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Mukerji A, Read B, Yang J, Baczynski M, Ng E, Dunn M, Ethier G, Abou Mehrem A, Beltempo M, Drolet C, da Silva O, Louis D, Lemyre B, Afifi J, Singh B, Sherlock R, Stavel M, Masse E, Kanungo J, Wong J, Bodani J, Khurshid F, Lee KS, Augustine S, de Oliveira CB, Makary H, Newman A, Ojah C, Shah PS. CPAP Versus NIPPV Postextubation in Preterm Neonates: A Comparative-Effectiveness Study. Pediatrics 2024; 153:e2023064045. [PMID: 38511227 DOI: 10.1542/peds.2023-064045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Nasal intermittent positive pressure ventilation (NIPPV) has been shown to be superior to nasal continuous positive airway pressure (CPAP) postextubation in preterm neonates. However, studies have not permitted high CPAP pressures or rescue with other modes. We hypothesized that if CPAP pressures >8 cmH2O and rescue with other modes were permitted, CPAP would be noninferior to NIPPV. METHODS We conducted a pragmatic, comparative-effectiveness, noninferiority study utilizing network-based real-world data from 22 Canadian NICUs. Centers self-selected CPAP or NIPPV as their standard postextubation mode for preterm neonates <29 weeks' gestation. The primary outcome was failure of the initial mode ≤72 hours. Secondary outcomes included failure ≤7 days, and reintubation ≤72 hours and ≤7 days. Groups were compared using a noninferiority adjusted risk-difference (aRD) margin of 0.05, and margin of no difference. RESULTS A total of 843 infants extubated to CPAP and 974 extubated to NIPPV were included. CPAP was not noninferior (and inferior) to NIPPV for failure of the initial mode ≤72 hours (33.0% vs 26.3%; aRD 0.07 [0.03 to 0.12], Pnoninferiority(NI) = .86), and ≤7 days (40.7% vs 35.8%; aRD 0.09 [0.05 to 0.13], PNI = 0.97). However, CPAP was noninferior (and equivalent) to NIPPV for reintubation ≤72 hours (13.2% vs 16.1%; aRD 0.01 [-0.05 to 0.02], PNI < .01), and noninferior (and superior) for reintubation ≤7 days (16.4% vs 22.8%; aRD -0.04 [-0.07 to -0.001], PNI < .01). CONCLUSIONS CPAP was not noninferior to NIPPV for failure ≤72 hours postextubation; however, it was noninferior to NIPPV for reintubation ≤72 hours and ≤7 days. This suggests CPAP may be a reasonable initial postextubation mode if alternate rescue strategies are available.
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Affiliation(s)
- Amit Mukerji
- McMaster Children's Hospital, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Brooke Read
- London Health Sciences Centre, London, Ontario, Canada
| | - Junmin Yang
- Mount Sinai Hospital, Department of Pediatrics
| | | | - Eugene Ng
- Sunnybrook Health Sciences Centre, Department of Pediatrics
| | - Michael Dunn
- Sunnybrook Health Sciences Centre, Department of Pediatrics
| | - Guillaume Ethier
- CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Ayman Abou Mehrem
- Foothills Medical Centre, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Marc Beltempo
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Christine Drolet
- CHU de Quebec, Department of Pediatrics, Laval University, Quebec, Quebec City, Canada
| | - Orlando da Silva
- London Health Sciences Centre, Department of Pediatrics, Western University, London, Ontario, Canada
| | - Deepak Louis
- Health Sciences Centre and St. Boniface Hospital, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brigitte Lemyre
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | - Edith Masse
- CIUSSSE-CHUS, Department of Pediatrics, University of Sherbrooke, Quebec, Canada
| | - Jaideep Kanungo
- Royal Victoria Hospital, University of Victoria, Victoria, British Columbia, Canada
| | - Jonathan Wong
- BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaya Bodani
- Regina General Hospital, Department of Pediatrics, University of Regina, Regina, Saskatchewan, Canada
| | - Faiza Khurshid
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kyong-Soon Lee
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Alana Newman
- Saint John Regional Hospital, Saint John, New Brunswick, Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
| | - Cecil Ojah
- Saint John Regional Hospital, Saint John, New Brunswick, Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
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Boutillier B, Ethier G, Boucoiran I, Reichherzer M, Luu TM, Morin L, Pearce R, Janvier A. Prenatal Workshops and Support Groups for Prospective Parents Whose Children Will Need Neonatal Care at Birth: A Feasibility and Pilot Study. Children (Basel) 2023; 10:1570. [PMID: 37761531 PMCID: PMC10529479 DOI: 10.3390/children10091570] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Support groups in neonatal intensive care units (NICUs) are beneficial to parents. The usefulness of prenatal support groups for prospective parents who will have a newborn requiring admission to the NICU has never been investigated. Methods: We assessed the needs of NICU parents regarding topics they would have wished to discuss prenatally and developed the content of a prenatal support workshop. A standardized survey prospectively evaluated the perspectives of pregnant women admitted to a high-risk pregnancy unit who participated in the resulting workshops. Results: During needs assessment, 295 parents invoked themes they would have wished to discuss antenatally: parental guilt, future parental role, normalizing their experience/emotions, coping with many losses, adapting to their new reality, control and trust, information about the NICU, technology around the baby, common neonatal interventions, the NICU clinical team, and the role of parents in the team. These findings were used to develop the workshop, including a moderator checklist and a visual presentation. Practical aspects of the meetings were tested/finalized during a pre-pilot phase. Among 21 pregnant women who answered the survey (average gestational age 29.3 weeks), all agreed that the workshop was useful, that it made them feel less lonely (95%), that exchanges with other women were beneficial (95%) and gave them a certain amount of control over their situation (89%). All answers to open-ended questions were positive. Conclusion: Prenatal educational/support workshops provide a unique and useful means to support future NICU parents. Future investigations will explore whether these prenatal interventions improve clinical outcomes.
