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Shi ZN, Zhang X, Du CY, Zhao B, Liu SG. Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome. World J Clin Cases 2024; 12:5366-5373. [DOI: 10.12998/wjcc.v12.i23.5366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Neonatal respiratory distress syndrome (NRDS) is one of the most common diseases in neonatal intensive care units, with an incidence rate of about 7% among infants. Additionally, it is a leading cause of neonatal death in hospitals in China. The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant
AIM To explore the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on keratin-14 (KRT-14) and endothelin-1 (ET-1) levels in peripheral blood and the effectiveness in treating NRDS.
METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included. Of these, 64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation. The expression of KRT-14 and ET-1 in the two groups was compared. The deaths, complications, and PaO2, PaCO2, and PaO2/FiO2 blood gas indexes in the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.
RESULTS The observation group had a significantly higher effectiveness rate than the control group. There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions, such as bronchial dysplasia, cyanosis, and shortness of breath. After treatment, the levels of PaO2 and PaO2/FiO2 in both groups were significantly higher than before treatment, while the level of PaCO2 was significantly lower. After treatment, the observation group had significantly higher levels of PaO2 and PaO2/FiO2 than the control group, while PaCO2 was notably lower in the observation group. After treatment, the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels. The observation group had a reduction of KRT-14 and ET-1 levels than the control group. ROC curve analysis showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816.
CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy. KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.
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Affiliation(s)
- Ze-Ning Shi
- Department of Pediatrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Xin Zhang
- Department of Anesthesiology, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Chun-Yuan Du
- Department of Gynecology and Obstetrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Bing Zhao
- Department of Anesthesiology, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Shu-Gang Liu
- Department of Pediatrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
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Yang H, Gao LJ, Lei J, Li Q, Cui L, Li XH, Yin WX, Tian SH. Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score, oxygenation index, and chest radiography grading. World J Clin Cases 2024; 12:4154-4165. [PMID: 39015913 PMCID: PMC11235558 DOI: 10.12998/wjcc.v12.i20.4154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome (RDS), but current assessment methods for RDS pose a cumulative risk of harm to neonates. Thus, a less harmful method for assessing the health of neonates with RDS is needed. AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores, oxygenation index, and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity. METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022. The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray grade of each newborn before and after treatment were collected. Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity. RESULTS The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment (P < 0.05). Spearman correlation analysis showed that before and after treatment, the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score, oxygenation index, and chest X-ray grade (ρ = 0.429-0.859, P < 0.05). Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS (area under the curve = 0.805-1.000, P < 0.05). CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score, oxygenation index, and chest X-ray grade. The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.
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Affiliation(s)
- Hai Yang
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Li-Jun Gao
- Ultrasound Function Department, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Jing Lei
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Qiang Li
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Liu Cui
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Xiao-Hua Li
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Wu-Xuan Yin
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Sen-Hua Tian
- Medical Imaging Department, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
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Zhao X, Xiao H, Li X, Zhu L, Peng Y, Chen H, Chen L, Xu D, Wang H. Multi-organ developmental toxicity and its characteristics in fetal mice induced by dexamethasone at different doses, stages, and courses during pregnancy. Arch Toxicol 2024; 98:1891-1908. [PMID: 38522057 DOI: 10.1007/s00204-024-03707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
Dexamethasone is widely used in pregnant women at risk of preterm birth to reduce the occurrence of neonatal respiratory distress syndrome and subsequently reduce neonatal mortality. Studies have suggested that dexamethasone has developmental toxicity, but there is a notable absence of systematic investigations about its characteristics. In this study, we examined the effects of prenatal dexamethasone exposure (PDE) on mother/fetal mice at different doses (0.2, 0.4, or 0.8 mg/kg b.i.d), stages (gestational day 14-15 or 16-17) and courses (single- or double-course) based on the clinical practice. Results showed that PDE increased intrauterine growth retardation rate, and disordered the serum glucose, lipid and cholesterol metabolic phenotypes, and sex hormone level of mother/fetal mice. PDE was further discovered to interfere with the development of fetal lung, hippocampus and bone, inhibits steroid synthesis in adrenal and testis, and promotes steroid synthesis in the ovary and lipid synthesis in the liver, with significant effects observed at high dose, early stage and double course. The order of severity might be: ovary > lung > hippocampus/bone > others. Correlation analysis revealed that the decreased serum corticosterone and insulin-like growth factor 1 (IGF1) levels were closely related to PDE-induced low birth weight and abnormal multi-organ development in offspring. In conclusion, this study systematically confirmed PDE-induced multi-organ developmental toxicity, elucidated its characteristics, and proposed the potential "glucocorticoid (GC)-IGF1" axis programming mechanism. This research provided an experimental foundation for a comprehensive understanding of the effect and characteristics of dexamethasone on fetal multi-organ development, thereby guiding the application of "precision medicine" during pregnancy.
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Affiliation(s)
- Xiaoqi Zhao
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan, 430071, China
| | - Hao Xiao
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China
| | - Xiaomin Li
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan, 430071, China
| | - Lu Zhu
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan, 430071, China
| | - Yu Peng
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan, 430071, China
| | - Huijun Chen
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China
| | - Dan Xu
- Department of Pharmaceutical Sciences, School of Pharmacy, Wuhan University, Wuhan, 430071, China.
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China.
| | - Hui Wang
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan, 430071, China.
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China.
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China.
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Darverkar N, Bhutada A, Banait Y, Deopujari S, Singh BR. Effectiveness of High-Flow Nasal Cannula (RAM Cannula) With T-piece Resuscitator to Deliver Continuous Positive Airway Pressure (CPAP) During Neonatal Transport. Cureus 2024; 16:e61514. [PMID: 38957251 PMCID: PMC11217873 DOI: 10.7759/cureus.61514] [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: 02/26/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
Background Newborns frequently experience respiratory distress (RD), necessitating preventive management during transportation. The use of Continuous Positive Airway Pressure (CPAP) is crucial in mitigating RD in neonates, particularly during transit. This study aims to assess the feasibility and efficacy of utilizing a RAM cannula (Neotech Products, Valencia, USA) with a T-piece resuscitator to deliver CPAP during neonatal transport. The objective is to evaluate the response of transported neonates to this intervention, including improvements in distress, surfactant requirements, ventilator dependency, and complications. Method and material Neonates with RD qualifying for CPAP support at birth and requiring transport to Neonatal Intensive Care Unit (NICU) care were included. The average duration of transport was 38 minutes (range 12 minutes to 2 hours). RAM cannula with a T-piece resuscitator was used for CPAP delivery during transportation. Vital parameters and interventions were monitored during transit, and outcomes were compared with inborn neonates receiving standard CPAP in the labor room. Results Out of 48 babies, nine babies required surfactant, and four needed invasive ventilation, with three developing a nasal injury. Compared to in-house preterm babies, these babies had more Positive End Expiratory Pressure (PEEP) knob adjustment, desaturation episodes, late surfactant administration, and intubation needs. Conclusion A high-flow nasal cannula combined with a T-piece resuscitator emerges as a promising modality for CPAP delivery during neonatal transportation, demonstrating efficacy with minimal complications.
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Affiliation(s)
- Nilesh Darverkar
- Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | | | - Yash Banait
- Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | | | - Brij Raj Singh
- Anatomy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
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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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Abdel-Latif ME, Tan O, Fiander M, Osborn DA. Non-invasive high-frequency ventilation in newborn infants with respiratory distress. Cochrane Database Syst Rev 2024; 5:CD012712. [PMID: 38695628 PMCID: PMC11064768 DOI: 10.1002/14651858.cd012712.pub2] [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] [Indexed: 05/05/2024]
Abstract
BACKGROUND Respiratory distress occurs in up to 7% of newborns, with respiratory support (RS) provided invasively via an endotracheal (ET) tube or non-invasively via a nasal interface. Invasive ventilation increases the risk of lung injury and chronic lung disease (CLD). Using non-invasive strategies, with or without minimally invasive surfactant, may reduce the need for mechanical ventilation and the risk of lung damage in newborn infants with respiratory distress. OBJECTIVES To evaluate the benefits and harms of nasal high-frequency ventilation (nHFV) compared to invasive ventilation via an ET tube or other non-invasive ventilation methods on morbidity and mortality in preterm and term infants with or at risk of respiratory distress. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and three trial registries in April 2023. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster- or quasi-RCTs of nHFV in newborn infants with respiratory distress compared to invasive or non-invasive ventilation. DATA COLLECTION AND ANALYSIS Two authors independently selected the trials for inclusion, extracted data, assessed the risk of bias, and undertook GRADE assessment. MAIN RESULTS We identified 33 studies, mostly in low- to middle-income settings, that investigated this therapy in 5068 preterm and 46 term infants. nHFV compared to invasive respiratory therapy for initial RS We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 0.67, 95% CI 0.20 to 2.18; 1 study, 80 infants) or the incidence of CLD (RR 0.38, 95% CI 0.09 to 1.59; 2 studies, 180 infants), both very low-certainty. ET intubation, death or CLD, severe intraventricular haemorrhage (IVH) and neurodevelopmental disability (ND) were not reported. nHFV vs nasal continuous positive airway pressure (nCPAP) used for initial RS We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 1.00, 95% CI 0.41 to 2.41; 4 studies, 531 infants; very low-certainty). nHFV may reduce ET intubation (RR 0.52, 95% CI 0.33 to 0.82; 5 studies, 571 infants), but there may be little or no difference in CLD (RR 1.35, 95% CI 0.80 to 2.27; 4 studies, 481 infants); death or CLD (RR 2.50, 95% CI 0.52 to 12.01; 1 study, 68 participants); or severe IVH (RR 1.17, 95% CI 0.36 to 3.78; 4 studies, 531 infants), all low-certainty evidence. ND was not reported. nHFV vs nasal intermittent positive-pressure ventilation (nIPPV) used for initial RS nHFV may result in little to no difference in mortality before hospital discharge (RR 1.86, 95% CI 0.90 to 3.83; 2 studies, 84 infants; low-certainty). nHFV may have little or no effect in reducing ET intubation (RR 1.33, 95% CI 0.76 to 2.34; 5 studies, 228 infants; low-certainty). There may be a reduction in CLD (RR 0.63, 95% CI 0.42 to 0.95; 5 studies, 307 infants; low-certainty). A single study (36 infants) reported no events for severe IVH. Death or CLD and ND were not reported. nHFV vs high-flow nasal cannula (HFNC) used for initial RS We are very uncertain whether nHFV reduces ET intubation (RR 2.94, 95% CI 0.65 to 13.27; 1 study, 37 infants) or reduces CLD (RR 1.18, 95% CI 0.46 to 2.98; 1 study, 37 participants), both very low-certainty. There were no mortality events before hospital discharge or severe IVH. Other deaths, CLD and ND, were not reported. nHFV vs nCPAP used for RS following planned extubation nHFV probably results in little or no difference in mortality before hospital discharge (RR 0.92, 95% CI 0.52 to 1.64; 6 studies, 1472 infants; moderate-certainty). nHFV may result in a reduction in ET reintubation (RR 0.42, 95% CI 0.35 to 0.51; 11 studies, 1897 infants) and CLD (RR 0.78, 95% CI 0.67 to 0.91; 10 studies, 1829 infants), both low-certainty. nHFV probably has little or no effect on death or CLD (RR 0.90, 95% CI 0.77 to 1.06; 2 studies, 966 infants) and severe IVH (RR 0.80, 95% CI 0.57 to 1.13; 3 studies, 1117 infants), both moderate-certainty. We are very uncertain whether nHFV reduces ND (RR 0.92, 95% CI 0.37 to 2.29; 1 study, 74 infants; very low-certainty). nHFV versus nIPPV used for RS following planned extubation nHFV may have little or no effect on mortality before hospital discharge (RR 1.83, 95% CI 0.70 to 4.79; 2 studies, 984 infants; low-certainty). There is probably a reduction in ET reintubation (RR 0.69, 95% CI 0.54 to 0.89; 6 studies, 1364 infants), but little or no effect on CLD (RR 0.88, 95% CI 0.75 to 1.04; 4 studies, 1236 infants); death or CLD (RR 0.92, 95% CI 0.79 to 1.08; 3 studies, 1070 infants); or severe IVH (RR 0.78, 95% CI 0.55 to 1.10; 4 studies, 1162 infants), all moderate-certainty. One study reported there might be no difference in ND (RR 0.88, 95% CI 0.35 to 2.16; 1 study, 72 infants; low-certainty). nHFV versus nIPPV following initial non-invasive RS failure nHFV may have little or no effect on mortality before hospital discharge (RR 1.44, 95% CI 0.10 to 21.33); or ET intubation (RR 1.23, 95% CI 0.51 to 2.98); or CLD (RR 1.01, 95% CI 0.70 to 1.47); or severe IVH (RR 0.47, 95% CI 0.02 to 10.87); 1 study, 39 participants, all low- or very low-certainty. Other deaths or CLD and ND were not reported. AUTHORS' CONCLUSIONS For initial RS, we are very uncertain if using nHFV compared to invasive respiratory therapy affects clinical outcomes. However, nHFV may reduce intubation when compared to nCPAP. For planned extubation, nHFV may reduce the risk of reintubation compared to nCPAP and nIPPV. nHFV may reduce the risk of CLD when compared to nCPAP. Following initial non-invasive respiratory support failure, nHFV when compared to nIPPV may result in little to no difference in intubation. Large trials, particularly in high-income settings, are needed to determine the role of nHFV in initial RS and following the failure of other non-invasive respiratory support. Also, the optimal settings of nHVF require further investigation.
