birth weight preterm infants with RDS, HHHFNC has a similar clinical effect as NIPPV, suggesting that HHHFNC is a safe and effective clinical option as a non-invasive ventilation treatment.
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Affiliation(s)
- Zhu Wang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou 511400, China.
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Zhong QH, Duan J, Zhang CY, Feng YL, Qi ZY, He XY, Liang K. [Effect of prone positioning on respiratory function in very preterm infants undergoing mechanical ventilation]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:608-612. [PMID: 30111467 PMCID: PMC7389764 DOI: 10.7499/j.issn.1008-8830.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the effect of prone positioning on respiratory function in very preterm infants undergoing mechanical ventilation. METHODS A total of 83 very preterm infants treated with mechanical ventilation were enrolled in the study and were randomly assigned to supine group and prone group. Four infants withdrew from the study and 79 infants completed treatment and observation (37 in the supine group and 42 in the prone group). Infants in both groups were mechanically ventilated in a volume assist-control mode. Infants in the prone group were ventilated in the supine position for 4 hours and in the prone position for 2 hours. Ventilator parameters, arterial blood gas analysis, and vital signs were recorded before grouping, every 6 hours in the supine group, and every hour after conversion into the prone position in the prone group, respectively. RESULTS Fraction of inspired oxygen (FiO2), peak inspiratory pressure, mean inspiratory pressure, and duration of ventilation were significantly lower in the prone group than in the supine group (P<0.05); there were no significant differences in tidal volume or positive end-expiratory pressure between the two groups (P>0.05). The prone group had a significantly higher PO2/FiO2 ratio but significantly lower oxygenation index and respiratory rate than the supine group (P<0.05). There were no significant differences in arterial oxygen tension, pH, base excess, heart rate, or mean blood pressure between the two groups (P>0.05). CONCLUSIONS Alternating ventilation between the prone position and supine position can improve oxygenation function, decrease the fraction of inspired oxygen, and shorten the duration of mechanical ventilation in very preterm infants undergoing mechanical ventilation.
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Affiliation(s)
- Qing-Hua Zhong
- NICU, Department of Pediatrics, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.
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165
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Spillane NT, Zamudio S, Alvarez-Perez J, Andrews T, Nyirenda T, Alvarez M, Al-Khan A. Increased incidence of respiratory distress syndrome in neonates of mothers with abnormally invasive placentation. PLoS One 2018; 13:e0201266. [PMID: 30048504 PMCID: PMC6062082 DOI: 10.1371/journal.pone.0201266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of abnormally invasive placentation (AIP) is increasing. Most of these pregnancies are delivered preterm. We sought to characterize neonatal outcomes in AIP pregnancies. METHODS In this retrospective case-control study (2006-2015), AIP neonates (n = 108) were matched to two controls each for gestational age, antenatal glucocorticoid exposure, sex, plurity, and delivery mode. Medical records were reviewed for neonatal and maternal characteristics/outcomes. Univariate and multivariate Poisson regressions were performed to determine relative risk ratios (RR). RESULTS There were no mortalities. All neonatal outcomes were similar except for respiratory distress syndrome (RDS), which affected 37% of AIP neonates (versus 21% of controls). AIP neonates required respiratory support (64.8% vs. 51.9%) and continuous positive airway pressure (53.7% vs. 42.1%) for a longer duration. Univariate regression yielded elevated RRs for RDS for AIP (RR 1.78, 95% CI 1.24-2.54), placenta previa (RR = 1.94, 95% CI 1.36-2.76), and placenta previa with bleeding (RR 2.29, 95% CI 1.36-3.86). One episode of bleeding had a RR of 2.43 (95% CI 1.57-3.76), 2 or more episodes had a RR of 2.95 (95% CI 1.96-4.44), and bleeding/abruption as the delivery indication had a RR of 2.57 (95% CI 1.82-3.64). A multivariate regression stratifying for AIP and evaluating the combined and individual associations of AIP, bleeding, placenta previa, and GA, resulted in elevated RRs for placenta previa alone (RR 2.16, 95% CI 1.15-4.06) and placenta previa and bleeding (RR 1.69, 95% CI 1.001-2.85). CONCLUSIONS The increased incidence of RDS at later gestational ages in AIP is driven by placenta previa. AIP neonates required respiratory support for a longer duration than age-matched controls. Providers should be prepared to counsel expectant parents and care for affected neonates.
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Affiliation(s)
- Nicole T. Spillane
- Department of Pediatrics, Division of Neonatology, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Rutgers University, New Jersey Medical School, Newark, New Jersey, United States of America
- * E-mail:
| | - Stacy Zamudio
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Center for Abnormal Placentation, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Jesus Alvarez-Perez
- Rutgers University, New Jersey Medical School, Newark, New Jersey, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Center for Abnormal Placentation, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Tracy Andrews
- Office of Research Administration, Department of Research Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Themba Nyirenda
- Office of Research Administration, Department of Research Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Manuel Alvarez
- Rutgers University, New Jersey Medical School, Newark, New Jersey, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Center for Abnormal Placentation, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Abdulla Al-Khan
- Rutgers University, New Jersey Medical School, Newark, New Jersey, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Center for Abnormal Placentation, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
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Zhu XW, Shi Y, Shi LP, Liu L, Xue J, Ramanathan R. Non-invasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: Study protocol for a multi-center prospective randomized controlled trial. Trials 2018; 19:319. [PMID: 29898763 PMCID: PMC6001134 DOI: 10.1186/s13063-018-2673-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 05/04/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Invasive mechanical ventilation (IMV) is associated with the development of adverse pulmonary and non-pulmonary outcomes in very premature infants. Various modes of non-invasive respiratory support are increasingly being used to decrease the incidence of bronchopulmonary dysplasia. The aim of this trial is to compare the effect of non-invasive high-frequency oscillatory ventilation (NHFOV) and nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS) as a primary non-invasive ventilation support mode. METHODS/DESIGN In this multi-center randomized controlled trial, 300 preterm infants born at a gestational age of 266/7 to 336/7 weeks with a diagnosis of RDS will be randomized to NHFOV or NCPAP as a primary mode of non-invasive respiratory support. The study will be conducted in 18 tertiary neonatal intensive care units in China. The primary outcome is the need for IMV during the first 7 days after enrollment in preterm infants randomized to the two groups. The prespecified secondary outcomes include days of hospitalization, days on non-invasive respiratory support, days on IMV, days on supplemental oxygen, mortality, need for a surfactant, severe retinopathy of prematurity requiring laser treatment or surgery, patent ductus arteriosus needing ligation, bronchopulmonary dysplasia, abdominal distention, air leak syndromes, intraventricular hemorrhage (≥ grade 3), spontaneous intestinal perforation, necrotizing enterocolitis (≥II stage), and nasal trauma. Other secondary outcomes include Bayley Scales of Infant Development at 18-24 months of corrected age. DISCUSSION In recent decades, several observational studies have compared the effects of NHFOV and NCPAP in neonates as a rescue mode or during weaning from IMV. To our knowledge, this will be the first multi-center prospective, randomized controlled trial to evaluate NHFOV as a primary mode in preterm infants with RDS in China or any other part of the world. Our trial may help to establish guidelines for NHFOV in preterm infants with RDS to minimize the need for IMV, and to decrease the significant pulmonary and non-pulmonary morbidities associated with IMV. TRIAL REGISTRATION ClinicalTrials.gov, NCT03099694 . Registered on 4 April 2017.
