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Farag MM, Hassan MAA, Fasseeh NAEM, Ghazal HAER. The effect of NHFOV on hemodynamics in mild and moderately preterm neonates: a randomized clinical trial. Eur J Pediatr 2024; 183:3263-3275. [PMID: 38703279 PMCID: PMC11263252 DOI: 10.1007/s00431-024-05515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study is to study cardio-respiratory effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. NCPAP as an initial mode of ventilation in moderate-late-preterm infants. A randomized controlled trial was conducted in NICU of Alexandria University Maternity Hospital (AUMH). One-hundred late-moderate-preterm infants were randomly assigned to either NHFOV-group (n = 50) or NCPAP-group (n = 50). For both groups, functional echocardiography was performed in the first 24 h to detect hemodynamic changes and respiratory outcome was monitored throughout the hospital stay. The main outcomes were hemodynamic measurements and myocardial function using functional echocardiography of those infants along with the respiratory outcome and complications. Kaplan-Meier survival plot was used representing time course of NCPAP and NHFOV failure. Left ventricular output values were not significantly different in both groups with median 202 ml/kg /min and IQR (176-275) in NCPAP-group and 226 ml/kg/min with IQR (181-286) in NHFOV group. Nevertheless, ejection fraction and fractional shortening were significantly higher in NHFOV-group with P 0.001. The time to weaning, the time to reach 30%-FIO2, the need for invasive ventilation, oxygen support duration, and maximal-FIO2 were significantly more in NCAPAP group. Conclusion: NHFOV is an effective and promising tool of non-invasive-ventilation which can be used as a primary modality of respiratory support in preterm infants with variable forms of respiratory distress syndrome without causing detrimental effect on hemodynamics or significant respiratory complications. Trial registration: NCT05706428 (registered on January 21, 2023). What is Known: • NHFOV might be beneficial as a secondary mode of ventilation and might have an impact on hemodynamics. What is New: • NHFOV can be used as an initial mode of ventilation with CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor adverse hemodynamic consequences.
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2
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Ognean ML, Bivoleanu A, Cucerea M, Galiș R, Roșca I, Surdu M, Stoicescu SM, Ramanathan R. Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units-The Results of a Recent Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:836. [PMID: 39062285 PMCID: PMC11276281 DOI: 10.3390/children11070836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). OBJECTIVES We aimed to identify the usage extent and clinical application of nHFOV in Romania. METHODS A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU's size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. RESULTS A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10-17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. CONCLUSIONS Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV.
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Affiliation(s)
- Maria Livia Ognean
- Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania;
- Neonatology Department, Clinical County Emergency Hospital, 550245 Sibiu, Romania
| | - Anca Bivoleanu
- Regional Neonatal Intensive Care Unit, Grigore T. Popa University of Medicine and Pharmacy, Cuza-Voda Clinical Hospital of Obstetrics and Gynaecology, 700038 Iasi, Romania
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania
| | - Radu Galiș
- Department of Neonatology, Emergency County Hospital Bihor, 410167 Oradea, Romania;
- Doctoral School, Poznan University of Medical Sciences, 60-512 Poznan, Poland
| | - Ioana Roșca
- Neonatology Department, Panait Sirbu Maternity Hospital, 050786 Bucharest, Romania
- Midwifery and Nursing Faculty, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Monica Surdu
- Neonatology Department, County Emergency Hospital Constanța, 900591 Constanta, Romania;
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania
| | - Silvia-Maria Stoicescu
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 010919 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Rangasamy Ramanathan
- Division of Neonatal Medicine, Cedars Sinai Guerin Children’s, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA;
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Al-lawama M, Alaraj B, Abu Zahra M, AlHasanat I, Habash H, Alhyari A, Alshajrawi L, Jaafreh S. RAM Cannula Versus Bi-Nasal Prongs as Respiratory Device Interfaces in Neonates of Thirty-Two or More Weeks of Gestation With Respiratory Distress: The First "ProRAM" Randomized Trial Report. J Clin Med Res 2024; 16:24-30. [PMID: 38327391 PMCID: PMC10846486 DOI: 10.14740/jocmr5077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
