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Czynski AJ, Laptook AR. The Time is NOW: Filling the Gaps in Treatment of Opioid-Exposed Infants: A Prospective, Pragmatic, Randomized Control Drug Trial. R I Med J (2013) 2021; 104:17-21. [PMID: 33789403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The opioid epidemic has reached into all aspects of life in the United States. The epidemic has crossed racial, economic, social, and generational barriers. This epidemic also impacts infants. Fetal exposure to opioids can produce a withdrawal effect in newborns, referred to as Neonatal Opioid Withdrawal Syndrome (NOWS). NOWS treatment lacks a standard approach, with prominent variation across the United States. Furthermore, many treatment strategies for NOWS are not evidence-based but reflect anecdotal experience. Variable approaches to NOWS treatment contribute to more extended hospital stays and greater postnatal opioid exposure. The most prolonged period of NOWS treatment occurs during the weaning phase. This paper describes the first prospective randomized control trial to address systematized weaning of opioids for infants with NOWS.
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Affiliation(s)
- Adam J Czynski
- Department of Pediatrics, Women and Infants Hospital, Brown University; COBRE on Opioids and Overdose, Rhode Island Hospital, Providence, RI
| | - Abbot R Laptook
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI
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Green TC, Kaplowitz E, Langdon K, Hughto JMW, Goedel WC, Czynski AJ, Fraser G, Rich J. COBRE on Opioid and Overdose: A Collaborative Research-Based Center Addressing the Crises in Rhode Island and Beyond. R I Med J (2013) 2021; 104:22-26. [PMID: 33789404 PMCID: PMC8049088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Overdose deaths across the country have spiked since the onset of the COVID-19 pandemic. It is crucial now, more than ever, to address the continuing and worsening, complex and dynamic opioid and overdose epidemics. In 2018, The Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, based at Rhode Island Hospital, launched with three major goals: 1) establish a center of scientific excellence on opioids and overdose; 2) train the next generation of scientists to become independent investigators and address the opioid and overdose crises; and 3) contribute to the scientific progress and solutions to combat these epidemics. To date, we have made substantial progress. While the opioid and overdose crises continue to evolve, the COBRE on Opioid and Overdose and its team of investigators are well poised to address the daunting task of understanding and meaningfully addressing these deadly epidemics, with the ultimate goal of saving lives.
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Affiliation(s)
- Traci C Green
- Department of Emergency Medicine, Alpert School of Brown University; The Opioid Policy Research Collaborative, The Heller School of Social Policy and Management at Brandeis University; Department of Epidemiology, Brown University School of Public Health; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Jaclyn M W Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown School of Public Health; Center for Health Promotion and Health Equity, Brown University; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - William C Goedel
- Department of Epidemiology, Brown School of Public Health; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Adam J Czynski
- Department of Pediatrics, Alpert Medical School of Brown University; Department of Pediatrics, Women & Infants Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Gayle Fraser
- The COBRE on Opioids and Overdose, Rhode Island Hospital
| | - Josiah Rich
- Departments of Medicine and Epidemiology, Brown University; The Center for Health and Justice Transformation, The Miriam Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital
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Merhar SL, Ounpraseuth S, Devlin LA, Poindexter BB, Young LW, Berkey SD, Crowley M, Czynski AJ, Kiefer AS, Whalen BL, Das A, Fuller JF, Higgins RD, Thombre V, Lester BM, Smith PB, Newman S, Sánchez PJ, Smith MC, Simon AE. Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome. Pediatrics 2021; 147:peds.2020-017830. [PMID: 33632932 PMCID: PMC7919109 DOI: 10.1542/peds.2020-017830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the neonatal opioid withdrawal syndrome (NOWS) epidemic in the United States, evidence is limited for pharmacologic management when first-line opioid medications fail to control symptoms. The objective with this study was to evaluate outcomes of infants receiving secondary therapy with phenobarbital compared with clonidine, in combination with morphine, for the treatment of NOWS. METHODS We performed a retrospective cohort study of infants with NOWS from 30 hospitals. The primary outcome measures were the length of hospital stay, duration of opioid treatment, and peak morphine