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Espíndola CS, Lopes YK, Ferreira GS, Cordeiro EC, Pereira SA, Montemezzo D. Predictive model development for premature infant extubation outcomes: development and analysis. Pediatr Res 2024:10.1038/s41390-024-03643-0. [PMID: 39438711 DOI: 10.1038/s41390-024-03643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 09/05/2024] [Accepted: 09/12/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Given the knowledge of the damage caused by prolonged invasive mechanical ventilation in premature newborns, withdrawing this support as quickly as possible is important to minimize morbidity. The aim of this study was to analyze the variables associated with extubation outcomes and to develop a predictive model for successful extubation in premature newborns. METHODS Data were obtained from a multicenter study involving six public maternity hospitals. The variables with the highest correlation to the extubation outcome were used to construct the predictive model through data analysis and machine learning methods, followed by training and testing of algorithms. RESULTS Data were collected from 405 premature newborns. The predictive model with the best metrics was trained and tested using the variables of gestational age, birth weight, weight at extubation, congenital infections, and time on invasive mechanical ventilation, based on 393 samples according to the extubation outcome (12 were discarded due to irretrievable missing data in important attributes). The model exhibited an accuracy of 77.78%, sensitivity of 79.41%, and specificity of 60%. CONCLUSION These variables generated a predictive model capable of estimating the probability of successful extubation in premature newborns. IMPACT Prolonged use of invasive mechanical ventilation in preterm newborns increases morbidity/mortality rates, emphasizing the importance of early withdrawal from invasive ventilatory support. However, the decision to extubate lacks tools with higher extubation outcome precision. The use of artificial intelligence through the construction of a predictive model can assist in the decision-making process for extubating preterm newborns based on real-world data. The implementation of this tool can optimize the decision to extubate preterm newborns, promoting successful extubation and reducing preterm newborns exposure to adverse events associated with extubation failure.
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Affiliation(s)
- Camila S Espíndola
- Master of Physiotherapy - Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Yuri K Lopes
- Department of Computer Science and faculty member of the Graduate Program in Applied Computing - Santa Catarina State University, Joinville, Santa Catarina, Brazil
| | - Grasiela S Ferreira
- Bachelor's Degree in Computer Science and Postgraduate student of the Graduate Program in Applied Computing - Santa Catarina State University, Joinville, Santa Catarina, Brazil
| | - Emanuella C Cordeiro
- Master of Physiotherapy - Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Silvana A Pereira
- Department of Physiotherapy and faculty member of the Graduate Program in Physiotherapy - Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Dayane Montemezzo
- Department of Physiotherapy and faculty member of the Graduate Program in Physiotherapy - Santa Catarina State University, Florianópolis, Santa Catarina, Brazil.
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Khalid L, Al-Balushi S, Manoj N, Rather S, Johnson H, Strauss L, Dutta S, Mukerji A. Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study. Am J Perinatol 2024; 41:e664-e670. [PMID: 35977710 DOI: 10.1055/a-1925-8643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether the initial pressure level on high continuous positive airway pressure (CPAP; ≥9 cm H2O), in relation to preextubation mean airway pressure (Paw), influences short-term clinical outcomes in preterm neonates. STUDY DESIGN In this retrospective cohort study, preterm neonates <29 weeks' gestational age (GA) extubated from mean Paw ≥9 cm H2O and to high CPAP (≥9 cm H2O) were classified into "higher level CPAP" (2-3 cm H2O higher than preextubation Paw) and "equivalent CPAP" (-1 to +1 cm H2O in relation to preextubation Paw). Only the first eligible extubation per infant was analyzed. The primary outcome was failure within ≤7 days of extubation, defined as any one or more of (1) need for reintubation, (2) escalation to an alternate noninvasive respiratory support mode, or (3) use of CPAP >preextubation Paw + 3 cm H2O. Secondary outcomes included individual components of the primary outcome, along with other clinical and safety outcomes. RESULTS Over a 10-year period (Jan 2011-Dec 2020), 175 infants were extubated from mean Paw >9 cm H2O to high CPAP pressures. Twenty-seven patients (median GA = 24.7, [interquartile range (IQR)]: (24.0-26.4) weeks and chronological age = 31, IQR: [21-40] days) were classified into the "higher level CPAP" group while 148 infants (median GA = 25.4, IQR: [24.6-26.6] weeks