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梁 国, 林 新. [Recent research on inhaled nitric oxide in preterm infants with a gestational age of <34 weeks]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:982-988. [PMID: 37718407 PMCID: PMC10511234 DOI: 10.7499/j.issn.1008-8830.2303146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 09/19/2023]
Abstract
Nitric oxide is a messenger molecule for vasodilation of vascular smooth muscle cells, and inhaled nitric oxide (iNO) can dilate pulmonary blood vessels and reduce pulmonary vascular resistance, thereby reducing pulmonary artery pressure, but with no influence on systemic circulation pressure. Guidelines in China and overseas recommend the use of iNO in full-term infants and late preterm infants, and it has been proved that it has a marked effect on persistent pulmonary hypertension and hypoxic respiratory failure in such infants. However, recent studies have shown that there is an increase in the off-label use of iNO in preterm infants with a gestational age of <34 weeks. This article reviews the research progress on the efficacy, safety, timing, dose, and withdrawal mode of iNO and its combination with vasoactive drugs in the treatment of preterm infants with a gestational age of <34 weeks in China and overseas, so as to provide a reference for clinical application.
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林 梅, 张 雪, 王 亚, 朱 晓, 薛 江. [Interpretation of the key updates in the 2022 European guideline on the management of neonatal respiratory distress syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:779-784. [PMID: 37668023 PMCID: PMC10484088 DOI: 10.7499/j.issn.1008-8830.2303046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 09/06/2023]
Abstract
With the deepening of clinical research, the management of neonatal respiratory distress syndrome (RDS) needs to be optimized and improved. This article aims to introduce the 2022 European guideline on the management of neonatal RDS, focusing on its key updates. The guide has optimized the management of risk prediction for preterm birth, maternal referral, application of prenatal corticosteroids, application of lung protective ventilation strategies, and general care for infants with RDS. The guideline is mainly applicable to the management of RDS in neonates with gestational age greater than 24 weeks.
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Mitra S, Altit G. L'utilisation du monoxyde d'azote inhalé chez les nouveau-nés. Paediatr Child Health 2023; 28:119-127. [PMID: 37151927 PMCID: PMC10156931 DOI: 10.1093/pch/pxac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/29/2022] [Indexed: 05/09/2023] Open
Abstract
Le monoxyde d'azote inhalé (NOi), un vasodilatateur pulmonaire sélectif, est utilisé pour le traitement des nouveau-nés en insuffisance respiratoire hypoxémique (IRH) associée à une hypertension pulmonaire persistante du nouveau-né. Idéalement, il doit commencer à être administré après la confirmation échocardiographique de ce type d'hypertension. L'utilisation de NOi est recommandée chez les nouveau-nés peu prématurés ou à terme chez qui survient une IRH malgré des stratégies d'oxygénation ou de ventilation optimales. Cependant, il n'est pas recommandé d'y recourir systématiquement chez les nouveau-nés prématurés sous assistance respiratoire. On peut l'envisager comme traitement de secours chez les nouveau-nés prématurés en IRH précoce associée à une rupture prolongée des membranes ou à un oligoamnios, ou en IRH tardive en cas d'hypertension pulmonaire liée à une dysplasie bronchopulmonaire et accompagnée d'une insuffisance ventriculaire droite marquée. On peut aussi l'envisager chez les nouveau-nés atteints d'une hernie diaphragmatique congénitale qui présentent une IRH persistante, malgré un recrutement pulmonaire optimal, des signes échocardiographiques d'hypertension pulmonaire suprasystémique et un fonctionnement ventriculaire gauche approprié.
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Affiliation(s)
- Souvik Mitra
- Société canadienne de pédiatrie, comité d'étude du fœtus et du nouveau-né, Ottawa (Ontario)Canada
| | - Gabriel Altit
- Société canadienne de pédiatrie, comité d'étude du fœtus et du nouveau-né, Ottawa (Ontario)Canada
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Mitra S, Altit G. Inhaled nitric oxide use in newborns. Paediatr Child Health 2023; 28:119-127. [PMID: 37151928 PMCID: PMC10156933 DOI: 10.1093/pch/pxac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/29/2022] [Indexed: 05/09/2023] Open
Abstract
Inhaled nitric oxide (iNO), a selective pulmonary vasodilator, is used as a therapeutic modality in infants with hypoxemic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN). iNO should ideally be initiated following echocardiographic confirmation of PPHN. Use of iNO is recommended in late preterm and term infants who develop HRF despite optimal oxygenation and ventilation strategies. However, routine iNO use in preterm infants on respiratory support is not recommended. iNO may be considered as a rescue modality in preterm infants with early-onset HRF when associated with prolonged rupture of membranes or oligohydramnios, or late-onset HRF in the context of bronchopulmonary dysplasia-associated pulmonary hypertension (PH) with severe right ventricular failure. A trial of iNO may also be considered for infants with congenital diaphragmatic hernia with persistent HRF despite optimal lung recruitment, and with echocardiographic evidence of supra-systemic PH and adequate left ventricular function.
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Affiliation(s)
- Souvik Mitra
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario, Canada
| | - Gabriel Altit
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario, Canada
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Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120:3-23. [PMID: 36863329 PMCID: PMC10064400 DOI: 10.1159/000528914] [Citation(s) in RCA: 115] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023]
Abstract
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).
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Affiliation(s)
- David G. Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
| | - Virgilio P. Carnielli
- Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C. Roehr
- Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christian P. Speer
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerry H.A. Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L. Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
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Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future. An Pediatr (Barc) 2021; 95:485.e1-485.e10. [PMID: 34857500 DOI: 10.1016/j.anpede.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and therefore is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
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Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, Spain; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, Spain; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, Spain; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, Spain
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, Spain; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, Spain; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, Spain; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Raquerl Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, Spain
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Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. [Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00221-6. [PMID: 34304986 DOI: 10.1016/j.anpedi.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they would be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high-quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and, therefore, is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
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Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, España; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, España; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, España; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, España
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, España; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, España; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, España; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Raquel Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, España
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Abalenikhina YV, Kosmachevskaya OV, Topunov AF. Peroxynitrite: Toxic Agent and Signaling Molecule (Review). APPL BIOCHEM MICRO+ 2020. [DOI: 10.1134/s0003683820060022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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