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Ok M, Naseri A, Ates MB, Ider M, Uney K, Sevinc M, Hatipoglu F, Yildiz R, Erturk A, Baspinar N, Iyigun SS. The Usefulness of Serum Brain Damage Biomarkers in Detection and Evaluation of Hypoxic Ischemic Encephalopathy in Calves with Perinatal Asphyxia. Animals (Basel) 2022; 12:3223. [PMID: 36428450 PMCID: PMC9686605 DOI: 10.3390/ani12223223] [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] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present study was to determine hypoxic brain damage in calves with perinatal asphyxia using brain-specific damage biomarkers. Ten healthy and 25 calves with perinatal asphyxia were enrolled in the study. Clinical examination, neurological status score, and laboratory analysis were performed at admission, 24, 48, and 72 h. Serum concentrations of ubiquitin carboxy-terminal hydrolysis 1 (UCHL1), calcium-binding protein B (S100B), adrenomodullin (ADM), activitin A (ACTA), neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) and creatine kinase-brain (CK-B) were measured. Histopathological and immunohistochemical examinations of the brain tissue were performed in 13 nonsurvivor calves. The neurological status score of the calves with asphyxia was significantly (p < 0.05) lower. Mix metabolic-respiratory acidosis and hypoxemia were detected in calves with asphyxia. Serum UCHL1 and S100B were significantly (p < 0.05) increased, and NSE, ACTA, ADM, and CK-B were decreased (p < 0.05) in calves with asphyxia. Histopathological and immunohistochemical examinations confirmed the development of mild to severe hypoxic-ischemic encephalopathy. In conclusion, asphyxia and hypoxemia caused hypoxic-ischemic encephalopathy in perinatal calves. UCHL1 and S100B concentrations were found to be useful markers for the determination of hypoxic-ischemic encephalopathy in calves with perinatal asphyxia. Neurological status scores and some blood gas parameters were helpful in mortality prediction.
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Affiliation(s)
- Mahmut Ok
- Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Amir Naseri
- Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Mehmet Burak Ates
- Department of Pathology, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Merve Ider
- Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Kamil Uney
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Mutlu Sevinc
- Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Fatih Hatipoglu
- Department of Pathology, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Ramazan Yildiz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, Burdur 15030, Türkiye
| | - Alper Erturk
- Department of Internal Medicine, Faculty of Veterinary Medicine, Hatay Mustafa Kemal University, Hatay 31060, Türkiye
| | - Nuri Baspinar
- Department of Biochemistry, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
| | - Suleyman Serhat Iyigun
- Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya 42250, Türkiye
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Roy SD, Alnaji F, Reddy DN, Barrowman NJ, Sheffield HA. Noninvasive ventilation of air transported infants with respiratory distress in the Canadian Arctic. Paediatr Child Health 2022; 27:272-277. [DOI: 10.1093/pch/pxac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/02/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Since 2016, use of nasal continuous positive airway pressure (nCPAP) in Nunavut for air transport in select patients has become common practice. This study examines the outcomes of patients transferred by air from the Qikiqtaaluk Region during air transport. We examined intubation rates, adverse events during transfer, and respiratory parameters at departure and upon arrival.
Methods
This was a retrospective review from September 2016 to December 2019 including patients under 2 years of age transferred by air on nCPAP from the Qikiqtaaluk Region of Nunavut.
Results
Data were collected for 40 transfers involving 34 unique patients. Six transfers were from remote communities in Nunavut to Iqaluit, and 33 transfers were from Iqaluit to CHEO. The primary outcome measure was whether the patient required intubation during transport, or urgent intubation upon arrival to CHEO. The median nCPAP setting during transport was 6 cm H2O (5–7 cm H2O) and at arrival to CHEO was 6 cm H2O (6–7 cm H2O). Six of the 33 (18.2%) patients required intubation during their hospital stay and five (15.2%) in a controlled ICU setting. There were no discernible adverse events that occurred during transport for 28 patients (84.5%). Four patients (12.1%) required a brief period of bag-mask ventilation and one patient had an episode of bradycardia.
Conclusions
nCPAP on air transport is a safe and useful method for providing ventilatory support to infants and young children with respiratory distress.