and chronological age = 26, IQR: [10-39] days) comprised the "equivalent CPAP" group. There was no difference in the primary outcome (44 vs. 51%; p = 0.51), including postadjustment for confounders (adjusted OR [aOR] = 0.47 [95% confidence interval (CI): 0.17-1.29; p = 0.14]). However, reintubation risk within 7 days was lower with higher level CPAP (7 vs. 37%; p < 0.01), including postadjustment (aOR = 0.07; 95% CI: 0.02-0.35; p < 0.01). CONCLUSION In this cohort, use of initial distending CPAP pressures 2 to 3 cm H2O higher than preextubation Paw did not alter the primary outcome of failure but did lower the risk of reintubation. The latter is an interesting hypothesis-generating finding that requires further confirmation. KEY POINTS · Use of high CPAP pressures (≥9 cm H2O) is gradually increasing in the care of preterm neonates.. · This study compares higher level versus equivalent CPAP in relation to preextubation Paw.. · The findings demonstrate no difference in failure as defined with use of higher level CPAP pressures..
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Affiliation(s)
- Lana Khalid
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Said Al-Balushi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nandita Manoj
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sufyan Rather
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather Johnson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Laura Strauss
- Department of Respiratory Therapy, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Nagaraj YK, Balushi SA, Robb C, Uppal N, Dutta S, Mukerji A. Peri-extubation settings in preterm neonates: a systematic review and meta-analysis. J Perinatol 2024; 44:257-265. [PMID: 38216677 DOI: 10.1038/s41372-024-01870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To systematically review: 1) peri-extubation settings; and 2) association between peri-extubation settings and outcomes in preterm neonates. STUDY DESIGN In this systematic review, studies were eligible if they reported patient-data on peri-extubation settings (objective 1) and/or evaluated peri-extubation levels in relation to clinical outcomes (objective 2). Data were meta-analyzed when appropriate using random-effects model. RESULTS Of 9681 titles, 376 full-texts were reviewed and 101 included. The pooled means of peri-extubation settings were summarized. For objective 2, three experimental studies were identified comparing post-extubation CPAP levels. Meta-analyses revealed lower odds for treatment failure [pooled OR 0.46 (95% CI 0.27-0.76); 3 studies, 255 participants] but not for re-intubation [pooled OR 0.66 (0.22-1.97); 3 studies, 255 participants] with higher vs. lower CPAP. CONCLUSIONS Summary of peri-extubation settings may guide clinicians in their own practices. Higher CPAP levels may reduce extubation failure, but more data on peri-extubation settings that optimize outcomes are needed.
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Affiliation(s)
| | | | - Courtney Robb
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nikhil Uppal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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Hoffman SB, Govindan RB, Johnston EK, Williams J, Schlatterer SD, du Plessis AJ. Autonomic markers of extubation readiness in premature infants. Pediatr Res 2023; 93:911-917. [PMID: 36400925 DOI: 10.1038/s41390-022-02397-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In premature infants, extubation failure is common and difficult to predict. Heart rate variability (HRV) is a marker of autonomic tone. Our aim is to test the hypothesis that autonomic impairment is associated with extubation readiness. METHODS Retrospective study of 89 infants <28 weeks. HRV metrics 24 h prior to extubation were compared for those with and without extubation success within 72 h. Receiver-operating curve analysis was conducted to determine the predictive ability of each metric, and a predictive model was created. RESULTS Seventy-three percent were successfully extubated. The success group had significantly lower oxygen requirement, higher sympathetic HRV metrics, and a lower parasympathetic HRV metric. α1 (measure of autocorrelation, related to sympathetic tone) was the best predictor of success-area under the curve (AUC) of .73 (p = 0.001), and incorporated into a predictive model had an AUC of 0.81 (p < 0.0001)-sensitivity of 81% and specificity of 78%. CONCLUSIONS Extubation success is associated with HRV. We show an autonomic imbalance with low sympathetic and elevated parasympathetic tone in those who failed. α1, a marker of sympathetic tone, was noted to be the best predictor of extubation success especially when incorporated into a clinical model. IMPACT This article depicts autonomic markers predictive of extubation success. We depict an autonomic imbalance in those who fail extubation with heightened parasympathetic and blunted sympathetic signal. We describe a predictive model for extubation success with a sensitivity of 81% and specificity of 78%.