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Affiliation(s)
- Mohamed E Abdel-Latif
- Discipline of Neonatology, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Acton, ACT, Australia
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, ACT, Australia
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Olive Tan
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, ACT, Australia
| | | | - David A Osborn
- Central Clinical School, School of Medicine, The University of Sydney, Sydney, Australia
- Department of Neonatology, Royal Prince Alfred Hospital, Camperdown, Australia
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Chan CS, Chiu M, Ariyapadi S, Brown LS, Burchfield P, Simcik V, Garcia K, Mazioniene K, Jaleel MA, Wyckoff MH, Kapadia VS, Kakkilaya V. Evaluation of a respiratory care protocol including less invasive surfactant administration in preterm infants. Pediatr Res 2024; 95:1603-1610. [PMID: 38097721 DOI: 10.1038/s41390-023-02963-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 05/26/2024]
Abstract
BACKGROUND Respiratory care protocol including less invasive śsurfactant administration (LISA) in ≤29 weeks' gestational age (GA) infants introduced in October 2018. METHODS Retrospective study of infants admitted on continuous positive airway pressure (CPAP) October 2018 to December 2021. Maternal and neonatal variables were compared between infants managed on CPAP with and without LISA. Infants who received LISA and subsequently required mechanical ventilation (MV) within 72 h of life (HOL) [LISA failure (LF)] were compared with those who required no MV [LISA success (LS)]. RESULTS 249 infants were admitted on CPAP, 5 were intubated prior to LISA, 143 required LISA and 101 remained on CPAP without surfactant. Of those receiving LISA, 108 were LS and 35 were LF. Compared to LS, LF infants were of lower GA and birth weight, required higher fractional inspired oxygen (FiO2), and CPAP level at birth, admission, one HOL, and an hour after LISA. Moreover, LF infants had higher mortality and morbidity. Together GA ≤ 25 weeks' and FiO2 ≥ 0.3 an hour after LISA best predicted LF. CONCLUSIONS Over 80% of infants admitted on CPAP avoided MV within 72 HOL. Early predictors of LF provide targets for future interventions to decrease need for MV in preterm infants. IMPACT Less invasive surfactant administration (LISA) decreases the need for mechanical ventilation (MV) and improves outcomes. However, some infants require MV within 72 h of life (HOL) despite LISA (LISA failure). Over 80% of ≤29 weeks' gestational age (GA) infants can be successfully managed on CPAP with or without surfactant in the first 72 HOL. A combination of factors including ≤25 weeks' GA and fraction of inspired oxygen ≥0.3 an hour after LISA predict LISA failure. Evaluation of a noninvasive respiratory support strategy including LISA provides targets for intervention to decrease need for MV in preterm infants.
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Affiliation(s)
- Christina S Chan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melody Chiu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Swathi Ariyapadi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Patti Burchfield
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kristi Garcia
- Parkland Health and Hospital System, Dallas, TX, USA
| | | | | | - Myra H Wyckoff
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishal S Kapadia
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Chen Y, Song Y, Peng H, Li J, Zhao C, Liu D, Tan J, Liu Y. Changes in Thymic Size and Immunity Are Associated with Bronchopulmonary Dysplasia. Am J Perinatol 2024; 41:e1732-e1739. [PMID: 37192653 DOI: 10.1055/s-0043-1768704] [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] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Preterm infants with bronchopulmonary dysplasia (BPD) are at increased risk for dysfunctional immune responses in the postnatal period. This study aimed to verify the hypothesis that thymic function is altered in infants with BPD and changes in the expression of thymic function-related genes affect thymic development. STUDY DESIGN Included in the study were infants who had a gestational age ≤32 weeks and survived to a postmenstrual age of ≥36 weeks. The clinical features and thymic size were comparatively studied between infants with and without BPD. Thymic function and the expression of thymic function-related genes were determined in BPD infants at birth, week 2, and 4 of life. The thymic size was ultrasonographically assessed in terms of the thymic index (TI) and thymic weight index (TWI). T-cell receptor excision circles (TRECs) and gene expression were quantitatively determined by real-time quantitative reverse transcription polymerase chain reaction. RESULTS Compared to non-BPD infants, their BPD counterparts had a shorter GA, lower birth weight, lower Apgar scores at birth, and were more likely to be of the male gender. BPD infants had an elevated incidence of respiratory distress syndrome and sepsis. TI was 1.73 ± 0.68 versus 2.87 ± 0.70 cm3 and TWI was 1.38 ± 0.45 versus 1.72 ± 0.28 cm3/kg in the BPD group versus the non-BPD group (p < 0.05). In BPD infants, no significant changes were observed in thymic size, lymphocyte counts, and TREC copy numbers at the first 2 weeks (p > 0.05), but they all exhibited a significant increase at week 4 (p < 0.05). BPD infants presented a trend toward increased expression of transforming growth factor-β1 and decreased expression of forkhead box protein 3 (Foxp3) from birth to week 4 (p < 0.05). Nonetheless, no significant difference was found in IL-2 or IL-7 expression at all time points (p > 0.05). CONCLUSION For preterm infants with BPD, reduced thymic size at birth might be associated with impaired thymic function. Thymic function was developmentally regulated in the BPD process. KEY POINTS · For preterm infants with BPD, reduced thymic size at birth might be associated with impaired thymic.. · BPD infants had an elevated incidence of respiratory distress syndrome and sepsis.. · Thymic function was developmentally regulated in the BPD process..
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Affiliation(s)
- Yan Chen
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Song
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Lab of Molecular Imaging, China
| | - Hua Peng
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Zhao
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Liu
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Tan
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalan Liu
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Besiri K, Begou O, Lallas K, Kontou A, Agakidou E, Deda O, Gika H, Verykouki E, Sarafidis K. Gastric Fluid Metabolomics Predicting the Need for Surfactant Replacement Therapy in Very Preterm Infants Results of a Case-Control Study. Metabolites 2024; 14:196. [PMID: 38668324 PMCID: PMC11051721 DOI: 10.3390/metabo14040196] [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: 02/11/2024] [Revised: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory distress syndrome (RDS) is a major morbidity of prematurity. In this case-control study, we prospectively evaluated whether untargeted metabolomic analysis (gas chromatography-mass spectrometry) of the gastric fluid could predict the need for surfactant in very preterm neonates. 43 infants with RDS necessitating surfactant (cases) were compared with 30 infants who were not treated with surfactant (controls). Perinatal-neonatal characteristics were recorded. Significant differences in gastric fluid metabolites (L-proline, L-glycine, L-threonine, acetyl-L-serine) were observed between groups, but none could solely predict surfactant administration with high accuracy. Univariate analysis revealed significant predictors of surfactant administration involving gastric fluid metabolites (L-glycine, acetyl-L-serine) and clinical parameters (gestational age, Apgar scores, intubation in the delivery room). Multivariable models were constructed for significant clinical variables as well as for the combination of clinical variables and gastric fluid metabolites. The AUC value of the first model was 0.69 (95% CI 0.57-0.81) and of the second, 0.76 (95% CI 0.64-0.86), in which acetyl-L-serine and intubation in the delivery room were found to be significant predictors of surfactant therapy. This investigation adds to the current knowledge of biomarkers in preterm neonates with RDS, but further research is required to assess the predictive value of gastric fluid metabolomics in this field.
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Affiliation(s)
- Konstantia Besiri
- 1st Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (K.B.); (A.K.); (E.A.)
| | - Olga Begou
- School of Chemistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), 57001 Thessaloniki, Greece; (O.D.); (H.G.)
| | - Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429 Thessaloniki, Greece;
| | - Angeliki Kontou
- 1st Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (K.B.); (A.K.); (E.A.)
| | - Eleni Agakidou
- 1st Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (K.B.); (A.K.); (E.A.)
| | - Olga Deda
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), 57001 Thessaloniki, Greece; (O.D.); (H.G.)
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Helen Gika
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), 57001 Thessaloniki, Greece; (O.D.); (H.G.)
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Eleni Verykouki
- Laboratory of Biometry, University of Thessaly, 38446 Volos, Greece;
| | - Kosmas Sarafidis
- 1st Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (K.B.); (A.K.); (E.A.)
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10
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Radicioni M, Pennoni S, Fantauzzi A, Bini V, Camerini P. Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration. J Ultrasound 2024; 27:87-96. [PMID: 37660325 PMCID: PMC10908957 DOI: 10.1007/s40477-023-00820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023] Open
Abstract
PURPOSE Concerns remain on different alveolar deposition of surfactant between LISA and INSURE methods. Ultrasound evaluation of diaphragm kinetics may provide clinical evidence on this issue, as indirect representation of the respiratory system compliance. METHODS This was a prospective-observational pilot study. The inclusion criterion was CPAP-supported infants ≤ 32 weeks with RDS receiving surfactant via minimally invasive technique. 52 patients randomized for surfactant administration via LISA or INSURE methods were enrolled. Right diaphragm (RD) global mean peak velocity (MPV) by Pulsed-Wave Tissue Doppler Imaging (PTDI) was recorded before and two hours after surfactant administration with simultaneous measurements of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio). Mechanical ventilation ≤ 72 h from birth represented treatment failure. RESULTS LISA infants had significantly higher gestational age (p = 0.029) and birth weight (p = 0.030) with lower CRIB-II scores (p = 0.030) than INSURE infants. LISA infants showed higher median MPV at baseline RD-PTDI US assessment (p = 0.024), but post-surfactant median MPV and other the investigated variables were similar at the adjusted analysis for gestational age and sedation. 8/52 (15%) infants who failed treatment had a significantly lower SF ratio (p = 0.002) and higher median MPV at RD-PTDI US (p = 0.004) after surfactant administration, despite the higher CPAP support level before (p = 0.007) and after (p = 0.001) surfactant administration. A full course of antenatal steroids was protective against mechanical ventilation (p = 0.038). CONCLUSIONS Different minimally invasive surfactant administration techniques do not appear to influence diaphragm kinetics evaluated by RD-PTDI US.
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Affiliation(s)
- Maurizio Radicioni
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy.
| | | | - Ambra Fantauzzi
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Piergiorgio Camerini
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy
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11
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Rallis D, Drogouti E, Karagianni P, Soubasi-Griva V, Tsakalidis C. Minimal invasive surfactant therapy in preterm infants with respiratory distress syndrome: a single-center experience. Minerva Pediatr (Torino) 2024; 76:72-78. [PMID: 33820400 DOI: 10.23736/s2724-5276.21.05867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Minimal invasive surfactant therapy (MIST) includes the tracheal instillation of surfactant via a thin catheter for the treatment of preterm infants with respiratory distress syndrome (RDS). We aimed to evaluate the impact of MIST compared to intubation, surfactant, extubation (INSURE) technique on respiratory outcomes. METHODS A prospectively recruited cohort of preterm infants ≤32 weeks with RDS was compared against a historical cohort of infants treated with INSURE. The primary outcome was the need for mechanical ventilation within 72 hours of age and secondary outcomes the overall need and duration of mechanical ventilation, the development of bronchopulmonary dysplasia, common morbidities, and survival. RESULTS Thirty-six infants treated with MIST of 29.1±2.2 weeks' gestation and 1219±238 g birthweight compared against 37 infants of 28.8±2.3 weeks' gestation and 1195±336 g birthweight treated with INSURE. A lower proportion of infants treated with MIST required mechanical ventilation within 72 hours of age compared to those treated with INSURE (11% compared 32%, P=0.042). However, no significant differences were noted regarding the overall intubation incidence, bronchopulmonary dysplasia, other morbidities, or survival. CONCLUSIONS In spontaneously breathing infants ≤32 weeks with RDS, the MIST technique was associated with a lower need for intubation within 72 hours of age, but otherwise with no significant differences regarding BPD or other neonatal morbidities.
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Affiliation(s)
- Dimitrios Rallis
- Second Neonatal Intensive Care Unit, Department of Neonatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece -
| | - Eftychia Drogouti
- Second Neonatal Intensive Care Unit, Department of Neonatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Paraskevi Karagianni
- Second Neonatal Intensive Care Unit, Department of Neonatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Vasiliki Soubasi-Griva
- Second Neonatal Intensive Care Unit, Department of Neonatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Christos Tsakalidis
- Second Neonatal Intensive Care Unit, Department of Neonatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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12
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Bhagwat AP, Sharath HV, Seth NH, Puri SN. Persistent Pulmonary Hypertension of Newborns Secondary to Labile Hypoxemia Associated With Cyanosis: A Case Series. Cureus 2024; 16:e54016. [PMID: 38476788 PMCID: PMC10928461 DOI: 10.7759/cureus.54016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 03/14/2024] Open
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a condition that can be fatal, marked by increased pulmonary vascular resistance that causes blood to shunt from the right to the left. Six infants that present with PPHN due to labile hypoxemia and related cyanosis are examined in this case series. Clinical manifestations, such as premature deliveries, maternal problems, and different reactions to early therapies, are revealed by perinatal and postnatal histories. The newborns' respiratory distress prompted the use of oxygen supplementation and continuous positive airway pressure (CPAP), but intubation was required due to continued hypoxemia. The series aims to establish a way for further study in this crucial area while offering insightful contributions to the clinical subtleties of PPHN and illustrating the importance of specific therapeutic approaches.
