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Stummer S, Reuter C, Czedik-Eysenberg I, Bertsch M, Klebermass-Schrehof K, Mader J, Buchmayer J, Bartha-Doering L, Berger A, Giordano V. "Every breath you take": evaluating sound levels and acoustic characteristics of various neonatal respiratory support and ventilation modalities. Front Pediatr 2024; 12:1379249. [PMID: 38706923 PMCID: PMC11066168 DOI: 10.3389/fped.2024.1379249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
Background Early sensory experiences have a significant impact on the later life of preterm infants. The NICU soundscape is profoundly influenced by various modalities of respiratory support or ventilation, which are often mandatory early in the care. The incubator, believed to shield from external noise, is less effective against noise originating inside. The objective of this study was to evaluate the sound levels and characteristics of frequently used respiratory support and ventilation modalities, taking into consideration the developing auditory system of premature infants. Methods To evaluate sound dynamics inside and outside an incubator during respiratory support/ventilation, experimental recordings were conducted at the Center for Pediatric Simulation Training of the Medical University Vienna. The ventilator used was a FABIAN HFOI®. Results Jet CPAP (Continuous positive airway pressure), whether administered via mask or prongs, generates significantly higher sound levels compared to High-flow nasal cannula (HFNC) and to High-frequency oscillatory ventilation (HFOV) delivered through an endotracheal tube. Upon evaluating the sound spectrum of jet CPAP support, a spectral peak is observed within the frequency range of 4 to 8 kHz. Notably, this frequency band aligns with the range where the hearing threshold of preterm infants is at its most sensitive. Conclusion Non-invasive HFNC and invasive HFOV generate lower sound levels compared to those produced by jet CPAP systems delivered via masks or prongs. Moreover, HFNC and HFOV show a reduced acoustic presence within the frequency range where the preterm infant's hearing is highly sensitive. Therefore, it is reasonable to speculate that the potential for auditory impairment might be more pronounced in preterm infants who require prolonged use of jet CPAP therapy during their time in the incubator.
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Affiliation(s)
- Sophie Stummer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | | | - Matthias Bertsch
- Department of Music Physiology, University of Music and Performing Arts Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Mader
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Julia Buchmayer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lisa Bartha-Doering
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Singh D, Fusch G. Investigating Noise Exposure to Newborn Infants From Respiratory Support: Methodological Considerations. Cureus 2021; 13:e19353. [PMID: 34909314 PMCID: PMC8653757 DOI: 10.7759/cureus.19353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Excessive noise in the neonatal intensive care unit (NICU) may lead to serious long-term effects on hearing and sensory development in newborns. As such, the maximum allowed noise level is 45 A-weighted decibels (dBA). Studies regarding noise exposure to ventilated preterm infants show inconsistent results; however, these studies also vary considerably in their methodology in terms of noise ascertainment. We hypothesized that the study methodology can significantly influence data quality when measuring noise levels. In this study, we aimed to investigate whether the variations in ventilator noise levels in NICUs could be a result of methodological differences in study designs. Methods A ventilator circuit was set up using nasal continuous positive airway pressure (nCPAP) and high-frequency (HF) modes with nasal prongs. Noise levels were measured using a commercially calibrated noise meter. Three different scenarios were tested: (1) measurements were taken at different angles (0° to 180°), with 180° facing the end of the nasal prongs, without a mannequin, with the membrane/orifice of the noise meter placed 2 mm laterally from the prongs; (2) noise levels were measured at 180° at distances of 0-20 mm from the nasal prongs; (3) measurements were taken in the oral cavity of a life-size intubation mannequin of a newborn baby. Results Overall, the noise levels produced at different settings varied significantly, ranging from 45.7 dB to 82.2 dB. The average environmental background noise was 44.4 dB. Noise levels typically increased as the angle increased, with the highest noise level recorded at 180° for both HF and nCPAP modes, at 58.4 dB and 58.2 dB, respectively. Noise levels recorded at HF were slightly higher than nCPAP values. Furthermore, with regard to distance, the highest mean value, 82.2 dB, was recorded with the noise meter approximately 3 mm from the nasal prongs, and the lowest mean value, 47.6 dB, was recorded at ~20 mm. During trials with the mannequin, the lowest value, 50.1 dB, was recorded at the entrance of the mouth with slightly higher values being recorded within the oral cavity. Conclusion The results indicate that small changes in experimental settings, such as positioning and distance from the nasal prongs, can greatly influence noise levels, particularly above the recommended levels for neonates. These differences may be attributed to wind-generated noise. In summary, some study results are potentially influenced more by the study design than the device type or ventilator setting. We recommend further research and detailed reporting in the NICU to gain deeper insights into the topic.