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Affiliation(s)
| | - Fuad Alnaji
- Children’s Hospital of Eastern Ontario , Ottawa, Ontario , Canada
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Trevisanuto D, Cavallin F, Loddo C, Brombin L, Lolli E, Doglioni N, Baraldi E. Trends in neonatal emergency transport in the last two decades. Eur J Pediatr 2021; 180:635-641. [PMID: 33410944 DOI: 10.1007/s00431-020-03908-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Although maternal antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. This study aimed to investigate trends over time in patient characteristics and respiratory management in a large series of neonatal emergency transfers, in order to provide health caregivers an up-to-date profile of such patients and their therapeutic needs. Trends in patient characteristics and respiratory management were evaluated in 3337 transfers by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Joinpoint regression analysis was performed to evaluate trends and to estimate annual percentage changes (APCs). Proportions of preterm neonates increased (APC2000-2012 2.25%), then decreased (APC2012-2019 - 6.04%). Transfers at birth increased (APC2000-2013 2.69%), then decreased (APC2013-2019 - 5.76%). Proportion of neonates with cardiac and surgical diseases declined (APCs2000-2019 - 6.82% and - 3.32%), while proportion of neonates with neurologic diseases increased (APC2000-2019 8.62%). Use of nasal-continuous-positive-airway-pressure (APC2000-2019 9.72%) and high-flow-nasal-cannula (APC2007-2019 58.51%) at call, and nasal-continuous-positive-airway-pressure (APC2000-2019 13.87%) and nasal-intermittent-mandatory-ventilation (APC2000-2019 32.46%) during transfer increased. Mechanical ventilation during transfer decreased (APC2014-2019 - 10.77%). Use of oxygen concentrations at 21% increased at call and during transfer (APCs 2000-2019 2.24% and 2.44%), while oxygen concentrations above 40% decreased at call and during transfer (APCs 2000-2019 - 3.93% and - 5.12%).Conclusion: Our findings revealed a shift toward a more "gentle" approach and the reduced use of oxygen in respiratory management. Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs. What is Known: • Although antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. • Trend studies investigating cohort information with appropriate statistical methods represent useful instruments to detect changes over time. What is New: • Our findings revealed marked changes in patient characteristics and respiratory management in a large series of neonatal emergency transfers during the last two decades. • Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy.
| | | | - Cristina Loddo
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | - Laura Brombin
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | - Elisabetta Lolli
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | - Nicoletta Doglioni
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
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Ide N, Allen G, Ashworth HC, Dada S. Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation. Front Pediatr 2021; 9:667404. [PMID: 34055699 PMCID: PMC8155575 DOI: 10.3389/fped.2021.667404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries.
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Affiliation(s)
- Nellie Ide
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Grace Allen
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | | | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Anderson CD, Webb E, Lampe GE, Clark T, Williams HL, Hillman NH. Interhospital Transport of Infants on Bubble Continuous Positive Airway Pressure via Ground and Air. Air Med J 2020; 39:458-463. [PMID: 33228894 DOI: 10.1016/j.amj.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/26/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of a respiratory protocol for the interhospital transport of infants with respiratory distress on bubble continuous positive airway pressure (bCPAP) and provide information on the safety of bCPAP during transport via ground and helicopter. METHODS We evaluated a retrospective cohort study of neonates (gestational age 22-41 weeks) transported to our level 4 neonatal intensive care unit (NICU) before (n = 529) and after implementing (n = 540) protocols for increasing bCPAP and intubation criteria. Infants were evaluated for intubation before transport, the safety of transport, and the need for intubation shortly after arrival in the NICU. RESULTS After initiating the protocols, less infants received mechanical ventilation, and more infants received bCPAP for transport via ground and helicopter. Upon arrival to the NICU, infants using the protocols had lower fraction of inspired oxygen and higher continuous positive airway pressures, and similar numbers required intubations in the first 12 hours. There were no differences in the rate of pneumothoraces. CONCLUSIONS bCPAP can be used on both ground and helicopter transport of very small infants. Respiratory protocols decreased mechanical ventilation during transport without increasing the need for intubation within 12 hours of arrival.
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Affiliation(s)
- Connie D Anderson
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO
| | - Ellen Webb
- Neonatal Transport Team, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Glorine E Lampe
- Neonatal Transport Team, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Toni Clark
- Neonatal Transport Team, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Howard L Williams
- SSM Health Systems, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Noah H Hillman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO; Neonatal Transport Team, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO.