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Affiliation(s)
- Xing-Wang Zhu
- Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing, 400042 China
- Jiulongpo People’s Hospital, Chongqing, 400024 China
| | - Yuan Shi
- Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing, 400042 China
| | - Li-Ping Shi
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, 310000 China
| | - Ling Liu
- Guiyang Maternity and Child Health Care Hospital, Guiyang, 550000 China
| | - Jiang Xue
- The Second Hospital of Shandong University, Jinan, 250000 China
| | - Rangasamy Ramanathan
- LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033 USA
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Shu XX, Chen C, Tang J, Wang H. [Clinical effect of bubble nasal continuous positive airway pressure versus conventional nasal continuous positive airway pressure in respiratory support for preterm infants with neonatal respiratory distress syndrome]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:433-437. [PMID: 29972114 PMCID: PMC7389941 DOI: 10.7499/j.issn.1008-8830.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the clinical effect and safety of bubble nasal continuous positive airway pressure (BNCPAP) versus conventional nasal continuous positive airway pressure (nCPAP) in respiratory support for preterm infants with neonatal respiratory distress syndrome (NRDS). METHODS A retrospective analysis was performed for the clinical data of 130 preterm infants with NRDS. Among them, 69 underwent BNCPAP and 61 underwent nCPAP. The two groups were compared in terms of mortality rate, duration of respiratory support, use of pulmonary surfactant (PS), and treatment failure rate, and the incidence rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), as well as the changes in blood gas pH, partial pressure of oxygen, and partial pressure of carbon dioxide. The safety was evaluated for both groups. RESULTS There were no significant differences between the BNCPAP group and the nCPAP group in sex distribution, gestational age, birth weight, Apgar score at 1 and 5 minutes after birth, delivery mode, and the severity of NRDS (P>0.05). No infants in the BNCPAP group died, and one infant in the nCPAP group died; there was no significant difference in the mortality rate between the two groups (P>0.05). There were also no significant differences between the two groups in the duration of noninvasive ventilation, treatment failure rate, the incidence rates of BPD and ROP, and the percentage of infants with a need for use or reuse of PS (P>0.05). After 8-12 hours of ventilation, there were no significant differences between the two groups in the changes in blood gas pH and oxygenation index (P>0.05), while the BNCPAP group had a significantly greater reduction in partial pressure of carbon dioxide than the nCPAP group (P<0.05). There were no significant differences between the two groups in the incidence rates of pneumothorax, nasal septal injury, and nasal mucosal injury (P>0.05). CONCLUSIONS BNCPAP and nCPAP have similar clinical effect and safety in respiratory support for preterm infants with NRDS.
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Affiliation(s)
- Xian-Xiao Shu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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Jain A, Singh I, Meher R, Raj A, Rajpurohit P, Prasad P. Deep neck space abscesses in children below 5 years of age and their complications. Int J Pediatr Otorhinolaryngol 2018; 109:40-43. [PMID: 29728182 DOI: 10.1016/j.ijporl.2018.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study the outcomes and complications of deep neck space abscesses in children less than 5 years of age over a period of 15 years. METHODS A retrospective analysis of children less than 5 years of age with deep neck space abscesses over a 15-year period was conducted at a tertiary care centre in India. Patients were evaluated with respect to the clinical, radiological and laboratory findings. All patients underwent surgical incision and drainage of the abscess and pus cultures were obtained. The incidence of complications was recorded. The collected data was tabulated and statistical analysis was done. RESULTS A total of 510 children less than 5 years of age were identified who were admitted for deep neck space abscess over a 15-year period. The mean age was 23.6 months. The most common organism isolated in the pus was Staphylococcus aureus (21%). The incidence of methicillin resistant S. aureus (MRSA) was 9%. Complications were reported in 10% patients. CONCLUSION Paediatric deep neck abscesses can be managed with prompt surgical management and intravenous antibiotics. Children less than 2 years of age, and those with multiple abscesses or retropharyngeal abscess were more prone to complications.
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Affiliation(s)
- Avani Jain
- Department of ENT, MAMC, New Delhi, India.
| | | | - Ravi Meher
- Department of ENT, MAMC, New Delhi, India
| | - Anoop Raj
- Department of ENT, MAMC, New Delhi, India
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Park JS, Choi YJ, Kim YT, Park S, Chae JH, Park JD, Cho YJ, Kim WS, Seong MW, Park SH, Kwon D, Chung DH, Suh DI. Pediatric Case Report on an Interstitial Lung Disease with a Novel Mutation of SFTPC Successfully Treated with Lung Transplantation. J Korean Med Sci 2018; 33:e159. [PMID: 29805340 PMCID: PMC5966374 DOI: 10.3346/jkms.2018.33.e159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/29/2018] [Indexed: 11/24/2022] Open
Abstract
Mutations of the surfactant protein (SP)-C gene (SFTPC) have been associated with neonatal respiratory distress syndrome (RDS) and childhood interstitial lung disease (ILD). If accurate diagnosis and proper management are delayed, irreversible respiratory failure demanding lung transplantation may ensue. A girl was born at term but was intubated and given exogenous surfactant due to RDS. Cough and tachypnea persisted, and symptoms rapidly progressed at 16 months of age despite treatment with antibiotics, oral prednisolone, methylprednisolone pulse therapy, and intravenous immunoglobulin. At 20 months, she visited our hospital for a second opinion. A computed tomography scan showed a diffuse mosaic pattern with ground-glass opacity and subpleural cysts compatible with ILD. A video-assisted thoracoscopic lung biopsy revealed ILD with eosinophilic proteinaceous material and macrophages in the alveolar space. Bilateral lung transplant from a 30-month-old child was done, and she was discharged in room air without acute complications. Genetic analysis revealed a novel c.203T>A, p.Val68Asp mutation of SP-C, based on the same exon as a known pathogenic mutation, p.Glu66Lys.
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Affiliation(s)
- Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jung Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Samina Park
- Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Dohee Kwon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVE To identify clinical and demographic variables that predict nasal high-flow (nHF) treatment failure when used as a primary respiratory support for preterm infants. STUDY DESIGN This secondary analysis used data from a multicenter, randomized, controlled trial comparing nHF with continuous positive airway pressure as primary respiratory support in preterm infants 28-36 completed weeks of gestation. Treatment success or failure with nHF was determined using treatment failure criteria within the first 72 hours after randomization. Infants in whom nHF treatment failed received continuous positive airway pressure, and were then intubated if failure criteria were again met. RESULTS There were 278 preterm infants included, with a mean gestational age (GA) of 32.0 ± 2.1 weeks and a birth weight of 1737 ± 580 g; of these, nHF treatment failed in 71 infants (25.5%). Treatment failure was moderately predicted by a lower GA and higher prerandomization fraction of inspired oxygen (FiO2): area under a receiver operating characteristic curve of 0.76 (95% CI, 0.70-0.83). Nasal HF treatment success was more likely in infants born at ≥30 weeks GA and with prerandomization FiO2 <0.30. CONCLUSIONS In preterm infants ≥28 weeks' GA enrolled in a randomized, controlled trial, lower GA and higher FiO2 before randomization predicted early nHF treatment failure. Infants were more likely to be successfully treated with nHF from soon after birth if they were born at ≥30 weeks GA and had a prerandomization FiO2 <0.30. However, even in this select population, continuous positive airway pressure remains superior to nHF as early respiratory support in preventing treatment failure. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000303741.
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Affiliation(s)
- Brett J Manley
- Newborn Research Center, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria.
| | - Calum T Roberts
- Newborn Research Center, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Pediatrics, Monash University, Melbourne, Australia
| | - Dag H Frøisland
- Newborn Research Center, The Royal Women's Hospital, Melbourne, Australia; Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway
| | - Lex W Doyle
- Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria; Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Center, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria
| | - Louise S Owen
- Newborn Research Center, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria
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Carns J, Kawaza K, Quinn MK, Miao Y, Guerra R, Molyneux E, Oden M, Richards-Kortum R. Impact of hypothermia on implementation of CPAP for neonatal respiratory distress syndrome in a low-resource setting. PLoS One 2018; 13:e0194144. [PMID: 29543861 PMCID: PMC5854332 DOI: 10.1371/journal.pone.0194144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Neonatal hypothermia is widely associated with increased risks of morbidity and mortality, but remains a pervasive global problem. No studies have examined the impact of hypothermia on outcomes for preterm infants treated with CPAP for respiratory distress syndrome (RDS). METHODS This retrospective analysis assessed the impact of hypothermia on outcomes of 65 neonates diagnosed with RDS and treated with either nasal oxygen (N = 17) or CPAP (N = 48) in a low-resource setting. A classification tree approach was used to develop a model predicting survival for subjects diagnosed with RDS. FINDINGS Survival to discharge was accurately predicted based on three variables: mean temperature, treatment modality, and mean respiratory rate. None of the 23 neonates with a mean temperature during treatment below 35.8°C survived to discharge, regardless of treatment modality. Among neonates with a mean temperature exceeding 35.8°C, the survival rate was 100% for the 31 neonates treated with CPAP and 36.4% for the 11 neonates treated with nasal oxygen (p<0.001). For neonates treated with CPAP, outcomes were poor if more than 50% of measured temperatures indicated hypothermia (5.6% survival). In contrast, all 30 neonates treated with CPAP and with more than 50% of temperature measurements above 35.8°C survived to discharge, regardless of initial temperature. CONCLUSION The results of our study suggest that successful implementation of CPAP to treat RDS in low-resource settings will require aggressive action to prevent persistent hypothermia. However, our results show that even babies who are initially cold can do well on CPAP with proper management of hypothermia.
