1
|
Fairchild KD, Petroni GR, Varhegyi NE, Strand ML, Josephsen JB, Niermeyer S, Barry JS, Warren JB, Rincon M, Fang JL, Thomas SP, Travers CP, Kane AF, Carlo WA, Byrne BJ, Underwood MA, Poulain FR, Law BH, Gorman TE, Leone TA, Bulas DI, Epelman M, Kline-Fath BM, Chisholm CA, Kattwinkel J. Ventilatory Assistance Before Umbilical Cord Clamping in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2411140. [PMID: 38758557 PMCID: PMC11102017 DOI: 10.1001/jamanetworkopen.2024.11140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/07/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Providing assisted ventilation during delayed umbilical cord clamping may improve outcomes for extremely preterm infants. Objective To determine whether assisted ventilation in extremely preterm infants (23 0/7 to 28 6/7 weeks' gestational age [GA]) followed by cord clamping reduces intraventricular hemorrhage (IVH) or early death. Design, Setting, and Participants This phase 3, 1:1, parallel-stratified randomized clinical trial conducted at 12 perinatal centers across the US and Canada from September 2, 2016, through February 21, 2023, assessed IVH and early death outcomes of extremely preterm infants randomized to receive 120 seconds of assisted ventilation followed by cord clamping vs delayed cord clamping for 30 to 60 seconds with ventilatory assistance afterward. Two analysis cohorts, not breathing well and breathing well, were specified a priori based on assessment of breathing 30 seconds after birth. Intervention After birth, all infants received stimulation and suctioning if needed. From 30 to 120 seconds, infants randomized to the intervention received continuous positive airway pressure if breathing well or positive-pressure ventilation if not, with cord clamping at 120 seconds. Control infants received 30 to 60 seconds of delayed cord clamping followed by standard resuscitation. Main Outcomes and Measures The primary outcome was any grade IVH on head ultrasonography or death before day 7. Interpretation by site radiologists was confirmed by independent radiologists, all masked to study group. To estimate the association between study group and outcome, data were analyzed using the stratified Cochran-Mantel-Haenszel test for relative risk (RR), with associations summarized by point estimates and 95% CIs. Results Of 1110 women who consented to participate, 548 were randomized and delivered infants at GA less than 29 weeks. A total of 570 eligible infants were enrolled (median [IQR] GA, 26.6 [24.9-27.7] weeks; 297 male [52.1%]). Intraventricular hemorrhage or death occurred in 34.9% (97 of 278) of infants in the intervention group and 32.5% (95 of 292) in the control group (adjusted RR, 1.02; 95% CI, 0.81-1.27). In the prespecified not-breathing-well cohort (47.5% [271 of 570]; median [IQR] GA, 26.0 [24.7-27.4] weeks; 152 male [56.1%]), IVH or death occurred in 38.7% (58 of 150) of infants in the intervention group and 43.0% (52 of 121) in the control group (RR, 0.91; 95% CI, 0.68-1.21). There was no evidence of differences in death, severe brain injury, or major morbidities between the intervention and control groups in either breathing cohort. Conclusions and Relevance This study did not show that providing assisted ventilation before cord clamping in extremely preterm infants reduces IVH or early death. Additional study around the feasibility, safety, and efficacy of assisted ventilation before cord clamping may provide additional insight. Trial Registration ClinicalTrials.gov Identifier: NCT02742454.