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Affiliation(s)
- Anushka P Bhagwat
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita H Seth
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saurabh N Puri
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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13
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Permall DL, Zhang Y, Li H, Guan Y, Chen X. A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants. Sci Rep 2024; 14:1429. [PMID: 38228632 PMCID: PMC10792160 DOI: 10.1038/s41598-023-50303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
To compare the therapeutic effect of less invasive surfactant administration (LISA) followed by synchronized nasal intermittent positive pressure ventilation (SNIPPV) and traditional intubate-Surfactant-Extubate (InSurE) strategy for the treatment of neonatal respiratory distress syndrome (NRDS). A single-center, non-randomized and single- blinded study Tertiary neonatal intensive care unit 89 infants enrolled were preterm with gestational age < 366/7 weeks and clinically diagnosed with neonatal RDS (NRDS) Interventions: 32 infants were assigned to the LISA + SNIPPV group and 57 infants to the InSurE + nCPAP group. No statistically significant differences were noted in the baseline characteristics of the enrolled infants. A lower proportion of infants developed BPD in the LISA + SNIPPV group compared to the InSurE + CPAP group [10 (31.25%) vs. 21 (36.84%), P > 0.05]; however, there was no statistically significant difference. The number needed to treat (NNT) with LISA + SNIPPV to prevent BPD development is 18. The mortality rate was not significant between our study arms [1 (3.13%) vs 2 (3.51%), P > 0.05]. There were no statistically significant differences in the durations (days) of MV [(12.18 ± 13.89) vs. (11.35 ± 11.61), P > 0.05], oxygen therapy [(35.03 ± 19.13) vs. (39.75 ± 17.91), P > 0.05] and re-intubation rates [(0.19 ± 0.40) vs. (0.21 ± 0.45), P > 0.05] between the two study groups. In terms of complications, the incidence of patent ductus arteriosus (PDA) [24 (75.00%) vs. 27 (47.37%), P < 0.05] was higher and a lower rate of disturbed liver function [1 (3.23%) vs. 19 (33.33%), P < 0.05] were observed in the LISA + SNIPPV group. Acid-base imbalances were reportedly significantly higher in the InSurE group (P < 0.05). No significant differences in other complications were noted. In the interventional group, FiO2 requirements were significantly lower up until the 3rd week of treatment [FiO2 at day 0, (30.75 ± 4.78) vs. (34.66 ± 9.83), P < 0.05; FiO2 at day 21, (25.32 ± 3.74) vs. (29.11 ± 8.17), P < 0.05], as was RSS on days 2 [(0.77 ± 0.38) vs. (1.94 ± 0.75), P < 0.05] and 3 [(0.66 ± 0.33) vs. (1.89 ± 0.82), P < 0.05] after treatment. Additionally, infants in the standard group had a significantly prolonged hospital stay (days) [(45.97 ± 16.93) vs. (54.40 ± 16.26), P < 0.05]. The combination of LISA and SNIPPV for NRDS can potentially lower the rate of BPD, FiO2 demand and shorten the length of hospitalization.
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Affiliation(s)
| | - Yuhan Zhang
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hanyue Li
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yafei Guan
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoqing Chen
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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14
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Mansouri M, Servatyari K, Rahmani K, Sheikhahmadi S, Hemmatpour S, Eskandarifar A, Rahimzadeh M. Surfactant administration methods for premature newborns: LISA vs. INSURE comparative analysis. J Neonatal Perinatal Med 2024; 17:233-239. [PMID: 38759030 DOI: 10.3233/npm-230194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Respiratory Distress Syndrome (RDS) is the most common respiratory disorder among premature infants. The use of surfactant has significantly reduced respiratory complications and mortality. There are two conventional methods for administering surfactant: Intubate-Surfactant-Extubate (INSURE) and Less Invasive Surfactant Administration (LISA). This study aims to compare the effects of surfactant administration using these two methods on the treatment outcomes of premature newborns. MATERIALS AND METHODS In this retrospective cohort study, we included 100 premature newborns with RDS and spontaneous breathing who were admitted to the Neonatal Intensive Care Unit of Besat Hospital in Sanandaj city in 2021. Exclusion criteria comprised congenital anomalies and the needing for intubation for resuscitation at birth. The outcomes of epmericaly trated with two methods were compared: the LISA (50 neonates) and the INSURE (50 neonates). Our interesting outcomes were needing for mechanical ventilation, duration of ventilation, pneumothorax, pulmonary hemorrhage, severe retinopathy, CPAP duration, and bronchopulmonary dysplasia. Finally, we entered the data into STATA-14 statistical software and analyzed it using chi-square and t-tests. RESULTS In this study, 69% of the neonates were boys. The LISA group exhibited significantly lower rates of need for mechanical ventilation (P = 0.003) and ventilation duration (P < 0.001) compared to the INSURE group. Conversely, there were no significant differences between the two groups (P > 0.05) in terms of pneumothorax, pulmonary hemorrhage, severe retinopathy, CPAP duration, and bronchopulmonary dysplasia rates. CONCLUSION The results of this study suggest that the LISA method is a safe and non-invasive approach for surfactant administration. Notably, it resulted in a reduced need for mechanical ventilation and decreased ventilation duration compared to the INSURE method.
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Affiliation(s)
- M Mansouri
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - K Servatyari
- Student Research Committee, Kurdistan University of Medical Science, Sanandaj, Iran
| | - K Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - S Sheikhahmadi
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - S Hemmatpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - A Eskandarifar
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - M Rahimzadeh
- Student Research Committee, Kurdistan University of Medical Science, Sanandaj, Iran
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15
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Bhader M, Al-Hindi M, Ghaddaf A, Alamoudi A, Abualola A, Kalantan R, AlKhulifi N, Halawani I, Al-Qurashi M. Noninvasive Neurally Adjusted Ventilation versus Nasal Continuous or Intermittent Positive Airway Pressure for Preterm Infants: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1935. [PMID: 38136137 PMCID: PMC10741611 DOI: 10.3390/children10121935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
The noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is a newly developed noninvasive ventilation technique with promising clinical and ventilatory outcomes for preterm infants. This systematic review and meta-analysis aimed to investigate whether NIV-NAVA has better clinical and ventilatory outcomes than nasal continuous airway pressure (NCPAP) or noninvasive positive pressure ventilation (NIPP) on premature infants. MEDLINE, Embase, and CENTRAL were searched, and randomized controlled trials (RCTs) that compared NIV-NAVA with NCPAP or NIPP for preterm infants (gestational age: <37 weeks) were included. We evaluated the following outcomes in the neonatal intensive care unit: the desaturation rate, failure of noninvasive modality requiring intubation when received as the primary mode or the need for re-intubation after extubation from mechanical ventilation in the secondary mode (weaning), length of stay, and fraction of inspired oxygen. The mean difference and risk ratio were used to represent continuous and dichotomous outcomes, respectively. We included nine RCTs involving 339 preterm infants overall. NIV-NAVA showed similar clinical and ventilatory outcomes to NCPAP or NIPP, except for the maximum diaphragmatic electrical activity. The rate of failure of the noninvasive modality was not statistically different between NIV-NAVA and NCPAP. The pooled estimates for the maximum electrical activity were significantly reduced in NIV-NAVA compared with those in NIPP. The findings suggest that NIV-NAVA may be as safe and effective as NCPAP and NIPP for preterm neonates, particularly those who may not tolerate these alternative noninvasive methods. However, further trials are recommended for greater evidence.
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Affiliation(s)
- Mohammed Bhader
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Mohammed Al-Hindi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
| | - Abdullah Ghaddaf
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Anas Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Amal Abualola
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Renad Kalantan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Norah AlKhulifi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Ibrahim Halawani
- College of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia;
| | - Mansour Al-Qurashi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia; (M.A.-H.); (A.G.); (A.A.); (R.K.); (N.A.); (M.A.-Q.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
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16
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Guellec I, Debillon T, Flamant C, Jarreau PH, Serraz B, Tourneux P. Management of respiratory distress in moderate and late preterm infants: clinical trajectories in the Neobs study. Eur J Pediatr 2023; 182:5661-5672. [PMID: 37823928 PMCID: PMC10746757 DOI: 10.1007/s00431-023-05259-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
Management of respiratory distress (RD) in the extremely preterm newborn meets recommendations. Few data are available concerning the management and the clinical course of moderate and late preterms with RD. Clinical course and management among moderate (30-33 weeks (wks) of gestation) and late preterms (34-36 wks) were assessed in the Neobs study, a French neonatal observational cohort study (2018) of preterms with RD in the first 24 h of life. Clinical course was defined as stable (use of non-invasive ventilation (NIV) only), initially severe (initial use of invasive ventilation (IV)), and worsening (switch off IV after NIV support). Surfactant therapy instillation and withdrawal of all ventilator support at 72 h were recorded. Among moderate (n = 279) and late (n = 281) preterms, the clinical course was similar (p < 0.27): stable (82.1 and 86.8%), worsening (11.8% and 9.3%), and initially severe RD (6.1% and 3.9%), respectively. Surfactant was administered more frequently in the moderate versus late preterm groups (28.3% vs 16.7%; p < 0.001). The recommended surfactant dose (200 mg/kg) was administered in 53.3-83.3% of moderate and 42.1-63.2% of late preterms according to the clinical course. Withdrawal of ventilatory support at 72 h was observed in 40.0% and 70.0% of moderate and late preterms, respectively (p < 0.05), and was significantly (p < 0.001) associated with clinical course (the minus proportion among the worsening group). CONCLUSION While the proportion of clinical course pattern is similar in moderate and late preterm infants, the management of RD varies with gestational age, with late preterm infants being managed later in life and moderate premature infants weaned from ventilation at a later stage. WHAT IS KNOWN • There is a lack of clear guidance on the management of respiratory distress (RD) in moderate-to-late preterm infants. • Neobs was a multicentre, observational study designed to characterise the real-world management of moderate-to-late preterm infants with RD in France. WHAT IS NEW • Secondary analyses of Neobs study data found that ventilatory support strategies were dependent on gestational age despite a similar clinical course. • At 30-33 weeks of gestation (wks), infants were more likely to receive non-invasive ventilation at delivery, while 34-36 wks infants were more likely to be managed using a wait-and-see approach.
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Affiliation(s)
- Isabelle Guellec
- Neonatal Intensive Care Unit, University Hospital of Nice-Côte d'Azur, 06200, Nice, France.
| | - Thierry Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, Grenoble, France
| | - Cyril Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit of Port-Royal, AP-HP Centre-Université de Paris, Paris, France
| | | | - Pierre Tourneux
- Neonatal Intensive Care Unit, University Hospital of Amiens, University of Picardy Jules Verne, Amiens, France
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17
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De Luca D, Loi B, Tingay D, Fiori H, Kingma P, Dellacà R, Autilio C. Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction. Semin Fetal Neonatal Med 2023; 28:101494. [PMID: 38016825 DOI: 10.1016/j.siny.2023.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France; Department of Pediatrics, Division of Neonatology, Stanford University, School of Medicine - Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France
| | - David Tingay
- Neonatal Research Unit, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Humberto Fiori
- Division of Neonatology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paul Kingma
- Perinatal Institute, Cincinnati Children's University Hospital Medical Center, Cincinnati, OH, USA
| | - Raffaele Dellacà
- Department of Electronics, Information and Bio-engineering, Polytechnical University of Milan, Milan, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology and Research Institute Hospital October 12 (imas12), Faculty of Biology, Complutense University, Madrid, Spain; Clinical Pathology and Microbiology Unit, San Carlo Hospital, Potenza, Italy
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18
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Corsini I, Lenzi MB, Ciarcià M, Matina F, Petoello E, Flore AI, Nogara S, Gangemi A, Fusco M, Capasso L, Raimondi F, Rodriguez-Fanjul J, Dani C, Ficial B. Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants. Eur J Pediatr 2023; 182:5375-5383. [PMID: 37740771 DOI: 10.1007/s00431-023-05200-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
Lung ultrasound (LU) has emerged as the imaging technique of choice for the assessment of neonates with respiratory distress syndrome (RDS) at the bedside. Scoring systems were developed to quantify RDS severity and to predict the need for surfactant administration. There is no data on the comparison of the three main LU scores (LUS) proposed by Brat, Raimondi and Rodriguez-Fanjul. Moreover, there is not enough evidence to recommend which score and which cut-off has the best ability to predict surfactant need. The three LUS were compared in terms of ability to predict the need for surfactant and reproducibility in a cohort of very preterm infants. This was an observational, retrospective, multicenter study. Neonates below 32 weeks of gestational age with RDS, on non-invasive ventilation with a LU performed prior to surfactant administration (1-3 h of life) were included. Brat, Raimondi, and Rodriguez-Fanjul's scores were calculated for each patient. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability to predict surfactant administration. K-Cohen test, Bland-Altman, and intraclass correlation coefficients were used to assess the intra and interobserver variability. Fifty-four preterm infants were enrolled. Brat, Raimondi, and Rodriguez-Fanjul scores showed a strong ability to predict the need for surfactant: the AUCs were 0.85 (95% CI 0.74-0.96), 0.85 (95% CI 0.75-0.96), and 0.79 (95% CI 0.67-0.92), respectively. No significant differences have been found between the AUCs using the DeLong test. Brat and Raimondi's scores had an optimal cut-off value > 8, while the Rodriguez-Fanjul's score > 10. The k-Cohen values of intraobserver agreement for Brat, Raimondi, and Rodriguez-Fanjul's scores were 0.896 (0.698-1.000), 1.000 (1.000-1.000), and 0.922 (0.767-1.000), respectively. The k-Cohen values of interobserver agreement were 0.896 (0.698-1.000), 0.911 (0.741-1.000), and 0.833 (0.612-1.000), respectively.Conclusions: The three LUS had an excellent ability to predict the need for surfactant and an optimal intra and interobserver agreement. The differences found between the three scores are minimal with negligible clinical implications. Since the optimal cut-off value differed, the same score should be used consistently within the same center. What is Known: • Lung ultrasound is a useful bedside imaging tool that should be used in the assessment of neonates with RDS • Scoring systems or lung ultrasound scores allow to quantify the severity of the pulmonary disease and to predict the need for surfactant replacement therapy What is New: • The three lung ultrasound scores by Brat, Raimondi and Rodriguez-Fanjul have an excellent ability to predict the need for surfactant replacement therapy, although with different cut-off values • All three lung ultrasound scores had an excellent intra and interobserver reproducibility.