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Muniyappa B, Honey G, Yoder BA. Efficacy and Safety of Nasal High-Flow Therapy for Neonatal Transport. Air Med J 2019; 38:298-301. [PMID: 31248542 DOI: 10.1016/j.amj.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/21/2019] [Accepted: 04/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Noninvasive ventilation, including nasal high-flow therapy (nHFT), provides effective neonatal respiratory support. There are limited data on nHFT use during neonatal transport. Our objective was to assess the efficacy and safety of nHFT during neonatal transport. METHODS One hundred ninety-five neonates transported on nHFT via a Neo-Pod "T" system (Westmed Inc, Tucson, AZ) were identified from Life Flight transport data. Data included demographics, transport location, distance, indication, and mode as well as pretransport and intratransport respiratory support data. We compared neonates who successfully tolerated nHFT transport with those who required support escalation (defined as increase in flow ≥2 L/min or fraction of inspired oxygen [FiO2] ≥20%). RESULTS Eighty-seven percent of neonates (170/195) were effectively transported on nHFT. Infants requiring escalation of nHFT support had a significantly higher pretransport FiO2 (median = 0.60 [interquartile range, 0.36-1.00] vs. 0.36 [0.23-0.56]; P < .05) and a longer ground time for stabilization (56 ± 25 vs. 39 ± 18 minutes, P < .05) and were more frequently transported by air. CONCLUSION Nasal HFT can be an effective mode of respiratory support in the transport of selected neonates. FiO2 at the time of transport may be a key parameter to aid in determining neonates who can be safely transported on nHFT.
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Affiliation(s)
- Bhanu Muniyappa
- Division of General Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
| | - Gina Honey
- Life Flight Children's Services, Intermountain Healthcare, Salt Lake City, UT
| | - Bradley A Yoder
- Life Flight Children's Services, Intermountain Healthcare, Salt Lake City, UT; Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
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Sheffield HA, Sheffield CA. Nasal CPAP on paediatric air transport in the Canadian Arctic: A case series. Paediatr Child Health 2018; 24:e94-e97. [PMID: 30996613 DOI: 10.1093/pch/pxy088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims Paediatric transport in remote regions of Canada represents a huge challenge given the acuity of the patients, immense distances, weather and lack of road infrastructure. Transport of patients in the Baffin region of Nunavut is completed entirely by air transport. Two very common paediatric transports are in regards to lower respiratory tract infections and premature deliveries in small rural communities north of Iqaluit. Recently, the advent of noninvasive ventilation has been introduced to the region. Method We report five cases of long-distance air transport of paediatric patients in respiratory distress using nasal continuous positive airway pressure (nCPAP). Two cases involve lower respiratory tract infections, and three cases involve neonates (two premature infants and one term infant). Results Overall, these cases highlight effective and safe use of noninvasive ventilation in air transport of patients in respiratory distress and demonstrate how this modality can improve patient transport in rural and remote regions.
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Zein H, Yusuf K, Paul R, Kowal D, Thomas S. Elective transfers of preterm neonates to regional centres on non-invasive respiratory support is cost effective and increases tertiary care bed capacity. Acta Paediatr 2018; 107:52-56. [PMID: 28871602 DOI: 10.1111/apa.14059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/04/2017] [Accepted: 08/30/2017] [Indexed: 11/27/2022]
Abstract
AIM Managing capacity at regional facilities caring for sick neonates is increasingly challenging. This study estimated the clinical and economic impact of the elective transfer of stable infants requiring nasal continuous positive airway pressure (NCPAP) from level three to level two neonatal intensive care units (NICUs) within an established clinical network of five NICUs. METHODS We retrospectively analysed the records of 99 stable infants transferred on NCPAP between two level three NICUs and three level two NICUs in Calgary, Canada, between June 2014 and May 2016. RESULTS The median gestational age and weight at birth were 28 weeks and 955 g, and the median corrected gestational age and weight at transfer were 33 weeks and 1597 g, respectively. This resulted in cost savings of $2.65 million Canadian dollars during the two-year study period, and 848 level three NICU days were freed up for potentially sick neonates. There were no adverse events associated with the transfers. CONCLUSION The elective transfer of stable neonates on NCPAP from level three to level two NICUs within an established clinical network led to substantial cost savings, was safe and increased the bed capacity at the two level three NICUs.
