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Yazdi S, Carlo WA, Nakhmani A, Boateng EO, Aban I, Ambalavanan N, Travers CP. Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:557-561. [PMID: 38365446 PMCID: PMC11327380 DOI: 10.1136/archdischild-2023-326605] [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: 11/09/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Optimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia (IH) and respiratory instability in preterm infants meeting criteria to discontinue CPAP. DESIGN Single-centre randomised clinical trial. SETTING Level 4 neonatal intensive care unit. PATIENTS 36 infants <34 weeks' gestation receiving CPAP≤5 cmH2O and fraction of inspired oxygen (FiO2) ≤0.30 and meeting respiratory stability criteria. INTERVENTIONS Extended CPAP was compared with weaning to low-flow NC (0.5 L/kg/min with a limit of 1.0 L/min) for 24 hours. OUTCOMES The primary outcome was IH (number of episodes with SpO2<85% lasting ≥10 s). Secondary outcomes included: coefficient of variability of SpO2, proportion of time in various SpO2 ranges, episodes (≥10 s) with SpO2<80%, median cerebral and renal oxygenation, median effective FiO2, median transcutaneous carbon dioxide and bradycardia (<100/min for≥10 s). RESULTS The median (IQR) episodes of IH per 24-hour period was 20 (6-48) in the CPAP group and 76 (18-101) in the NC group (p=0.03). Infants continued on CPAP had less bradycardia, time with SpO2 <91% and <85%, and lower FiO2 (all p<0.05). There were no statistically significant differences in IH<80%, median transcutaneous carbon dioxide or median cerebral or renal oxygenation. CONCLUSION In preterm infants meeting respiratory stability criteria for CPAP cessation, extended CPAP decreased IH, bradycardia and other hypoxaemia measures compared with weaning to low-flow NC during the 24-hour intervention. TRIAL REGISTRATION NUMBER NCT04792099.
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Affiliation(s)
- Siamak Yazdi
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Waldemar A Carlo
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Arie Nakhmani
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ernestina O Boateng
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Immaculada Aban
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Namasivayam Ambalavanan
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Colm P Travers
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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Nour BA, El-Rahman AMA, Hameed SAEAE, Mohsen N, Mohamed A, El-Bayoumi MA, Abdel-Hady HE. Lung and diaphragm ultrasound as predictors of successful weaning from nasal continuous positive airway pressure in preterm infants. Pediatr Pulmonol 2024; 59:1428-1437. [PMID: 38501314 DOI: 10.1002/ppul.26933] [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: 10/23/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Assessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants. STUDY DESIGN This prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP. RESULTS Out of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning. CONCLUSION LUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.
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Affiliation(s)
- Basma Ahmed Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Nada Mohsen
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Hesham Elsayed Abdel-Hady
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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3
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Lyle ANJ, Shaikh H, Oslin E, Gray MM, Weiss EM. Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials: A Systematic Review. JAMA Netw Open 2023; 6:e2348882. [PMID: 38127349 PMCID: PMC10739112 DOI: 10.1001/jamanetworkopen.2023.48882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Representativeness of populations within neonatal clinical trials is crucial to moving the field forward. Although racial and ethnic disparities in research inclusion are well documented in other fields, they are poorly described within neonatology. Objective To describe the race and ethnicity of infants included in a sample of recent US neonatal clinical trials and the variability in this reporting. Evidence Review A systematic search of US neonatal clinical trials entered into Cochrane CENTRAL 2017 to 2021 was conducted. Two individuals performed inclusion determination, data extraction, and quality assessment independently with discrepancies adjudicated by consensus. Findings Of 120 studies with 14 479 participants that met the inclusion criteria, 75 (62.5%) included any participant race or ethnicity data. In the studies that reported race and ethnicity, the median (IQR) percentage of participants of each background were 0% (0%-1%) Asian, 26% (9%-42%) Black, 3% (0%-12%) Hispanic, 0% (0%-0%) Indigenous (eg, Alaska Native, American Indian, and Native Hawaiian), 0% (0%-0%) multiple races, 57% (30%-68%) White, and 7% (1%-21%) other race or ethnicity. Asian, Black, Hispanic, and Indigenous participants were underrepresented, while White participants were overrepresented compared with a reference sample of the US clinical neonatal intensive care unit (NICU) population from the Vermont Oxford Network. Many participants were labeled as other race or ethnicity without adequate description. There was substantial variability in terms and methods of reporting race and ethnicity data. Geographic representation was heavily skewed toward the Northeast, with nearly one-quarter of states unrepresented. Conclusions and Relevance These findings suggest that neonatal research may perpetuate inequities by underrepresenting Asian, Black, Hispanic, and Indigenous neonates in clinical trials. Studies varied in documentation of race and ethnicity, and there was regional variation in the sites included. Based on these findings, funders and clinical trialists are advised to consider a 3-point targeted approach to address these issues: prioritize identifying ways to increase diversity in neonatal clinical trial participation, agree on a standardized method to report race and ethnicity among neonatal clinical trial participants, and prioritize the inclusion of participants from all regions of the US in neonatal clinical trials.