dose. Outcomes were compared by group by using analysis of variance and multivariable linear regression controlling for relevant confounders. RESULTS Of 563 infants with NOWS treated with morphine, 32% (n = 180) also received a secondary medication. Seventy-two received phenobarbital and 108 received clonidine. After adjustment for covariates, length of hospital stay was 10 days shorter, and, in some models, duration of morphine treatment was 7.5 days shorter in infants receiving phenobarbital compared with those receiving clonidine, with no difference in peak morphine dose. Infants were more likely to be discharged from the hospital on phenobarbital than clonidine (78% vs 29%, P < .0001). CONCLUSIONS Among infants with NOWS receiving morphine and secondary therapy, those treated with phenobarbital had shorter length of hospital stay and shorter morphine treatment duration than clonidine-treated infants but were discharged from the hospital more often on secondary medication. Further investigation is warranted to determine if the benefits of shorter hospital stay and shorter duration of morphine therapy justify the possible neurodevelopmental consequences of phenobarbital use in infants with NOWS.
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Affiliation(s)
- Stephanie L. Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Lori A. Devlin
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Brenda B. Poindexter
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Leslie W. Young
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Sean D. Berkey
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Moira Crowley
- Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Adam J. Czynski
- Department of Pediatrics, Women and Infant’s Hospital, Providence, Rhode Island
| | - Autumn S. Kiefer
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Bonny L. Whalen
- Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Abhik Das
- RTI International, Rockville, Maryland
| | - Janell F. Fuller
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Rosemary D. Higgins
- National Institute of Child Health and Human Development, Bethesda, Maryland and George Mason University, Fairfax, Virginia
| | - Vaishali Thombre
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Barry M. Lester
- Center for the Study of Children at Risk, Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - P. Brian Smith
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | | | - Pablo J. Sánchez
- Nationwide Children’s Hospital, College of Medicine, The Ohio State University, Columbus, Ohio
| | - M. Cody Smith
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia; and
| | - Alan E. Simon
- Environmental Influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health, Rockville, Maryland
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Young LW, Hu Z, Annett RD, Das A, Fuller JF, Higgins RD, Lester BM, Merhar SL, Simon AE, Ounpraseuth S, Smith PB, Crawford MM, Atz AM, Cottrell LE, Czynski AJ, Newman S, Paul DA, Sánchez PJ, Semmens EO, Smith MC, Turley CB, Whalen BL, Poindexter BB, Snowden JN, Devlin LA. Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal. Pediatrics 2021; 147:e2020008839. [PMID: 33386337 PMCID: PMC7780957 DOI: 10.1542/peds.2020-008839] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Variation in pediatric medical care is common and contributes to differences in patient outcomes. Site-to-site variation in the characteristics and care of infants with neonatal opioid withdrawal syndrome (NOWS) has yet to be quantified. Our objective was to describe site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS. METHODS Cross-sectional study of 1377 infants born between July 1, 2016, and June 30, 2017, who were ≥36 weeks' gestation, with NOWS (evidence of opioid exposure and NOWS scoring within the first 120 hours of life) born at or transferred to 1 of 30 participating hospitals nationwide. Site-to-site variation for each parameter within the 3 domains was measured as the range of individual site-level means, medians, or proportions. RESULTS Sites varied widely in the proportion of infants whose mothers received adequate prenatal care (31.3%-100%), medication-assisted treatment (5.9%-100%), and prenatal counseling (1.9%-75.5%). Sites varied in the proportion of infants with toxicology screening (50%-100%) and proportion of infants receiving pharmacologic therapy (6.7%-100%), secondary medications (1.1%-69.2%), and nonpharmacologic interventions including fortified feeds (2.9%-90%) and maternal breast milk (22.2%-83.3%). The mean length of stay varied across sites (2-28.8 days), as did the proportion of infants discharged with their parents (33.3%-91.1%). CONCLUSIONS Considerable site-to-site variation exists in all 3 domains. The magnitude of the observed variation makes it unlikely that all infants are receiving efficient and effective care for NOWS. This variation should be considered in future clinical trial development, practice implementation, and policy development.