Background Using bilateral short nasal prongs as an interface for noninvasive respiratory support is challenging, and it is associated with nasal injury. We aimed to compare RAM cannula with nasal prongs in delivering noninvasive ventilation to newborn infants. Methods This is a single-center randomized trial (trial registry: ISRCTN10561691). The setting involves a tertiary neonatal unit with a capacity of 30 beds and more than 13 years of experience in neonatal noninvasive ventilation. We included 50 infants born at ≥ 32 weeks of gestation, who had respiratory distress at birth. We excluded those with major congenital anomalies and those who required intubation in the delivery room. Primary outcomes were intubation rate and use of noninvasive positive-pressure ventilation (NIPPV); other outcomes included air leak and nasal injury rate. The infants were assigned using randomly generated numbers into bi-nasal prong and RAM canula groups in a 1:1 ratio. Results Two and four babies in the RAM and prong groups, respectively, were upgraded to NIPPV (P = 0.600). One versus no baby in the RAM vs. prong groups was intubated (P = 1.000). Newborns in the prong group required oxygen support for a longer period (mean duration: 154.6 ± 255.2 h) than those in the RAM group (40.7 ± 72.6 h, P = 0.030). None of the patients in the RAM group had traumatic nasal injury compared to five babies in the prong group (P = 0.050). Four babies in our study developed air leaks, with two in each group. Conclusions The use of RAM cannula in delivering noninvasive ventilation to newborns ≥ 32 weeks of age did not affect the noninvasive ventilation failure rate or incidence of air leak. The use was associated with a shorter duration of respiratory support and a reduced risk of nasal septal injury.
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Affiliation(s)
- Manar Al-lawama
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical sciences, Yarmouk University, Irbid, Jordan
| | - Bayan Alaraj
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abu Zahra
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ibtehal AlHasanat
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan
| | - Heba Habash
- Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Sallam Jaafreh
- School of Medicine, The University of Jordan, Amman, Jordan
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4
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Kim Y, Kim H, Choi J, Cho K, Yoo D, Lee Y, Park SJ, Jeong MH, Jeong SH, Park KH, Byun SY, Kim T, Ahn SH, Cho WH, Lee N. Early prediction of need for invasive mechanical ventilation in the neonatal intensive care unit using artificial intelligence and electronic health records: a clinical study. BMC Pediatr 2023; 23:525. [PMID: 37872515 PMCID: PMC10591351 DOI: 10.1186/s12887-023-04350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Respiratory support is crucial for newborns with underdeveloped lung. The clinical outcomes of patients depend on the clinician's ability to recognize the status underlying the presented symptoms and signs. With the increasing number of high-risk infants, artificial intelligence (AI) should be considered as a tool for personalized neonatal care. Continuous monitoring of vital signs is essential in cardiorespiratory care. In this study, we developed deep learning (DL) prediction models for rapid and accurate detection of mechanical ventilation requirements in neonates using electronic health records (EHR). METHODS We utilized data from the neonatal intensive care unit in a single center, collected between March 3, 2012, and March 4, 2022, including 1,394 patient records used for model development, consisting of 505 and 889 patients with and without invasive mechanical ventilation (IMV) support, respectively. The proposed model architecture includes feature embedding using feature-wise fully connected (FC) layers, followed by three bidirectional long short-term memory (LSTM) layers. RESULTS A mean gestational age (GA) was 36.61 ± 3.25 weeks, and the mean birth weight was 2,734.01 ± 784.98 g. The IMV group had lower GA, birth weight, and longer hospitalization duration than the non-IMV group (P < 0.05). Our proposed model, tested on a dataset from March 4, 2019, to March 4, 2022. The mean AUROC of our proposed model for IMV support prediction performance demonstrated 0.861 (95%CI, 0.853-0.869). It is superior to conventional approaches, such as newborn early warning score systems (NEWS), Random Forest, and eXtreme gradient boosting (XGBoost) with 0.611 (95%CI, 0.600-0.622), 0.837 (95%CI, 0.828-0.845), and 0.0.831 (95%CI, 0.821-0.845), respectively. The highest AUPRC value is shown in the proposed model at 0.327 (95%CI, 0.308-0.347). The proposed model performed more accurate predictions as gestational age decreased. Additionally, the model exhibited the lowest alarm rate while maintaining the same sensitivity level. CONCLUSION Deep learning approaches can help accurately standardize the prediction of invasive mechanical ventilation for neonatal patients and facilitate advanced neonatal care. The results of predictive, recall, and alarm performances of the proposed model outperformed the other models.