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Affiliation(s)
- Allison N J Lyle
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Henna Shaikh
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Elliott Mark Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
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4
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Massa-Buck B, Rastogi D, Rastogi S. Complications associated with incorrect use of nasal CPAP. J Perinatol 2023; 43:975-981. [PMID: 37231122 DOI: 10.1038/s41372-023-01700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Nasal continuous positive airway pressure (nCPAP) is a safe, effective, non-invasive respiratory modality to deliver positive end expiratory pressure in neonates. Many studies have established its associated improved respiratory outcomes without increase in major morbidities associated with preterm neonates. In contrast, there is paucity in literature addressing complications such as nasal injury, abdominal distention, air leak syndromes (especially pneumothorax), hearing loss, heat and chemical burns, swallowing and aspiration of small components of the nasal interface and delay in escalation of respiratory support associated with the use of nCPAP, most frequently due to its incorrect use. This is a comprehensive review that seeks to address the different complications that are associated with the incorrect use of nCPAP highlighting that these are operator-related and not device-related.
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Affiliation(s)
- Beri Massa-Buck
- George Washington University Hospital, Division of Neonatology, Children's National Hospital, Washington DC, USA
| | - Deepa Rastogi
- Division of Pediatric Pulmonology, Children's National Hospital, Washington DC, USA
| | - Shantanu Rastogi
- George Washington University Hospital, Division of Neonatology, Children's National Hospital, Washington DC, USA.
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Vitti JD, de Castro AAM, Serrão NF. Use of noninvasive mechanical ventilation weaning protocol in neonatal intensive care units in Brazil: a descriptive study. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021382. [PMID: 37194837 PMCID: PMC10184999 DOI: 10.1590/1984-0462/2023/41/2021382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/13/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aimed to investigate whether neonatal intensive care units (NICUs) in Brazilian hospitals use a protocol for weaning from noninvasive ventilation (NIV), how this ventilatory support is withdrawn, and whether there is consensus among the methods used by the institutions. METHODS A cross-sectional survey was conducted from December 2020 to February 2021, based on responses to an electronic questionnaire, filled out by physical therapists working in NICU in Brazilian hospitals about the routine of physical therapy and the use of NIV and its weaning. RESULTS A total of 93 answers to the electronic questionnaire met the study criteria: 52.7% were from public health institutions, with an average of 15 NICU beds (15.2±15.9), 85% of the physical therapists worked exclusively in the NICU, 34.4% of the NICU had 24-h physical therapy care, 66.7% of the units use the continuous positive airway pressure (CPAP) as ventilatory mode, and 72% the nasal prong as NIV interface; 90% of the NICU physical therapists answered that their NICU had no NIV weaning protocol, with various methods of weaning reported, the most cited being pressure weaning. CONCLUSIONS Most Brazilian NICUs have no NIV weaning protocol. The most used method among institutions, with or without a protocol, is pressure weaning. Although most of the participating physical therapists work exclusively in NICU, many hospitals do not have the recommended workload, which can be one of the negative factors in the organization of protocols and in the progress of ventilatory weaning.
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Abdelmawla M, Seleem W, Farooqui M, Eltayeb A, Elsayed Y. Prediction of weaning readiness off nasal CPAP in preterm infants using point-of-care lung ultrasound. Pediatr Pulmonol 2022; 57:2128-2135. [PMID: 35652432 DOI: 10.1002/ppul.26014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
This study's primary aim was to assess whether end-expiratory lung ultrasound severity score (expLUSsc) at Day 3 of life, the second week of life, and before weaning off nasal continuous positive airway pressure (nCPAP) can predict the weaning readiness off nCPAP trial in preterm infants. The secondary aim was to evaluate the value of adding lung tidal recruitment (LTR) to expLUSsc (expLUSsc-plus-LTR) to improve predictability. We conducted a prospective study on premature infants <33 weeks of gestation. Point-of-care lung ultrasound (POC-LUS) was performed on Day 3, the second week of life, before and after the trial off nCPAP. expLUSsc, pleural thickness, and LTR were assessed. A receiver operator curve was constructed to evaluate the ability of POC-LUS to predict the weaning readiness off nCPAP. A total of 148 studies were performed on 39 infants, of them 12 weaned off nCPAP from the first trial and 27 infants failed attempts off nCPAP. An expLUSsc cut-off 8 before the first trial of weaning off nCPAP has a sensitivity and specificity of 88% and 90%, and positive and negative predictive values of 87% and 92%, respectively, with area under the curve (AUC) was 0.87 (CI: 0.8-0.93), p < .0001. If LTR is added to an expLUSsc cut-off 8 (expLUSsc-plus-LTR) before the first trial of weaning, then sensitivity and specificity of 95% and 90%, and positive and negative predictive values of 88% and 90%, respectively, with AUC was 0.95 (CI: 0.91-0.99), p < .0001. In conclusion, this study demonstrated the ability of POC-LUS to predict the weaning readiness off nCPAP in premature infants. The use of this simple bedside noninvasive test can potentially avoid the exposure of premature infants to multiple unsuccessful weaning cycles.