Collapse
Affiliation(s)
- Karen D. Fairchild
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Gina R. Petroni
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Nikole E. Varhegyi
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Marya L. Strand
- Division of Neonatology, Department of Pediatrics, St Louis University, St Louis, Missouri
| | - Justin B. Josephsen
- Division of Neonatology, Department of Pediatrics, St Louis University, St Louis, Missouri
| | - Susan Niermeyer
- Section of Neonatology, Department of Pediatrics, University of Colorado, Denver
| | - James S. Barry
- Section of Neonatology, Department of Pediatrics, University of Colorado, Denver
| | - Jamie B. Warren
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Monica Rincon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Jennifer L. Fang
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sumesh P. Thomas
- Section of Newborn Critical Care, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Colm P. Travers
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Andrea F. Kane
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Waldemar A. Carlo
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Bobbi J. Byrne
- Division of Neonatology, Department of Pediatrics, Indiana University, Indianapolis
| | - Mark A. Underwood
- Division of Neonatology, Department of Pediatrics, University of California, Davis, Sacramento
| | - Francis R. Poulain
- Division of Neonatology, Department of Pediatrics, University of California, Davis, Sacramento
| | - Brenda H. Law
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Terri E. Gorman
- Division of Neonatology, Department of Pediatrics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tina A. Leone
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, New York
| | - Dorothy I. Bulas
- Department of Radiology, Children’s National Medical Center, Washington, DC
| | - Monica Epelman
- Department of Radiology, Nemours Children’s Hospital, Orlando, Florida
| | - Beth M. Kline-Fath
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christian A. Chisholm
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville
| | - John Kattwinkel
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville
| |
Collapse
|
2
|
Caffarelli C, Santamaria F, Piro E, Basilicata S, Delle Cave V, Cipullo M, Bernasconi S, Corsello G. New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine. Ital J Pediatr 2022; 48:189. [PMID: 36435791 PMCID: PMC9701393 DOI: 10.1186/s13052-022-01374-8] [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: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022] Open
Abstract
In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Simona Basilicata
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valeria Delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marilena Cipullo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
| |
Collapse
|
3
|
Badurdeen S, Davis PG, Hooper SB, Donath S, Santomartino GA, Heng A, Zannino D, Hoq M, Omar F Kamlin C, Kane SC, Woodward A, Roberts CT, Polglase GR, Blank DA. Physiologically based cord clamping for infants ≥32+0 weeks gestation: A randomised clinical trial and reference percentiles for heart rate and oxygen saturation for infants ≥35+0 weeks gestation. PLoS Med 2022; 19:e1004029. [PMID: 35737735 PMCID: PMC9269938 DOI: 10.1371/journal.pmed.1004029] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/08/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, the majority of newborns requiring resuscitation at birth are full term or late-preterm infants. These infants typically have their umbilical cord clamped early (ECC) before moving to a resuscitation platform, losing the potential support of the placental circulation. Physiologically based cord clamping (PBCC) is clamping the umbilical cord after establishing lung aeration and holds promise as a readily available means of improving early newborn outcomes. In mechanically ventilated lambs, PBCC improved cardiovascular stability and reduced hypoxia. We hypothesised that PBCC compared to ECC would result in higher heart rate (HR) in infants needing resuscitation, without compromising safety. METHODS AND FINDINGS Between 4 July 2018 and 18 May 2021, infants born at ≥32+0 weeks' gestation with a paediatrician called to attend were enrolled in a parallel-arm randomised trial at 2 Australian perinatal centres. Following initial stimulation, infants requiring further resuscitation were randomised within 60 seconds of birth using a smartphone-accessible web link. The intervention (PBCC) was to establish lung aeration, either via positive pressure ventilation (PPV) or effective spontaneous breathing, prior to cord clamping. The comparator was early cord clamping (ECC) prior to resuscitation. The primary outcome was mean HR between 60 to 120 seconds after birth, measured using 3-lead electrocardiogram, extracted from video recordings blinded to group allocation. Nonrandomised infants had deferred cord clamping (DCC) ≥120 seconds in the observational study arm. Among 508 at-risk infants enrolled, 123 were randomised (n = 63 to PBCC, n = 60 to ECC). Median (interquartile range, IQR) for gestational age was 39.9 (38.3 to 40.7) weeks in PBCC infants and 39.6 (38.4 to 40.4) weeks in ECC infants. Approximately 49% and 50% of the PBCC and ECC infants were female, respectively. Five infants (PBCC = 2, ECC = 3, 4% total) had missing primary outcome data. Cord clamping occurred at a median (IQR) of 136 (126 to 150) seconds in the PBCC arm and 37 (27 to 51) seconds in the ECC arm. Mean HR between 60 to 120 seconds after birth was 154 bpm (beats per minute) for PBCC versus 158 bpm for ECC (adjusted mean difference -6 bpm, 95% confidence interval (CI) -17 to 5 bpm, P = 0.39). Among 31 secondary outcomes, postpartum haemorrhage ≥500 ml occurred in 34% and 32% of mothers in the PBCC and ECC arms, respectively. Two hundred ninety-five nonrandomised infants (55% female) with median (IQR) gestational age of 39.6 (38.6 to 40.6) weeks received DCC. Data from these infants was used to create percentile charts of expected HR and oxygen saturation in vigorous infants receiving DCC. The trial was limited by the small number of infants requiring prolonged or advanced resuscitation. PBCC may provide other important benefits we did not measure, including improved maternal-infant bonding and higher iron stores. CONCLUSIONS In this study, we observed that PBCC resulted in similar mean HR compared to infants receiving ECC. The findings suggest that for infants ≥32+0 weeks' gestation who receive brief, effective resuscitation at closely monitored births, PBCC does not provide additional benefit over ECC (performed after initial drying and stimulation) in terms of key physiological markers of transition. PBCC was feasible using a simple, low-cost strategy at both cesarean and vaginal births. The percentile charts of HR and oxygen saturation may guide clinicians monitoring the transition of at-risk infants who receive DCC. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000621213.
