1
|
Mense L, Hansmann T, Seipolt B, Kaufmann M, Rüdiger M. Surfactant administration during endotracheal CPAP: feasibility, risk factors for failure and short-term outcomes of DD-SURF. Acta Paediatr 2023. [PMID: 36946356 DOI: 10.1111/apa.16767] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
AIM Whereas there is agreement, that surfactant should be administered without mechanical ventilation, there is still a debate concerning the optimal method. DD-SURF combines the benefits of INSURE and less invasive surfactant administration (LISA). The efficacy of this approach has not been evaluated yet. METHODS Retrospective cohort study of all preterm newborns below 300/7 weeks gestational age admitted to the neonatal intensive care unit. Data on surfactant therapy, respiratory support during the first 96 hours of life and neonatal morbidities until hospital discharge were collected from the electronic patient charts to evaluate the efficacy and safety of our approach. RESULTS 222 newborns met the inclusion criteria. 174 (78%) received surfactant in the delivery room by the DD-SURF procedure. 21 infants (10%) were not extubated after surfactant administration (Surf-and-vent group). 75% of patients after DD-SURF did not require reintubation. Intraventricular hemorrhage and bronchopulmonary dysplasia occured more often in infants after DD-SURF failure than after successful DD-SURF. CONCLUSION DD-SURF potentially combines the benefits of INSURE and LISA and represents a useful alternative of surfactant delivery with comparable success rates to thin-catheter surfactant administration.
Collapse
Affiliation(s)
- L Mense
- University Hospital Carl Gustav Carus Dresden, Department of Pediatrics, Division of Neonatology & Pediatric Intensive Care Medicine, TU, Dresden
- Saxony Center for Feto/Neonatal Health, TU, Dresden
| | - T Hansmann
- University Hospital Carl Gustav Carus Dresden, Department of Pediatrics, Division of Neonatology & Pediatric Intensive Care Medicine, TU, Dresden
| | - B Seipolt
- University Hospital Carl Gustav Carus Dresden, Department of Pediatrics, Division of Neonatology & Pediatric Intensive Care Medicine, TU, Dresden
- Saxony Center for Feto/Neonatal Health, TU, Dresden
| | - M Kaufmann
- University Hospital Carl Gustav Carus Dresden, Department of Pediatrics, Division of Neonatology & Pediatric Intensive Care Medicine, TU, Dresden
- Saxony Center for Feto/Neonatal Health, TU, Dresden
| | - M Rüdiger
- University Hospital Carl Gustav Carus Dresden, Department of Pediatrics, Division of Neonatology & Pediatric Intensive Care Medicine, TU, Dresden
- Saxony Center for Feto/Neonatal Health, TU, Dresden
| |
Collapse
|
2
|
Kaufmann M, Seipolt B, Rüdiger M, Mense L. Tactile stimulation in very preterm infants and their needs of non-invasive respiratory support. Front Pediatr 2022; 10:1041898. [PMID: 36467488 PMCID: PMC9715591 DOI: 10.3389/fped.2022.1041898] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
AIM Despite the lack of evidence, current resuscitation guidelines recommend tactile stimulation in apneic infants within the first minutes of life. The aim was to investigate whether timing, duration or intensity of tactile stimulation influences the extent of non-invasive respiratory support in extremely preterm infants during neonatal resuscitation. METHODS In an observational study, we analyzed 47 video recordings and physiological parameters during postnatal transition in preterm infants below 320/7 weeks of gestational age. Infants were divided into three groups according to the intensity of respiratory support. RESULTS All infants were stimulated at least once during neonatal resuscitation regardless of their respiratory support. Only 51% got stimulated within the first minute. Rubbing the feet was the preferred stimulation method and was followed by rubbing or touching the chest. Almost all very preterm infants were exposed to stimulation and manipulation most of the time within their first 15 min of life. Tactile stimulation lasted significantly longer but stimulation at multiple body areas started later in infants receiving prolonged non-invasive respiratory support. CONCLUSION This observational study demonstrated that stimulation of very preterm infants is a commonly used and easy applicable method to stimulate spontaneous breathing during neonatal resuscitation. The concomitant physical stimulation of different body parts and therefore larger surface areas might be beneficial.
