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Kong JY, Quek BH, Lim CSE, Sultana R, Ng YYV, Rajadurai VS, Yeo KT. Colorimetric CO2 Detector to Improve Effective Mask Ventilations in Very Preterm Infants: A Pilot Randomized Controlled Study. Neonatology 2024; 121:494-502. [PMID: 38537615 DOI: 10.1159/000538083] [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: 10/30/2023] [Accepted: 02/24/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION End-tidal CO2 (ETCO2) detector is currently recommended for confirmation of endotracheal tube placement during neonatal resuscitation. Whether it is feasible to use ETCO2 detectors during mask ventilation to reduce risk of bradycardia and desaturations, which are associated with increased risk of death in preterm babies, is unknown. METHODS This is a pilot randomized controlled trial (NCT04287907) involving newborns 24 + 0/7 to 32 + 0/7 weeks gestation who required mask ventilation at birth. Infants were randomized into groups with or without colorimetric ETCO2 detectors. Combined duration of any bradycardia (<100 bpm) and time below prespecified target oxygen saturation (SpO2) as measured by pulse oximetry were compared. RESULTS Fifty participants were randomized, 47 with outcomes analysed (2 incomplete data, 1 postnatal diagnosis of trachea-oesophageal fistula). Mean gestational age and birthweight were 28.5 ± 1.9 versus 29.4 ± 1.6 weeks (p = 0.1) and 1,252.7 ± 409.7 g versus 1,334.6 ± 369.1 g (p = 0.5) in the intervention and control arm, respectively. Mean combined duration of bradycardia and desaturation was 276.7 ± 197.7 s (intervention) and 322.7 ± 277.7 s (control) (p = 0.6). Proportion of participants with any bradycardia or desaturation at 5 min were 38.1% (intervention) and 56.5% (control) (p = 0.2). No chest compressions, epinephrine administration, or death occurred in the delivery room. CONCLUSION This pilot study demonstrates the feasibility of a trial to evaluate colorimetric ETCO2 detectors during mask ventilation of very preterm infants to reduce bradycardia and low SpO2. Further assessment with a larger population will be required to determine if ETCO2 detector usage at resuscitation reduces risk of adverse outcomes, including death and disability, in very preterm infants.
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Affiliation(s)
- Juin Yee Kong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Charis S E Lim
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Yvonne Y V Ng
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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Del Sindaco G, Berkenou J, Pagnano A, Rothenbuhler A, Arosio M, Mantovani G, Linglart A. Neonatal and Early Infancy Features of Patients With Inactivating PTH/PTHrP Signaling Disorders/Pseudohypoparathyroidism. J Clin Endocrinol Metab 2023; 108:2961-2969. [PMID: 37098127 PMCID: PMC10583975 DOI: 10.1210/clinem/dgad236] [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: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Pseudohypoparathyroidism (PHP) and related disorders newly referred to as inactivating PTH/PTHrP signaling disorders (iPPSD) are rare endocrine diseases. Many clinical features including obesity, neurocognitive impairment, brachydactyly, short stature, parathyroid hormone (PTH) resistance, and resistance to other hormones such as thyroid-stimulating hormone (TSH) have been well described, yet they refer mainly to the full development of the disease during late childhood and adulthood. OBJECTIVE A significant delay in diagnosis has been reported; therefore, our objective is to increase awareness on neonatal and early infancy presentation of the diseases. To do so, we analyzed a large cohort of iPPSD/PHP patients. METHODS We included 136 patients diagnosed with iPPSD/PHP. We retrospectively collected data on birth and investigated the rate of neonatal complications occurring in each iPPSD/PHP category within the first month of life. RESULTS Overall 36% of patients presented at least one neonatal complication, far more than the general population; when considering only the patients with iPPSD2/PHP1A, it reached 47% of the patients. Neonatal hypoglycemia and transient respiratory distress appeared significantly frequent in this latter group, ie, 10.5% and 18.4%, respectively. The presence of neonatal features was associated with earlier resistance to TSH (P < 0.001) and with the development of neurocognitive impairment (P = 0.02) or constipation (P = 0.04) later in life. CONCLUSION Our findings suggest that iPPSD/PHP and especially iPPSD2/PHP1A newborns require specific care at birth because of an increased risk of neonatal complications. These complications may predict a more severe course of the disease; however, they are unspecific which likely explains the diagnostic delay.