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Affiliation(s)
- Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Kondwani Kawaza
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - MK Quinn
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Yinsen Miao
- Department of Statistics, Rice University, Houston, Texas, United States of America
| | - Rudy Guerra
- Department of Statistics, Rice University, Houston, Texas, United States of America
| | - Elizabeth Molyneux
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Maria Oden
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
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Sorèze Y. [Intervention and role of the paediatrician in the delivery room]. Soins Pediatr Pueric 2018; 39:26-29. [PMID: 29576209 DOI: 10.1016/j.spp.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Some newborns require the presence of a paediatrician in the delivery room, for emergency care. This generally leads to hospitalisation in neonatal intensive care or neonatology. Prematurity and respiratory distress are the main causes. These unexpected situations are a source of anxiety for the parents. It is essential that the multidisciplinary team draws on both its technical and relational expertise, in order to provide optimal treatment to the infant while supporting the parents with the necessary empathy.
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Affiliation(s)
- Yohan Sorèze
- Service de réanimation néonatale et pédiatrique, Hôpital Armand-Trousseau, AP-HP, 26 avenue du Docteur Arnold Netter, 75012 Paris, France.
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173
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Bamat NA, Guevara JP, Bryan M, Roberts RS, Yoder BA, Lemyre B, Chiu A, Millar D, Kirpalani H. Variation in Positive End-Expiratory Pressure Levels for Mechanically Ventilated Extremely Low Birth Weight Infants. J Pediatr 2018; 194:28-33.e5. [PMID: 29275926 PMCID: PMC5826866 DOI: 10.1016/j.jpeds.2017.10.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/15/2017] [Accepted: 10/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that significant positive end-expiratory pressure (PEEP) level variation exists between neonatal centers. STUDY DESIGN We performed a secondary analysis cohort study of the Nasal Intermittent Positive-Pressure Ventilation trial. Our study population was extremely low birth weight infants requiring mechanical ventilation within 28 days of life. The exposure was neonatal center; 34 international centers participated in the trial. Subjects from centers with fewer than 5 eligible cases were excluded. The main outcome was the maximal PEEP level used during the first course of mechanical ventilation. Infant characteristics judged a priori to directly influence clinical PEEP level selection and all characteristics associated with PEEP at P <.05 in bivariable analyses were included with and without center in multivariable linear regression models. Variation in PEEP level use between centers following adjustment for infant characteristics was assessed. RESULTS A total of 278 extremely low birth weight infants from 17 centers were included. Maximal PEEP ranged from 3 to 9 cm H2O, mean = 5.7 (SD = 0.9). Significant variation between centers remained despite adjustment for infant characteristics (P < .0001). Further, center alone explained a greater proportion of the PEEP level variation than all infant characteristics combined. CONCLUSIONS Marked variation in PEEP levels for extremely low birth weight infants exists between neonatal centers. Research providing evidence-based guidance for this important aspect of respiratory care in preterm infants at high risk of lung injury is needed. TRIAL REGISTRATION ClinicalTrials.gov: NCT00433212.
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Affiliation(s)
- Nicolas A Bamat
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - James P Guevara
- PolicyLab: Center to Bridge Research, Practice, and Policy, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matthew Bryan
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Robin S Roberts
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Bradley A Yoder
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Brigitte Lemyre
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Aaron Chiu
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Millar
- Department of Neonatology, Royal Maternity Hospital, Belfast, United Kingdom
| | - Haresh Kirpalani
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
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174
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Alonso-Ojembarrena A, Segado-Arenas A, Benavente-Fernández I, Lubián-López SP. Feasibility of Helmet-delivered Continous Positive Airway Pressure in Very Low Birthweight Infants. Indian Pediatr 2018; 55:165-166. [PMID: 29503275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We describe our experience with helmet-delivered continuous positive airway pressure in five preterm newborns. We analyzed oxygen requirement, arterial oxygen saturation, respiratory rate, medium arterial pressure, heart rate, apneic spells and patient's comfort. The patients' vital signs or pain scale were not different before and after treatment.
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Affiliation(s)
| | - Antonio Segado-Arenas
- Department of Pediatrics, Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz (Spain)
| | - Isabel Benavente-Fernández
- Department of Pediatrics, Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz (Spain)
| | - Simón Pedro Lubián-López
- Department of Pediatrics, Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz (Spain)
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175
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Lal SN, Kaur J, Anthwal P, Goyal K, Bahl P, Puliyel JM. Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial. Indian Pediatr 2018; 55:27-30. [PMID: 28952459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis. DESIGN Randomized controlled trial. SETTING Tertiary-care hospital in New Delhi, India. Participants: 72 infants (age <1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP. PARTICIPANTS 72 infants (age <1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP. INTERVENTION The outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis. MAIN OUTCOME MEASURES Change in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score. RESULTS 14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate [8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively. CONCLUSIONS nCPAP helped reduce respiratory distress significantly compared to standard care.
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Affiliation(s)
- Sandeep Narayan Lal
- Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India. Correspondence to: Dr Sandeep Narayan Lal, Department of Pediatrics, St Stephens Hospital, Tis Hazari, Delhi 110054, India.
| | - Jaspreet Kaur
- Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India
| | - Pooja Anthwal
- Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India
| | - Kanika Goyal
- Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India
| | - Pinky Bahl
- Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India
| | - Jacob M Puliyel
- Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India
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Mannan MA, Hossain MA, Nasim J, Sabina Y, Navila F, Subir D. Immediate Outcome of Preterm Neonates with Respiratory Distress Syndrome Required Mechanical Ventilation. Mymensingh Med J 2018; 27:130-135. [PMID: 29459604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. This clinical intervention study was done to analyze immediate outcome of preterm neonates with RDS required mechanical ventilation and conducted on preterm neonates with RDS required mechanical ventilation from July 2014 to June 2015. Total of 31 preterm neonates with RDS were mechanically ventilated during the study period, of which 77.42% (N=24) survived. The survival rate was highest among 30- <34 weeks (100%) gestational age (GA) group and lowest in 27- <30 weeks (56%) GA, (p=0.0036). The neonates with Birth Weight (BW) 1500gm -1800gm were higher rate of recovery which was 100% and gradually declined in 1000-1499gm (93.75%) and 800-999gm (33.33%) BW groups (p=0.00083). In this study most of the neonates were male (61.29%) but recovery rate was relatively better among baby girls (83.33%) than baby boys (73.68%) (p=0.53). RDS with surfactant therapy was better outcome than non surfactant group & survival of neonates who got surfactant were 93.33% & non surfactant neonates were 62.50%, (p=0.040). Majority (71.43%) of RDS with surfactant therapy recovered earlier <7 days than non surfactant therapy neonates (30.00%) and most of non surfactant neonates (70.00%) required prolonged ventilator support >7days (p=0.045). During the period of ventilation a total 17(54.84%) neonates developed different complications, of which ventilator associated pneumonia was (16.13%), sepsis (16.13%), pneumothorax (9.68%), pulmonary hemorrhage (6.45%) and intraventricular hemorrhage (6.45%) and among them 10 neonates recovered. No complications encountered in 14(45.16%) neonates, all of them survived, (p=0.0064). All (N=31) preterm neonates were candidate for surfactant therapy but only 15 neonates got surfactant therapy, remaining (N=16) did not get for their financial issue. As mechanical ventilation with surfactant therapy reduces the neonatal mortality; hence, facilities for neonatal ventilation and cost effective surfactant therapy should be included in the regional and central hospitals providing intensive care for neonates.