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Affiliation(s)
- Leslie W Young
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, Vermont;
| | | | - Robert D Annett
- Department of Pediatrics, Medical Center, University of Mississippi, Jackson, Mississippi
| | - Abhik Das
- Research Triangle Institute International, Rockville, Maryland
| | - Janell F Fuller
- Health Sciences Center, The University of New Mexico, Albuquerque, New Mexico
| | - Rosemary D Higgins
- National Institute of Child Health and Human Development, Bethesda, Maryland
- College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Barry M Lester
- Department of Pediatrics and Center for the Study of Children at Risk, Warren Alpert Medical School, Brown University and
| | - Stephanie L Merhar
- Division of Neonatology and Perinatal Institute and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alan E Simon
- Environmental Influences on Child Health Outcomes Program and Office of the Director, National Institutes of Health, Rockville, Maryland
| | | | - P Brian Smith
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina;
| | | | - Andrew M Atz
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lesley E Cottrell
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Adam J Czynski
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
| | | | - David A Paul
- Division of Neonatology, Department of Pediatrics, ChristianaCare, Newark, Delaware
| | - Pablo J Sánchez
- Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - M Cody Smith
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia;
| | - Christine B Turley
- Department of Pediatrics, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Bonny L Whalen
- Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
| | | | - Jessica N Snowden
- Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Lori A Devlin
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
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Flannery T, Davis JM, Czynski AJ, Dansereau LM, Oliveira EL, Camardo SA, Lester BM. Neonatal Abstinence Syndrome Severity Index Predicts 18-Month Neurodevelopmental Outcome in Neonates Randomized to Morphine or Methadone. J Pediatr 2020; 227:101-107.e1. [PMID: 32805259 PMCID: PMC7731918 DOI: 10.1016/j.jpeds.2020.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop an index to determine which opioid-exposed neonates have the most severe neonatal abstinence syndrome (NAS). STUDY DESIGN Full-term neonates with NAS (n = 116) from mothers maintained on methadone or buprenorphine were enrolled from 8 sites into a randomized clinical trial of morphine vs methadone. Ninety-nine (85%) were evaluated at hospital discharge using the NICU Network Neurobehavioral Scale (NNNS). At 18 months, 83 of 99 (83.8%) were evaluated with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), and 77 of 99 (77.7%) were evaluated with the Child Behavior Checklist (CBCL). RESULTS Cluster analysis was used to define high (n = 21) and low (n = 77) NAS severity. Compared with infants in the low NAS severity cluster, infants in the high NAS severity cluster had a longer length of stay (P < .001), longer length of stay due to NAS (P < .001), longer duration of treatment due to NAS (P < .001), and higher total dose of the study drug (P < .001) and were more likely to have received phenobarbital (P < .001), to have been treated with morphine (P = .020), and to have an atypical NNNS profile (P = .005). The 2 groups did not differ in terms of maximum Finnegan score. At 18 months, in unadjusted analyses, compared with the high-severity cluster, the low-severity cluster had higher scores on the Bayley-III Cognitive (P = .013), Language (P < .001), and Motor (P = .041) composites and less total behavior problems on the CBCL (P = .028). In adjusted analyses, the difference in the Bayley-III Language composite remained (P = .013). CONCLUSIONS Presumptive measures of NAS severity can be aggregated to develop an index that predicts developmental outcomes at age 18 months.
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Affiliation(s)
- Tess Flannery
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
| | - Jonathan M Davis
- Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Boston, MA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Adam J Czynski
- Department of Pediatrics, Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Lynne M Dansereau
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
| | - Erica L Oliveira
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
| | - Samantha A Camardo
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
| | - Barry M Lester
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.