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Affiliation(s)
- Suma B Hoffman
- Division of Neonatology, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Rathinaswamy B Govindan
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
| | - Elena K Johnston
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Sarah D Schlatterer
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adre J du Plessis
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Mohsen N, Nasef N, Ghanem M, Yeung T, Deekonda V, Ma C, Kajal D, Baczynski M, Jain A, Mohamed A. Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study. Pediatr Pulmonol 2023; 58:530-539. [PMID: 36324211 DOI: 10.1002/ppul.26223] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chest ultrasound has emerged as a promising tool in predicting extubation readiness in adults and children, yet its utility in preterm infants is lacking. Our aim was to assess the utility of lung ultrasound severity score (LUSS) and diaphragmatic function in predicting extubation readiness in extremely preterm infants. STUDY DESIGN In this prospective cohort study, preterm infants < 28 weeks gestational age (GA) who received invasive mechanical ventilation for ≥12 h were enrolled. Chest ultrasound was performed before extubation. The primary outcome was lung ultrasound accuracy for predicting successful extubation at 3 days. Descriptive statistics and logistic regression were done using SPSS version 22. RESULTS We enrolled 45 infants, of whom 36 (80%) were successfully extubated. GA and postmenstrual age (PMA) at extubation were significantly higher in the successful group. The LUSS was significantly lower in the successful group compared to failed group (11.9 ± 3.2 vs. 19.1 ± 3.1 p < 0.001). The two groups had no statistically significant difference in diaphragmatic excursion or diaphragmatic thickness fraction. Logistic regression analysis controlling for GA and PMA at extubation showed LUSS was an independent predictor for successful extubation (odd ratio 0.46, 95% confidence interval [0.23-0.9], p = 0.02). The area under the receiver operating characteristic curve was 0.95 (p ˂ 0.001) for LUSS, and a cut-off value of ≥15 had 95% sensitivity and 85% specificity in detecting extubation failure. CONCLUSION In extremely preterm infants, lung ultrasound has good accuracy for predicting successful extubation. However, diaphragmatic measurements were not reliable predictors.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Telford Yeung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, Ontario, Canada
| | | | - Carmen Ma
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
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Shalish W, Keszler M, Kovacs L, Chawla S, Latremouille S, Beltempo M, Kearney RE, Sant'Anna GM. Age at First Extubation Attempt and Death or Respiratory Morbidities in Extremely Preterm Infants. J Pediatr 2023; 252:124-130.e3. [PMID: 36027982 DOI: 10.1016/j.jpeds.2022.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the timing of first extubation in extremely preterm infants and explore the relationship between age at first extubation, extubation outcome, and death or respiratory morbidities. STUDY DESIGN In this subanalysis of a multicenter observational study, infants with birth weights of 1250 g or less and intubated within 24 hours of birth were included. After describing the timing of first extubation, age at extubation was divided into early (within 7 days from birth) vs late (days of life 8-35), and extubation outcome was divided into success vs failure (reintubation within 7 days after extubation), to create 4 extubation groups: early success, early failure, late success, and late failure. Logistic regression analyses were performed to evaluate associations between the 4 groups and death or bronchopulmonary dysplasia, bronchopulmonary dysplasia among survivors, and durations of respiratory support and oxygen therapy. RESULTS Of the 250 infants included, 129 (52%) were extubated within 7 days, 93 (37%) between 8 and 35 days, and 28 (11%) beyond 35 days of life. There were 93, 36, 59, and 34 infants with early success, early failure, late success, and late failure, respectively. Although early success was associated with the lowest rates of respiratory morbidities, early failure was not associated with significantly different respiratory outcomes compared with late success or late failure in unadjusted and adjusted analyses. CONCLUSIONS In a contemporary cohort of extremely preterm infants, early extubation occurred in 52% of infants, and only early and successful extubation was associated with decreased respiratory morbidities. Predictors capable of promptly identifying infants with a high likelihood of early extubation success or failure are needed.