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Affiliation(s)
- M A Mannan
- Dr Md Abdul Mannan, Associate Professor of Neonatology, Department of Neonatology, Ad-din Medical College Hospital (AMCH), Dhaka, Bangladesh
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Horn AR, Weijer C, Grimshaw J, Brehaut J, Fergusson D, Goldstein CE, Taljaard M. An Ethical Analysis of the SUPPORT Trial: Addressing Challenges Posed by a Pragmatic Comparative Effectiveness Randomized Controlled Trial. Kennedy Inst Ethics J 2018; 28:85-118. [PMID: 29628452 DOI: 10.1353/ken.2018.0003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The SUPPORT trial highlights ethical challenges raised by comparative effectiveness randomized controlled trials (ceRCTs) involving one or more usual care interventions. Debate about the SUPPORT trial has focused on whether study interventions posed "reasonably foreseeable risks" to enrolled infants and, thereby, reflects a preoccupation with U.S. regulations. As ceRCTs are conducted globally, our analysis of the SUPPORT trial is grounded in internationally accepted ethical principles. We argue that the central ethical issue raised by the SUPPORT trial is the following: should the SUPPORT trial interventions be conceptualized as practice, or research? The answer to this question has important implications for "downstream" ethical requirements-including whether the usual care interventions in ceRCTs require research ethics committee review, undergo harm-benefit analysis, and are included in informed consent documents-and it is antecedent to the development of ethical guidance for ceRCTs.
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178
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Lin HJ, Huang CT, Hsiao HF, Chiang MC, Jeng MJ. End-tidal carbon dioxide measurement in preterm infants with low birth weight. PLoS One 2017; 12:e0186408. [PMID: 29040312 PMCID: PMC5645127 DOI: 10.1371/journal.pone.0186408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023] Open
Abstract
Objective There are conflicting data regarding the use of end-tidal carbon dioxide (PetCO2) measurement in preterm infants. The aim of this study was to evaluate the effects of different dead space to tidal volume ratios (VD/VT) on the correlation between PetCO2 and arterial carbon dioxide pressure (PaCO2) in ventilated preterm infants with respiratory distress syndrome (RDS). Methods We enrolled ventilated preterm infants (with assist control mode or synchronous intermittent mandatory mode) with RDS who were treated with surfactant in this prospective study. Simultaneous PetCO2 and PaCO2 data pairs were obtained from ventilated neonates monitored using mainstream capnography. Data obtained before and after surfactant treatment were also analyzed. Results One-hundred and one PetCO2 and PaCO2 pairs from 34 neonates were analyzed. There was a moderate correlation between PetCO2 and PaCO2 values (r = 0.603, P < 0.01). The correlation was higher in the post-surfactant treatment group (r = 0.786, P < 0.01) than the pre-surfactant treatment group (r = 0.235). The values of PaCO2 and PetCO2 obtained based on the treatment stage of surfactant therapy were 42.4 ± 8.6 mmHg and 32.6 ± 7.2 mmHg, respectively, in pre-surfactant treatment group, and 37.8 ± 10.3 mmHg and 33.7 ± 9.3 mmHg, respectively, in the post-surfactant treatment group. Furthermore, we found a significant decrease in VD/VT in the post-surfactant treatment group when compared to the pre-surfactant treatment group (P = 0.003). Conclusions VD/VT decreased significantly after surfactant therapy and the correlation between PetCO2 and PaCO2 was higher after surfactant therapy in preterm infants with RDS.
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Affiliation(s)
- Hsin-Ju Lin
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Tzu Huang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Feng Hsiao
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail: (MCC); (MJJ)
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Children’s Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (MCC); (MJJ)
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179
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Wang LP, Mao QH, Yang L. Effect of pulmonary surfactant combined with mechanical ventilation on oxygenation functions and expressions of serum transforming growth factor-beta1 (TGF-β1) and bone morphogenetic protein 7 (BMP-7) of neonatal respiratory distress syndrome. Eur Rev Med Pharmacol Sci 2017; 21:4357-4361. [PMID: 29077160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate and discuss the effect of early treatment with pulmonary surfactant (PS) on oxygenation functions in neonates with acute respiratory distress syndrome (ARDS), to understand the expression trend of serum transforming growth factor-beta 1 (TGF-β1) and bone morphogenetic protein 7 (BMP-7) in children with neonatal respiratory distress syndrome (NRDS), and to provide help for early prevention and treatment of NRDS. PATIENTS AND METHODS All the children were treated with mechanical ventilation; among them, 25 NRDS children who were given PS within 12 h after birth were selected as PS group, and 25 NRDS children who were never given PS were selected as conventional mechanical ventilation (CMV) group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expressions of serum TGF-β1 and BMP-7 in the two groups of children and monitor their oxygenation function indexes in 0, 1, 3, and 7 d after birth, respectively. RESULTS The content of serum TGF-β1 and BMP-7 in children of both PS group and CMV group trended to be higher at 1 d after birth while it was decreased at 7 d after birth compared with that in other days. The TGF-β1 content at 3 and 7 d after birth and the BMP-7 expression level at 7 d after birth in CMV group were significantly higher than those in PS group (p<0.05). After treatment, the values of oxygenation index (OI) and respiratory index (RI) at different time points (6, 12, 24, 48 h) in PS group were lower than those in CMV group (p<0.05). The mechanical ventilation duration in PS group (81±25 h) was decreased compared with that in CMV group (102±24 h); the oxygenation time in PS group (99±37 h) was less than that in CMV group (122±28 h); the number of cases of complications in PS group and CMV group was 3 (12%) and 6 (24%), respectively, and the effective rates of treatment were 96.0% and 84.0%, respectively (p<0.05). CONCLUSIONS Early application of PS combined with mechanical ventilation can remarkably improve lung oxygenation and compliance, suppress inflammatory responses, and effectively treat the NRDS. Monitoring the changes of serum BMP-7 and TGF-β1 is very important for treatment and prognosis assessment of the NRDS.
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Affiliation(s)
- L-P Wang
- Neonatal Department, Jining No.1 People's Hospital, Shandong, China.
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180
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Jin Z, Yang M, Lin R, Huang W, Wang J, Hu Z, Shu Q. Application of end-tidal carbon dioxide monitoring via distal gas samples in ventilated neonates. Pediatr Neonatol 2017; 58:370-375. [PMID: 28511794 DOI: 10.1016/j.pedneo.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous research has suggested correlations between the end-tidal partial pressure of carbon dioxide (PETCO2) and the partial pressure of arterial carbon dioxide (PaCO2) in mechanically ventilated patients, but both the relationship between PETCO2 and PaCO2 and whether PETCO2 accurately reflects PaCO2 in neonates and infants are still controversial. This study evaluated remote sampling of PETCO2 via an epidural catheter within an endotracheal tube to determine the procedure's clinical safety and efficacy in the perioperative management of neonates. METHODS Abdominal surgery was performed under general anesthesia in 86 full-term newborns (age 1-30 days, weight 2.55-4.0 kg, American Society of Anesthesiologists class I or II). The infants were divided into 2 groups (n = 43 each), and carbon dioxide (CO2) gas samples were collected either from the conventional position (the proximal end) or a modified position (the distal end) of the epidural catheter. RESULTS The PETCO2 measured with the new method was significantly higher than that measured with the traditional method, and the difference between PETCO2 and PaCO2 was also reduced. The accuracy of PETCO2 measured increased from 78.7% to 91.5% when the modified sampling method was used. The moderate correlation between PETCO2 and PaCO2 by traditional measurement was 0.596, which significantly increased to 0.960 in the modified sampling group. Thus, the PETCO2 value was closer to that of PaCO2. CONCLUSION PETCO2 detected via modified carbon dioxide monitoring had a better accuracy and correlation with PaCO2 in neonates.
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Affiliation(s)
- Ziying Jin
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
| | - Maoying Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Binjiang District, Hangzhou, Zhejiang Province, China
| | - Ru Lin
- Department of Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wenfang Huang
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jiangmei Wang
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhiyong Hu
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiang Shu
- Department of Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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181
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Abstract
BACKGROUND Assisted ventilation for extremely preterm infants (<28 weeks of gestation) has become less invasive, but it is unclear whether such developments in care are associated with improvements in short-term or long-term lung function. We compared changes over time in the use of assisted ventilation and oxygen therapy during the newborn period and in lung function at 8 years of age in children whose birth was extremely premature. METHODS We conducted longitudinal follow-up of all survivors of extremely preterm birth who were born in Victoria, Australia, in three periods - the years 1991 and 1992 (225 infants), 1997 (151 infants), and 2005 (170 infants). Perinatal data were collected prospectively, including data on the duration and type of assisted ventilation provided, the duration of oxygen therapy, and oxygen requirements at 36 weeks of age. Expiratory airflow was measured at 8 years of age, and values were converted to z scores for age, height, ethnic group, and sex. RESULTS The duration of assisted ventilation rose substantially over time, with a large increase in the duration of nasal continuous positive airway pressure. Despite the increase in the use of less invasive ventilation over time, the duration of oxygen therapy and the rate of oxygen dependence at 36 weeks rose, and airflows at 8 years of age were worse in 2005 than in earlier periods. For instance, for 2005 versus 1991-1992, the mean difference in the z scores for the ratio of forced expiratory volume in 1 second to forced vital capacity was -0.75 (95% confidence interval [CI], -1.07 to -0.44; P<0.001), and for 2005 versus 1997 the mean difference was -0.53 (95% CI, -0.86 to -0.19; P=0.002). CONCLUSIONS Despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood over time. (Funded by the National Health and Medical Research Council of Australia and the Victorian Government's Operational Infrastructure Support Program.).