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Affiliation(s)
- Younga Kim
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
| | | | | | | | | | | | - Su Jeong Park
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
| | - Mun Hui Jeong
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
| | - Seong Hee Jeong
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
| | - Shin-Yun Byun
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
| | - Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung-Ho Ahn
- Department of Neurology, Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Woo Hyun Cho
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Narae Lee
- Department of Pediatrics, Pusan National University School of Medicine, 20, Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea.
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Gupta R, Bandyopadhyay T, Yadav B, Guleria M, Maria A. Sonographic assessment of diaphragmatic thickness and excursion to predict CPAP failure in neonates below 34 weeks of gestation: A prospective cohort study. Pediatr Pulmonol 2023; 58:2889-2898. [PMID: 37530492 DOI: 10.1002/ppul.26608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND To evaluate the diagnostic accuracy of sonographic assessment of diaphragmatic dimensions and excursions in predicting Continuous Positive Airway Pressure (CPAP) failure in preterm neonates with respiratory distress. METHODS Prospective cohort study among preterm neonates less than 34 weeks of gestation who were hemodynamically stable and either admitted with respiratory distress or who developed respiratory distress shortly after admission to the NICU and having Silverman-Anderson Score (SAS) ≥ 3/10 were included. We performed sonographic assessment of diaphragmatic dimensions and excursions before and one hour ±30 minutes after application of CPAP. 'CPAP failure' was defined as combined outcome of the need of surfactant and/or upgradation of respiratory support within first 72 hours after a trial of CPAP. Clinical parameters and diaphragmatic measurements were compared between CPAP failure and success groups. RESULTS Of 62 participants, 20 (32%) failed CPAP. On binomial logistic regression (after adjustment for gestational age and birth weight), initial SAS, higher diaphragmatic excursion (both left and right, before and after CPAP application), lower left hemidiaphragm diaphragmatic thickness fraction (DTF) (before CPAP application) and lower right DTF (after CPAP application) were independent predictors of CPAP failure. However, the receiver-operating characteristics curves showed that excursions of right and left hemi-diaphragm both before and after CPAP application, had highest accuracies in predicting CPAP failure (AUC 0.84, 0.80 and 0.86, 0.78, respectively; p < .001). CONCLUSION Diaphragmatic excursion can be a useful parameter to predict the failure of CPAP in preterm neonates with respiratory distress.
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Affiliation(s)
- Rashi Gupta
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | | | - Bharti Yadav
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Munish Guleria
- Department of Radiodiagnosis, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
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Sahni M, Bhandari V. Invasive and non-invasive ventilatory strategies for early and evolving bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151815. [PMID: 37775369 DOI: 10.1016/j.semperi.2023.151815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
In the age of surfactant and antenatal steroids, neonatal care has improved outcomes of preterm infants dramatically. Since the early 2000's neonatologists have strived to decrease bronchopulmonary dysplasia (BPD) by decreasing ventilator-associated lung injury and utilizing many novel modes of non-invasive respiratory support. After the initial success with nasal continuous positive airway pressure, it was established that discontinuing invasive ventilation early in favor of non-invasive respiratory support is the most effective way to reduce the incidence of BPD. In this review, we discuss the management of the preterm lung from the time of delivery, through the phases of respiratory distress syndrome (early BPD) and then evolving BPD. The goal remains to optimize respiratory support of the preterm lung while minimizing ventilator-associated lung injury and oxygen toxicity. A multidisciplinary approach involving the medical team and family is quintessential in reaching this goal and involves adequate respiratory support, optimizing nutrition and fluid balance as well as preventing infections.
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Affiliation(s)
- Mitali Sahni
- Pediatrix Medical Group, Sunrise Children's Hospital, Las Vegas, NV, United States; University of Nevada, Las Vegas, NV, United States
| | - Vineet Bhandari
- Neonatology Research Laboratory (Room #206), Education and Research Building, Cooper University Hospital, Camden, NJ, United States; The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, Camden, NJ, United States.