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Affiliation(s)
- Mohamed Abdelmawla
- Department of Pediatrics, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Wail Seleem
- Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mansoor Farooqui
- Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Abdulla Eltayeb
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Elsayed
- Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
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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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8
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Gentle SJ, Carper B, Laughon MM, Jensen EA, Williams A, Travers CP, Ambalavanan N, Lal CV, Carlo WA. Duration of noninvasive respiratory support and risk for bronchopulmonary dysplasia or death. J Perinatol 2022; 42:454-460. [PMID: 35034096 PMCID: PMC9007818 DOI: 10.1038/s41372-021-01269-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether the duration of noninvasive respiratory support exposure is associated with bronchopulmonary dysplasia (BPD) or death in preterm infants. METHODS Multicenter, retrospective study of infants born at <29 weeks' gestation. The association between days on noninvasive respiratory support and BPD or death was determined using instrumental variable techniques and generalized propensity score matching to account for potential confounding by illness severity. RESULTS Among 6268 infants 36% developed BPD or died. The median duration of noninvasive respiratory support was 18 days. There was inconsistency in the association between noninvasive support and BPD or death when analyzed by instrumental variable techniques (Average Marginal Effect -0.37; 95% CI -1.23 to 0.50) and generalized propensity score matching (Average Marginal Effect 0.46; 95% CI 0.33 to 0.60). CONCLUSION Findings on the association between duration of exposure to noninvasive respiratory support and the development of BPD or death were inconclusive. CLINICALTRIALS GOV ID Generic Database:NCT00063063.
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Affiliation(s)
- Samuel J Gentle
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Benjamin Carper
- Statistics and Epidemiology Unit, RTI International, Research Triangle, NC, USA
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Erik A Jensen
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Austin Williams
- Statistics and Epidemiology Unit, RTI International, Research Triangle, NC, USA
| | - Colm P Travers
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Charitharth V Lal
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Standardized nCPAP Care Bundle to Decrease Days to Wean Off nCPAP: A Quality Improvement Initiative. Adv Neonatal Care 2021; 22:284-290. [PMID: 34743116 DOI: 10.1097/anc.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective bubble nasal continuous positive airway pressure (bnCPAP) implementation is a means to maintain functional residual capacity (FRC) and avoid pulmonary morbidities in neonates. PURPOSE A quality improvement project was introduced to establish a standardized bnCPAP care bundle. METHODS A bnCPAP care bundle focusing on shoulder roll use, bnCPAP positioning, assessment for suctioning need, and nasopharynx suctioning was created. The outcome measures collected were percentage of time the infant's pulse saturation was less than 86%, corrected gestational age (CGA) when off bnCPAP, length of time a neonate is on bnCPAP, Downes' score, and compliance to bnCPAP care bundle. RESULTS An independent-samples t test found a statistically significant higher mean prior to the initiative in the percentage of time the oxygen saturation was less than 86%, Downes' score, length of time, and CGA to wean off bnCPAP (M = 11.7% ± 10.1%, M = 1.6 ± 1.1, M = 27.7 days ± 29.0 days, and M = 35.0 weeks ± 3.38 weeks, respectively) than after the initiative (M = 4.0% ± 4.8%, M = 1.1 ± 0.8, M = 11.2 days ± 10.2 days, and M = 32.8 weeks ± 1.00 weeks, respectively). IMPLICATIONS FOR PRACTICE AND RESEARCH Implementing a standardized bnCPAP care bundle showed improvement in oxygen saturation and increased success of weaning off bnCPAP. Future studies to increase the collected data are needed to compare the outcomes on infants born at each gestational age.