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Affiliation(s)
- Lex W Doyle
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Elizabeth Carse
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Anne-Marie Adams
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Sarath Ranganathan
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Gillian Opie
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
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Tewabe T, Mohammed S, Tilahun Y, Melaku B, Fenta M, Dagnaw T, Belachew A, Molla A, Belete H. Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review. BMC Res Notes 2017; 10:265. [PMID: 28693597 PMCID: PMC5504561 DOI: 10.1186/s13104-017-2573-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/28/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Sepsis remains a major cause of morbidity and mortality among neonates. The risk factors and clinical outcomes of sepsis are poorly understood. Most cases of sepsis occurred mostly within the first week of newborns life related to perinatal risk factors. Late onset sepsis is related to hospital acquired infections which is seen after seven days of age. The purpose of this study was to assess clinical outcome and risk factors of neonatal sepsis in Felege Hiwot referral hospital Bahir Dar, North West Ethiopia. RESULTS Among the total 225 neonatal charts reviewed; 164 (72.9%) were age less than or equal to 7 days, and 144 (64%) were males. About 29 (12.9%) neonates were with irregular respiratory signs and 40 (17.8%) had meconium aspiration syndrome. Regarding the clinical outcome of neonatal sepsis: 189 (84%) were improved after treatment, 9 (4%) were died and 13 (5.8%) referred to other organizations for further treatment. Respiratory distress syndrome [AOR = 0.258 (0.072-0.930)] and meconium aspiration syndrome [AOR = 0.1989 (0.059-0.664)] were the determinant factors for poor outcome of neonatal sepsis. CONCLUSION The clinical outcome of neonatal sepsis in Felege Hiwot referral hospital was not satisfactory. The significant risk factors for poor outcome of neonatal sepsis were respiratory distress syndrome and meconium aspiration syndrome. Recommendations to improve neonatal outcome are: performing essential newborn care for all newborns and arranging appropriate follow up until the end of neonatal period, increasing antenatal care and early detection and management of neonatal infections or problems.
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Affiliation(s)
- Tilahun Tewabe
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seida Mohammed
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Tilahun
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Birhanie Melaku
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mequanint Fenta
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tsigiereda Dagnaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Belachew
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashagre Molla
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habte Belete
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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183
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Manley BJ, Roberts CT, Arnolda GRB, Wright IMR, Owen LS, Dalziel KM, Foster JP, Davis PG, Buckmaster AG. A multicentre, randomised controlled, non-inferiority trial, comparing nasal high flow with nasal continuous positive airway pressure as primary support for newborn infants with early respiratory distress born in Australian non-tertiary special care nurseries (the HUNTER trial): study protocol. BMJ Open 2017; 7:e016746. [PMID: 28645982 PMCID: PMC5541635 DOI: 10.1136/bmjopen-2017-016746] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. METHODS AND ANALYSIS The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial. Infants are eligible if born at a gestational age ≥31 weeks with birth weight ≥1200 g and admitted to a participating non-tertiary SCN, are <24 hours old at randomisation and require non-invasive respiratory support or supplemental oxygen for >1 hour. Infants are randomised to treatment with either nHF or CPAP. The primary outcome is treatment failure within 72 hours of randomisation, as determined by objective oxygenation, apnoea or blood gas criteria or by a clinical decision that urgent intubation and mechanical ventilation, or transfer to a tertiary NICU, is required. Secondary outcomes include incidence of pneumothorax requiring drainage, duration of respiratory support, supplemental oxygen and hospitalisation, costs associated with hospital care, cost-effectiveness, parental stress and satisfaction and nursing workload. ETHICS AND DISSEMINATION Multisite ethical approval for the study has been granted by The Royal Children's Hospital, Melbourne, Australia (Trial Reference No. 34222), and by each participating site. The trial is currently recruiting in eight centres in Victoria and New South Wales, Australia, with one previous site no longer recruiting. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001203640; pre-results.
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Affiliation(s)
- Brett J Manley
- Neonatal Services and Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Calum T Roberts
- Neonatal Services and Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Gaston R B Arnolda
- Department of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ian M R Wright
- Illawarra Health and Medical Research Institute and Graduate Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Paediatrics, The Wollongong Hospital, Wollongong, New South Wales, Australia
- Paediatrics and Child Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise S Owen
- Neonatal Services and Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Clinical Sciences Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Kim M Dalziel
- Centre for Health Policy, Melbourne School of Global and Population Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jann P Foster
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Sydney Nursing School/Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Peter G Davis
- Neonatal Services and Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Clinical Sciences Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Adam G Buckmaster
- Paediatrics and Child Health, University of Newcastle, Newcastle, New South Wales, Australia
- Central Coast Local Health District, Gosford, New South Wales, Australia
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184
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Huber BM, Bassler D. [Successful Treatment of Neonatal Respiratory Transitional Disorder with Pulmo/Vivianit comp. in 2 Cases]. Complement Med Res 2017; 24:172-174. [PMID: 28601877 DOI: 10.1159/000475906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Disorders of the respiratory transition at birth are major reasons for neonates being admitted to intensive care units and separated from their mothers. This has potential long-lasting consequences for the mother-infant interaction as well as the long-term development of the child. There is an urgent need for effective preventive and therapeutic measures for this frequent disorder. CASE REPORT We report the cases of 2 newborn infants with respiratory transitional disorder treated off-label with the anthroposophic medicament Pulmo/Vivianit comp. based on pathophysiological considerations and on particular parental request. In both cases, an immediate and sustainable response could be documented without adverse effects. CONCLUSION This new therapeutic approach merits further attention in clinical research but cannot be recommended for routine practice before more high-level evidence is available.
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185
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Breen CM, Riazat MI, McCallion N, Boyle MA. Congenital hypofibrinogenaemia: a presymptomatic detection of an extremely rare bleeding disorder in preterm twins. BMJ Case Rep 2017; 2017:bcr-2017-219332. [PMID: 28583924 PMCID: PMC5534860 DOI: 10.1136/bcr-2017-219332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/03/2022] Open
Abstract
Twenty-eight-week-old preterm monochorionic-diamniotic twins were admitted to the neonatal intensive care unit secondary to low birth weight and mild respiratory distress syndrome. A low fibrinogen level of less than 0.5 g/L was detected following an abnormal full blood count. They required fibrinogen transfusions until 32 weeks corrected gestation to maintain adequate fibrinogen levels. Parental screening revealed that their mother had a previously undiagnosed hypofibrinogenaemia. Of note, her only symptom was menorrhagia. This may have implications on further pregnancies as it can be associated with spontaneous miscarriage and post-partum haemorrhage. Congenital hypofibrinogenaemia is a rare disorder and there are no reported cases from Ireland. A higher degree of suspicion for screening is required to detect new cases and demonstrates the benefits of checking parental levels in such situations.
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Affiliation(s)
| | | | - Naomi McCallion
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | - Michael A Boyle
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
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186
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Abstract
Preterm birth rates are rising, and many preterm infants have breathing difficulty after birth. Treatments for infants with prolonged breathing difficulty include oxygen therapy, exogenous surfactant, various modes of respiratory support, and postnatal corticosteroids. In this Series paper, we review the history of neonatal respiratory care and its effect on long-term outcomes, and we outline the future direction of the research field. The delivery and monitoring of oxygen therapy remains controversial, despite being in use for more than 50 years. Exogenous surfactant replacement has been used for 25 years and has dramatically reduced mortality and morbidity, but more research on when and how it is administered is needed. Methods and techniques of neonatal respiratory support are evolving. Clinicians are moving away from routine intubation and ventilation, and new modes of non-invasive support are being investigated. Postnatal corticosteroids have a limited role in infants with evolving bronchopulmonary dysplasia, but more research is needed to identify the best timing, type, dose, and method of administration. Despite advances in neonatal care in the past 50 years, bronchopulmonary dysplasia, with all its adverse short-term and long-term consequences, is still a serious problem in neonatal care. The challenge remains to support breathing in preterm infants, with special attention to risk factors in the subpopulation of infants that are at highest risk of bronchopulmonary dysplasia, without damaging their lungs or adversely affecting their long-term health.