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7
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Im JE, Park S, Kim YJ, Yoon SA, Lee JH. Predicting the need for intubation within 3 h in the neonatal intensive care unit using a multimodal deep neural network. Sci Rep 2023; 13:6213. [PMID: 37069174 PMCID: PMC10106895 DOI: 10.1038/s41598-023-33353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/12/2023] [Indexed: 04/19/2023] Open
Abstract
Respiratory distress is a common chief complaint in neonates admitted to the neonatal intensive care unit. Despite the increasing use of non-invasive ventilation in neonates with respiratory difficulty, some of them require advanced airway support. Delayed intubation is associated with increased morbidity, particularly in urgent unplanned cases. Early and accurate prediction of the need for intubation may provide more time for preparation and increase safety margins by avoiding the late intubation at high-risk infants. This study aimed to predict the need for intubation within 3 h in neonates initially managed with non-invasive ventilation for respiratory distress during the first 48 h of life using a multimodal deep neural network. We developed a multimodal deep neural network model to simultaneously analyze four time-series data collected at 1-h intervals and 19 variables including demographic, physiological and laboratory parameters. Evaluating the dataset of 128 neonates with respiratory distress who underwent non-invasive ventilation, our model achieved an area under the curve of 0.917, sensitivity of 85.2%, and specificity of 89.2%. These findings demonstrate promising results for the multimodal model in predicting neonatal intubation within 3 h.
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Affiliation(s)
- Jueng-Eun Im
- Biomedical Engineering, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Seung Park
- Biomedical Engineering, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungdae-ro 1, Seowon-gu, Cheongju, 28644, Republic of Korea
| | - Shin Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungdae-ro 1, Seowon-gu, Cheongju, 28644, Republic of Korea.
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungdae-ro 1, Seowon-gu, Cheongju, 28644, Republic of Korea
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8
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Wang K, Zhou X, Gao S, Li F, Ju R. Noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation for preterm infants as an extubation support: A systematic review and meta-analysis. Pediatr Pulmonol 2023; 58:704-711. [PMID: 36372443 DOI: 10.1002/ppul.26244] [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: 09/11/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to explore whether noninvasive high-frequency oscillatory ventilation (NHFOV) could reduce the incidence of reintubation compared with nasal intermittent positive pressure ventilation (NIPPV) in the postextubation phase of preterm infants. METHODS Randomized controlled trials of NHFOV versus NIPPV were searched in PubMed, EMBASE, Cochrane Central, and MEDLINE. Meta-analysis was performed using Review Manager 5.3. RESULTS Four randomized controlled trials including 1138 preterm infants were included in this study. Compared with NIPPV, NHFOV reduced the incidence of reintubation in the post-extubation phase of preterm infants (p = 0.01, RR = 0.72, 95% confidence interval (CI): 0.56∼0.94), and no heterogeneity was found in the four studies (p = 0.55, I2 = 0%). In the sensitivity analysis, the result showed that there was no significant difference in the incidence of reintubation between NHFOV and NIPPV after excluding one study (p = 0. 05, RR = 0.76 95% CI: 0.58∼1.00), and no heterogeneity was found in the other three studies (p = 0.95, I2 = 0%). There was no statistical difference between NHFOV and NIPPV in BPD, air leak, IVH (≥Grade III) and mortality. CONCLUSION Among mechanically ventilated preterm infants, compared with NIPPV, NHFOV was potentially beneficial to reduce the incidence of reintubation after extubation and did not increase the risk of complications.