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Affiliation(s)
- Wissam Shalish
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Martin Keszler
- Division of Neonatology, Women and Infants Hospital of Rhode Island, Brown University, Providence, RI
| | - Lajos Kovacs
- Department of Neonatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sanjay Chawla
- Division of Neonatal-Perinatal Medicine, Hutzel Women's Hospital, Children's Hospital of Michigan, Central Michigan University, Wayne State University, Detroit, MI
| | - Samantha Latremouille
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Robert E Kearney
- Division of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Guilherme M Sant'Anna
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Li Z, Xue J, Guo XY, Wang F, Zhang X, Li Q, Tang JL, Ji J, Du GJ. Accuracy of the spontaneous breathing trial using a combined CPAP + PSV model to predict extubation outcomes in very preterm infants. BMC Pediatr 2022; 22:627. [PMID: 36324104 PMCID: PMC9632075 DOI: 10.1186/s12887-022-03642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Very preterm infants often require mechanical ventilation. However, objective criteria to predict the outcomes of extubation in very premature neonates remain lacking. The aim of this study was to investigate the accuracy of the spontaneous breathing trial (SBT) using a combined model of continuous positive airway pressure (CPAP) and low-level pressure support ventilation (PSV) to predict the extubation outcomes of preterm infants with gestational age < 32 weeks. Methods Preterm infants with gestational age < 32 weeks, birth weight < 1500 g and requiring mechanical ventilation were selected for the study. All infants underwent a 10-minute SBT using CPAP combined with low-level PSV prior to the planned extubation. Then, the infants were extubated within 1 h after SBT. The outcomes of extubation were considered successful if the neonates did not require reintubation 72 h after extubation. Results A total of 119 eligible preterm infants were enrolled in the study, with a median gestational age of 28.9 (27.1–30.3) weeks and a median birth weight of 1100 (900–1350) g. In total, 101 of all infants had successful extubation, 18 of whom failed and eventually had to be reintubated. Of the 102 infants who achieved SBT, 99 were successfully extubated, and 15 of the 17 infants who did not pass SBT had failed extubation. Finally, the diagnostic value for SBT could be assessed with a sensitivity of 98%, a specificity of 83.3%, a positive predictive value of 97.1% and a negative predictive value of 88.2%. Conclusion SBT using a combined CPAP + low-level PSV model can predict the outcomes of extubation in very preterm infants with high sensitivity and specificity.
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Affiliation(s)
- Zhe Li
- grid.27255.370000 0004 1761 1174Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 250033 Jinan, Shandong China
| | - Jiang Xue
- grid.27255.370000 0004 1761 1174Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 250033 Jinan, Shandong China
| | - Xin-Yuan Guo
- grid.27255.370000 0004 1761 1174Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 250033 Jinan, Shandong China
| | - Fang Wang
- grid.27255.370000 0004 1761 1174Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 250012 Jinan, Shandong China
| | - Xue Zhang
- grid.27255.370000 0004 1761 1174Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 250033 Jinan, Shandong China
| | - Qi Li
- grid.27255.370000 0004 1761 1174Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 250033 Jinan, Shandong China
| | - Jing-Liang Tang
- grid.413059.a0000 0000 9952 9510School of Ethnic Medicine, Key Laboratory of Chemistry in Ethnic Medicinal Resources, State Ethnic Affairs Commission & Ministry of Education, Yunnan Minzu University, 650500 Kunming, Yunnan, China
| | - Juan Ji
- Department of Neonatology, Feixian People’s Hospital, 273400 Feixian, Shandong China
| | - Guang-Jun Du
- grid.460018.b0000 0004 1769 9639Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021 Jinan, Shandong China
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Zong H, Huang Z, Zhao J, Lin B, Fu Y, Lin Y, Huang P, Sun H, Yang C. The Value of Lung Ultrasound Score in Neonatology. Front Pediatr 2022; 10:791664. [PMID: 35633958 PMCID: PMC9130655 DOI: 10.3389/fped.2022.791664] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/20/2022] [Indexed: 12/11/2022] Open
Abstract