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Affiliation(s)
- Iuri Corsini
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
| | - Maria Beatrice Lenzi
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Martina Ciarcià
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Federico Matina
- Neonatal Intensive Care Unit, Hospital Cervello Palermo, Palermo, Italy
| | - Enrico Petoello
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonella Gangemi
- Neonatal Intensive Care Unit, Hospital Cervello Palermo, Palermo, Italy
| | - Monica Fusco
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Javier Rodriguez-Fanjul
- Neonatology Department, Institut d'Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Carlo Dani
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Department of Neurosciences, Drug Research and Child Health, University of Florence, PsychologyFlorence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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19
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Breindahl N, Tolsgaard MG, Henriksen TB, Roehr CC, Szczapa T, Gagliardi L, Vento M, Støen R, Bohlin K, van Kaam AH, Klotz D, Durrmeyer X, Han T, Katheria AC, Dargaville PA, Aunsholt L. Curriculum and assessment tool for less invasive surfactant administration: an international Delphi consensus study. Pediatr Res 2023; 94:1216-1224. [PMID: 37142651 PMCID: PMC10444608 DOI: 10.1038/s41390-023-02621-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Training and assessment of operator competence for the less invasive surfactant administration (LISA) procedure vary. This study aimed to obtain international expert consensus on LISA training (LISA curriculum (LISA-CUR)) and assessment (LISA assessment tool (LISA-AT)). METHODS From February to July 2022, an international three-round Delphi process gathered opinions from LISA experts (researchers, curriculum developers, and clinical educators) on a list of items to be included in a LISA-CUR and LISA-AT (Round 1). The experts rated the importance of each item (Round 2). Items supported by more than 80% consensus were included. All experts were asked to approve or reject the final LISA-CUR and LISA-AT (Round 3). RESULTS A total of 153 experts from 14 countries participated in Round 1, and the response rate for Rounds 2 and 3 was >80%. Round 1 identified 44 items for LISA-CUR and 22 for LISA-AT. Round 2 excluded 15 items for the LISA-CUR and 7 items for the LISA-AT. Round 3 resulted in a strong consensus (99-100%) for the final 29 items for the LISA-CUR and 15 items for the LISA-AT. CONCLUSIONS This Delphi process established an international consensus on a training curriculum and content evidence for the assessment of LISA competence. IMPACT This international consensus-based expert statement provides content on a curriculum for the less invasive surfactant administration procedure (LISA-CUR) that may be partnered with existing evidence-based strategies to optimize and standardize LISA training in the future. This international consensus-based expert statement also provides content on an assessment tool for the LISA procedure (LISA-AT) that can help to evaluate competence in LISA operators. The proposed LISA-AT enables standardized, continuous feedback and assessment until achieving proficiency.
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Affiliation(s)
- Niklas Breindahl
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Prehospital Center Region Zealand, Næstved, Denmark.
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tine B Henriksen
- Department of Paediatrics (Intensive Care Neonatology), Aarhus University Hospital, Aarhus, Denmark
- Perinatal Research Unit, Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Charles C Roehr
- Newborn Services, Southmead Hospital, North Bristol NHS Trust Bristol, Bristol, UK
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Tomasz Szczapa
- 2nd Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Maximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE) and Health Research Institute (IISLAFE), Valencia, Spain
| | - Ragnhild Støen
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kajsa Bohlin
- Department of Neonatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Klotz
- Center for Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Xavier Durrmeyer
- Department of Neonatal Intensive Care and Neonatology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- GRC CARMAS, IMRB, Université Paris Est Créteil, Faculté de Santé de Créteil, Créteil, France
| | - Tongyan Han
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, 92123, USA
| | - Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Lise Aunsholt
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
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20
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Zores C, Zana-Taïeb E, Caeymaex L, Fumeaux CF, Kuhn P. French Neonatal Society issues recommendations on preventing nasal injuries in preterm newborn infants during non-invasive respiratory support. Acta Paediatr 2023; 112:1849-1859. [PMID: 37222380 DOI: 10.1111/apa.16857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/25/2023]
Abstract
AIM To issue practical recommendations regarding the optimal care of nasal skin when non-invasive ventilation support is used. METHODS We performed a systematic search of PubMed to identify relevant papers published in English or French through December 2019. Different grades of evidence were evaluated. RESULTS Forty-eight eligible studies. The incidence in preterm infants was high. The lesions were more frequent for preterm infants born under 30 weeks of gestational age and/or below 1500 g. The lesion was most often located on the skin of the nose but could also be found on the intranasal mucous membranes or elsewhere on the face. Nasal injuries appear early after the beginning of non-invasive ventilation at a mean of 2-3 days for cutaneous lesions and eight or nine for intranasal lesions. The most effective strategies to prevent trauma are the use of a hydrocolloid at the beginning of the support ventilation, the preferential use of a mask and the rotation of ventilation interfaces. CONCLUSION Nasal injuries with continuous positive airway pressure treatment in preterm newborn infants were frequent and can induce pain, discomfort and sequelae. The immature skin of preterm newborn infants needs specific attention from trained caregivers and awareness by parents.
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Affiliation(s)
- Claire Zores
- Médecine et Réanimation du Nouveau - né, Service de Pédiatrie 2, Pôle Medico - Chirurgical Pédiatrique Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
- INCI, UPR 3212, CNRS and University of Strasbourg, Strasbourg, France
| | - Elodie Zana-Taïeb
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, Paris, France
- U955 INSERM, Université de Paris, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit Centre Hospitalier Intercommunal Creteil, Creteil, France
- Faculty of Health, University Paris East Creteil, Val de Marne, Creteil, France
| | - Céline Fischer Fumeaux
- Department of Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre Kuhn
- Médecine et Réanimation du Nouveau - né, Service de Pédiatrie 2, Pôle Medico - Chirurgical Pédiatrique Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
- INCI, UPR 3212, CNRS and University of Strasbourg, Strasbourg, France
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21
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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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22
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Luo K, Wang H, Huang F, Tang J. Optimal timing and cutoff range of lung ultrasound in predicting surfactant administration in neonates: A meta-analysis and systematic review. PLoS One 2023; 18:e0287758. [PMID: 37498845 PMCID: PMC10374100 DOI: 10.1371/journal.pone.0287758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/11/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Timely application of surfactant replacement therapy is critical for neonates with respiratory distress syndrome (RDS). Presently, early clinical decision on surfactant use relies solely on ventilator parameters. However, ventilator parameters are unable to truly recapitulate the extent of surfactant deficiency. Lung ultrasound has been increasingly used in the early prediction of surfactant use in recent years, but its predictive value remains unclear. Therefore, we conducted this study to examine its predictive value in surfactant use and determine the optimal timing and cutoff value. METHODS Studies on neonates with respiratory distress or diagnosed with RDS were collected from PubMed, Embase, Cochrane Library, and Web of Science. Primary outcomes included sensitivity, specificity, and positive and negative predictive values of lung ultrasound. RESULTS Ten eligible studies with 1162 participants were included. The sensitivity and specificity of lung ultrasound in predicting surfactant use were 0.86 (95% CI: 0.81-0.90) and 0.82 (95% CI: 0.71-0.90), respectively. Lung ultrasound performed within 1-3 h after birth had a sensitivity of 0.89 (95% CI: 0.79-0.95) and a Youden's index of 0.67. Compared with a lung ultrasound score (LUS) cutoff of ≤6/7, ≤8, >5, >6/7, and >8, a LUS cutoff of ≤5 had higher Youden's index (0.73) and sensitivity (0.94, 95% CI: 0.85-0.97) in predicting surfactant use. CONCLUSIONS Lung ultrasound is effective for predicting surfactant use in neonates. Lung ultrasound within 1-3 h after birth and a LUS cutoff of 5 are recommended. However, the symptoms and oxygenation of the neonatal patients must also be considered.
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Affiliation(s)
- Keren Luo
- Department of Neonatology, West China Second Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu City, Sichuan Province, China
| | - Haoran Wang
- West China School of Medicine, Sichuan University, Chengdu City, Sichuan Province, China
| | - Fangjun Huang
- West China School of Medicine, Sichuan University, Chengdu City, Sichuan Province, China
| | - Jun Tang
- Department of Neonatology, West China Second Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu City, Sichuan Province, China
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23
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Lee R, Kostina E, Dassios T, Greenough A. Influence of sex on the requirement for and outcomes following late postnatal corticosteroid treatment. Eur J Pediatr 2023; 182:1417-1423. [PMID: 36692623 PMCID: PMC10023612 DOI: 10.1007/s00431-023-04826-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/25/2023]
Abstract
There remains a disparity between the outcomes of male and female prematurely born infants. Our aim was to assess the influence of sex on the requirement for late (> 7 days) postnatal corticosteroid (PNS) treatment and the outcomes following treatment. A retrospective whole population study of infants born at less than 28 weeks of gestation in all neonatal units in England between 2014 and 2018. The impact of exposure to at least five consecutive days of dexamethasone or hydrocortisone on bronchopulmonary dysplasia (BPD) at 36 weeks corrected gestation and survival to discharge from neonatal care was determined. Ten thousand, six hundred and fifty-five infants survived to seven days. Male sex was associated with an increased incidence of BPD (OR 1.41, 95%CI 1.287-1.552, p < 0.001) and death (OR 1.227, 95%CI 1.123-1.452, p < 0.001). Two thousand, three hundred and forty-four infants (22%) received at least one course of PNS at a median of 23 (IQR 15-40) days after birth. Males (23.6%) were more likely to receive PNS than females (20.1%), p < 0.001 and receive repeated courses (mean 1.67 compared to a mean of 1.59 in the females), p = 0.027. Multivariate regression analysis identified no significant differences in the incidence of BPD or death between male and females who received PNS. Conclusions: Males and females had similar outcomes after receiving PNS, but a significantly greater proportion of males met the clinical threshold to receive PNS and were more likely to receive repeated courses which may expose them to a greater risk of adverse long-term outcomes. What is Known: • There remains a difference in outcomes of male and female infants born prematurely. • Prematurely born male infants were more likely to receive postnatal corticosteroids and a greater number of courses but had similar outcomes compared to female infants. What is New: • Postnatal corticosteroids have long-term adverse effects. Such outcomes should be considered when weighing up the risk-benefit ratio of prescribing postnatal corticosteroids, particularly in very prematurely born male infants.
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Affiliation(s)
- Rebecca Lee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Emily Kostina
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Neonatal Intensive Care Centre, King's College NHS Foundation Trust, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
- Asthma UK Centre for Allergic Mechanisms in Asthma, London, United Kingdom.
- NIHR Biomedical Research Centre based at Guy's and St Thomas NHS Foundation Trust and King's College London, London, United Kingdom.
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24
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Nitzan I, Abu Omar R, Mimouni FB, Burshtein-Sorotzkin D, Algavish-Landau N, Attia-Reches S. Capnography for catheter location confirmation in minimally invasive surfactant administration. J Perinatol 2023; 43:300-304. [PMID: 36720984 DOI: 10.1038/s41372-023-01624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Minimally Invasive Surfactant Treatment (MIST) is a common method for administering surfactant as a treatment for respiratory distress syndrome. However, tracheal catheter placement can be difficult to confirm. We assessed the presence of carbon dioxide (CO2) in tracheal and esophageal gas aspirated using CO2 detector. STUDY DESIGN Retrospective arm: 20 infants, MIST catheter placement was assessed with a CO2 detector in two techniques and confirmed with clinical response. Prospective arm-10 infants, aimed to check for CO2 presence in aspirated esophageal gas during routine nasogastric tube insertion. RESULTS Retrospective arm: All infants had positive capnography. One infant that had no clinical response to MIST was diagnosed with total anomalous pulmonary venous return. All 10 infants of the prospective arm had a Negative capnography (P < 0.001, Fisher's exact test). CONCLUSIONS Readily available CO2 detectors can distinguish between tracheal and esophageal placement of MIST catheters prior to MIST.