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Affiliation(s)
- Devika Singh
- Department of Pediatrics, McMaster University, Hamilton, CAN
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, CAN.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, CAN
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Antinmaa J, Salonen J, Jääskeläinen SK, Kaljonen A, Lapinleimu H. Continuous positive airway pressure treatment may negatively affect auditory maturation in preterm infants. Acta Paediatr 2021; 110:2976-2983. [PMID: 34254379 DOI: 10.1111/apa.16029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
AIM Nasal continuous positive airway pressure (CPAP) devices generate loud noise, which might harm auditory function and maturation. The function of auditory pathways can be examined by using brainstem auditory evoked potential (BAEP) and brainstem audiometry (BA) recordings. Our objective was to study whether CPAP treatment during the neonatal period is associated with abnormalities in BAEP and BA recordings. METHODS Included in this retrospective study were preterm infants (birth weight ≤1500 g and/or gestational age ≤32 weeks) born between 2002 and 2006 with a comprehensive clinical background and follow-up data, including the duration of CPAP treatment (n = 162). BAEP and BA were recorded near the mean corrected age of one month. The following variables from BAEP and BA examinations were analysed: latencies of BAEP components I, III, V, interpeak intervals (IPI) I-V, I-III, III-V (ms), amplitude I and V (µV), amplitude ratio I/V and BA thresholds. RESULTS In the adjusted analysis, a longer CPAP treatment leads to longer latencies of BAEP component III (p = 0.01) and V (p = 0.02) in the right ear. CONCLUSION CPAP treatment may impair the auditory maturation and processing mediated via the dominant right ear. The hearing and neurodevelopment of the children who are treated with CPAP should be followed.
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Affiliation(s)
- Jaana Antinmaa
- Department of Clinical Neurophysiology Turku University Hospital and University of Turku Turku Finland
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
- Department of Paediatric Neurology Tampere University Hospital Tampere Finland
| | - Jaakko Salonen
- Department of Otorhinolaryngology Turku University Hospital and University of Turku Turku Finland
| | - Satu K. Jääskeläinen
- Department of Clinical Neurophysiology Turku University Hospital and University of Turku Turku Finland
| | - Anne Kaljonen
- Department of Biostatistics Faculty of Medicine University of Turku Turku Finland
| | - Helena Lapinleimu
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
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Parra J, de Suremain A, Berne Audeoud F, Ego A, Debillon T. Sound levels in a neonatal intensive care unit significantly exceeded recommendations, especially inside incubators. Acta Paediatr 2017; 106:1909-1914. [PMID: 28477430 DOI: 10.1111/apa.13906] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
Abstract
AIM This study measured sound levels in a 2008 built French neonatal intensive care unit (NICU) and compared them to the 2007 American Academy of Pediatrics (AAP) recommendations. The ultimate aim was to identify factors that could influence noise levels. METHODS The study measured sound in 17 single or double rooms in the NICU. Two dosimeters were installed in each room, one inside and one outside the incubators, and these conducted measurements over a 24-hour period. The noise metrics measured were the equivalent continuous sound level (Leq ), the maximum noise level (Lmax ) and the noise level exceeded for 10% of the measurement period (L10 ). RESULTS The mean Leq , L10 and Lmax were 60.4, 62.1 and 89.1 decibels (dBA), which exceeded the recommended levels of 45, 50 and 65 dBA (p < 0.001), respectively. The Leq inside the incubator was significantly higher than in the room (+8 dBA, p < 0.001). None of the newborns' characteristics, the environment or medical care was correlated to an increased noise level, except for a postconceptional age below 32 weeks. CONCLUSION The sound levels significantly exceeded the AAP recommendations, particularly inside incubators. A multipronged strategy is required to improve the sound environment and protect the neonates' sensory development.