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Czynski AJ, Davis JM, Dansereau LM, Engelhardt B, Marro P, Bogen DL, Hudak ML, Shenberger J, Wachman EM, Oliveira EL, Lester BM. Neurodevelopmental Outcomes of Neonates Randomized to Morphine or Methadone for Treatment of Neonatal Abstinence Syndrome. J Pediatr 2020; 219:146-151.e1. [PMID: 31987653 PMCID: PMC7161698 DOI: 10.1016/j.jpeds.2019.12.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/27/2019] [Accepted: 12/11/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the effects of pharmacologic treatment of neonatal abstinence syndrome on neurodevelopmental outcome from a randomized, controlled trial. STUDY DESIGN Eight sites enrolled 116 full-term newborn infants with neonatal abstinence syndrome born to mothers maintained on methadone or buprenorphine into a randomized trial of morphine vs methadone. Ninety-nine infants (85%) were evaluated at hospital discharge using the NICU Network Neurobehavioral Scale. At 18 months, 83 of 99 infants (83.8%) were evaluated with the Bayley Scales of Infant and Toddler Development-Third Edition and 77 of 99 (77.7%) with the Child Behavior Checklist (CBCL). RESULTS Primary analyses showed no significant differences between treatment groups on the NICU Network Neurobehavioral Scale, Bayley Scales of Infant and Toddler Development-Third Edition, or CBCL. However in post hoc analyses, we found differences by atypical NICU Network Neurobehavioral Scale profile on the CBCL. Infants receiving adjunctive phenobarbital had lower Bayley Scales of Infant and Toddler Development-Third Edition scores and more behavior problems on the CBCL. In adjusted analyses, internalizing and total behavior problems were associated with use of phenobarbital (P = .03; P = .04), maternal psychological distress (measured by the Brief Symptom Inventory) (both P < .01), and infant medical problems (both P = .02). Externalizing problems were associated with maternal psychological distress (P < .01) and continued maternal substance use (P < .01). CONCLUSIONS Infants treated with either morphine or methadone had similar short-term and longer term neurobehavioral outcomes. Neurodevelopmental outcome may be related to the need for phenobarbital, overall health of the infant, and postnatal caregiving environment. TRIAL REGISTRATION ClinicalTrials.gov: NCT01958476.
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Affiliation(s)
- Adam J Czynski
- Department of Pediatrics, Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI.
| | - Jonathan M Davis
- Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Boston, MA; The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Lynne M Dansereau
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
| | - Barbara Engelhardt
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
| | - Peter Marro
- Department of Pediatrics, Maine Medical Center, Portland, ME
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mark L Hudak
- Department of Pediatrics, Jacksonville-University of Florida Health, Jacksonville, FL
| | | | | | - Erica L Oliveira
- Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
| | - Barry M Lester
- Department of Pediatrics, Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI; Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI
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Roberts KD, Brown R, Lampland AL, Leone TA, Rudser KD, Finer NN, Rich WD, Merritt TA, Czynski AJ, Kessel JM, Tipnis SM, Stepka EC, Mammel MC. Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial. J Pediatr 2018; 193:40-46.e1. [PMID: 29174079 DOI: 10.1016/j.jpeds.2017.09.068] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/01/2017] [Accepted: 09/26/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine if preterm infants with moderate respiratory distress syndrome on continuous positive airway pressure (CPAP) who received surfactant via a laryngeal mask airway (LMA) would have a decreased rate of intubation and mechanical ventilation compared with those on CPAP who did not receive surfactant. STUDY DESIGN In this prospective, multicenter, randomized controlled trial, 103 premature infants 280/7-356/7 weeks gestation, ≥1250 g and ≤36 hours old on CPAP requiring fraction of inspired oxygen 0.30-0.40 were assigned to receive surfactant administered through an LMA then placed back on CPAP (LMA group) or maintained on CPAP with no surfactant administered (control group). The primary outcome was treatment failure necessitating intubation and mechanical ventilation in the first 7 days of life. RESULTS Surfactant administration through an LMA (n = 50) significantly decreased the rate of intubation and mechanical ventilation compared with controls (n = 53): 38% vs 64%, respectively, OR 0.30 (95% CI 0.13, 0.70), P = .006, number needed to treat: 4). There were no serious adverse events associated with placement of the LMA or surfactant administration. CONCLUSIONS In premature neonates with moderate respiratory distress syndrome, surfactant administered through an LMA decreased the rate of intubation and mechanical ventilation. This intervention may have significant impact on clinical care in both high and low resource settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01116921.