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Affiliation(s)
- Itamar Nitzan
- Shaare Zedek Medical Center, Jerusalem, Israel. .,Department of Pediatrics, Hebrew University of Jerusalem Medical School, Jerusalem, Israel.
| | - Rawan Abu Omar
- Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Pediatrics, Hebrew University of Jerusalem Medical School, Jerusalem, Israel
| | - Francis B Mimouni
- Shaare Zedek Medical Center, Jerusalem, Israel.,Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
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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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26
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Kim YJ, Lim G, Lee R, Chung S, Son JS, Park HW. Association between vitamin D level and respiratory distress syndrome: A systematic review and meta-analysis. PLoS One 2023; 18:e0279064. [PMID: 36701289 PMCID: PMC9879443 DOI: 10.1371/journal.pone.0279064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 11/14/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Growing evidence suggests an association between the vitamin D levels and respiratory outcomes of preterm infants. The objective of this systematic review and meta-analysis was to explore whether premature neonates with a vitamin D deficiency have an increased risk of respiratory distress syndrome (RDS). METHODS We searched PubMed, EMBASE, and the Cochrane Library up through July 20, 2021. The search terms were 'premature infant', 'vitamin D', and 'respiratory distress syndrome'. We retrieved randomized controlled trials and cohort and case-control studies. For statistical analysis, we employed the random-effects model in Comprehensive Meta-Analysis Software ver. 3.3. We employed the Newcastle-Ottawa Scales for quality assessment of the included studies. RESULTS A total of 121 potentially relevant studies were found, of which 15 (12 cohort studies and 3 case-control studies) met the inclusion criteria; the studies included 2,051 preterm infants. We found significant associations between RDS development in such infants and vitamin D deficiency within 24 h of birth based on various criteria, thus vitamin D levels < 30 ng/mL (OR 3.478; 95% CI 1.817-6.659; p < 0.001), < 20 ng/mL (OR 4.549; 95% CI 3.007-6.881; p < 0.001), < 15 ng/mL (OR 17.267; 95% CI 1.084-275.112; p = 0.044), and < 10 ng/ml (OR 1.732; 95% CI 1.031-2.910; p = 0.038), and an even lower level of vitamin D (SMD = -0.656; 95% CI -1.029 to -0.283; p = 0.001). CONCLUSION Although the vitamin D deficiency definitions varied and different methods were used to measure vitamin D levels, vitamin D deficiency or lower levels of vitamin D within 24 h of birth were always associated with RDS development. Monitoring of neonatal vitamin D levels or the maintenance of adequate levels may reduce the risk of RDS.
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Affiliation(s)
- Yoo Jinie Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Gina Lim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Ran Lee
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
- Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
- Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Sung Son
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
- Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
- Konkuk University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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27
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[Efficacy of volume-targeted ventilation versus high-frequency oscillatory ventilation in the treatment of neonatal respiratory distress syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1321-1325. [PMID: 36544413 PMCID: PMC9785079 DOI: 10.7499/j.issn.1008-8830.2207034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To study the clinical efficacy of volume-targeted ventilation (VTV) versus high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS A retrospective cohort analysis was performed on the medical data of 140 neonates with severe NRDS who were admitted from September 2016 to February 2022, with 55 neonates in the VTV group and 85 in the HFOV group. The neonates in the VTV group received conventional mechanical ventilation and target tidal volume, and those in the HFOV group received HFOV. Arterial blood gas parameters were collected at 48 hours after admission, and related indices during hospitalization were recorded, including mortality rate, duration of invasive mechanical ventilation, duration of oxygen therapy, and the incidence rates of complications. RESULTS Compared with the VTV group, the HFOV group had significantly lower incidence rates of grade Ⅲ-Ⅳ periventricular-intraventricular hemorrhage and neonatal necrotizing enterocolitis (P<0.05), and there were no significant differences between the two groups in the duration of invasive mechanical ventilation, the duration of oxygen therapy, mortality rate, and the incidence rates of bronchopulmonary dysplasia, hypocapnia, hypercapnia, periventricular leukomalacia, and retinopathy of prematurity (P>0.05). CONCLUSIONS HFOV has a better clinical efficacy than VTV in the treatment of NRDS.
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Solis-Garcia G, González-Pacheco N, Ramos-Navarro C, Vigil-Vázquez S, Gutiérrez-Vélez A, Merino-Hernández A, Rodríguez Sánchez De la Blanca A, Sánchez-Luna M. Lung recruitment in neonatal high-frequency oscillatory ventilation with volume-guarantee. Pediatr Pulmonol 2022; 57:3000-3008. [PMID: 35996817 DOI: 10.1002/ppul.26124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimal lung volume strategy during high-frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV-VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV-VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure. DESIGN AND METHODS The prospective observational study was done in a tertiary-level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV-VG in preterm infants with severe respiratory failure. RESULTS Twenty-seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23-25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2 O (IQR: 10-13), median critical lung opening mPaw during recruitment was 14 cm H2 O (IRQ: 12-16), and median optimal mPaw was 12 cm H2 O (IQR: 10-14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO2 : 65.0 vs. 45.0, p < 0.01, SpO2/FiO2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01). CONCLUSION In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV-VG.
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Affiliation(s)
- Gonzalo Solis-Garcia
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,The Hospital for Sick Children, Toronto, Canada
| | - Noelia González-Pacheco
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Ramos-Navarro
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Sara Vigil-Vázquez
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Gutiérrez-Vélez
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Amaia Merino-Hernández
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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29
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Federici C, Fornaro G, Roehr CC. Cost-saving effect of early less invasive surfactant administration versus continuous positive airway pressure therapy alone for preterm infants with respiratory distress syndrome. Eur J Hosp Pharm 2022; 29:346-352. [PMID: 33658228 PMCID: PMC9614139 DOI: 10.1136/ejhpharm-2020-002465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early rescue surfactant therapy using less invasive surfactant administration (LISA) can reduce the need for mechanical ventilation and avoid complications in preterm infants with respiratory distress syndrome. The purpose of this study was to estimate the budget impact of LISA compared with management based on continuous positive airway pressure (CPAP) alone and rescue surfactant therapy in case of CPAP failure. METHODS A budget impact model was built comparing LISA with CPAP alone in order to estimate the potential resource consumption and budget impact from the perspective of the National Health Service in England. A literature review was conducted to populate the model. Deterministic and probabilistic sensitivity analyses were conducted to characterise the existing uncertainty and to explore the contribution of individual model parameters to the overall budget impact. RESULTS Early rescue with LISA is expected to reduce resource consumption and costs compared with conservative therapy based on CPAP alone for preterm infants born at 25-32 weeks gestation. Savings are higher for preterm infants of 25-28 weeks (expected budget impact -£5146 per case, 95% credible interval (CrI) -£22 403 to £13, probability of being cost saving 97.4%) than for preterm infants of 29-32 weeks (-£176, 95% CrI -£4279 to £339, probability of being cost saving 85%). The impact of bronchopulmonary dysplasia (BPD) and intraventricular haemorrhage on resource consumption and the expected reduction in the incidence of BPD with LISA are the most influential parameters on the budget. CONCLUSIONS Early rescue with LISA used in preterm infants with respiratory distress syndrome and fraction of inspired oxygen ≥0.3 is expected to be cost saving compared with management based on CPAP alone, particularly in those born at 25-28 weeks gestation.
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Affiliation(s)
- Carlo Federici
- CERGAS - Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milano, Lombardia, Italy
| | - Giulia Fornaro
- CERGAS - Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milano, Lombardia, Italy
| | - Charles Christopher Roehr
- Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK
- Newborn Services, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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30
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Tao S, Du J, Chi X, Zhu Y, Wang X, Meng Q, Ling X, Diao F, Song C, Jiang Y, Lv H, Lu Q, Qin R, Huang L, Xu X, Liu C, Ding Y, Jiang T, Ma H, Xia Y, Liu J, Lin Y, Jin G, Hu Z. Associations between antenatal corticosteroid exposure and neurodevelopment in infants. Am J Obstet Gynecol 2022; 227:759.e1-759.e15. [PMID: 35667419 DOI: 10.1016/j.ajog.2022.05.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has been well recognized that antenatal administration of dexamethasone to pregnant women at risk of preterm delivery may markedly accelerate fetal maturation and reduce the risk of adverse perinatal outcomes in their preterm infants, particularly for births before 34 weeks of gestation. Since 2015, antenatal corticosteroid administration has been extended beyond 34 weeks of gestation by clinical guidelines, as it might have beneficial effects on fetal maturation and perinatal outcomes. However, concerns regarding the potential influence of antenatal corticosteroid treatment on offspring neurodevelopment have been raised. OBJECTIVE This study aimed to investigate whether maternal antenatal corticosteroid administration was associated with neurodevelopment in infants at 1 year of age. STUDY DESIGN In this prospective and longitudinal birth cohort study, women were followed up throughout gestation, and their infants underwent a Bayley Scales of Infant and Toddler Development, Third Edition, screening test at 1 year of age between December 2018 and September 2020. Finally, 1609 pregnant women and 1759 infants were included in the current study. Using a generalized linear mixed model, we examined the association between antenatal corticosteroid exposure and infant neurodevelopment in cognitive, receptive communication, expressive communication, fine motor, and gross motor functions. RESULTS Of the 1759 infants eligible for this study, 1453 (82.6%) were singletons. A total of 710 infants were exposed to antenatal corticosteroids, among whom 415 were dexamethasone exposed and 483 were prednisone exposed. Dexamethasone was prescribed most often in late pregnancy, whereas prednisone was often used before 8 weeks of gestation among women who conceived through assisted reproductive technology. Compared with those who had no exposure, antenatal corticosteroid exposure was associated with an increased risk of infants being noncompetent in the cognitive development domain after adjusting for conventional risk factors (adjusted risk ratio, 1.53; 95% confidence interval, 1.08-2.18; P=.017). For medication-specific exposure, those exposed vs not exposed to antenatal dexamethasone were 1.62-fold (95% confidence interval, 1.10-2.38; P=.014) more likely to be noncompetent in the cognitive development domain at 1 year. The association did not vary markedly between preterm and term infants, singletons and twins, or assisted reproductive technology-conceived and spontaneously conceived infants (all P>.05 for heterogeneity). In contrast, a null association was observed for the risk of being noncompetent in any domain of neurodevelopment with antenatal prednisone exposure at early pregnancy. CONCLUSION Here, antenatal corticosteroid, particularly dexamethasone exposure, was markedly associated with an increased risk of infants being noncompetent in the cognitive development domain at 1 year of age. These findings may provide new information when weighing the benefits and potential risks of maternal antenatal corticosteroid administration.
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Affiliation(s)
- Shiyao Tao
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiangbo Du
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xia Chi
- Department of Child Health Care, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Xiaoyan Wang
- Department of Obstetrics, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Qingxia Meng
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Reproductive Genetic Center, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiufeng Ling
- Department of Reproduction, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Feiyang Diao
- Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ci Song
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yangqian Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong Lv
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Qun Lu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rui Qin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Huang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Xu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cong Liu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuqing Ding
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Jiang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongxia Ma
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Lin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Department of Maternal, Child, and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guangfu Jin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine (Suzhou Centre), Nanjing Medical University Affiliated Suzhou Hospital, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.
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31
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Maternal Voice Exposure and Its Effect on Premature Infants' Feeding Milestones: A Systematic Review. Adv Neonatal Care 2022; 23:E40-E49. [PMID: 36191331 DOI: 10.1097/anc.0000000000001029] [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 Premature infants experience alterations in maternal stimulation (including auditory sensory alteration such as talking or singing to the infant in the neonatal intensive care unit) due to admission to the neonatal intensive care unit. Because of their physiological and neurobehavioral immaturity, infants are at an increased risk of delays in reaching feeding milestones (a key developmental milestone), which often need to be achieved before discharge. PURPOSE This systematic review evaluated the literature regarding the effect of maternal speech on achievement of feeding milestones in premature infants. DATA SOURCES A systematic search of CINAHL, PubMed, Web of Science, and Google Scholar from 2010 to 2021. STUDY SELECTION Studies were selected if they examined the effect of maternal voice interventions on premature infants' feeding milestones. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS Six studies were identified. This systematic review of the literature on the effects of maternal voice on feeding milestones in premature infants found equivocal results. IMPLICATIONS FOR PRACTICE Given the inconsistent results, this systematic review does not support a change in clinical practice. However, encouragement of maternal visits is highly recommended as the additional benefits of the mother's presence may extend beyond exposure to maternal voice. IMPLICATIONS FOR RESEARCH More research is needed including use of more homogenous samples, application of recommended decibel levels, and utilization of an adequately powered randomized controlled trial to further examine the effects of maternal voice on feeding milestones.