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Affiliation(s)
- Hussein Zein
- Section of Neonatology; Department of Paediatrics; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Kamran Yusuf
- Section of Neonatology; Department of Paediatrics; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Renee Paul
- Foothills Medical Centre; Calgary Alberta Canada
| | - Derek Kowal
- Foothills Medical Centre; Calgary Alberta Canada
| | - Sumesh Thomas
- Section of Neonatology; Department of Paediatrics; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
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Abstract
To minimize ventilator-associated lung injury in neonates, use of noninvasive (NIV) respiratory support has markedly increased over the past decade, especially in neonates younger than 28-weeks gestational age and 1250 g. Previously, neonates with respiratory failure who required anything greater than an oxyhood or low-flow nasal cannula were intubated for transport. This increased use has required transport teams to develop or incorporate a new set of support tools to minimize lung injury. This article reviews the various modes of NIV used during neonatal transport, important patient selection criteria, appropriate assessment, and the associated risks and benefits.
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Affiliation(s)
- Donald Null
- Division of Neonatology, Newborn ICU, Neonatal Transport, UC Davis Children's Hospital, 2516 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Kevin Crezee
- Department of Medical Affairs, Mallinckrodt Pharmaceuticals, Perryville III Corporate Park, 53 Frontage Road, 3rd Floor, PO Box 9001, Hampton, NJ 08827-9001, USA
| | - Tamara Bleak
- Intermountain Life Flight Children's Services, 250 North 2370 West, Salt Lake City, UT 84116, USA
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Respiratory Support for Pharmacologically Induced Hypoxia in Neonatal Calves. Vet Med Int 2016; 2016:2129362. [PMID: 26998379 PMCID: PMC4779535 DOI: 10.1155/2016/2129362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/12/2016] [Indexed: 12/04/2022] Open
Abstract
Practical methods to provide respiratory support to bovine neonates in a field setting are poorly characterised. This study evaluated the response of healthy neonatal calves with pharmacologically induced respiratory suppression to nasal oxygen insufflation and to continuous positive airway pressure (CPAP) delivered via an off-the-shelf device. Ten calves were randomised to receive either nasal oxygen insufflation (Group 1, n = 5) or CPAP (Group 2, n = 5) as a first treatment after induction of respiratory depression by intravenous administration of xylazine, fentanyl, and diazepam. Calves received the alternate treatment after 10 minutes of breathing ambient air. Arterial blood gas samples were obtained prior to sedation, following sedation, following the first and second treatment, and after breathing ambient air before and after the second treatment. Oxygen insufflation significantly increased arterial oxygen partial pressure (PaO2) but was also associated with significant hypercapnia. When used as the first treatment, CPAP was associated with significantly decreased arterial partial pressure of carbon dioxide but did not increase PaO2. These results suggest that the use of CPAP may represent a practical method for correction of hypercapnia associated with inadequate ventilation in a field setting, and further research is required to characterise the use of CPAP with increased inspired oxygen concentrations.
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Knauer H, Baker DL, Hebbeler K, Davis-Alldritt L. The Mismatch Between Children’s Health Needs and School Resources. J Sch Nurs 2015; 31:326-33. [DOI: 10.1177/1059840515579083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
There are increasing numbers of children with special health care needs (CSHCN) who require various levels of care each school day. The purpose of this study was to examine the role of public schools in supporting CSHCN through in-depth key informant interviews. For this qualitative study, the authors interviewed 17 key informants to identify key themes, provide recommendations, and generate hypotheses for further statewide survey of school nurse services. Key informants identified successful strategies and challenges that public schools face in meeting the needs of all CSHCN. Although schools are well intentioned, there is wide variation in the ability of schools to meet the needs of CSHCN. Increased funding, monitoring of school health services, integration of services, and interagency collaboration are strategies that could improve the delivery of health services to CSHCN in schools.