Collapse
Affiliation(s)
- Shiraz Badurdeen
- Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- * E-mail:
| | - Peter G. Davis
- Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit and Clinical Sciences Research, Murdoch Children’s Research Institute, Melbourne, Australia
- The University of Melbourne, Department of Obstetrics and Gynaecology, Melbourne, Australia
| | - Stuart B. Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Susan Donath
- Clinical Epidemiology and Biostatistics Unit and Clinical Sciences Research, Murdoch Children’s Research Institute, Melbourne, Australia
| | | | - Alissa Heng
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit and Clinical Sciences Research, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit and Clinical Sciences Research, Murdoch Children’s Research Institute, Melbourne, Australia
| | - C. Omar F Kamlin
- Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Australia
| | - Stefan C. Kane
- The University of Melbourne, Department of Obstetrics and Gynaecology, Melbourne, Australia
- Division of Maternity Services and Department of Maternal Fetal Medicine, The Royal Women’s Hospital, Melbourne, Australia
| | - Anthony Woodward
- Division of Maternity Services and Department of Maternal Fetal Medicine, The Royal Women’s Hospital, Melbourne, Australia
| | - Calum T. Roberts
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Douglas A. Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, Australia
| | | |
Collapse
|
4
|
Li Y, Fu Y, Zhang Y, Yu S, Luo J, Li Y, Wang C, Zhu J, Li H. An overview of COVID-19 aerosol box for preventing droplet and aerosol contaminations in healthcare providers performing airway intubation. Drug Dev Ind Pharm 2022; 47:1693-1699. [PMID: 35285771 DOI: 10.1080/03639045.2022.2053984] [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: 01/25/2023]
Abstract
The COVID-19 is caused by the SARS-CoV-2, which is extremely infectious. Numerous virologist suggestions and guidelines advised using P2/N95 masks, gloves, goggles, face-shields, and frocks or gowns as routine specific protective tools during airway management to protect healthcare personnel from infection (PPE). However, numerous imitation research has indicated that conventional PPE cannot adequately protect healthcare personnel. Since then, numerous firms and healthcare professionals have created their personal reformed devices "aerosol containment devices" (ACD). Their usage has expanded throughout the world without being properly evaluated for usefulness, efficacy, or safety. The practice of "ACD" has been shown to make tracheal intubation (TI) more problematic in several simulated tests. Furthermore, the device should limit the transmission of droplets from a patient; however, it might put healthcare personnel at danger of being exposed to greater levels of viral aerosols. Consequently, the existing state of information suggests that "ACD" deprived of a vacuum mechanism can simply protect healthcare personnel against viral transmission to a limited extent. We search various databases for the literatures with keywords "COVID-19", "aerosol box", "aerosol contaminations" and "droplet contaminations. The current review focused on the aerosol box from various perspectives, including their mechanism, optimum time of use, the spread of aerosol control, current gaps and future perspective for bridging those gaps.
Collapse
Affiliation(s)
- Yan Li
- The outpatient department, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yujun Fu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yunwei Zhang
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Shuai Yu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jinhong Luo
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yuanyuan Li
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Caihong Wang
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jingjing Zhu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Huiling Li
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China.,Hainan Clinical Medical school of Southern Medical University, Sanya, Hainan, China
| |
Collapse
|