Point-of-care lung ultrasound (LUS) is increasingly applied in the neonatal intensive care unit (NICU). Diagnostic applications for LUS in the NICU contain the diagnosis of many common neonatal pulmonary diseases (such as Respiratory distress syndrome, Transient tachypnea of the newborn, Meconium aspiration syndrome, Pneumonia, Pneumothorax, and Pleural effusion) which have been validated. In addition to being employed as a diagnostic tool in the classical sense of the term, recent studies have shown that the number and type of artifacts are associated with lung aeration. Based on this theory, over the last few years, LUS has also been used as a semi-quantitative method or as a "functional" tool. Scores have been proposed to monitor the progress of neonatal lung diseases and to decide whether or not to perform a specific treatment. The semi-quantitative LUS scores (LUSs) have been developed to predict the demand for surfactant therapy, the need of respiratory support and the progress of bronchopulmonary dysplasia. Given their ease of use, accuracy and lack of invasiveness, the use of LUSs is increasing in clinical practice. Therefore, this manuscript will review the application of LUSs in neonatal lung diseases.
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Affiliation(s)
- Haifeng Zong
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Zhifeng Huang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jie Zhao
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yongping Fu
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanqing Lin
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Peng Huang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Hongyan Sun
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chuanzhong Yang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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Li J, Zhang J, Hao Q, Shen Z, Du Y, Chen H, Cheng X. The Impact of Time Interval Between First Extubation and Reintubation on Bronchopulmonary Dysplasia or Death in Very Low Birth Weight Infants. Front Pediatr 2022; 10:867767. [PMID: 35547548 PMCID: PMC9085302 DOI: 10.3389/fped.2022.867767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the association between time from first extubation to reintubation and moderate-to-severe bronchopulmonary dysplasia (BPD) or death in very low birth weight infants. STUDY DESIGN Infants weighing <1,500 g at birth, requiring mechanical ventilation, and undergoing their initial extubation were retrospectively included from January 2014 to December 2021. They were divided into the moderate-to-severe BPD/death group and the comparison group according to the incidence of moderate-to-severe BPD or death. We defined time to reintubation as the time interval between first extubation and reintubation. In a stepwise multivariate logistic regression analysis, we examined the association between time to reintubation and moderate-to-severe BPD/death using different observation windows after initial extubation (24-h intervals). RESULTS A total of 244 infants were recruited, including 57 cases in the moderate-severe BPD/death group and 187 cases in the comparison group, and 93 (38.1%) cases were reintubated at least one time after their first extubation. Univariate analysis showed that reintubation rates within different observation windows in the moderate-to-severe BPD/death group were statistically significantly (p < 0.05) higher than those in the comparison group. Multivariate regression analysis showed that reintubation within observation windows 48 h or 72 h post-extubation was an independent risk factor in moderate-to-severe BPD/death and death, but not moderate-to-severe BPD. When the time window was 48 h, the probability of moderate-to-severe BPD/death [odds ratio (OR): 3.778, 95% confidence interval (CI): 1.293-11.039] or death (OR: 4.734, 95% CI: 1.158-19.354) was highest. While after extending the observation window to include reintubations after 72 h from initial extubation, reintubation was not associated with increased risk of moderate-to-severe BPD and/or death. CONCLUSIONS Not all reintubations conferred increased risks of BPD/death. Only reintubation within 72 h from initial extubation was independently associated with increased likelihood of moderate-to-severe BPD/death and death in very low birth weight infants, and reintubation within the first 48 h post-extubation posed the greatest risk.
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Affiliation(s)
- Jing Li
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Zhang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingfei Hao
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziyun Shen
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanna Du
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoming Chen
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiuyong Cheng
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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