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Affiliation(s)
- Johanna Parra
- Intensive and Regular Neonatal Care Unit; CHR Chambery; Chambéry France
| | | | | | - Anne Ego
- Clinical Research Center (CICO3); CHU Grenoble Alpes; Grenoble France
- CNRS; CHU Grenoble Alpes; VETAGRO SUP; Grenoble Institute of Engineering Univ. Grenoble Alpes; TIMC-IMAG; Univ. Grenoble Alpes; Grenoble France
| | - Thierry Debillon
- Intensive and Regular Neonatal Care Unit; CHU Grenoble Alpes; Grenoble France
- CNRS; CHU Grenoble Alpes; VETAGRO SUP; Grenoble Institute of Engineering Univ. Grenoble Alpes; TIMC-IMAG; Univ. Grenoble Alpes; Grenoble France
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Falk M, Donaldsson S, Jonsson B, Drevhammar T. Return of neonatal CPAP resistance - the Medijet device family examined using in vitro flow simulations. Acta Paediatr 2017; 106:1760-1766. [PMID: 28715132 DOI: 10.1111/apa.13994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/08/2017] [Accepted: 07/13/2017] [Indexed: 12/01/2022]
Abstract
AIM Medijet nasal continuous positive airway pressure (CPAP) generators are a family of devices developed from the Benveniste valve. Previous studies have shown that the in vitro performance of the Medijet disposable generator was similar to the Neopuff resistor system. We hypothesised that resistance would be the main mechanism of CPAP generation in the Medijet disposable generator. METHODS The in vitro performance of the Medijet reusable and disposable systems, the Neopuff resistor system and the Benveniste and Infant Flow nonresistor systems were investigated using static and dynamic bench tests. RESULTS Large differences in performance were found between the different systems. The disposable Medijet demonstrated high resistance, low pressure stability and high imposed work of breathing. The results also showed that encapsulating the Benveniste valve changed it into a resistor system. CONCLUSION The main mechanism of CPAP generation for the disposable Medijet generator was resistance. The Medijet device family showed increasing resistance with each design generation. The high resistance of the Medijet disposable generator could be of great value when examining the clinical importance of pressure stability. Our results suggest that this device should be used cautiously in patients where pressure-stable CPAP is believed to be clinically important.
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Affiliation(s)
- Markus Falk
- Department of Women′s and Children′s Health; Karolinska Institutet; Stockholm Sweden
- Anesthesiology and ICU Department; Östersund Hospital; Östersund Sweden
| | - Snorri Donaldsson
- Department of Women′s and Children′s Health; Karolinska Institutet; Stockholm Sweden
- Neonatology Department; Karolinska University Hospital; Stockholm Sweden
| | - Baldvin Jonsson
- Department of Women′s and Children′s Health; Karolinska Institutet; Stockholm Sweden
- Neonatology Department; Karolinska University Hospital; Stockholm Sweden
| | - Thomas Drevhammar
- Department of Women′s and Children′s Health; Karolinska Institutet; Stockholm Sweden
- Anesthesiology and ICU Department; Östersund Hospital; Östersund Sweden
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A Novel Approach to Improving Fat Delivery in Neonatal Enteral Feeding. Nutrients 2015; 7:5051-64. [PMID: 26110253 PMCID: PMC4488830 DOI: 10.3390/nu7065051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/25/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022] Open
Abstract
Continuous infusion systems used for enteral nutrition support in the neonatal intensive care unit deliver as little as 60% of the fat in human milk to the neonate. This study determined the effect of mixing common feedings for preterm infants in the feeding bag and tubing on fat losses during enteral feeding. Laboratory models were developed to assess the contribution of various mixing techniques to delivered fat content. Fat content was measured periodically during feeding and compared to baseline measurements. A multistage approach incorporating a feeding bag inverter and a tubing circulation loop delivered >90% of milk fat when used in conjunction with a commercial continuous infusion system. With unfortified human milk, this approach delivered 91.9% ± 1.5% of fat content over a one hour feed, significantly greater (p < 0.01) than 77.5% ± 2.2% delivered by continuous infusion controls (Mean ± SEM). With fortified human milk, this approach delivered 92.1% ± 2.4% of fat content, significantly greater (p < 0.01) than 79.4% ± 1.0% delivered by a non-adapted infusion system (Mean ± SEM). Mixing human milk during continuous infusion improves fat delivery, which may improve nutrition and growth outcomes in low birth weight neonates.
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Continuous positive airway pressure in preterm neonates: An update of current evidence and implications for developing countries. Indian Pediatr 2015; 52:319-28. [DOI: 10.1007/s13312-015-0632-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lahav A. Questionable sound exposure outside of the womb: frequency analysis of environmental noise in the neonatal intensive care unit. Acta Paediatr 2015; 104:e14-9. [PMID: 25264140 DOI: 10.1111/apa.12816] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 09/05/2014] [Accepted: 09/23/2014] [Indexed: 11/29/2022]
Abstract
AIM Recent research raises concerns about the adverse effects of noise exposure on the developing preterm infant. However, current guidelines for NICU noise remain focused on loudness levels, leaving the problem of exposure to potentially harmful sound frequencies largely overlooked. This study examined the frequency spectra present in a level-II NICU. METHODS Noise measurements were taken in two level-II open-bay nurseries. Measurements were taken over 5 days for a period of 24 h each. Spectral analysis was focused on comparing sound frequencies in the range of human speech during daytime (7 AM-7 PM) vs. night-time (7 PM-7 AM). RESULTS On average, daytime noise levels (Leq = 60.05 dBA) were higher than night-time (Leq = 58.67 dBA). Spectral analysis of frequency bands (>50 dB) revealed that infants were exposed to frequencies <500 Hz 100% of the time and to frequencies >500 Hz 57% of the time. During daytime, infants were exposed to nearly 20% more sounds within the speech frequency range compared with night-time (p = 0.018). CONCLUSION Measuring the frequency spectra of NICU sounds is necessary to attain a thorough understanding of both the noise levels and the type of sounds that preterm infants are exposed to throughout their hospital stay. The risk of high-frequency noise exposure in the preterm population is still unclear and warrants further investigation.