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Affiliation(s)
- Béatrice Boutillier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Guillaume Ethier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Martin Reichherzer
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Thuy Mai Luu
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Lucie Morin
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Rebecca Pearce
- Parent Representative, Collaborates with Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada;
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
- Bureau de L’éthique Clinique (BEC), Université de Montréal, Montréal, QC H3C 3J7, Canada
- Unité de Soins Palliatifs, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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Gariépy-Assal L, Janaillac M, Ethier G, Pennaforte T, Lachance C, Barrington KJ, Moussa A. A tiny baby intubation team improves endotracheal intubation success rate but decreases residents' training opportunities. J Perinatol 2023; 43:215-219. [PMID: 36309565 DOI: 10.1038/s41372-022-01546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/15/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the educational and clinical impact of a tiny baby intubation team (TBIT). STUDY DESIGN Retrospective study comparing endotracheal intubation (ETI) performed: pre-implementation of a TBIT (T1), 6 months post-implementation (T2), and 4 years post-implementation (T3). RESULTS Post-implementation (T2), first-attempt success rate in tiny babies increased (44% T1; 59% T2, p = 0.04; 56% T3, p = NS) and the proportion of ETIs performed by residents decreased (53% T1; 37% T2, p = 0.001; 45% T3, p = NS). After an educational quality improvement intervention (prioritizing non-tiny baby ETIs to residents, systematic simulation training and ETI using videolaryngoscopy), in T3 residents' overall (67% T1; 60% T2, p = NS; 79% T3, p = 0.02) and non-tiny baby ETI success rate improved (72% T1; 60% T2, p = NS; 82% T3, p = 0.02). CONCLUSION A TBIT improves success rate of ETIs in ELBW infants but decreases educational exposure of residents. Educational strategies may help maintain resident procedural competency without impacting on quality of care.
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Affiliation(s)
- L Gariépy-Assal
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - M Janaillac
- Service de néonatologie, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - G Ethier
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada
| | - T Pennaforte
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - C Lachance
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada
| | - K J Barrington
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada.,CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
| | - A Moussa
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada. .,CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada. .,Centre de pédagogie appliquée aux sciences de la santé, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Roychoudhury S, Lodha A, Synnes A, Abou Mehrem A, Canning R, Banihani R, Beltempo M, Theriault K, Yang J, Shah PS, Soraisham AS, Ting J, Abou Mehrem A, Alvaro R, Adie M, Ng E, Pelausa E, Beltempo M, Claveau M, Barrington K, Lapoint A, Ethier G, Drolet C, Piedboeuf B, Afifi J, Dahlgren L, Wood S, Metcalfe A, O’Quinn C, Helewa M, Taboun F, Melamed N, Abenhaim H, Wou K, Gratton R, Boucoiran I, Taillefer C, Theriault K, Allen V, Synnes A, Grunau R, Hendson L, Moddemann D, de Cabo C, Nwaesei C, Church P, Banihani R, Pelausa E, Nguyen KA, Khairy M, Beltempo M, Dorval V, Luu TM, Bélanger S, Afifi J. Neurodevelopmental outcomes of preterm infants conceived by assisted reproductive technology. Am J Obstet Gynecol 2021; 225:276.e1-276.e9. [PMID: 33798481 DOI: 10.1016/j.ajog.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There have been concerns about the development of children conceived through assisted reproductive technology. Despite multiple studies investigating the outcomes of assisted conception, data focusing specifically on the neurodevelopmental outcomes of infants conceived through assisted reproductive technology and born preterm are limited. OBJECTIVE This study aimed to evaluate and compare the neurodevelopmental outcomes of preterm infants born at <29 weeks' gestation at 18 to 24 months' corrected age who were conceived through assisted reproductive technology and those who were conceived naturally. STUDY DESIGN This retrospective cohort study included inborn, nonanomalous infants, born at <29 weeks' gestation between January 1, 2010, and December 31, 2016, who had a neurodevelopmental assessment at 18 to 24 months' corrected age at any of the 10 Canadian Neonatal Follow-Up Network clinics. The primary outcome was neurodevelopmental impairment at 18 to 24 months, defined as the presence of any of the following: cerebral palsy; Bayley-III cognitive, motor, or language composite score of <85; sensorineural or mixed hearing loss; and unilateral or bilateral visual impairment. Secondary outcomes included mortality, composite of mortality or neurodevelopmental impairment, significant neurodevelopmental impairment, and each component of the primary outcome. We compared outcomes between infants conceived through assisted reproductive technology and those