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10
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Duyka B, Beaullieu C, Khan AM. A comparison of methods of discontinuing nasal CPAP in premature infants <30 weeks gestation: a feasibility study. J Perinatol 2021; 41:2658-2663. [PMID: 34511596 PMCID: PMC8435158 DOI: 10.1038/s41372-021-01200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/24/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether abrupt discontinuation vs gradual wean of nasal CPAP (NCPAP) in infants <30 weeks gestation results in a decreased duration of NCPAP therapy. STUDY DESIGN We performed a single-center, randomized control trial of premature infants born <30 weeks gestation (n = 66), comparing discontinuation of NCPAP from 6 cmH2O (CWP) (fast wean arm) to discontinuation at 4 CWP, weaning by 1 CWP per day (slow wean arm). The primary outcome was the total number of days on NCPAP or mechanical ventilation. Secondary outcomes included wean failure, growth, length of stay, and related comorbidities. RESULTS Duration of NCPAP or mechanical ventilation was longer in the slow wean arm compared to the fast wean arm (17 vs 12 days, p = 0.03). There were no differences observed in secondary outcomes. CONCLUSION In weaning NCPAP, abrupt discontinuation may be associated with a shorter duration of positive pressure respiratory support compared to a gradual weaning strategy.
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Affiliation(s)
- Brittany Duyka
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
| | - Claire Beaullieu
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Amir M Khan
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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11
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Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks of Gestational Age: A Randomized Control Trial. J Pediatr 2021; 230:93-99.e3. [PMID: 33127365 DOI: 10.1016/j.jpeds.2020.10.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare immediate cessation of nasal continuous positive airway pressure (NCPAP) vs a stepwise decrease in pressure on the duration of NCPAP therapy in infants born prematurely. STUDY DESIGN A single center study in infants 230-326 weeks of gestational age. NCPAP was stopped either at 5 cm H2O (control) or 3 cm H2O after a stepwise pressure wean (wean) using defined stability and failure criteria. Primary outcome is total NCPAP days. RESULTS We enrolled 226 infants; 116 were randomly assigned to control and 110 to the wean group. There was no difference in the total NCPAP days between groups (median [25th, 75th percentiles] 16 [5, 36] vs 14 [7, 33] respectively). There were no differences between groups in secondary outcomes, including duration of hospital stay, critical care days, and oxygen supplementation. A higher proportion of control infants failed the initial attempt to discontinue NCPAP (43% vs 27%, respectively; P < .01) and required ≥2 attempts (20% vs 5%, respectively; P < .01). In addition, infants 23-27 weeks of gestational age in the wean group were 2.4-times more likely to successfully stop NCPAP at the first attempt (P = .02) vs controls. CONCLUSIONS Discontinuation of NCPAP after a gradual pressure wean to 3 cm H2O did not decrease the duration of NCPAP therapy compared with stopping from 5 cm H2O in infants ≤32 weeks of gestational age. However, weaning decreased failed initial attempts to stop NCPAP, particularly among infants <28 weeks of gestational age. TRIAL REGISTRATION Clinicaltrials.gov: NCT02064712.
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12
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Puthattayil ZB, Moore GP, Tang K, Huneault-Purney N, Lawrence SL. Evaluating the impact of CPAP weaning procedures on total days on nasal CPAP: A retrospective chart review. J Neonatal Perinatal Med 2021; 14:537-546. [PMID: 33523028 DOI: 10.3233/npm-200625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no consensus on how to wean infants from Nasal Continuous Positive Airway Pressure (NCPAP). We hypothesized that ceasing NCPAP abruptly would decrease the duration required, compared with a gradual wean. METHODS This retrospective chart review included preterm infants requiring NCPAP for over 48 hours. Cohort1 weaned NCPAP by cycling on and off, while cohort 2 ceased NCPAP abruptly. The primary outcome was total days on NCPAP. Secondary outcomes included rate of bronchopulmonary dysplasia, weight gain, duration of hospital stay, and compliance with the use of stability criteria. RESULTS 81 infants met inclusion criteria in cohort one, and 89 in cohort two. Median days on NCPAP were 17.0 and 11.0 days, respectively, not significant. There was no significant difference in secondary outcomes. CONCLUSIONS There was no significant association between the two NCPAP weaning protocols and the outcomes studied.