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Affiliation(s)
- Amir Lahav
- Department of Pediatrics and Newborn Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Pediatrics; MassGeneral Hospital for Children; Harvard Medical School; Boston MA USA
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9
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Wald M. „Nasal continuous positive airway pressure“ und noninvasive Beatmung bei Frühgeborenen. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Roberts CT, Dawson JA, Alquoka E, Carew PJ, Donath SM, Davis PG, Manley BJ. Are high flow nasal cannulae noisier than bubble CPAP for preterm infants? Arch Dis Child Fetal Neonatal Ed 2014; 99:F291-5. [PMID: 24625433 DOI: 10.1136/archdischild-2013-305033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Noise exposure in the neonatal intensive care unit is believed to be a risk factor for hearing loss in preterm neonates. Continuous positive airway pressure (CPAP) devices exceed recommended noise levels. High flow nasal cannulae (HFNC) are an increasingly popular alternative to CPAP for treating preterm infants, but there are no in vivo studies assessing noise production by HFNC. OBJECTIVE To study whether HFNC are noisier than bubble CPAP (BCPAP) for preterm infants. METHODS An observational study of preterm infants receiving HFNC or BCPAP. Noise levels within the external auditory meatus (EAM) were measured using a microphone probe tube connected to a calibrated digital dosimeter. Noise was measured across a range of frequencies and reported as decibels A-weighted (dBA). RESULTS A total of 21 HFNC and 13 BCPAP noise measurements were performed in 21 infants. HFNC gas flows were 2-5 L/min, and BCPAP gas flows were 6-10 L/min with set pressures of 5-7 cm of water. There was no evidence of a difference in average noise levels measured at the EAM: mean difference (95% CI) of -1.6 (-4.0 to 0.9) dBA for HFNC compared to BCPAP. At low frequency (500 Hz), HFNC was mean (95% CI) 3.0 (0.3 to 5.7) dBA quieter than BCPAP. Noise increased with increasing BCPAP gas flow (p=0.007), but not with increasing set pressure. There was a trend to noise increasing with increasing HFNC gas flows. CONCLUSIONS At the gas flows studied, HFNC are not noisier than BCPAP for preterm infants.
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Klingenberg C, Pettersen M, Hansen EA, Gustavsen LJ, Dahl IA, Leknessund A, Kaaresen PI, Nordhov M. Patient comfort during treatment with heated humidified high flow nasal cannulae versus nasal continuous positive airway pressure: a randomised cross-over trial. Arch Dis Child Fetal Neonatal Ed 2014; 99:F134-7. [PMID: 24225220 DOI: 10.1136/archdischild-2013-304525] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare patient comfort in preterm infants treated with heated humidified high flow nasal cannulae (HHHFNC) versus nasal continuous positive airway pressure (NCPAP). DESIGN Randomised cross-over trial (2×24 h). SETTING Single tertiary neonatal unit. PATIENTS 20 infants less than 34 weeks postmenstrual age treated with NCPAP due to mild respiratory illness. INTERVENTIONS After parental consent, infants were randomised to 24 h of treatment with NCPAP or HHHFNC followed by 24 h of the alternate therapy. MAIN OUTCOME MEASURES Primary outcome was patient comfort assessed by the EDIN (neonatal pain and discomfort) scale. Secondary outcomes were respiratory parameters (respiratory rate, FiO2, SpO2, TcPCO2), ambient noise, salivary cortisol and parental assessments of their child. RESULTS We found no differences between HHHFNC and NCPAP in mean cumulative EDIN score (10.7 vs 11.1, p=0.25) or ambient noise (70 vs 74 dBa, p=0.18). Parents assessed HHHFNC treatment as significantly better in the three domains, 1) child satisfied, 2) parental contact and interaction and 3) possibility to take part in care. Mean respiratory rate over 24 h was lower during HHHFNC than CPAP (41 vs 46, p=0.001). Other respiratory parameters were similar. CONCLUSIONS Using EDIN scale, we found no difference in patient comfort with HHHFNC versus NCPAP. However, parents preferred HHHFNC, and during HHHFNC respiratory rate was lower than during NCPAP. CLINICALTRIALSGOV, NUMBER NCT01526226.