conceived naturally, using bivariate and multivariable analyses after adjustment. RESULTS Of the 4863 eligible neonates, 651 (13.4%) were conceived using assisted reproductive technology. Maternal age; education level; and rates of diabetes mellitus, receipt of antenatal corticosteroids, and cesarean delivery were higher in the assisted reproduction group than the natural conception group. Neonatal morbidity and death rates were similar except for intraventricular hemorrhage, which was lower in the assisted reproduction group (33% [181 of 546] vs 39% [1284 of 3318]; P=.01). Of the 4176 surviving infants, 3386 (81%) had a follow-up outcome at 18 to 24 months' corrected age. Multivariable logistic regression adjusting for gestational age, antenatal steroids, sex, small for gestational age, multiple gestations, mode of delivery, maternal age, maternal education, pregnancy-induced hypertension, maternal diabetes mellitus, and smoking showed that infants conceived through assisted reproduction was associated with lower odds of neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86) and the composite of death or neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.54-0.84). Conception through assisted reproductive technology was associated with decreased odds of a Bayley-III composite cognitive score of <85 (adjusted odds ratio, 0.68; 95% confidence interval, 0.48-0.99) and composite language score of <85 (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.88). CONCLUSION Compared with natural conception, assisted conception was associated with lower odds of adverse neurodevelopmental outcomes, especially cognitive and language outcomes, at 18 to 24 months' corrected age among preterm infants born at <29 weeks' gestation. Long-term follow-up studies are required to assess the risks of learning disabilities and development of complex visual-spatial and processing skills in these children as they reach school age.
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Mohamed I, Ethier G, Goyer I, Major P, Dahdah N. Oral everolimus treatment in a preterm infant with multifocal inoperable cardiac rhabdomyoma associated with tuberous sclerosis complex and a structural heart defect. BMJ Case Rep 2014; 2014:bcr-2014-205138. [PMID: 25427930 DOI: 10.1136/bcr-2014-205138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyoma (RHM) is a benign cardiac tumour usually associated with tuberous sclerosis complex (TSC). Most RHMs are asymptomatic and regress spontaneously during the first years of life. Haemodynamically significant RHMs are classically treated with surgical excision. We present a case of a premature infant, born to a mother having TSC, with a prenatal diagnosis of pulmonary valve atresia and a large ventricular septal defect. Multiple cardiac RHMs were also present, including a large tumour affecting the right ventricular filling. Owing to the prematurity and low birth weight, the infant was inoperable. In this report, we describe our approach to pharmacologically reduce the RHM size using oral everolimus in preparation for a two-ventricle surgical repair of the structural cardiac defect. We also specifically describe the dose of everolimus that was used in this case to achieve therapeutic serum levels, which was seven times lower than the conventional dose applicable for older infants.
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Affiliation(s)
- Ibrahim Mohamed
- Department of Neonatology, CHU Ste-Justine, Montreal, Canada
| | | | - Isabelle Goyer
- Department of Neonatology, CHU Ste-Justine, Montreal, Canada
| | - Philippe Major
- Division of Pediatric Cardiology, CHU Ste-Justine, Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Montreal, Canada
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Abstract
Electrical phrenic nerve stimulation (EPNS) applied at end expiration during exclusive nasal breathing can be used to characterize upper airway (UA) dynamics during wakefulness by dissociating phasic activation of UA and respiratory muscles. The UA level responsible for the EPNS-induced increase in UA resistance is unknown. The influence of the twitch expiratory timing (200 ms and 2 s) on UA resistance was studied in nine normal awake subjects by looking at instantaneous flow, esophageal and pharyngeal pressures, and genioglossal electromyogram (EMG) activity during EPNS at baseline and at -10 cmH(2)O. The majority of twitches had a flow-limited pattern. Twitches realized at 200 ms and 2 s did not differ in their maximum inspiratory flows, but esophageal pressure measured at maximum inspiratory flow was significantly less negative with late twitches (-6.6 +/- 2.7 and -5.0 +/- 3.0 cmH(2)O respectively, P = 0.04). Pharyngeal resistance was higher when twitches were realized at 2 s than at 200 ms (6.4 +/- 2.4 and 2.7 +/- 1.1 cmH(2)O x l(-1). s, respectively). EMG activity significant rose at peak esophageal pressure with a greater increase for late twitches. We conclude that twitch-induced UA collapse predominantly occurs at the pharyngeal level and that UA stability assessed by EPNS depends on the expiratory time at which twitches are performed.
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Affiliation(s)
- F Sériès
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Québec, Canada G1V 4G5.
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