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Affiliation(s)
- Kaixu Wang
- Department of Neonatology, The Affiliated Women's and Children's Hospital, School of Medicine, UESTC, Chengdu, China
| | - Xiaofeng Zhou
- Department of Neonatology, The Affiliated Women's and Children's Hospital, School of Medicine, UESTC, Chengdu, China
| | - Shuqiang Gao
- Department of Neonatology, The Affiliated Women's and Children's Hospital, School of Medicine, UESTC, Chengdu, China
| | - Fang Li
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Ju
- Department of Neonatology, The Affiliated Women's and Children's Hospital, School of Medicine, UESTC, Chengdu, China
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9
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A Three-Arm Randomized, Controlled Trial of Different Nasal Interfaces on the Safety and Efficacy of Nasal Intermittent Positive-Pressure Ventilation in Preterm Newborns. Indian J Pediatr 2022; 89:1195-1201. [PMID: 35503591 DOI: 10.1007/s12098-022-04095-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of different nasal interfaces for delivering non invasive positive pressure ventilation (NIPPV) in preterm neonates. METHODS In this three-arm parallel group stratified nonblinded randomized trial involving 210 preterm neonates the participants were randomly allocated to 'nasal mask', 'nasal prongs' and '4 hourly rotation of masks and prongs' groups in a 1:1:1 ratio. The groups were further stratified by gestational age (26-316/7 wk versus 32-366/7 wk) and indication of NIPPV (primary versus post extubation). Primary outcome was incidence of NIPPV failure within 72 h of initiation. Secondary outcomes were moderate/severe nasal injury, requirement of surfactant post randomization, total duration of respiratory support, duration of NICU stay, common neonatal morbidities and mortality. RESULTS Primary analysis revealed that mask group was superior to prongs and rotation groups in terms of reduction in NIPPV failure within 72 h (8.6%, 24.3%, 22.8%, p = 0.033), decreased incidence of moderate/severe nasal injury (8.6%, 22.8%, 11.4% p = 0.038), decreased requirement of surfactant (20%, 38.6%, 42.8%, p = 0.01) and reduction in total duration of respiratory support [median (interquartile range)-6 (3, 10) d, 7.7 (4.9, 19.2) d, 7 (5.5, 18.5) d, p = 0.005]. Post hoc analysis confirmed that nasal mask was superior to prongs with respect to primary outcome (p = 0.012) and also reduced surfactant requirement compared to both prongs (p = 0.015) and rotation (p = 0.003) groups. Other pairwise comparisons were not statistically significant. CONCLUSIONS Administering NIPPV by nasal mask significantly decreases the incidence of NIPPV failure within first 72 h compared to nasal prongs and also reduces the requirement of surfactant compared to both prongs and rotation groups.
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10
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Mohsen N, Nasef N, Elkhouli M, Ghanem M, Dalby A, Yoon EW, Finan E, Shah PS, Mohamed A. Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study. Pediatr Pulmonol 2022; 57:1000-1007. [PMID: 35032109 DOI: 10.1002/ppul.25827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify the predictors of successful first trial off nasal continuous positive airway pressure (nCPAP). METHODS A retrospective cohort study of infants ≤29 weeks' gestation who required nCPAP for >24 h was conducted. Logistic regression was used to detect predictors for successful trial off nCPAP. Statistical analysis was performed using the SAS software. RESULTS A total of 727 infants were included in the analysis. Infants who were successful in their first trial off nCPAP (n = 313) were of higher gestational age (GA) and birth weight (BW), as well as a higher proportion of female infants, compared with those who were not successful (p < 0.01). When stratified by GA, a negative correlation was noted between GA and postmenstrual age at successful trial off nCPAP or high flow nasal cannula (HFNC) (r = 0.45, p < 0.01). Logistic regression analysis showed that GA (odds ratio [OR] 1.13, 95% confidence interval [CI] [1.03-1.24], p = 0.01) and percentage of time spent with an oxygen saturation over 89% in the 24 h preceding the trial off nCPAP (OR 1.08, 95% CI [1.05-1.11], p = 0.00) were independent predictors for successful trial off nCPAP. CONCLUSION Successful trial off nCPAP or HFNC in preterm infants is significantly associated with higher GA, BW, female gender, and the specific oxygen saturation histogram in the preceding 24-h period.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Mohamed Elkhouli
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Allison Dalby
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Eugene Woojin Yoon
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Emer Finan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (HPME), University of Toronto, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
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Bhat BV. Newer Perspective in Neonatology-Need for Updating. Indian J Pediatr 2021; 88:668-669. [PMID: 34097237 DOI: 10.1007/s12098-021-03752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Ballambattu Vishnu Bhat
- Department of Pediatrics and Neonatology and Division of Research, Aarupadai Veedu Medical College & Hospital, Vinayaka Mission's Research Foundation, Pondicherry, 607403, India.
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