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Affiliation(s)
- Giulia Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Jugurtha Berkenou
- AP-HP, Service d’endocrinologie et diabète de l’enfant, Hôpital Bicêtre Paris-Saclay, Le Kremlin-Bicêtre 94270, France
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, ERN BOND, ERN for rare endocrine disorders, Plateforme d’expertise des maladies rares de Paris Saclay, Paris, France
| | - Angela Pagnano
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Anya Rothenbuhler
- AP-HP, Service d’endocrinologie et diabète de l’enfant, Hôpital Bicêtre Paris-Saclay, Le Kremlin-Bicêtre 94270, France
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, ERN BOND, ERN for rare endocrine disorders, Plateforme d’expertise des maladies rares de Paris Saclay, Paris, France
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Agnès Linglart
- AP-HP, Service d’endocrinologie et diabète de l’enfant, Hôpital Bicêtre Paris-Saclay, Le Kremlin-Bicêtre 94270, France
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, ERN BOND, ERN for rare endocrine disorders, Plateforme d’expertise des maladies rares de Paris Saclay, Paris, France
- Université Paris Saclay, INSERM U1185, Le Kremlin-Bicêtre 94270, France
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Guta NM. Application of Donabedian quality-of-care framework to assess quality of neonatal resuscitation, its outcome, and associated factors among resuscitated newborns at public hospitals of East Wollega zone, Oromia, Western Ethiopia, 2021. BMC Pediatr 2022; 22:605. [PMID: 36258182 PMCID: PMC9578212 DOI: 10.1186/s12887-022-03638-y] [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: 02/17/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they received at birth. However, the quality of care newborns received at birth may be below the WHO resuscitation standard. The reason for the poor quality of care is unclear. The Donabedian model, according to the World Health Organization (WHO), is an appropriate framework for health care assessment that focuses on improving the quality of care. So this study aims to assess the quality of neonatal resuscitation, outcome, and its associated factors among newborns with birth asphyxia at public hospitals in the East Wollega zone, 2021. Methods An institution-based cross-sectional study was conducted to observe 410 asphyxiated newborns using consecutive sampling methods. Data was gathered using a pretested structured questionnaire and checklist. Epi-data version 3.1 was used to enter data, which was subsequently exported to Statistical Package for Social Sciences version 25 for analysis. A logistic regression model was employed to determine the variables associated with the outcome variable. The adjusted odds ratio with a 95% confidence interval was calculated, and all variables associated with the outcome variable with a p-value less than 0.05 in multivariable analysis were determined to be significant factors for the outcome of resuscitated newborns. Result A total of 410 asphyxiated newborns were included in this study with a response rate of 97%. From this 87.6% of resuscitated newborns survived. Keeping baby warm [AOR = 6.9; CI (3.1, 15.6)] is associated significantly with increased chances of survival while meconium presence in the airway [AOR = 0.26; CI (0.1, 0.6)], prematurity [AOR = 0.24; CI (0.12, 0.48)], and presence of cord prolapse [AOR = 0.08; CI (0.03, 0.19)] were factors significantly associated with decreased survival of resuscitated newborns at 1 h of life. Conclusion Newborns who were kept warm were more likely to survive compared to their counterparts. While the presence of meconium in the airway, preterm, and cord prolapse was associated with the decreased survival status of newborns. Facilitating referral linkage in the event of cord prolapse, counseling on early antenatal care initiation to decrease adverse outcomes (prematurity), and neonatal resuscitation refresher training is strongly recommended.
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Affiliation(s)
- Nuredin Mohammed Guta
- Department of Nursing, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia.
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Lim SH, Ng KC, Ching CK, Ong GYK, Chia YW, Biswas A, Oh JHH, Lim JH, Zarisfi F, Loke JH, Leong BSH. SRFAC: resuscitation and saving lives in the COVID-19 era and beyond. Singapore Med J 2021; 62:369-371. [PMID: 35001110 PMCID: PMC8804488 DOI: 10.11622/smedj.2021106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Kee Chong Ng
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Gene Yong-Kwang Ong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Yew Woon Chia
- Cardiac Intensive Care Unit, Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Agnihotri Biswas
- Department of Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Janice Hui Hong Oh
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Jia Hao Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Faraz Zarisfi
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Jun Hao Loke
- Singapore Resuscitation and First Aid Council Unit for Pre-hospital Emergency Care, Singapore
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