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Affiliation(s)
- Heather Knauer
- School of Public Health, University of California, Berkeley, CA, USA
| | - Dian L. Baker
- School of Nursing, California State University, Sacramento, CA, USA
- Center for Excellence in Developmental Disabilities, Medical Investigation of Neurodevelopmental Disorders Institute at the University of California Davis, Sacramento, CA, USA
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Najafian B, Fakhraie SH, Afjeh SA, Kazemian M, Shohrati M, Saburi A. Early surfactant therapy with nasal continuous positive airway pressure or continued mechanical ventilation in very low birth weight neonates with respiratory distress syndrome. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12206. [PMID: 24910785 PMCID: PMC4028758 DOI: 10.5812/ircmj.12206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/09/2013] [Accepted: 06/29/2013] [Indexed: 11/24/2022]
Abstract
Background: Various strategies have been suggested for the treatment of respiratory distress syndrome (RDS). Objectives: The aim of this study was to compare the efficacies of two common methods of RDS management among neonates with low birth weight. Patients and Methods: A cohort study was conducted on 98 neonates with definite diagnosis of RDS during 2008-2009. The neonates were divided into two groups by a blinded supervisor using simple randomization (odd and even numbers). Forty-five cases in the first group were treated with intubation, surfactant therapy, extubation (INSURE method) followed by nasal continuous positive airway pressure (N.CPAP) and 53 cases in the second group underwent intubation, surfactant therapy followed by mechanical ventilation (MV). Results: Five (11.1%) cases in the first group and 23 (43%) cases in the second group expired during the study. The rates of MV dependency among cases with INSURE failure and cases in the MV group were 37% and 83%, respectively (P < 0.001). Birth weight (BW) (P = 0.017), presence of retinopathy of prematurity (P = 0.022), C/S delivery (P = 0.029) and presence of lung bleeding (P = 0.010) could significantly predict mortality in the second group, although only BW (P = 0.029) had a significant impact on the mortality rate in the first group. Moreover, BW was significantly related to the success rate in the first group (P = 0.001). Conclusions: Our findings demonstrated that INSURE plus NCPAP was more effective than the routine method (permanent intubation after surfactant prescription). In addition, the lower rates of mortality, MV dependency, duration of hospitalization, and complications were observed in cases treated with the INSURE method compared to the routine one.
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Affiliation(s)
- Bita Najafian
- Department of Pediatrics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Pediatrics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Seyed Hasan Fakhraie
- Department of Pediatrics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Seyed Abulfazl Afjeh
- Department of Pediatrics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Abulfazl Afjeh, Department of Pediatrics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188600067, E-mail:
| | - Mohammad Kazemian
- Department of Pediatrics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Majid Shohrati
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Amin Saburi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children. Intensive Care Med 2014; 40:592-9. [PMID: 24531340 DOI: 10.1007/s00134-014-3226-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Optimal respiratory support for interhospital transport of critically ill children is challenging and has been scarcely investigated. High-flow nasal cannula (HFNC) therapy has emerged as a promising support mode in the paediatric intensive care unit (PICU), but no data are available on HFNC used during interhospital transport. We aimed to assess the safety of HFNC during retrievals of critically ill children and its impact on the need for invasive ventilation (IV). METHODS This was a retrospective, single-centre study of children under 2 years old transported by a specialized paediatric retrieval team to PICU. We compared IV rates before (2005-2008) and after introduction of HFNC therapy (2009-2012). RESULTS A total of 793 infants were transported. The mean transport duration was 1.4 h (range 0.25-8), with a mean distance of 205 km (2-2,856). Before introduction of HFNC, 7 % (n = 23) were retrieved on non-invasive ventilation (NIV) and 49 % (n = 163) on IV. After introduction of HFNC, 33 % (n = 150) were retrieved on HFNC, 2 % (n = 10) on NIV, whereas IV decreased to 35 % (n = 162, p < 0.001). No patients retrieved on HFNC required intubation during retrieval, or developed pneumothorax or cardiac arrest. Using HFNC was associated with a significant reduction in IV initiated by the retrieval team (multivariate OR 0.51; 95 % CI 0.27-0.95; p = 0.032). CONCLUSIONS We report on a major change of practice in transport of critically ill children in our retrieval system. HFNC therapy was increasingly used and was not inferior to low-flow oxygen or NIV. Randomized trials are needed to assess whether HFNC can reduce the need for IV in interhospital transport of critically ill children.
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Foley M, Dunbar N, Clancy J. Collaborative care for children: a grand rounds presentation. J Sch Nurs 2013; 30:251-5. [PMID: 23553624 DOI: 10.1177/1059840513484364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
At the end of the 2011-2012 school year, two collaborative initiatives took place in Springfield, MA, between the public school system and Baystate Medical Center, an affiliate of Tufts University. The success of these initiatives was highlighted during grand rounds that featured academic medical center physicians and nurses as well as public school nurses. The program highlighted care of urban children with one of two chronic diseases, type 1 diabetes or asthma. Although the treatment and care of both these chronic childhood illnesses vary greatly, it is evident that primary care providers, school nurses, and students can benefit from increased collaboration, communication, and understanding of each other's roles. The partnerships were developed in an effort to overcome health care disparities that can and do exist in urban school districts such as Springfield, MA. In this commentary, we discuss important outcomes that resulted from the joint presentation at grand rounds.