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Affiliation(s)
- Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, , Tromsø, Norway
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12
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König K, Stock EL, Jarvis M. Noise levels of neonatal high-flow nasal cannula devices--an in-vitro study. Neonatology 2013; 103:264-7. [PMID: 23466653 DOI: 10.1159/000346764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/21/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Excessive ambient noise levels have been identified as a potential risk factor for adverse outcome in very preterm infants. Noise level measurements for continuous positive airway pressure (CPAP) devices demonstrated that these constantly exceed current recommendations. The use of high-flow nasal cannula (HFNC) as an alternative non-invasive ventilation modality has become more popular in recent years in neonatal care. OBJECTIVE To study noise levels of two HFNC devices commonly used in newborns. As a comparison, noise levels of a continuous flow CPAP device were also studied. METHODS In-vitro study. The noise levels of two contemporary HFNC devices (Fisher & Paykel NHF™ and Vapotherm Precision Flow®) and one CPAP device (Dräger Babylog® 8000 plus) were measured in the oral cavity of a newborn manikin in an incubator in a quiet environment. HFNC flows of 4-8 l/min and CPAP pressures of 4-8 cm H2O were applied. The CPAP flow was set at 8 l/min as per unit practice. RESULTS Vapotherm HFNC generated the highest noise levels, measuring 81.2-91.4 dB(A) with increasing flow. Fisher & Paykel HFNC noise levels were between 78.8 and 81.2 dB(A). The CPAP device generated the lowest noise levels between 73.9 and 77.4 dB(A). CONCLUSIONS Both HFNC devices generated higher noise levels than the CPAP device. All noise levels were far above current recommendations of the American Academy of Pediatrics. In light of the long duration of non-invasive respiratory support of very preterm infants, less noisy devices are required to prevent the potentially adverse effects of continuing excessive noise exposure in the neonatal intensive care unit.
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Affiliation(s)
- Kai König
- Department of Paediatrics, Mercy Hospital for Women, Melbourne, Vic., Australia.
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Which continuous positive airway pressure system is best for the preterm infant with respiratory distress syndrome? Clin Perinatol 2012; 39:483-96. [PMID: 22954264 DOI: 10.1016/j.clp.2012.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Various commercial and home-made continuous positive airway pressure (CPAP) systems are described in this article. CPAP may be delivered via a range of device-patient interfaces; nasal CPAP is most common, and short binasal prongs impose the least extrinsic load impedance on the infant. The source of pressure generation is categorized as either constant pressure or constant flow. The efficacy of different systems may vary according to whether lung volume recruitment, airway patency, minimization of work of breathing, or central nervous system stimulation are the primary goal of the clinical decision to use CPAP therapy.
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McMahon E, Wintermark P, Lahav A. Auditory brain development in premature infants: the importance of early experience. Ann N Y Acad Sci 2012; 1252:17-24. [PMID: 22524335 DOI: 10.1111/j.1749-6632.2012.06445.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Preterm infants in the neonatal intensive care unit (NICU) often close their eyes in response to bright lights, but they cannot close their ears in response to loud sounds. The sudden transition from the womb to the overly noisy world of the NICU increases the vulnerability of these high-risk newborns. There is a growing concern that the excess noise typically experienced by NICU infants disrupts their growth and development, putting them at risk for hearing, language, and cognitive disabilities. Preterm neonates are especially sensitive to noise because their auditory system is at a critical period of neurodevelopment, and they are no longer shielded by maternal tissue. This paper discusses the developmental milestones of the auditory system and suggests ways to enhance the quality control and type of sounds delivered to NICU infants. We argue that positive auditory experience is essential for early brain maturation and may be a contributing factor for healthy neurodevelopment. Further research is needed to optimize the hospital environment for preterm newborns and to increase their potential to develop into healthy children.
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Affiliation(s)
- Erin McMahon
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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15
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Gustafsson PE, Gustafsson PA, Ivarsson T, Nelson N. Diurnal cortisol levels and cortisol response in youths with obsessive-compulsive disorder. Neuropsychobiology 2008; 57:14-21. [PMID: 18424906 DOI: 10.1159/000123117] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 01/22/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects. METHODS Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined. RESULTS Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters. CONCLUSION These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.
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Affiliation(s)
- Per E Gustafsson
- Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden.
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