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32
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El-Farrash RA, DiBlasi RM, AbdEL-Aziz EA, El-Tahry AM, Eladawy MS, Tadros MA, Koriesh MA, Farid JV, AbdElwahab RS, Elsayed MA, Barakat NM. Postextubation Noninvasive Ventilation in Respiratory Distress Syndrome: A Randomized Controlled Trial. Am J Perinatol 2022; 29:1577-1585. [PMID: 33621983 DOI: 10.1055/s-0041-1723999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Successful extubation and prevention of reintubation remain primary goals in neonatal ventilation. Our aim was to compare three modalities of postextubation respiratory support-noninvasive positive pressure ventilation (NIPPV), nasal bilevel positive airway pressure (N-BiPAP), and nasal continuous positive airway pressure (NCPAP)-using the RAM cannula in preterm neonates with respiratory distress syndrome (RDS). Our secondary aim was to define the predictors of successful extubation. STUDY DESIGN A total of 120 preterm neonates (gestational age ≤35 weeks) with RDS who had undergone primary invasive ventilation were randomized to receive either NIPPV, N-BiPAP, or NCPAP. The incidence of respiratory failure in the first 48 hours postextubation, total days of invasive and noninvasive ventilation, duration of hospitalization, and mortality were measured and compared among the three different noninvasive support modalities. RESULTS There were no significant differences in the postextubation respiratory failure rates and the number of days of invasive as well as noninvasive ventilation among the three different support modalities (p > 0.05). The total number of days of mechanical ventilation and the duration of hospitalization were significantly higher in the N-BiPAP group than those in the NCPAP or NIPPV groups (p < 0.05). A gestational age of at least 29 weeks and a birth weight of at least 1.4 kg were predictive of successful extubation with a sensitivity of 98.2 and 85.3% and a specificity of 63.6 and 90.9%, respectively. CONCLUSION Longer durations of mechanical ventilation and hospitalization were observed with N-BiPAP as a noninvasive mode of ventilation, but there was no significant difference in the extubation failure rates among the three modalities. Gestational age and birth weight were shown to be independent predictors of successful extubation of preterm neonates with RDS. KEY POINTS · Successful extubation and reintubation prevention of preterms are primary goals in neonatal ventilation.. · NIPPV, N-BiPAP, and NCPAP could be used as postextubation noninvasive modes in preterm neonates.. · Gestational age and birth weight are independent predictors of successful extubation of preterms..
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Affiliation(s)
- Rania A El-Farrash
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Robert M DiBlasi
- Department of Respiratory Care, Seattle Children's Hospital and Research Institute, Seattle, Washington
| | - Eman A AbdEL-Aziz
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham M El-Tahry
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed S Eladawy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mourad A Tadros
- Department of Pediatrics and Neonatology, Algalaa Gynecology and Children's Military Hospital, Cairo, Egypt
| | | | | | | | - Medhat A Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Noha M Barakat
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Berka I, Korček P, Straňák Z. Serial Measurement of Interleukin-6 Enhances Chance to Exclude Early-Onset Sepsis in Very Preterm Infants. Clin Pediatr (Phila) 2022; 62:288-294. [PMID: 36146924 DOI: 10.1177/00099228221124672] [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: 11/15/2022]
Abstract
The aim of this retrospective study was to evaluate the reliability of peak interleukin-6 (IL-6) level within 24 hours after delivery as a predictor for early-onset sepsis (EOS) in very preterm neonates. Interleukin-6 was assessed at 2 hours and at 12 to 24 hours after delivery. The highest level was considered a peak value. The definition of EOS was based on positive blood culture and clinical signs of infection or negative blood culture, clinical signs of infection, and C-reactive protein >10 mg/L. Among 445 enrolled infants, 53 developed EOS. A peak IL-6 level of more than 200 ng/L had a sensitivity of 89% and specificity of 77% for the presence of EOS. The negative predictive value was 98%. Receiver operating characteristics curve had area under the curve of 0.92. Peak IL-6 is a reliable marker of systemic inflammatory response and might be useful to exclude EOS within the first 24 hours.
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Affiliation(s)
- Ivan Berka
- Institute for the Care of Mother and Child-Neonatology, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Korček
- Institute for the Care of Mother and Child-Neonatology, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zbyněk Straňák
- Institute for the Care of Mother and Child-Neonatology, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
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顾 兆, 王 永, 张 春, 张 立, 赵 月, 刘 茜, 朱 海. [Mortality and cause of death of hospitalized neonates in Weifang, China: a multicenter study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:994-1000. [PMID: 36111717 PMCID: PMC9495240 DOI: 10.7499/j.issn.1008-8830.2203138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the changes in the mortality rate and cause of death of hospitalized neonates in grade A tertiary hospitals in Weifang City of Shandong Province during a 10-year period. METHODS A retrospective analysis was performed on 461 neonates who died in three grade A tertiary hospitals in Weifang City of Shandong Province from January 1, 2012 to December 31, 2021. The related clinical data were collected to examine the changes of neonatal mortality with time, gestational age (GA) and birth weight (BW). The main causes of death of the neonates were compared between the first 5 years (2012-2016) and the last 5 years (2017-2021) in the period. RESULTS A total of 43 037 neonates were admitted from 2012 to 2021, among whom 461 died, resulting in a mortality rate of 1.07%. The mortality rate in the last 5 years was significantly lower than that in the first 5 years [0.96% (211/22 059 vs 1.19% (250/20 978); P<0.05]. The mortality rate of neonates decreased with the increases in GA and BW (P<0.05). In the first 5 years, the top three main causes of neonatal death were respiratory distress syndrome (RDS), sepsis, and pneumorrhagia, while in the last 5 years, the top three causes were sepsis, pneumorrhagia, and RDS. The leading cause of death was severe asphyxia for the neonates with a GA of <26 weeks and a BW of <750 g in both the first and last 5 years. For the neonates with a GA of 26-<28 weeks, the leading cause of death changed from RDS in the first 5 years to pneumorrhagia in the last 5 years. For the neonates with a BW of 750-<1 000 g, the leading cause of death changed from pneumorrhagia in the first 5 years to RDS in the last 5 years. For the neonates with a GA of 28-<32 weeks and a BW of 1 000-<1 500 g, the leading cause of death was RDS in both the first and last 5 years. For the neonates with a GA of 32-<37 weeks and a BW of 1 500-<2 500 g, the leading cause of death changed from RDS in the first 5 years to sepsis in the last 5 years. The leading cause of death was sepsis for the neonates with a GA of 37-<42 weeks and a BW of 2 500-<4 000 g in both the first and last 5 years. CONCLUSIONS The mortality rate of neonates in the grade A tertiary hospitals in Weifang City of Shandong Province has been decreasing in the past 10 years, and it decreases with the increases in GA and BW. Sepsis, RDS, and pneumorrhagia are the leading causes of neonatal death. The mortality rate caused by RDS decreases from the first 5 years to the last 5 years, while the mortality rate caused by sepsis or pneumorrhagia increases from the first 5 years to the last 5 years. Therefore, reducing the incidence rates of sepsis, RDS, and pneumorrhagia is the key to reducing neonatal mortality.
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Hu L, Qiu H, Liu L, Guérin C, Chen C. Editorial: Acute respiratory distress syndrome and mechanical ventilation. Front Med (Lausanne) 2022; 9:994611. [PMID: 36203758 PMCID: PMC9530929 DOI: 10.3389/fmed.2022.994611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Linhui Hu
- Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
- Clinical Research Center, Center of Scientific Research, Maoming People's Hospital, Maoming, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- *Correspondence: Ling Liu
| | - Claude Guérin
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Lyon, France
- Claude Guérin
| | - Chunbo Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Chunbo Chen
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Kartikeswar GAP, Parikh T, Pandya D, Pandit A. Lung ultrasound (LUS) in pre-term neonates with respiratory distress: A prospective observational study. Lung India 2022; 39:417-421. [PMID: 36629201 PMCID: PMC9623872 DOI: 10.4103/lungindia.lungindia_13_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/26/2022] [Accepted: 03/09/2022] [Indexed: 01/14/2023] Open
Abstract
Aim To find out the diagnostic use of lung ultrasound (LUS) in respiratory distress in neonates by taking clinico-radiological (clinical plus X-ray) diagnosis as the gold standard. Secondary objectives were to find out if modified LUS score can predict the need for surfactant therapy. Methods A prospective observational study was done in a tertiary care neonatal intensive care unit over a period of 1 year (January-December 2018). All pre-term infants with respiratory distress were screened with LUS and CXR within 2 h of admission and modified LUS score was calculated to find out the lung water content and its correlation with the severity of respiratory distress syndrome (RDS). Results In total, 92 neonates were screened during the study period, and 61 were finally diagnosed as RDS. The Kappa statistic between the clinico-radiological diagnosis and LUS diagnosis was 0.639. LUS diagnosis and CXR diagnosis had a Kappa correlation value of 0.786 (95% CI: 0.678-0.983). The most common LUS feature in RDS was pleural line thickening (100%), followed by whiteout lungs (75.4%). The modified LUS score was higher in babies who needed surfactant therapy (median (IQR): 49 (44, 53.5) vs. 29.5 (21, 46)) (P < 0.0001). Conclusion Our study shows that LUS in neonatal RDS can predict the severity of the disease, need for surfactant therapy and has good agreement with clinical and Xray diagnosis.
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Affiliation(s)
| | - Tushar Parikh
- Department of Pediatrics, Division of Neonatology, KEM Hospital, Pune, Maharashtra, India
| | - Dhyey Pandya
- Department of Pediatrics, Division of Neonatology, KEM Hospital, Pune, Maharashtra, India
| | - Anand Pandit
- Department of Paediatrics, KEM Hospital, Pune, Maharashtra, India
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Schmitz T, Doret-Dion M, Sentilhes L, Parant O, Claris O, Renesme L, Abbal J, Girault A, Torchin H, Houllier M, Le Saché N, Vivanti AJ, De Luca D, Winer N, Flamant C, Thuillier C, Boileau P, Blanc J, Brevaut V, Bouet PE, Gascoin G, Beucher G, Datin-Dorriere V, Bounan S, Bolot P, Poncelet C, Alberti C, Ursino M, Aupiais C, Baud O. Neonatal outcomes for women at risk of preterm delivery given half dose versus full dose of antenatal betamethasone: a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial. Lancet 2022; 400:592-604. [PMID: 35988568 DOI: 10.1016/s0140-6736(22)01535-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antenatal betamethasone is recommended before preterm delivery to accelerate fetal lung maturation. However, reports of growth and neurodevelopmental dose-related side-effects suggest that the current dose (12 mg plus 12 mg, 24 h apart) might be too high. We therefore investigated whether a half dose would be non-inferior to the current full dose for preventing respiratory distress syndrome. METHODS We designed a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial in 37 level 3 referral perinatal centres in France. Eligible participants were pregnant women aged 18 years or older with a singleton fetus at risk of preterm delivery and already treated with the first injection of antenatal betamethasone (11·4 mg) before 32 weeks' gestation. We used a computer-generated code producing permuted blocks of varying sizes to randomly assign (1:1) women to receive either a placebo (half-dose group) or a second 11·4 mg betamethasone injection (full-dose group) 24 h later. Randomisation was stratified by gestational age (before or after 28 weeks). Participants, clinicians, and study staff were masked to the treatment allocation. The primary outcome was the need for exogenous intratracheal surfactant within 48 h after birth. Non-inferiority would be shown if the higher limit of the 95% CI for the between-group difference between the half-dose and full-dose groups in the primary endpoint was less than 4 percentage points (corresponding to a maximum relative risk of 1·20). Four interim analyses monitoring the primary and the secondary safety outcomes were done during the study period, using a sequential data analysis method that provided futility and non-inferiority stopping rules and checked for type I and II errors. Interim analyses were done in the intention-to-treat population. This trial was registered with ClinicalTrials.gov, NCT02897076. FINDINGS Between Jan 2, 2017, and Oct 9, 2019, 3244 women were randomly assigned to the half-dose (n=1620 [49·9%]) or the full-dose group (n=1624 [50·1%]); 48 women withdrew consent, 30 fetuses were stillborn, 16 neonates were lost to follow-up, and 9 neonates died before evaluation, so that 3141 neonates remained for analysis. In the intention-to-treat analysis, the primary outcome occurred in 313 (20·0%) of 1567 neonates in the half-dose group and 276 (17·5%) of 1574 neonates in the full-dose group (risk difference 2·4%, 95% CI -0·3 to 5·2); thus non-inferiority was not shown. The per-protocol analysis also did not show non-inferiority (risk difference 2·2%, 95% CI -0·6 to 5·1). No between-group differences appeared in the rates of neonatal death, grade 3-4 intraventricular haemorrhage, stage ≥2 necrotising enterocolitis, severe retinopathy of prematurity, or bronchopulmonary dysplasia. INTERPRETATION Because non-inferiority of the half-dose compared with the full-dose regimen was not shown, our results do not support practice changes towards antenatal betamethasone dose reduction. FUNDING French Ministry of Health.