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Affiliation(s)
- Z B Puthattayil
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Obstetrics, Gynecology and Newborn Care, Division of Neonatology, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - G P Moore
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Obstetrics, Gynecology and Newborn Care, Division of Neonatology, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - K Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute (CHEO RI)
| | - N Huneault-Purney
- Department of Obstetrics, Gynecology and Newborn Care, Division of Neonatology, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - S L Lawrence
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Obstetrics, Gynecology and Newborn Care, Division of Neonatology, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
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13
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Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource-Constrained Settings. Int J Pediatr 2020; 2020:8871980. [PMID: 33014078 PMCID: PMC7519183 DOI: 10.1155/2020/8871980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
Preterm birth complications are responsible for almost one-third of the global neonatal mortality burden, and respiratory distress syndrome remains the single most common cause of these preventable deaths. Since its inception, almost half a century ago, nasal continuous positive airway pressure (NCPAP) has evolved to become the primary modality for neonatal respiratory care in both the developed and developing world. Although evidence has demonstrated the effectiveness of low-cost bubble NCPAP in reducing newborn mortality, its widespread use is yet to be seen in resource-constrained settings. Moreover, many tertiary hospitals in developing countries still utilise an inexpensive locally assembled bNCPAP system of unknown efficacy and safety. This review provides a brief overview of the history, physiological benefits, indications, contraindications, and complications of bNCPAP. Evidence regarding the effectiveness of low-cost bNCPAP in the neonatal intensive care unit is also summarised. The article further details a locally assembled bNCPAP system used in resource-constrained settings and highlights the care package for neonates receiving bNCPAP, failure criteria, and strategies for weaning.
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14
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Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal. J Clin Med 2020; 9:jcm9041191. [PMID: 32331217 PMCID: PMC7230457 DOI: 10.3390/jcm9041191] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Since the beginning of March 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused more than 13,000 deaths in Europe, almost 54% of which has occurred in Italy. The Italian healthcare system is experiencing a stressful burden, especially in terms of intensive care assistance. In fact, the main clinical manifestation of COVID-19 patients is represented by an acute hypoxic respiratory failure secondary to bilateral pulmonary infiltrates, that in many cases, results in an acute respiratory distress syndrome and requires an invasive ventilator support. A precocious respiratory support with non-invasive ventilation or high flow oxygen should be avoided to limit the droplets’ air-dispersion and the healthcare workers’ contamination. The application of a continuous positive airway pressure (CPAP) by means of a helmet can represent an effective alternative to recruit diseased alveolar units and improve hypoxemia. It can also limit the room contamination, improve comfort for the patients, and allow for better clinical assistance with long-term tolerability. However, the initiation of a CPAP is not free from pitfalls. It requires a careful titration and monitoring to avoid a delayed intubation. Here, we discuss the rationale and some important considerations about timing, criteria, and monitoring requirements for patients with COVID-19 respiratory failure requiring a CPAP treatment.
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15
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Nasef N, Rashed HM, Aly H. Practical aspects on the use of non-invasive respiratory support in preterm infants. Int J Pediatr Adolesc Med 2020; 7:19-25. [PMID: 32373698 PMCID: PMC7193067 DOI: 10.1016/j.ijpam.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Preterm infants frequently present with respiratory insufficiency requiring respiratory assistance. Invasive mechanical ventilation has been associated with several short and long term complications. Therefore, the practice of early use of non-invasive ventilation has been adopted. Nasal CPAP proved efficacy as an initial therapy for preterm infants. Non-invasive positive pressure ventilation is an alternative used to mitigate CPAP failure in infants with apnea or increased work of breathing. High flow nasal cannula gained popularity primarily due to the ease of its use, despite multiple prominent trials that demonstrated its inferiority. Bi-level positive airway pressure and neurally adjusted non-invasive ventilatory are used in infants with apnea and increased work of breathing. The effectiveness of non invasive ventilation tools can be augmented by having a proper protocol for initiation, weaning, skin care, positioning, and developmental care during their application.
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Affiliation(s)
- Nehad Nasef
- Neonatal Intensive Care Unit, Mansora University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Egypt
| | - Hend Me Rashed
- School of Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
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16
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Extended Continuous Positive Airway Pressure and Improved Functional Residual Capacity in Infants Born Preterm. J Pediatr 2020; 217:7-9. [PMID: 31604628 DOI: 10.1016/j.jpeds.2019.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022]
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17
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van Delft B, Van Ginderdeuren F, Lefevere J, van Delft C, Cools F. Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis. BMJ Paediatr Open 2020; 4:e000858. [PMID: 33263087 PMCID: PMC7678397 DOI: 10.1136/bmjpo-2020-000858] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The optimal method to wean preterm infants from non-invasive respiratory support (NIVRS) with nasal continuous positive airway pressure (CPAP) or high-flow nasal cannula is still unclear, and methods used vary considerably between neonatal units. OBJECTIVE Perform a systematic review and meta-analysis to determine the most effective strategy for weaning preterm infants born before 37 weeks' gestation from NIVRS. METHOD EMBASE, MEDLINE, CINAHL, Google and Cochrane Central Register of Controlled Trials were searched for randomised controlled trials comparing different weaning strategies of NIVRS in infants born before 37 weeks' gestation. RESULTS Fifteen trials (1.547 infants) were included. With gradual pressure wean, the relative risk of successful weaning at the first attempt was 1.30 (95% CI 0.93 to 1.83), as compared with sudden discontinuation. Infants were weaned at a later postmenstrual age (PMA) (median difference (MD) 0.93 weeks (95% CI 0.19 to 1.67)). A stepdown strategy to nasal cannula resulted in an almost 3-week reduction in the PMA at successful weaning (MD -2.70 (95% CI -3.87 to -1.52)) but was associated with a significantly longer duration of oxygen supplementation (MD 7.80 days (95% CI 5.31 to 10.28)). A strategy using interval training had no clinical benefits. None of the strategies had any effect on the risk of chronic lung disease or the duration of hospital stay. CONCLUSION A strategy of gradual weaning of airway pressure might increase the chances of successful weaning. Stepdown strategy from CPAP to nasal cannula is a useful alternative resulting in an earlier weaning, but the focus should remain on continued weaning in order to avoid prolonged oxygen supplementation. Interval training should probably not be used.