Collapse
Affiliation(s)
- Maxi Kaufmann
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Barbara Seipolt
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Mario Rüdiger
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Lars Mense
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| |
Collapse
|
3
|
Frühauf A, Winkler JL, Wimberger P, Nitzsche K, Komár M, Rüdiger M, Seipolt B, Birdir C. Systemischer Lupus erythematodes, Hypothyreose und Kardiomyopathie in der Schwangerschaft: ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Frühauf
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - JL Winkler
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - P Wimberger
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - K Nitzsche
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - M Komár
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - M Rüdiger
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Kinder- und Jugendmedizin
| | - B Seipolt
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Kinder- und Jugendmedizin
| | - C Birdir
- Universitätsklinikum ‘Carl Gustav Carus’ Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| |
Collapse
|
4
|
Bluth A, Nitzsche K, Seipolt B, Sturm AK, Birdir C, Wimberger P. Fallbericht: Neonatales Multiorganversagen am ersten Lebenstag bei intrauteriner Erythroleukämie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Bluth
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Dresden, Deutschland
| | - K Nitzsche
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Dresden, Deutschland
| | - B Seipolt
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Kinder- und Jugendmedizin, Dresden, Deutschland
| | - AK Sturm
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Institut für Pathologie, Dresden, Deutschland
| | - C Birdir
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Dresden, Deutschland
| | - P Wimberger
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Dresden, Deutschland
| |
Collapse
|
5
|
Richter M, Seipolt B. Schmerztherapie bei Früh- und Neugeborenen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Abstract
Pain is a central topic on neonatal intensive care units (NICU). Acute as well as prolonged (continuous and chronic) pain frequently occurs. Due to a lack of validated physiological measurement instruments for pain (e. g. saliva cortisol, skin conductance and heart rate variability) pain in neonatology can only be assessed by external observation through the bedside team with pain scores using a regular, standardized procedure. During this very vulnerable period pain and medications (analgesics/sedatives) can negatively influence the brain development of premature babies and neonates. Therefore, limitation of the number of pain stimuli and the medicinal guideline "as much as necessary but as little as possible" are eminently important. When dealing with prolonged (continuous and chronic) pain, further challenges are a reduction of analgesics and sedatives as well as avoidance of withdrawal symptoms.
Collapse
Affiliation(s)
- M Richter
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, 01307, Dresden, Deutschland.
| | - B Seipolt
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, 01307, Dresden, Deutschland
| |
Collapse
|
7
|
Kindler A, Seipolt B, Heilmann A, Range U, Rüdiger M, Hofmann SR. Development of a Diagnostic Clinical Score for Hemodynamically Significant Patent Ductus Arteriosus. Front Pediatr 2017; 5:280. [PMID: 29312911 PMCID: PMC5743666 DOI: 10.3389/fped.2017.00280] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/12/2017] [Indexed: 11/13/2022] Open
Abstract
There is no consensus about the hemodynamic significance and, therefore, the need to treat a persistent ductus arteriosus in preterm newborns. Since the diagnosis of a hemodynamically significant persistent ductus arteriosus (hsPDA) is made by a summary of non-uniform echo-criteria in combination with the clinical deterioration of the preterm neonate, standardized clinical and ultrasound scoring systems are needed. The objective of this study was the development of a clinical score for the detection and follow-up of hsPDA. In this observational cohort study of 154 preterm neonates (mean gestational age 28.1 weeks), clinical signs for the development of hsPDA were recorded in a standardized score and compared to echocardiography. Analyzing the significance of single score parameters compared to the diagnosis by echocardiography, we developed a short clinical score (calculated sensitivity 84% and specificity 80%). In conclusion, this clinical diagnostic PDA score is non-invasive and quickly to implement. The continuous assessment of defined clinical parameters allows for a more precise diagnosis of hemodynamic significance of PDA and, therefore, should help to detect preterm neonates needing PDA-treatment. The score, therefore, allows a more targeted use of echocardiography in these very fragile preterm neonates.
Collapse
Affiliation(s)
- Annemarie Kindler
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Barbara Seipolt
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Antje Heilmann
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mario Rüdiger
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sigrun Ruth Hofmann
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
8
|
Wetzel A, Hiller Y, Seipolt B, Bergert R, Rüdiger M. Kreißsaal – der optimale Start ins Leben. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Affiliation(s)
- Barbara Seipolt
- Clinic of Pediatrics, Medical Faculty, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | | | | |
Collapse
|