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Affiliation(s)
- Kari D Roberts
- Department of Pediatrics, University of Minnesota, Minneapolis, MN.
| | - Roland Brown
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Andrea L Lampland
- Department of Pediatrics, University of Minnesota, Minneapolis, MN; Department of Pediatrics, Children's Minnesota, St. Paul, MN
| | - Tina A Leone
- Department of Pediatrics, Columbia University, New York, NY
| | - Kyle D Rudser
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Neil N Finer
- Department of Pediatrics, University of California-San Diego, San Diego, CA
| | - Wade D Rich
- Department of Pediatrics, Sharp Mary Birch, San Diego, CA
| | - T Allen Merritt
- Department of Pediatrics, Loma Linda University, Loma Linda, CA
| | - Adam J Czynski
- Department of Pediatrics, Loma Linda University, Loma Linda, CA
| | - Julie M Kessel
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
| | - Sajani M Tipnis
- Department of Pediatrics, University of Mississippi, Jackson, MS
| | - Erin C Stepka
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Mark C Mammel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN; Department of Pediatrics, Children's Minnesota, St. Paul, MN
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Czynski AJ, Terry MH, Deming DD, Power GG, Buchholz JN, Blood AB. Cerebral autoregulation is minimally influenced by the superior cervical ganglion in two- week-old lambs, and absent in preterm lambs immediately following delivery. PLoS One 2013; 8:e82326. [PMID: 24349256 PMCID: PMC3857252 DOI: 10.1371/journal.pone.0082326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/23/2013] [Indexed: 11/19/2022] Open
Abstract
Cerebral vessels in the premature newborn brain are well supplied with adrenergic nerves, stemming from the superior cervical ganglia (SCG), but their role in regulation of blood flow remains uncertain. To test this function twelve premature or two-week-old lambs were instrumented with laser Doppler flow probes in the parietal cortices to measure changes in blood flow during changes in systemic blood pressure and electrical stimulation of the SCG. In lambs delivered prematurely at ∼129 days gestation cerebral perfusion and driving pressure demonstrated a direct linear relationship throughout the physiologic range, indicating lack of autoregulation. In contrast, in lambs two-weeks of age, surgical removal of one SCG resulted in ipsilateral loss of autoregulation during pronounced hypertension. Electrical stimulation of one SCG elicited unilateral increases in cerebral resistance to blood flow in both pre-term and two-week-old lambs, indicating functioning neural pathways in the instrumented, anesthetized lambs. We conclude cerebral autoregulation is non-functional in preterm lambs following cesarean delivery. Adrenergic control of cerebral vascular resistance becomes effective in newborn lambs within two-weeks after birth but SCG-dependent autoregulation is essential only during pronounced hypertension, well above the normal range of blood pressure.
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Affiliation(s)
- Adam J. Czynski
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, California, United States of America
| | - Michael H. Terry
- Department of Respiratory Care, Pulmonary Physiology Laboratories, Loma Linda University Medical Center, Loma Linda, California, United States of America
| | - Douglas D. Deming
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, California, United States of America
| | - Gordon G. Power
- Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California, United States of America
| | - John N. Buchholz
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, California, United States of America
| | - Arlin B. Blood
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, California, United States of America
- Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California, United States of America
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