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18
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Lemieux-Bourque C, Piedboeuf B, Fontela PS, Bornais K, Beltempo M. Pressure versus Sudden Wean from Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis. Neonatology 2020; 117:537-544. [PMID: 32580200 DOI: 10.1159/000507863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nasal continuous positive airway pressure (NCPAP) is a well-studied treatment for respiratory problems in preterm infants. However, the best strategy for NCPAP weaning is unknown. OBJECTIVE We aimed to compare the success of progressive pressure wean versus sudden wean for discontinuation of NCPAP in preterm infants. METHODS We conducted a systematic review and meta-analysis of publications identified by searching MEDLINE, Embase, -CINAHL, and CENTRAL. Randomized controlled trials comparing pressure wean to sudden wean for NCPAP in preterm infants were included. Primary outcomes were postmenstrual age (PMA) at successful weaning and weight gain. Secondary outcomes were total duration of ventilation, success of weaning strategy on first attempt, length of stay (LOS), and bronchopulmonary dysplasia (BPD). RESULTS Two trials (422 infants) were eligible for inclusion. Pressure wean was associated with a higher PMA at weaning (33.9 ± 2.1 vs. 32.1 ± 2.0 weeks, mean difference [MD] 0.88, 95% CI 0.40 to 1.35, low quality evidence). Daily weight gain was only reported in 1 trial. Total duration of ventilation was not reported. Pressure wean was associated with higher probability of successful weaning at first attempt (risk ratio [RR] 1.25, 95% CI 1.03-1.53). However, it was not associated with LOS (MD -2.5 days, 95% CI -7.3 to 2.4) or BPD (RR 0.92, 95% CI 0.52-1.63). CONCLUSION Sudden wean of NCPAP was associated with a lower PMA at successful wean compared to pressure wean but also with a lower rate of successful wean at first attempt, most likely because of the developmental stage at which weaning is possible.
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Affiliation(s)
- Charlotte Lemieux-Bourque
- CHU de Québec Research Center, Quebec, Québec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Bruno Piedboeuf
- CHU de Québec Research Center, Quebec, Québec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Patricia S Fontela
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada.,Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Kevin Bornais
- Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Québec, Canada, .,McGill University Health Centre Research Institute, Montreal, Québec, Canada,
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19
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Morris L, Cook N, Ramsey A, Alacapa JV, Smith LE, Gray C, Craft JA, Chin R, Christensen M. Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature. J Pediatr Nurs 2020; 50:37-45. [PMID: 31704558 DOI: 10.1016/j.pedn.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 01/09/2023]
Abstract
PROBLEM The paucity of up-to-date recommendations and evidence-based models, whether it is physician-initiated or initiated by other healthcare professionals, for humidified high flow oxygen therapy among children. ELIGIBILITY CRITERIA The inclusion criteria included the following: 1) use of high flow oxygen therapy (≥15 L/min); 2) published studies from the year 2000 and onwards; 3) research article in a peer-reviewed journal; 4) studies conducted in a hospital setting involving paediatric patients <18 years old; 5) availability of full article online. SAMPLE From March to April 2018, electronic databases such as PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica Database, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, SCOPUS, Ovid, Informit, and Google Scholar were accessed. The systematic search initially yielded 41 studies. RESULTS Eventually, three eligible studies were reviewed and appraised. Overarching themes were identified: 1) the lack of weaning standards; 2) the limited focus on young population in intensive care settings; and 3) the paucity of weaning models. CONCLUSION The lack of studies suggested that this is a fertile area for research. In this light, this paper challenged researchers, clinicians, and experts to develop evidence-based standards and models of weaning towards efficient and better quality of care. IMPLICATION This review may lead to the development of nurse-led or nurse-initiated weaning protocols to enable timely weaning intervention for children and thus reduce the need for prolonged oxygen use. Furthermore, this may also instigate an economic evaluation of a nurse-lead weaning against current models of medically lead weaning.