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Affiliation(s)
| | - Nancy Dunbar
- Baystate Pediatric Endocrinology, Springfield, MA, USA
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Kapadia J, Brazier A, Stone S, Farrer K. Safety of nasal continuous positive airway pressure during nurse-led, single-clinician neonatal transfers. Acta Paediatr 2012; 101:e266-7. [PMID: 22385502 DOI: 10.1111/j.1651-2227.2012.02657.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Baird JS, Ravindranath TM. Out-of-hospital noninvasive ventilation: epidemiology, technology and equipment. Pediatr Rep 2012; 4:e17. [PMID: 22802995 PMCID: PMC3395975 DOI: 10.4081/pr.2012.e17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/04/2012] [Accepted: 01/20/2012] [Indexed: 11/23/2022] Open
Abstract
Noninvasive ventilation has been utilized successfully in the pre- and out-of-hospital settings for a variety of disorders, including respiratory distress syndrome in neonates, neurologic and pulmonary diseases in infants and children, and heart failure as well as chronic obstructive pulmonary disease in adults. A variety of interfaces as well as mechanical positive pressure devices have been used: simple continuous positive airway pressure devices are available which do not require sophisticated equipment, while a broad spectrum of ventilators have been used to provide bilevel positive airway pressure. Extensive training of transport teams may be important, particularly when utilizing bilevel positive airway pressure in infants and children.
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Affiliation(s)
- John Scott Baird
- Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA
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Resnick S, Sokol J. Impact of introducing binasal continuous positive airway pressure for acute respiratory distress in newborns during retrieval: Experience from Western Australia. J Paediatr Child Health 2010; 46:754-9. [PMID: 20825610 DOI: 10.1111/j.1440-1754.2010.01834.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM We aimed to review the impact of introducing binasal continuous positive airway pressure (CPAP) for acute respiratory distress in newborns ≥32 weeks gestation during retrieval in Western Australia. METHODS Retrospective review of newborns ≥32 weeks gestation with acute respiratory distress, transported by the Western Australian Neonatal Transport Service between February 2002 and December 2004. RESULTS Respiratory management of 369 newborns was examined. CPAP use increased significantly during the study period from 33% in 2002 to 59% in 2004. Overall, endotracheal tube (ETT) ventilation was required in 108 (29%), nasal CPAP in 166 (45%) and cot oxygen in 95 (26%) patients. Twenty-two (13%) newborns in the CPAP group subsequently required ETT ventilation within 24 h: these babies had higher initial oxygen requirements than those successfully transported on CPAP alone. There was no significant morbidity or mortality in patients retrieved on CPAP. CONCLUSION CPAP was increasingly utilised as an alternative to ETT ventilation for the management of most cases of less severe acute respiratory distress in near-term neonates on retrieval. This review demonstrated that newborns requiring more than 45-50% oxygen at the time of retrieval were more likely to require intubation at a later time, and hence may benefit from intubation at the time of retrieval. A prospective randomised trial would assist in ascertaining the true benefit of CPAP during retrieval in the newborn period.
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Affiliation(s)
- Steven Resnick
- Western Australian Neonatal Transport Service, Neonatology Clinical Care Unit, Princess Margaret and King Edward Hospitals, University of Western Australia, Perth, WA 6008, Australia.
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Jackson L, Skeoch CH. Setting up a neonatal transport service: air transport. Early Hum Dev 2009; 85:477-81. [PMID: 19481377 DOI: 10.1016/j.earlhumdev.2009.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
Air transport is an integral part of any system that provides neonatal care in the developed world. To ensure that this is developed in an efficient and appropriate manner a prospective analysis is required to allow a multidisciplinary team to progress a project aimed at providing appropriate staff with adequate training using equipment that has satisfied all regulatory bodies. This article highlights the difficulties in achieving this, reflecting on the way in which established air transport teams have overcome many of the difficulties. The commonalities with land based transport are emphasised along with those issues which are specific to teams providing such a service who aspire to become "air capable".
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Affiliation(s)
- Lesley Jackson
- West of Scotland Neonatal Transport Service, Ground Floor, Cuthbertson Building, Glasgow Royal Infirmary, Scotland, United Kingdom.
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