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Affiliation(s)
- Louise S Owen
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
| | - Brett J Manley
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Peter G Davis
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Lex W Doyle
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
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187
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Shin J, Park K, Lee EH, Choi BM. Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as an Initial Respiratory Support in Preterm Infants with Respiratory Distress: a Randomized, Controlled Non-Inferiority Trial. J Korean Med Sci 2017; 32:650-655. [PMID: 28244292 PMCID: PMC5334164 DOI: 10.3346/jkms.2017.32.4.650] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/07/2017] [Indexed: 11/20/2022] Open
Abstract
Heated, humidified, high-flow nasal cannula (HHFNC) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress. But there are limited studies that compares HHFNC with nasal continuous positive airway pressure (nCPAP) only as the initial treatment of respiratory distress in preterm infants immediately after birth. The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress. Preterm infants at between 30 and 35 weeks of gestational age were randomized to HHFNC or nCPAP when they showed respiratory distress in less than 24 hours of age postnatally. Preterm infants who needed invasive respiratory supports were excluded. Primary outcome was the incidence of treatment failure (defined as need for the intubation or mechanical ventilation). Eighty-five infants were analyzed. Sixteen of 42 infants randomized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP (Risk difference 17.17 [-1.90-36.23]; P = 0.099). In terms of the reason for treatment failure, the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group (P = 0.020). There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications. Although HHFNC is safe compared to nCPAP, it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress.
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Affiliation(s)
- Jeonghee Shin
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | | | - Eun Hee Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
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188
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Unal S, Aktas S, Aksu M, Hirfanoglu IM, Atalay Y, Turkyilmaz C. Iloprost Instillation in Two Neonates with Pulmonary Hypertension. J Coll Physicians Surg Pak 2017; 27:257-259. [PMID: 28492159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 01/16/2017] [Indexed: 06/07/2023]
Abstract
Pulmonary hypertension may coexist with certain diseases in neonates. Iloprost inhalation is one of the treatments which cause selective pulmonary vasodilatation. Inhalation is not an easy way of drug administration in mechanically ventilated infants; as some exhibit desaturations during inhalation. Moreover, inhalation of drug requires cessation of mechanical ventilation, if patient is on high frequency oscillatory ventilation. We presented two patients with pulmonary hypertension; term baby with congenital diaphragmatic hernia and preterm baby with respiratory distress syndrome; who had iloprost instillation during mechanical ventilation treatment. Iloprost instillation was well tolerated with no side effects in the term patient with diaphragmatic hernia; whereas severe blood pressure fluctuations were observed in the preterm infant. This report may courage administration of iloprost in term neonates with resistant pulmonary hypertension.
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MESH Headings
- Administration, Inhalation
- Female
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/etiology
- Iloprost/administration & dosage
- Iloprost/therapeutic use
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/etiology
- Infant, Very Low Birth Weight
- Male
- Respiratory Distress Syndrome, Newborn/complications
- Respiratory Distress Syndrome, Newborn/therapy
- Treatment Outcome
- Vasodilator Agents/administration & dosage
- Vasodilator Agents/therapeutic use
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Affiliation(s)
- Sezin Unal
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Selma Aktas
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Meltem Aksu
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Ibrahim M Hirfanoglu
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Yildiz Atalay
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Canan Turkyilmaz
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
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189
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Dute J. European Court of Human Rights. Eur J Health Law 2017; 24:199-220. [PMID: 29210261 DOI: 10.1163/15718093-12423507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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190
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Soonsawad S, Swatesutipun B, Limrungsikul A, Nuntnarumit P. Heated Humidified High-Flow Nasal Cannula for Prevention of Extubation Failure in Preterm Infants. Indian J Pediatr 2017; 84:262-266. [PMID: 28054235 DOI: 10.1007/s12098-016-2280-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/14/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare extubation failure rate between the heated humidified high-flow nasal cannula (HHHFNC) and continuous positive airway pressure (CPAP) groups. METHODS Intubated infants with gestational age (GA) <32 wk, who were ready to extubate, were randomized to receive respiratory support with either CPAP or HHHFNC after extubation. In CPAP group, nasal mask CPAP with preset pressure and fraction of inspired oxygen (FiO2) equal to positive end-expiratory pressure (PEEP) and FiO2 of ventilator before extubation was applied. In the HHHFNC group, predefined flow rate according to the protocol was applied. Primary outcome was extubation failure within 72 h after endotracheal tube removal. RESULTS Forty-nine infants were enrolled; 24 in the HHHFNC and 25 in the CPAP group. Baseline demographic and respiratory conditions before extubation were similar. There was no difference in infants who met failed extubation criteria between the two groups [8 (33%) in HHHFNC vs. 6 (24%) in CPAP group (p = 0.47)]. However, 6 infants (75%) in HHHFNC and 4 infants (66%) in CPAP group who met failed extubation criteria could be rescued by bilevel CPAP. Therefore, the reintubation rate was comparable [2 infants (8.3%) in HHHFNC vs. 2 infants (8%) in CPAP group]. Morbidities or related complications were not different but infants in the HHHFNC group had significantly less nasal trauma (16.7% vs. 44%; p = 0.03). CONCLUSIONS In the index study, the extubation failure rate was not statistically different between infants who were on HHHFNC or CPAP support.
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Affiliation(s)
- Sasivimon Soonsawad
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Buranee Swatesutipun
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Anchalee Limrungsikul
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pracha Nuntnarumit
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
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191
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Janjindamai W, Pasee S, Thatrimontrichai A. The Optimal Predictors of Readiness for Extubation in Low Birth Weight Infants. J Med Assoc Thai 2017; 100:427-434. [PMID: 29911842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Reintubation, following an unsuccessful extubation from mechanical ventilation is traumatic to the infant and the family. However, 20 to 40% of infants fail extubation and reintubation. OBJECTIVE Determine the optimal predictors of readiness for extubation in low birth weight infants during endotracheal tubecontinuous positive airway pressure (ET CPAP) for three minutes. The primary outcome was reintubation within 72 hours of extubation and the secondary outcomes were the causes and risk factors of reintubation. MATERIAL AND METHOD A prospective cohort study was undertaken in 51 mechanically ventilated infants who were considered to be ready for extubation. The infants were changed to ET CPAP for a 3-minute spontaneous breathing test (SBT) before extubated. Infants were divided into two groups based upon whether they failed or passed the extubation attempt. Extubation failure was defined as reintubation within 72 hours of extubatio RESULTS Forty-five of 51 infants (88%) were successfully extubated. Out of the 51 infants only one infant failed the SBT. The three predictors of extubation success that included the SBT, ratio of minute ventilation during ET CPAP to mechanical ventilation and ratio of respiratory frequency during ET CPAP to mechanical ventilation were not significantly different. Using synchronized nasal intermittent positive pressure ventilation after extubation in the failed extubation group was significantly higher than the successful extubation group (66.7% vs. 15.7%, p = 0.02). CONCLUSION The SBT and minute ventilation ratio in low birth weight infants were not optimal predictors of readiness for extubation. However, a further prospective study in this field with a larger number of subjects and a proper indication for extubation should be considered.
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192
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Gondwe MJ, Gombachika B, Majamanda MD. Experiences of caregivers of infants who have been on bubble continuous positive airway pressure at Queen Elizabeth Central Hospital, Malawi: A descriptive qualitative study. Malawi Med J 2017; 29:10-15. [PMID: 28567190 PMCID: PMC5442485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND An innovative, low-cost bubble continuous positive airway pressure (bCPAP) device has recently been introduced in Malawi for the treatment of respiratory distress in infants. While this novel bCPAP system has been shown to be safe and effective in reducing infant mortality, caregivers' experiences have not been investigated. The purpose of this study was to explore experiences of parents and guardians of infants who had been on bCPAP at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. METHODS This was a descriptive phenomenological study that was carried out at the Chatinkha nursery unit and the paediatric nursery ward at QECH, from January to February 2015. Purposive sampling was used to select participants for in-depth interviews. Data saturation was reached with 12 caregivers. Data were analysed using Colaizzi's framework. RESULTS Caregivers received inadequate, inconsistent, and sporadic information about bCPAP. Student nurses and doctors were best able to answer caregivers' questions and concerns. When their infants were on bCPAP, caregivers felt anxious and fearful. However, upon implementation of bCPAP treatment for their children, the caregivers were satisfied with it. The main sources of psychological stress were limited parent-child interaction and the constraints of prescribed visiting hours. Family, friends, and caregiver involvement in the care of infants provided some psychological comfort. CONCLUSIONS The results show gaps in the information and psychological support that mothers of infants on bCPAP receive in hospital. We recommend that psychological support be given to the mothers of infants on bCPAP at QECH.