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Affiliation(s)
- Thomas Schmitz
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Centre for Research in Epidemiology and Statistics, INSERM U1153, INRA, Paris, France.
| | - Muriel Doret-Dion
- Department of Obstetrics and Gynaecology, Hospital Femme-Mère-Enfant, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Parant
- Department of Obstetrics and Gynaecology, Toulouse University Hospital, Toulouse, France
| | - Olivier Claris
- Department of Neonatology, Hospital Femme-Mère-Enfant, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Laurent Renesme
- Department of Neonatology, Bordeaux University Hospital, Bordeaux, France
| | - Julie Abbal
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Aude Girault
- Université Paris Cité, Centre for Research in Epidemiology and Statistics, INSERM U1153, INRA, Paris, France; MaternitéPort-Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Héloïse Torchin
- Université Paris Cité, Centre for Research in Epidemiology and Statistics, INSERM U1153, INRA, Paris, France; Department of Neonatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Houllier
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nolwenn Le Saché
- Department of Neonatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Daniele De Luca
- Department of Neonatology, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynaecology, University Medical Centre of Nantes, Centre d'Investigation Clinique CIC Mere enfant, Nantes, France; National Institute of Agricultural Research, UMR 1280, Physiology of Nutritional Adaptations, University of Nantes, IMAD and CRNH-Ouest, Nantes, France
| | - Cyril Flamant
- Department of Neonatology, Nantes University Hospital, Nantes, France
| | - Claire Thuillier
- Department of Obstetrics and Gynaecology, Poissy Hospital Centre, Poissy, France
| | - Pascal Boileau
- Department of Neonatology, Poissy Hospital Centre, Poissy, France
| | - Julie Blanc
- Department of Obstetrics and Gynaecology, Marseille Nord University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Véronique Brevaut
- Department of Neonatology, Marseille Nord University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre-Emmanuel Bouet
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Géraldine Gascoin
- Department of Neonatology, Angers University Hospital, Angers, France
| | - Gaël Beucher
- Department of Obstetrics and Gynaecology, Caen University Hospital, Caen, France
| | | | - Stéphane Bounan
- Department of Obstetrics and Gynaecology, Saint-Denis Hospital, Saint-Denis, France
| | - Pascal Bolot
- Department of Neonatology, Saint-Denis Hospital, Saint-Denis, France
| | - Christophe Poncelet
- Department of Obstetrics and Gynaecology, Pontoise Hospital, Pontoise, France
| | - Corinne Alberti
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM U1123, ECEVE, Paris, France
| | - Moreno Ursino
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche des Cordeliers, Université Paris Cité, INSERM U1138, Inria, HeKA, Paris, France
| | - Camille Aupiais
- Université Paris Cité, INSERM U1123, ECEVE, Paris, France; Paediatric Emergency Department, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Paris Nord University, Paris, France
| | - Olivier Baud
- Université Paris Cité, INSERM U1141, Paris, France; Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland.
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Srivatsa B, Hagan JL, Clark RH, Kupke KG. Oxygenation Factors Associated with Retinopathy of Prematurity in Infants of Extremely Low Birth Weight. J Pediatr 2022; 247:46-52.e4. [PMID: 35427689 DOI: 10.1016/j.jpeds.2022.03.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/06/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study characteristics of oxygenation during the first 2 postnatal months and correlation with the occurrence and severity of retinopathy of prematurity (ROP) among infants of extremely low birth weight. STUDY DESIGN This retrospective study analyzed the incidence and severity of hyperoxemia and hypoxemia while on respiratory support with or without supplemental oxygen among infants of extremely low birth weight (birth weight <1000 g) admitted to the neonatal intensive care unit during 2016-2020. The findings were correlated with the occurrence and severity of ROP after adjusting for baseline covariates. RESULTS After adjusting for differences in baseline demographic and clinical features, the group with severe ROP was exposed to greater fraction of inspired oxygen (FiO2) (P = .001) and experienced more frequent FiO2 titration adjustments (P = .001) compared with the group without ROP. Ambient air hyperoxemia occurred more frequently in the group without ROP (P = .003), and iatrogenic hyperoxemia occurred more frequently in the group with severe ROP (P = .046). There were no differences in the severity of ambient and iatrogenic hyperoxemia in the study population. The group with severe ROP demonstrated more hypoxemic episodes (P = .01) and longer time spent in the severe hypoxemic range (P = .005) compared with the group without ROP. CONCLUSIONS Severe ROP is associated with greater FiO2 exposure, increased iatrogenic hyperoxemia, decreased ambient air hyperoxemia, and increased hypoxemia in infants of extremely low birth weight despite a greater frequency of FiO2 titration. This study illustrates the need for automated closed loop FiO2 delivery systems to further optimize oxygen saturation targeting in this high-risk population.
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Affiliation(s)
- Bharath Srivatsa
- Neonatology Associates of Atlanta, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL.
| | | | | | - Kenneth G Kupke
- Neonatology Associates of Atlanta, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL
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Guan X, Gao S, Zhao H, Zhou H, Yang Y, Yu S, Wang J. Clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia. BMC Pediatr 2022; 22:452. [PMID: 35897053 PMCID: PMC9325944 DOI: 10.1186/s12887-022-03508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumonia is a serious problem that threatens the health of newborns. This study aimed to investigate the clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia. METHODS This was a retrospective analysis of cases of community-acquired viral pneumonia in the Neonatal Department. Nasopharyngeal aspirate (NPA) samples were collected for pathogen detection, and clinical data were collected. We analysed pathogenic species and clinical characteristics among these infants. RESULTS RSV is the main virus in term infants, and parainfluenza virus (PIV) 3 is the main virus in preterm infants. Patients infected with PIV3 were more susceptible to coinfection with bacteria than those with respiratory syncytial virus (RSV) infection (p < 0.05). Preterm infants infected with PIV3 were more likely to be coinfected with bacteria than term infants (p < 0.05), mainly gram-negative bacteria (especially Klebsiella pneumonia). Term infants with bacterial infection were more prone to fever, cyanosis, moist rales, three concave signs, elevated C-reactive protein (CRP) levels, respiratory failure and the need for higher level of oxygen support and mechanical ventilation than those with simple viral infection (p < 0.05). The incidence of hyponatremia in neonatal community-acquired pneumonia (CAP) was high. CONCLUSIONS RSV and PIV3 were the leading causes of neonatal viral CAP. PIV3 infection is the main cause of viral CAP in preterm infants, and these individuals are more likely to be coinfected with bacteria than term infants, mainly gram-negative bacteria. Term infants with CAP coinfected with bacteria were more likely to have greater disease severity than those with single viral infections.
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Affiliation(s)
- Xinxian Guan
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Shasha Gao
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - He Zhao
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Huiting Zhou
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yan Yang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Shenglin Yu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China.
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China.
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Balazs G, Balajthy A, Riszter M, Kovacs T, Szabo T, Belteki G, Balla G. Incidence, predictors of success and outcome of LISA in very preterm infants. Pediatr Pulmonol 2022; 57:1751-1759. [PMID: 34931458 PMCID: PMC9325361 DOI: 10.1002/ppul.25798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to examine the success rate of less invasive surfactant administration (LISA), to identify early predictive factors for the outcome of LISA, and to compare neonatal outcomes between the LISA failure group and the group of infants who were successfully treated with LISA. DESIGN A retrospective cohort study. PATIENTS Infants born at less than 33 weeks of gestation (n = 158) and treated with LISA for respiratory distress syndrome. RESULTS LISA was successful in 86 cases (54.4%); 72 preterm infants (45.6%) needed additional surfactant therapy and/or mechanical ventilation in the first 72 h (LISA failure). In a multivariate logistic regression analysis, six independent predictors of LISA success were identified: core temperature at the time of admission (adjusted odds ratio (OR): 3.56), dose of poractant alfa (<200 mg/kg; adjusted OR: 0.254), elevated C-reactive protein (>10 mg/L) at 24 h of life (adjusted OR: 0.28), highest respiratory severity score (RSS) during the first hour of life or at the time of LISA (adjusted OR: 0.463), maternal age (adjusted OR: 0.923), and birth weight (adjusted OR: 1.003). The receiver operating curve created by using the identified factors indicates good predictive power with an area under the curve of 0.85. LISA failure was associated with a substantially higher risk of complications. CONCLUSION LISA success can be predicted by variables available before the intervention. Failure of LISA is relatively frequent event in very preterm infants and is associated with adverse outcomes. Prevention of hypothermia during early stabilization and appropriate dosing of surfactant may increase LISA success rates and improve patient outcome.
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Affiliation(s)
- Gergely Balazs
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andras Balajthy
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Magdolna Riszter
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamas Kovacs
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamas Szabo
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gusztav Belteki
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gyorgy Balla
- Department of Pediatrics, Divison of Neonatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Zhang Y, Shao S, Mu Q, Feng J, Liu J, Zeng C, Qin J, Zhang X. Plasma apelin and vascular endothelial growth factor levels in preterm infants: relationship to neonatal respiratory distress syndrome. J Matern Fetal Neonatal Med 2022; 35:10064-10071. [PMID: 35731544 DOI: 10.1080/14767058.2022.2089554] [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: 10/17/2022]
Abstract
AIM The study aimed to determine the association between cord plasma levels of apelin and vascular endothelial growth factor (VEGF) with respiratory distress syndrome (RDS) in preterm infants. METHODS This case-control study included 120 preterm infants admitted to the neonatal intensive care unit of our hospital between January 2019 and January 2020. The infants were divided into RDS (n = 60) and non-RDS groups (n = 60). The cord plasma apelin and VEGF levels, perinatal characteristics, and neonatal complications were compared between the two groups. RESULTS The plasma apelin levels in the RDS group were significantly higher than in the non-RDS group (158.9 ± 24.8 vs. 125.2 ± 18.2 pg/mL, respectively), whereas VEGF levels in the non-RDS group were significantly higher than in the RDS group (187.4 ± 28.5 vs. 245.1 ± 44.8 pg/mL, respectively) (both p < .001). Infants with more severe RDS had higher plasma apelin levels and lower plasma VEGF levels. In the receiver operating characteristic curve analysis for the prediction of RDS, a cutoff of 148.4 pg/mL for apelin level yielded a sensitivity of 63.3% and a specificity of 95.0%, whereas a cutoff of 214.2 pg/mL for VEGF level showed a sensitivity of 86.7% and a specificity of 75.0%. Apelin levels were negatively correlated with VEGF levels in infants with RDS (r = 0.84, p < .001). CONCLUSION Differences in cord plasma apelin and VEGF levels may aid in the early diagnosis and treatment of RDS in preterm infants.
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Affiliation(s)
- Yimin Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Shuming Shao
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, China
| | - Qing Mu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, China
| | - Jing Feng
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Liu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Chaomei Zeng
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Xiaorui Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
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Matyas M, Iancu M, Hasmasanu M, Man A, Zaharie G. Association Analysis of the Cerebral Fractional Tissue Oxygen Extraction (cFTOE) and the Cerebral Oxygen Saturation (crSaO 2) with Perinatal Factors in Preterm Neonates: A Single Centre Study. J Clin Med 2022; 11:jcm11123546. [PMID: 35743612 PMCID: PMC9224851 DOI: 10.3390/jcm11123546] [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] [Received: 05/08/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Background: Near-infrared spectroscopy (NIRS) is a non-invasive, easily performed method of monitoring brain oxygenation. The regional cerebral oxygen saturation (crSaO2) and the cerebral fractional tissue oxygen extraction (cFTOE) evaluated by NIRS provide more accurate information on brain oxygenation than the blood oxygen saturation. We investigated the effect of perinatal factors on cerebral oxygenation of preterm newborns. (2) Methods: We conducted a longitudinal study with 48 preterm newborns <34 weeks of gestation who underwent NIRS registration during the first 72 h of life. crSaO2 was measured and cFTOE was calculated foreach patient. (3) Results: One-way ANOVA showed no significant main effect of IVH severity on crSaO2 and cFTOE (p > 0.05); there was a tendency toward statistical significance concerning the difference between the means of crSaO2 (p = 0.083) and cFTOE (p = 0.098). Patients with intraventricular haemorrhage (IVH) had a lower mean of crSaO2 and a higher mean of cFTOE (59.67 ± 10.37% vs. 64.92 ± 10.16% for crSaO2; 0.37 ± 0.11 vs. 0.32 ± 0.11 for cFTOE) compared to those with no IVH. Significantly lower values of crSaO2 and higher values of cFTOE were found in neonates receiving inotropic treatment (p < 0.0001). Episodes of apnoea also proved to influence the cerebral oxygen saturation of the study group (p = 0.0026). No significant association between the maternal hypertension treatment and the cerebral oxygenation of preterms was found. (4) Conclusions: This study showed a decreased cerebral oxygen saturation of preterms with IVH, inotrope support and apnoea episodes.
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Affiliation(s)
- Melinda Matyas
- Neonatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 3, Clinicilor Street, 400012 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8, Victor Babes Street, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-0740-130-888
| | - Monica Hasmasanu
- Neonatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 3, Clinicilor Street, 400012 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| | - Anca Man
- Neonatology Department, County Emergency Hospital, 3, Clinicilor Street, 400347 Cluj-Napoca, Romania;
| | - Gabriela Zaharie
- Neonatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 3, Clinicilor Street, 400012 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
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Singh S, Ananthan A, Nanavati R. Post-INSURE Administration of Heated Humidified High-Flow Therapy Versus Nasal Continuous Positive Airway Pressure in Preterm Infants More Than 28 Weeks Gestation with Respiratory Distress Syndrome: A Randomized Non-Inferiority Trial. J Trop Pediatr 2022; 68:6649677. [PMID: 35877150 DOI: 10.1093/tropej/fmac062] [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: 11/14/2022]
Abstract
In preterm infants with respiratory distress syndrome (RDS), non-invasive ventilation (NIV) is usually provided using nasal continuous positive airway pressure (NCPAP) or non-invasive mechanical ventilation after surfactant administration by INtubation-SURfactant-Extubation (INSURE) method. Heated humidified high-flow nasal cannula (HHHFNC) is a mode of NIV with advantages of ease of application, less grades of nasal injury and easy handling. This study was done to compare the effectiveness of HHHFNC therapy administration as post-INSURE respiratory support in preterm infants as compared to NCPAP. The primary outcome was to compare the rate of treatment failure within 7 days of randomization to HHHFNC or NCPAP as a post-INSURE ventilatory modality. It was a pilot trial wherein all preterm infants more than 1 kg and more than 28 weeks gestational age with RDS who required surfactant were randomized to receive NCPAP or HHHFNC. Infants with an urgent need for intubation and mechanical ventilation were considered to have treatment failure. Thirty babies were enrolled-15 in each group. Baseline demographic characteristics were comparable. There was no significant difference in the primary outcome of early failure rate, i.e. mechanical ventilation rate within 7 days of starting treatment. There were no significant differences in other outcomes except nasal injury which was significantly lesser in the HHHFNC group. In conclusion, HHHFNC appears to be non-inferior to NCPAP when used in preterm infants more than 28 weeks gestation with RDS as a post-INSURE ventilatory modality.