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Affiliation(s)
- Louise Morris
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Nicole Cook
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Amanda Ramsey
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Jason V Alacapa
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of New South Wales, Kensington, New South Wales, Australia.
| | - Louise E Smith
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of New South Wales, Kensington, New South Wales, Australia
| | | | - Judy A Craft
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Raymond Chin
- Campbelltown Hospital, Campbelltown, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
| | - Martin Christensen
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of Sunshine Coast, Sippy Downs, Queensland, Australia
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20
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Warburton A, Monga R, Sampath V, Kumar N. Continuous pulse oximetry and respiratory rate trends predict short-term respiratory and growth outcomes in premature infants. Pediatr Res 2019; 85:494-501. [PMID: 30679791 DOI: 10.1038/s41390-018-0269-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND To examine the correlation between interval vital signs recorded by nursing staff and continuous monitor recordings, and to determine whether aggregated monitor recordings can better predict impending escalation of respiratory support in premature infants. METHOD Preterm infants on noninvasive respiratory support or room air (RA) were prospectively enrolled. Nursing-and monitor-recorded pulse oximetry (SpO2) and respiratory rates (RR) data were recorded daily. RESULTS Ninety four infants were recruited with median gestational age of 32 weeks and birth weight of 1848 g. > 3 × 106 data points were analyzed over 2204 patient days. Median events/day recorded was 8 (nursing) and 1424 (monitor) per infant. We did not find a strong correlation between monitor- and nursing events of tachypnea (RR > 70) and hypoxia (SpO2 < 90%). Infants with monitor-recorded hypoxia for > 5%/day (p < 0.0001) or tachypnea for > 30%/day (p < 0.0001) were more likely to require an increase in respiratory support within next 3 days. Monitor-recorded hypoxia and tachypnea were also associated with poor weight gain. CONCLUSIONS Monitor-recorded trends for tachypnea and oxygen saturations < 90% were able to predict short-term respiratory outcomes, and were associated with growth outcomes. This study emphasizes the potential for monitor-recorded data to augment clinical decision making at the bedside.
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Affiliation(s)
- Alyssa Warburton
- Division of Neonatology, Hurley Children's Hospital, Flint, MI, 48503, USA
| | - Ranjan Monga
- Division of Neonatology, Hurley Children's Hospital, Flint, MI, 48503, USA
| | - Venkatesh Sampath
- Division of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA
| | - Navin Kumar
- Division of Neonatology, Hurley Children's Hospital, Flint, MI, 48503, USA.
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21
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Nour I, Abdel‐Hady H. The ideal strategy of weaning from nasal continuous positive airway pressure in preterm infants: are we there yet? Acta Paediatr 2019; 108:575. [PMID: 30585349 DOI: 10.1111/apa.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Islam Nour
- Department of Pediatrics/Neonatology Mansoura University Children's Hospital Mansoura Egypt
| | - Hesham Abdel‐Hady
- Department of Pediatrics/Neonatology Mansoura University Children's Hospital Mansoura Egypt
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Özkan H, Erdeve Ö, Kutman HGK. Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment. Turk Arch Pediatr 2018; 53:S45-S54. [PMID: 31236018 PMCID: PMC6568291 DOI: 10.5152/turkpediatriars.2018.01806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Respiratory distress syndrome is the leading cause of respiratory failure in preterm infants. The incidence and severity of respiratory distress syndrome are inversely related to the gestational age of the newborn. The major underlying pathophysiologic mechanisms are surfactant deficiency and anatomic, structural immaturity of the lung. Recent improvements such as antenatal steroid treatment to enhance pulmonary maturity, appropriate resuscitation facilitated by placental transfusion and immediate use of continuous positive airway pressure for alveolar recruitment, early rescue administration of surfactant, ventilation with gentler modes to minimize damage to the immature lungs, and the other supportive therapies have significantly decreased respiratory distress syndrome-related morbidity and mortality. This guideline was addressed to overview the mentioned improvements in order to standardize respiratory distress syndrome management in neonatal intensive care units in Turkey.