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Affiliation(s)
- Mtisunge Joshua Gondwe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Belinda Gombachika
- Department of Medical/Surgical Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi
| | - Maureen D Majamanda
- Department of Medical/Surgical Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi
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193
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Wu J, Zhai J, Jiang H, Sun Y, Jin B, Zhang Y, Zhou B. Effect of Change of Mechanical Ventilation Position on the Treatment of Neonatal Respiratory Failure. Cell Biochem Biophys 2017; 72:845-9. [PMID: 25647746 DOI: 10.1007/s12013-015-0547-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim of the study was to evaluate the effect of different ventilation positions in newborn infants with respiratory failure. A total of 67 newborn infant cases with respiratory failure were treated in neonatal intensive care unit of Xuzhou Central Hospital from February 2012 to August 2013. These infants were randomly divided into supine group (n = 33) and different position group (n = 34). Supine position for 4 h and prone position for 4 h were alternated in different position group. The results for 8 and 16 h ventilator parameters: oxygenation index OI (OI = PaO2/FiO2), the lung mechanics parameters, ventilator weaning time, arterial carbon dioxide partial pressure (PaCO2), and arterial oxygen tension (PaO2) after 1 h of ventilator weaning were recorded and compared. PaO2 in the different position ventilation groups for 8 h (65.29 ± 7.62 mm Hg) and 16 h (67.52 ± 9.31 mm Hg) were correspondingly higher than PaO2 at 8 h (60.13 ± 8.95 mm Hg) and 16 h (62.22 ± 10.83 mm Hg) in the supine position ventilation group, and the difference was statistically significant (P < 0.05), whereas OI at 8 h (166.95 ± 25.27 mm Hg) and 16 h (169.59 ± 20.28 mm Hg) in the former group was correspondingly higher than the OI at 8 h (150.16 ± 20.51 mm Hg) and 16 h (152.23 ± 22.45 mm Hg) in the latter group, and the difference was statistically significant (P < 0.05). The ventilator weaning time of the two groups and the change in the PaCO2 and PaO2, an hour after ventilator weaning was very similar and the difference was not statistically significant (P > 0.05). The symptoms of respiratory failure and oxygenation can be effectively improved in the newborn infants with different ventilation positions compared to traditional supine position.
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Affiliation(s)
- Jiebin Wu
- Department of Pediatrics, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Jingfang Zhai
- Obstetrical Department, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Hongxia Jiang
- Department of Pediatrics, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Yingjun Sun
- Department of Pediatrics, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Bao Jin
- Department of Pediatrics, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Yanyan Zhang
- Department of Pediatrics, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Bin Zhou
- Department of Pediatrics, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China.
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194
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Abd El-Fattah N, Nasef N, Al-Harrass MF, Khashaba M. Sustained lung inflation at birth for preterm infants at risk of respiratory distress syndrome: The proper pressure and duration. J Neonatal Perinatal Med 2017; 10:409-417. [PMID: 29286940 DOI: 10.3233/npm-171760] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Variations exist among the administered pressure and duration of sustained lung inflation (SLI) in the delivery room (DR). We aimed to evaluate the appropriate pressure and duration needed for SLI in preterm infants with respiratory distress syndrome. METHODS We prospectively randomized 100 preterm (<32 weeks) infants to receive either conventional therapy of continuous positive airway pressure (CPAP) at 5 cm H2O, or four groups of CPAP plus a single maneuver of SLI at four regimens based on administered pressures and durations; P20D20 (Pressure of 20 cm H2O for a duration of 20 seconds), P20D10 (20 cm H2O for 10 seconds), P15D20 (15 cm H2O for 20 seconds), and P15D10 (15 cm H2O for 10 seconds) using a T-piece ventilator. The primary outcome was the need for endotracheal intubation (ETT) in the DR. Broncho-alveolar lavage (BAL) was obtained from intubated infants for interleukin-10 (IL-10) assessment. RESULTS SLI decreased the need for ETT in the DR (21% versus 55%, p < 0.01) compared to conventional therapy. ETT requirement was significantly lower in P20D10 (20%), P15D20 (20%), and P15D10 (20%) groups, but not P20D20 (25%) compared to the conventional group (55%, p < 0.05). Group P20D20 had significant higher BAL levels of IL-10 [713.8 (IQR 611-874) versus 535.4 (IQR 480-563) pg/ml, p < 0.05] compared to the conventional group, and to other SLI groups. Pneumothorax was not significantly different among studied groups. CONCLUSION SLI for a pressure and duration ≥20 cm H2O for 20 seconds is not superior to lower pressures for shorter duration and may be injurious to lungs.
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Affiliation(s)
- N Abd El-Fattah
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
| | - N Nasef
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - M F Al-Harrass
- Department of Clinical Pathology, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mohammed Khashaba
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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195
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Abstract
In the last 4 decades, advances in neonatology have led to a significant increase in the survival of preterm infants. One of the biggest advances was the introduction of surfactant replacement therapy for the treatment of respiratory distress syndrome. This is the main cause of respiratory insufficiency in preterm infants and is one of the major causes of perinatal morbidity and mortality. Surfactant replacement therapy is already a well-investigated and established therapy in neonatology. However, surfactant replacement therapy has progressed and been refined over recent decades, especially with the increasing care for preterm infants born before 26 weeks' gestational age and the recent clinical focus on avoiding mechanical ventilation. Clinical evidence is evolving on new types of surfactant, surfactant dosages, co-medication given before, with, or after surfactant replacement, and new technical advances regarding the mode of administration.
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Affiliation(s)
- H.J. Niemarkt
- Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands
| | - M.C. Hütten
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Boris W. Kramer
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
- *Prof. Boris W. Kramer, Department of Pediatrics, Maastricht University Medical Center, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
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196
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Al-Hathlol K, Bin Saleem N, Khawaji M, Al Saif S, Abdelhakim I, Al-Hathlol B, Bazbouz E, Al Anzi Q, Al-Essa A. Early extubation failure in very low birth weight infants: Clinical outcomes and predictive factors. J Neonatal Perinatal Med 2017; 10:163-169. [PMID: 28409751 DOI: 10.3233/npm-171647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify the clinical outcomes and the potential predictive factors of early extubation failure (EEF) in very low birth weight (VLBW) infants. METHODS A retrospective study of VLBW infants admitted to the neonatal intensive care unit (NICU) over fifteen years. Neonates were intubated and mechanically ventilated on the first day of life, and early extubated within the first 3 days. EEF was defined as the need for re-intubation within 3 days of the first extubation. A composite outcome of mortality or any major morbidity (grade 3-4 intraventricular hemorrhage or periventricular leukomalacia; stage 3-4 retinopathy of prematurity, moderate-severe bronchopulmonary dysplasia or stage 2-3 necrotizing enterocolitis) was assessed. RESULTS In total, 394 infants were extubated early. Of those, 347 (88%) had early extubation success (EES), whereas 47 (12%) had EEF. Incidence of the composite outcome was significantly higher in the EEF group than the EES group, even after adjusting for confounding factors. Logistic regression indicated that birth weight < 1000 g (p < 0.01), administration of≥2 doses of surfactant (p < 0.01) and administration of≥2 inotropic agents (p < 0.01) were all significantly associated with EEF. The area under the curve (AUC) for the combination of these three factors (AUC = 0.77) indicated significantly higher predictive value (p < 0.01) for EEF in VLBW infants, compared with individual factors (AUC = 0.59 for≥2 inotropic agents, AUC = 0.64 for birth weight≤1000 g and AUC = 0.66 for≥2 doses of surfactant). CONCLUSION EEF is associated with poor clinical outcomes in VLBW infants. The combination of birth weight and the requirement for surfactants and inotropic agents can predict EEF.