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Affiliation(s)
- Srijan Singh
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
| | - Anitha Ananthan
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai 400012, India
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Neonatal Sequential Organ Failure Assessment (nSOFA) Score within 72 Hours after Birth Reliably Predicts Mortality and Serious Morbidity in Very Preterm Infants. Diagnostics (Basel) 2022; 12:diagnostics12061342. [PMID: 35741152 PMCID: PMC9221565 DOI: 10.3390/diagnostics12061342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to assess the applicability of the neonatal sequential organ failure assessment score (nSOFA) within 72 h after delivery as a predictor for mortality and adverse outcome in very preterm neonates. Inborn neonates <32 weeks of gestation were evaluated. The nSOFA scores were calculated from medical records in the first 72 h after birth and the peak value was used for analysis. Death or composite morbidity at hospital discharge defined the adverse outcome. Composite morbidity consisted of chronic lung disease, intraventricular haemorrhage ≥grade III, periventricular leukomalacia and necrotizing enterocolitis. Among 423 enrolled infants (median birth weight 1070 g, median gestational age 29 weeks), 27 died and 91 developed composite morbidity. Death or composite morbidity was associated with organ dysfunction as assessed by nSOFA, systemic inflammatory response, and low birthweight. The score >2 was associated with OR 2.5 (CI 1.39−4.64, p = 0.002) for the adverse outcome. Area under the curve of ROC was 0.795 (95% CI = 0.763−0.827). The use of nSOFA seems to be reasonable for predicting mortality and morbidity in very preterm infants. It constitutes a suitable basis to measure the severity of organ dysfunction regardless of the cause.
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Mikolajcikova S, Lasabova Z, Holubekova V, Skerenova M, Zibolenova J, Matasova K, Zibolen M, Calkovska A. The Common Haplotype GATGACA in Surfactant-Protein B Gene Is Protective for Respiratory Distress Syndrome in Preterm Neonates. Front Pediatr 2022; 10:851042. [PMID: 35692980 PMCID: PMC9174893 DOI: 10.3389/fped.2022.851042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Respiratory distress syndrome (RDS), a disorder of primary surfactant deficiency resulting in pulmonary insufficiency, remains a significant problem for preterm neonates. Associations between genetic variants of surfactant proteins and RDS have been reported, but haplotypes of the surfactant protein B gene (SFTPB) have not been studied. The aim of the study was to prove the hypothesis that certain haplotypes of SFTPB may be protective or risk factors for RDS. Methods The study was performed with 149 preterm infants, born <34 weeks of gestation, with 86 infants with mild RDS or without RDS (control group) and 63 infants with severe RDS (patient group). RDS was considered severe if multiple doses of exogenous surfactant and/or mechanical ventilation within the first 72 h of life were needed. The venous blood sample was used for the analysis of gene polymorphisms associated with RDS, genotyping, and haplotype estimation. Multivariate logistic regression analysis and the odds ratio were calculated to detect the contribution of the studied variables to the development of RDS. Results A new association of the common single nucleotide polymorphism (SNP) rs2304566 with RDS in premature infants was detected. Analysis of rs2304566 polymorphisms using a logistic regression model showed that there are two significant predictors inversely related to the occurrence of RDS (Apgar score of 5 min, CT and TT genotype in rs2304566 polymorphism). Gestational age, birth weight, and sex have border significance. Moreover, in the patient group, the frequency of the GATGACA haplotype in the SFTPB gene was lower (p = 0.037), and the GATGGCA haplotype was higher (p = 0.059) in comparison with the control group. Conclusion The common haplotype GATGACA of the SFTPB gene can be protective against RDS in preterm infants. The trend of a higher frequency of GATGGCA in the SFTPB gene in infants with severe RDS suggests that this haplotype may be a risk factor for RDS susceptibility.
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Affiliation(s)
- Silvia Mikolajcikova
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Zora Lasabova
- Department of Molecular Biology and Genomics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Veronika Holubekova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Maria Skerenova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Jana Zibolenova
- Department of Public Health, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Katarina Matasova
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Mirko Zibolen
- Clinic of Neonatology, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Andrea Calkovska
- Department of Physiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
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Jarcho-Levin syndrome in Pakistan: a case report and review of 321 cases on the principles of diagnosis and management. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Jarcho-Levin syndrome (JLS) is a genetic condition that constitutes specific vertebral anomalies combined with coastal or thoracic anomalies due to specific gene mutations. Although the condition is associated typically to Puerto-Ricans, we describe the novel case of JLS in a Pakistani family that presented with respiratory distress secondary to the condition.
Case presentation
The case is a full-term girl that had a webbed neck with an undefined chest deformity. Radiology showed kyphoscoliosis and a crablike chest. Early identification of these high morbidity conditions is key to allow for optimal treatment and improved outcomes.
Conclusions
We have provided a brief breakdown of the management principles of the condition and more than 80 years after the first case of Jarcho-Levin syndrome was reported, we present the diagnostic criterion for JLS.
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Meier A, Kock KDS. Need for oxygen therapy and ventilatory support in premature infants in a hospital in Southern Brazil. World J Crit Care Med 2022; 11:160-168. [PMID: 36331991 PMCID: PMC9136723 DOI: 10.5492/wjccm.v11.i3.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/19/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term. A preterm infant (PI) is classified when gestational age (GA) < 37 wk.
AIM To analyze prognostic indicators related to the use of oxygen therapy, non-invasive ventilation (continuous positive airway pressure) and mechanical ventilation (MV) in PI.
METHODS This is a retrospective cohort. The sample was composed of PIs from a private hospital in southern Brazil. We included neonates with GA < 37 wk of gestation in the period of January 1, 2018 to December 31, 2018. For data collection, electronic records were used in the Tasy PhilipsTM system, identifying the variables: maternal age, type of birth, prenatal information, GA, Apgar score, birth weight, neonatal morbidities, vital signs in the 1st hour at birth, need for oxygen therapy, continuous positive airway pressure and MV, hospitalization in the neonatal intensive care unit, length of stay and discharge or death.
RESULTS In total, 90 PI records were analyzed. The median (p25-p75) of GA was 34.0 (31.9-35.4) wk, and there were 45 (50%) males. The most common morbidity among PIs was the acute respiratory discomfort syndrome, requiring hospitalization in the neonatal intensive care unit in 76 (84.4%) cases. The utilization rate of oxygen therapy, continuous positive airway pressure and MV was 12 (13.3%), 37 (41.1%) and 13 (14.4%), respectively. The median (p25-p75) length of stay was 12.0 (5.0-22.2) d, with 10 (11.1%) deaths. A statistical association was observed with the use of MV and GA < 28 wk, lower maternal age, low birth weight, Apgar < 8 and neonatal deaths.
CONCLUSION The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.
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Affiliation(s)
- Amanda Meier
- Department of Physiotherapy, University of South of Santa Catarina, Tubarão 88704-001, SC, Brazil
| | - Kelser de Souza Kock
- Department of Physiotherapy, University of South of Santa Catarina, Tubarão 88704-001, SC, Brazil
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The Relationship between Antenatal Corticosteroid Administration-to-Delivery Intervals and Neonatal Respiratory Distress Syndrome and Respiratory Support. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2310080. [PMID: 35295172 PMCID: PMC8920661 DOI: 10.1155/2022/2310080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Background Administration of antenatal corticosteroids (ACSs) is an effective strategy for managing preterm infants, which improves neonatal respiratory distress syndrome (NRDS) and attenuates the risk of neonatal mortality. However, many preterm infants are not exposed to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear. Therefore, this study explored the relationship between ACS-to-birth intervals and NRDS and respiratory support in preterm infants. Methods In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wks of gestation were recruited from January 2015 to July 2021. All participants were categorised based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2–7 d, and >7 d. Multivariable logistic regression analysis examined the relationships between the ACS-to-birth interval and primary or secondary outcome while adjusting for potential confounders. Results Of the 706 eligible neonates, 264, 83, 292, and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2–7 d, and >7 d, respectively. After adjusting these confounding factors, the multivariable logistic analysis showed a significantly increased risk of NRDS (aOR: 1.8, 95% CI: 1.2–2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1–6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7–4.4), endotracheal intubation in the delivery room (aOR: 1.9, 95% CI: 1.0–3.7), and mechanical ventilation (aOR: 1.9, 95% CI: 1.1–3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2–7 d group. Conclusions Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in the delivery room, and the risk of mechanical ventilation are higher when the neonates are exposed to an ACS interval for less than 24 h before delivery.
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Lettau M, Timm S, Dittmayer C, Lopez-Rodriguez E, Ochs M. The ultrastructural heterogeneity of lung surfactant revealed by serial section electron tomography: Insights into the 3D architecture of human tubular myelin. Am J Physiol Lung Cell Mol Physiol 2022; 322:L873-L881. [PMID: 35438000 DOI: 10.1152/ajplung.00020.2022] [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: 11/22/2022] Open
Abstract
Weibel's hypothetical 3D model in 1966 provided first ultrastructural details into tubular myelin (TM), a unique, complex surfactant subtype found in the hypophase of the alveolar lining layer. Although initial descriptions by electron microscopy (EM) were already published in the 1950s, a uniform morphological differentiation from other intraalveolar surfactant subtypes is still missing and potential structure-function relationships remain enigmatic. Technical developments in volume EM methods now allow a more detailed reinvestigation. To address unanswered ultrastructural questions, we analyzed ultrathin sections of humanized SP-A1/SP-A2 co-expressing mouse as well as human lung samples by conventional transmission EM. We combined these 2D information with 3D analysis of single- and dual-axis electron tomography of serial sections for high z-resolution (in a range of a few nm) and extended volumes of up to 1 µm total z-information. This study reveals that TM constitutes a heterogeneous surfactant organization mainly comprised of distorted parallel membrane planes with local intersections, which are distributed all over the TM substructure. These intersecting membrane planes form, among other various polygons, the well-known 2D "lattice", respectively 3D quadratic tubules, which in many analyzed spots of human alveoli appear to be less abundant than also observed non-concentric 3D lamellae. The additional application of serial section electron tomography to conventional transmission EM demonstrates a high heterogeneity of TM membrane networks, which indicates dynamic transformations between its substructures. Our method provides an ideal basis for further in and ex vivo structural analyses of surfactant under various conditions at nanometer scale.
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Affiliation(s)
- Marie Lettau
- Institute of Functional Anatomy, Charité , Berlin, Germany
| | - Sara Timm
- Core Facility Electron Microscopy, Charité , Berlin, Germany
| | | | | | - Matthias Ochs
- Institute of Functional Anatomy, Charité , Berlin, Germany.,German Center for Lung Research, Berlin, Germany
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Robledo KP, Tarnow-Mordi WO, Rieger I, Suresh P, Martin A, Yeung C, Ghadge A, Liley HG, Osborn D, Morris J, Hague W, Kluckow M, Lui K, Soll R, Cruz M, Keech A, Kirby A, Simes J, Popat H, Reid S, Gordon A, De Waal K, Wright IM, Wright A, Buchan J, Stubbs M, Newnham J, Simmer K, Young C, Loh D, Kok Y, Gill A, Strunk T, Jeffery M, Chen Y, Morris S, Sinhal S, Cornthwaite K, Walker SP, Watkins AM, Collins CL, Holberton JR, Noble EJ, Sehgal A, Yeomans E, Elsayed K, Mohamed AL, Broom M, Koh G, Lawrence A, Gardener G, Fox J, Cartwright DW, Koorts P, Pritchard MA, McKeown L, Lainchbury A, Shand AW, Michalowski J, Smyth JP, Bolisetty S, Adno A, Lee G, Seidler AL, Askie LM, Groom KM, Eaglen DA, Baker EC, Patel H, Wilkes N, Gullam JE, Austin N, Leishman DE, Weston P, White N, Cooper NA, Broadbent R, Stitely M, Dawson P, El-Naggar W, Furlong M, Hatfield T, de Luca D, Benachi A, Letamendia-Richard E, Escourrou G, Dell'Orto V, Sweet D, Millar M, Shah S, Sheikh L, Ariff S, Morris EA, Young L, Evans SK, Belfort M, Aagaard K, Pammi M, Mandy G, Gandhi M, Davey J, Shenton E, Middleton J, Black R, Cheng A, Murdoch J, Jacobs C, Meyer L, Medlin K, Woods H, O'Connor KA, Bice C, Scott K, Hayes M, Cruickshank D, Sam M, Ireland S, Dickinson C, Poulsen L, Fucek A, Hegarty J, Rogers J, Sanchez D, Zupan Simunek V, Hanif B, Pahl A, Metayer J, Duley L, Marlow N, Schofield D, Bowen J. Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): a multicentre, randomised clinical trial. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:150-157. [DOI: 10.1016/s2352-4642(21)00373-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023]
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