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Affiliation(s)
- Hasan Özkan
- Division of Neonatology, Department of Pediatrics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Ömer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - H Gözde Kanmaz Kutman
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Zekai Tahir Burak Womens' Health Training and Research Hospital, Ankara, Turkey
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23
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Brenne H, Grunewaldt KH, Follestad T, Bergseng H. A randomised cross-over study showed no difference in diaphragm activity during weaning from respiratory support. Acta Paediatr 2018; 107:1726-1732. [PMID: 29504671 DOI: 10.1111/apa.14303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/18/2018] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
AIM We measured electrical activity of the diaphragm (Edi) to compare the breathing effort in preterm infants during weaning from respiratory support with high-flow nasal cannulae (HFNC) or nasal continuous positive airway pressure (nCPAP). METHODS This randomised cross-over study was carried out at St Olav's University Hospital, Trondheim, Norway, from December 2013 to June 2015. We gave 21 preterm infants weighing at least 1000 g HFNC 6 L/minute for four hours and nCPAP 3 cmH2 O for four hours with a one-hour wash-out period. Measurements included diaphragmatic load, Edi, vital signs and a modified Silverman-Andersen Retraction Score. RESULTS We found no differences in HFNC and nCPAP in the median Edi peak (8.0 μV versus 7.8 μV, p = 0.095), median Edi min (1.1 μV versus 1.2 μV in, p = 0.958) or mean heart rate (157 versus 159, p = 0.300) in the 21 infants who took part. The mean respiratory rate was significantly lower during HFNC than nCPAP (47 versus 52, p = 0.012). The modified Silverman-Andersen Retraction Score showed no significant differences. CONCLUSION This study of preterm infants found no difference in the breathing effort measured by Edi between HFNC 6 L/minute and nCPAP 3 cmH2 O. HFNC could replace nCPAP when preterm infants are ready for weaning.
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Affiliation(s)
- Hilde Brenne
- Department of Pediatrics; St. Olav University Hospital; Trondheim Norway
| | - Kristine Hermansen Grunewaldt
- Department of Pediatrics; St. Olav University Hospital; Trondheim Norway
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Turid Follestad
- Department of Public Health and Nursing; Faculty of Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Håkon Bergseng
- Department of Pediatrics; St. Olav University Hospital; Trondheim Norway
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology (NTNU); Trondheim Norway
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24
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Jensen CF, Sellmer A, Ebbesen F, Cipliene R, Johansen A, Hansen RM, Nielsen JP, Nikitina OH, Petersen JP, Henriksen TB. Sudden vs Pressure Wean From Nasal Continuous Positive Airway Pressure in Infants Born Before 32 Weeks of Gestation: A Randomized Clinical Trial. JAMA Pediatr 2018; 172:824-831. [PMID: 30039171 PMCID: PMC6143058 DOI: 10.1001/jamapediatrics.2018.2074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Nasal continuous positive airway pressure (nCPAP) is a well-established treatment of respiratory distress syndrome in preterm infants. Suboptimal weaning from nCPAP may be associated with lung injury, pulmonary morbidity, and infant weight gain. To our knowledge, the best weaning strategy from nCPAP is unknown. OBJECTIVE To compare the effect of sudden wean and pressure wean from nCPAP in very preterm infants. DESIGN, SETTING, AND PARTICIPANTS A randomized, clinical, open-label, multicenter trial was conducted at 6 neonatal intensive care units in Denmark from September 2012 to December 2016 and included infants born before 32 weeks of gestation. INTERVENTIONS Sudden wean with discontinuation of nCPAP without a prior reduction in pressure. Pressure wean with gradual pressure reduction prior to the discontinuation of nCPAP. MAIN OUTCOME AND MEASURES The primary outcome was weight gain velocity from randomization to postmenstrual age 40 weeks. Secondary outcomes included other measures of growth, nCPAP and the duration of oxygen supplementation, postmenstrual age at successful wean and at discharge, successful wean at the first attempt, the number of attempts to wean, and the length of the hospital stay. Prespecified subgroup analyses by gestational age were performed. RESULTS Of the 372 randomized infants, 185 (49.7%) were randomized to sudden wean and 187 infants (50.3%) to pressure wean. A total of 177 infants in both groups completed the trial (median gestational age for sudden and pressure wean, 30 weeks [interquartile range, 29-31]; male: sudden wean, 89 [50%]; pressure wean, 96 [54%]). There was no difference in mean [SD] weight gain velocity from randomization to 40 weeks postmenstrual age between the 2 groups (22 [6] g/kg/day). No difference was found in any of the secondary outcomes. More infants born before 28 weeks of gestation were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group (risk difference, 31%; 95% CI, 13%-50%), but there was no difference in the duration of nCPAP and oxygen supplementation. CONCLUSIONS AND RELEVANCE Overall, we found no difference in weight gain velocity or any of the secondary outcomes between very preterm infants who were randomized to sudden wean or pressure wean from nCPAP. However, among infants born before 28 weeks' gestation, infants from the pressure wean group were more often successfully weaned during the first attempt without a longer total duration of nCPAP treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01721629.
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Affiliation(s)
- Christina Friis Jensen
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark,Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Sellmer
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark,Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Rasa Cipliene
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Johansen
- Department of Pediatrics, Randers Regional Hospital, Randers, Denmark
| | | | | | | | | | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark,Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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