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MESH Headings
- Airway Extubation/adverse effects
- Airway Extubation/methods
- Female
- Humans
- Infant, Newborn
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal
- Intubation, Intratracheal/adverse effects
- Intubation, Intratracheal/methods
- Male
- Outcome Assessment, Health Care
- Pulmonary Surfactants/therapeutic use
- Respiration, Artificial/adverse effects
- Respiration, Artificial/methods
- Respiratory Distress Syndrome, Newborn/physiopathology
- Respiratory Distress Syndrome, Newborn/therapy
- Retrospective Studies
- Saudi Arabia
- Treatment Failure
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197
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Abstract
OBJECTIVE To assess the association between delivery room (DR) continuous positive airway pressure (CPAP) and pneumothorax (PT) in term newborns. METHODS Two studies performed in community hospitals used data extracted from computerized records of term newborns. Infants receiving positive pressure ventilation in the DR were excluded. Tabulated data included receipt of DR CPAP, PT on the day of birth, and gestational age (GA). In a case-control study from 2001-2013, infants with PT were compared to controls without PT but with respiratory distress or hypoxia persisting from birth for receipt of DR CPAP. In a cohort study from 2014-2016, infants receiving and not receiving DR CPAP were compared for the incidence of PT. RESULTS In the case-control study, data were obtained for 169 cases and 850 controls. Compared to controls, PT infants were more likely to have received DR CPAP (16.8% vs. 40.2%, respectively, P < 0.001). Logistic regression revealed DR CPAP (Adjusted Odds Ratio [AOR] = 3.30, 95% confidence interval [CI] = 2.31, 4.72, P < 0.001) and GA (AOR = 1.21, 95% CI = 1.05, 1.39, P = 0.009) to be independent predictors of early PT.In the cohort study, PT was observed in 0.1% of 9255 control infants not receiving DR CPAP and 4.8% of 228 infants receiving DR CPAP (P < 0.001). In logistic regression analyses, DR CPAP significantly predicted PT (OR = 59.59, 95% CI = 23.34, 147.12, P < 0.001) and remained a significant predictor of PT after controlling for gestational age. CONCLUSION Respiratory conditions treated with CPAP in delivery rooms are associated with increased risk of PT. A cause-and-effect relationship between CPAP and PT cannot be claimed in this study. Further research is needed to better understand this relationship.
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Affiliation(s)
- L Clevenger
- Saint Joseph Hospital, Denver, CO, USA
- Good Samaritan Hospital, Lafayette, CO, USA
| | - J R Britton
- Saint Joseph Hospital, Denver, CO, USA
- Good Samaritan Hospital, Lafayette, CO, USA
- Colorado Permanente Medical Group, Denver, CO, USA
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198
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Lemyre B, Laughon M, Bose C, Davis PG. Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants. Cochrane Database Syst Rev 2016; 12:CD005384. [PMID: 27976361 PMCID: PMC6463790 DOI: 10.1002/14651858.cd005384.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nasal continuous positive airway pressure (NCPAP) is a strategy for maintaining positive airway pressure throughout the respiratory cycle through the application of bias flow of respiratory gas to an apparatus attached to the nose. Treatment with NCPAP is associated with decreased risk of mechanical ventilation and might be effective in reducing chronic lung disease. Nasal intermittent positive pressure ventilation (NIPPV) is a form of noninvasive ventilation during which patients are exposed intermittently to higher levels of airway pressure, along with NCPAP through the same nasal device. OBJECTIVES To examine the risks and benefits of early NIPPV versus early NCPAP alone for preterm infants at risk of or in respiratory distress within the first hours after birth.Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints include chronic lung disease (CLD) (oxygen therapy at 36 weeks' postmenstrual age), air leaks, duration of respiratory support, duration of oxygen therapy, intraventricular hemorrhage, and incidence of mortality. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9), MEDLINE via PubMed (1966 to September 28, 2015), Embase (1980 to September 28, 2015), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to September 28, 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. A member of the Cochrane Neonatal Review Group handsearched abstracts from the European Society of Pediatric Research (ESPR). We contacted the authors of ongoing clinical trials to ask for information. SELECTION CRITERIA We considered all randomized and quasi-randomized controlled trials. Studies selected compared NIPPV versus NCPAP treatment, starting at birth or shortly thereafter in preterm infants (< 37 weeks' gestational age). DATA COLLECTION AND ANALYSIS We performed data collection and analysis using the recommendations of the Cochrane Neonatal Review Group. MAIN RESULTS Ten trials, enrolling a total of 1061 infants, met criteria for inclusion in this review. Meta-analyses of these studies showed significantly reduced risk of meeting respiratory failure criteria (typical risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; typical risk difference (RD) -0.09, 95% CI -0.13 to -0.04) and needing intubation (typical RR 0.78, 95% CI 0.64 to 0.94; typical RD -0.07, 95% CI -0.12 to -0.02) among infants treated with early NIPPV compared with early NCPAP. The meta-analysis did not demonstrate a reduction in the risk of CLD among infants randomized to NIPPV (typical RR 0.78, 95% CI 0.58 to 1.06). Investigators observed no evidence of harm. Review authors graded the quality of the evidence as moderate (unblinded studies). AUTHORS' CONCLUSIONS Early NIPPV does appear to be superior to NCPAP alone for decreasing respiratory failure and the need for intubation and endotracheal tube ventilation among preterm infants with respiratory distress syndrome. Additional studies are needed to confirm these results and to assess the safety of NIPPV compared with NCPAP alone in a larger patient population.
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Affiliation(s)
- Brigitte Lemyre
- Children's Hospital of Eastern OntarioDivision of Neonatology401 Smyth RoadOttawaONCanadaKlH 8L1
| | - Matthew Laughon
- The University of North Carolina at Chapel HillDepartment of Pediatrics, Division of Neonatal‐Perinatal MedicineCB# 75964th Floor, UNC HospitalsChapel HillNorth CarolinaUSA27599
| | - Carl Bose
- The University of North Carolina at Chapel HillDepartment of Pediatrics, Division of Neonatal‐Perinatal MedicineCB# 75964th Floor, UNC HospitalsChapel HillNorth CarolinaUSA27599
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199
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Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol 2016; 43:693-705. [PMID: 27837753 DOI: 10.1016/j.clp.2016.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nasal high-flow therapy (nHFT) has become a popular form of noninvasive respiratory support in neonatal intensive care units. A meeting held in Oxford, UK, in June 2015 examined the evidence base and proposed a consensus statement. In summary, nHFT is effective for support of preterm infants following extubation. There is growing evidence evaluating its use in the primary treatment of respiratory distress. Further study is needed to assess which clinical conditions are most amenable to nHFT support, the most effective flow rates, and escalation and weaning strategies. Its suitability as first-line treatment needs to be further evaluated.
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Affiliation(s)
- Charles C Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK; Department of Neonatology, Charitè University Medical School, Charitéplatz 1, Berlin 10117, Germany.
| | - Bradley A Yoder
- Division of Neonatology, University of Utah School of Medicine, Williams Building 295, Chipeta Way, Salt Lake City, UT 84108, USA
| | - Peter G Davis
- Neonatal Research, The Royal Women's Hospital, Locked Bag 300, Cnr Grattan Street & Flemington Road, Parkville, Victoria 3052, Australia
| | - Kevin Ives
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK
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Welty SE. Continuous Positive Airway Pressure Strategies with Bubble Nasal Continuous Positive Airway Pressure: Not All Bubbling Is the Same: The Seattle Positive Airway Pressure System. Clin Perinatol 2016; 43:661-671. [PMID: 27837751 DOI: 10.1016/j.clp.2016.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Premature neonates are predisposed to complications, including bronchopulmonary dysplasia (BPD). BPD is associated with long-term pulmonary and neurodevelopmental consequences. Noninvasive respiratory support with nasal continuous positive airway pressure (CPAP) has been recommended strongly by the American Academy of Pediatrics. However, CPAP implementation has shown at least a 50% failure rate. Enhancing nasal CPAP effectiveness may decrease the need for mechanical ventilation and reduce the incidence of BPD. Bubble nasal CPAP is better than nasal CPAP using mechanical devices and the bubbling provides air exchange in distal respiratory units. The Seattle PAP system reduces parameters that assess work of breathing.
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Affiliation(s)
- Stephen E Welty
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, W1604, Houston, TX 77030, USA.
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