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Cucerea M, Moscalu M, Ognean ML, Fagarasan A, Toma D, Marian R, Anciuc-Crauciuc M, Racean A, Gall Z, Simon M. Impact of Early Surfactant Administration on Ductus Arteriosus Assessed at 24 h in Preterm Neonates Less than 32 Weeks of Gestational Age. Biomedicines 2024; 12:1136. [PMID: 38927343 PMCID: PMC11201054 DOI: 10.3390/biomedicines12061136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to investigate whether early surfactant administration affects the status of ductus arteriosus (DA) in preterm infants ≤ 32 weeks of gestational age (GA) within 24 h of birth. MATERIALS AND METHODS It is a prospective study conducted from 1 March 2022 to 31 December 2023 in a tertiary academic center. In-born infants ≤ 32 weeks of gestation (n = 88) were enrolled. The study group was further divided into surfactant (n = 44) and non-surfactant (n = 44) subgroups. RESULTS A total of 76% of the preterm infants who received surfactant therapy (RRR = 0.839) recorded an increase in Kindler score at 24 h of life (1 - RR = 1 - 0.24 = 76%). Surfactant administration was significantly associated with decreased pre-ductal diastolic pressure (29.9 mmHg vs. 34.8 mmHg, p = 0.0231), post-ductal diastolic pressure (28.7 mmHg vs. 32.2 mmHg, p = 0.0178), pre-ductal MAP (41.6 mmHg vs. 46.5 mmHg, p = 0.0210), and post-ductal MAP (41.0 mmHg vs. 45.3 mmHg, p = 0.0336). There were no significant changes in ductus arteriosus parameters at 24 h of life. CONCLUSIONS Early surfactant administration does not affect the status of ductus arteriosus in preterm infants ≤ 32 weeks of gestational age at 24 h of life.
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Affiliation(s)
- Manuela Cucerea
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.); (A.R.); (Z.G.); (M.S.)
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria-Livia Ognean
- Dental Medicine and Nursing Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Amalia Fagarasan
- Pediatrics 3 Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (A.F.); (D.T.)
| | - Daniela Toma
- Pediatrics 3 Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (A.F.); (D.T.)
| | - Raluca Marian
- Cellular and Molecular Biology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania;
| | - Madalina Anciuc-Crauciuc
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.); (A.R.); (Z.G.); (M.S.)
| | - Andreea Racean
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.); (A.R.); (Z.G.); (M.S.)
| | - Zsuzsanna Gall
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.); (A.R.); (Z.G.); (M.S.)
| | - Marta Simon
- Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.); (A.R.); (Z.G.); (M.S.)
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Levy P, Thomas AR, Law BHY, Joynt C, Gupta R, Elshenawy S, Reed D, Pavlek LR, Shepherd J, Gowda S, Johnson BA, Ball M, Ali N. Multicentre study protocol comparing standard NRP to deveLoped Educational Modules for Resuscitation of Neonates in the Delivery Room with Congenital Heart Disease (LEARN-CHD). BMJ Open 2023; 13:e067391. [PMID: 37019485 PMCID: PMC10083808 DOI: 10.1136/bmjopen-2022-067391] [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] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Infants born with critical congenital heart defects (CCHDs) have unique transitional pathophysiology that often requires special resuscitation and management considerations in the delivery room (DR). While much is known about neonatal resuscitation of infants with CCHDs, current neonatal resuscitation guidelines such as the neonatal resuscitation programme (NRP) do not include algorithm modifications or education specific to CCHDs. The implementation of CCHD specific neonatal resuscitation education is further hampered by the large number of healthcare providers (HCPs) that need to be reached. Online learning modules (eLearning) may provide a solution but have not been designed or tested for this specific learning need. Our objective in this study is to design targeted eLearning modules for DR resuscitation of infants with specific CCHDs and compare HCP knowledge and team performance in simulated resuscitations among HCPs exposed to these modules compared with directed CCHD readings. METHODS AND ANALYSIS In a prospective multicentre trial, HCP proficient in standard NRP education curriculum are randomised to either (a) directed CCHD readings or (b) CCHD eLearning modules developed by the study team. The efficacy of these modules will be evaluated using (a) individual preknowledge/postknowledge testing and (b) team-based resuscitation simulations. ETHICS AND DISSEMINATION This study protocol is approved by nine participating sites: the Boston Children's Hospital Institutional Review Board (IRB-P00042003), University of Alberta Research Ethics Board (Pro00114424), the Children's Wisconsin IRB (1760009-1), Nationwide Children's Hospital IRB (STUDY00001518), Milwaukee Children's IRB (1760009-1) and University of Texas Southwestern IRB (STU-2021-0457) and is under review at following sites: University of Cincinnati, Children's Healthcare of Atlanta, Children's Hospital of Los Angeles and Children's Mercy-Kansas City. Study results will be disseminated to participating individuals in a lay format and presented to the scientific community at paediatric and critical care conferences and published in relevant peer-reviewed journals.
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Affiliation(s)
- Philip Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa R Thomas
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda Hiu Yan Law
- Department of Pediatrics, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Chloe Joynt
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ruby Gupta
- Department of Pediatrics, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Summer Elshenawy
- Department of Pediatrics, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - Danielle Reed
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Leeann R Pavlek
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jennifer Shepherd
- Department of Pediatrics, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Sharada Gowda
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Beth Ann Johnson
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Molly Ball
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Noorjahan Ali
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Bjorkman K, Maldonado JR, Saey S, McLennan D. In vitro performance of Lifetech IBS Angel™ (iron-based bioresorbable scaffold) stents during overdilation for use in pediatric patients. Front Cardiovasc Med 2022; 9:1006063. [PMID: 36440051 PMCID: PMC9682241 DOI: 10.3389/fcvm.2022.1006063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/13/2022] [Indexed: 09/08/2024] Open
Abstract
Objectives The objective of this study was to assess the mechanical performance of the Lifetech IBS Angel stents during overdilation as is often required in pediatric applications; including time of first fracture, foreshortening, and the type of fracturing that occurs. Materials and methods In vitro testing was performed and repeated for each stent three times under physiologic conditions with continuous audiovisual imaging allowing for post-testing evaluations. Assessment of sheath fit was also completed. Results A total of 47 stents on monorail system were overdilated to complete fracture after passing through either a 4 or 5 French sheath. First strut fracture occurred in 4 and 6 mm stents when they reached greater than 50% overexpansion. Larger stents could achieve at least 30% increased diameter prior to first strut fracture. No fragmentation of any of the stents was seen throughout testing. Conclusion The IBS Angel has thin struts allowing for a lower profile with increased maneuverability and use with smaller sheaths. Embolization potential of strut fragments was not seen. Increased diameter well beyond design parameters was seen in all with acceptable foreshortening.
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Affiliation(s)
- Kurt Bjorkman
- Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States
| | | | - Stephanie Saey
- Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States
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