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Peebles PJ, Jensen EA, Herrick HM, Wildenhain PJ, Rumpel J, Moussa A, Singh N, Abou Mehrem A, Quek BH, Wagner M, Pouppirt NR, Glass KM, Tingay DG, Hodgson KA, O’Shea JE, Sawyer T, Brei BK, Jung P, Unrau J, Kim JH, Barry J, DeMeo S, Johnston LC, Nishisaki A, Foglia EE. Endotracheal Tube Size Adjustments Within Seven Days of Neonatal Intubation. Pediatrics 2024; 153:e2023062925. [PMID: 38469643 PMCID: PMC10979295 DOI: 10.1542/peds.2023-062925] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal endotracheal tube (ETT) size recommendations are based on limited evidence. We sought to determine data-driven weight-based ETT sizes for infants undergoing tracheal intubation and to compare these with Neonatal Resuscitation Program (NRP) recommendations. METHODS Retrospective multicenter cohort study from an international airway registry. We evaluated ETT size changes (downsizing to a smaller ETT during the procedure or upsizing to a larger ETT within 7 days) and risk of procedural adverse outcomes associated with first-attempt ETT size selection when stratifying the cohort into 200 g subgroups. RESULTS Of 7293 intubations assessed, the initial ETT was downsized in 5.0% of encounters and upsized within 7 days in 1.5%. ETT downsizing was most common when NRP-recommended sizes were attempted in the following weight subgroups: 1000 to 1199 g with a 3.0 mm (12.6%) and 2000 to 2199 g with a 3.5 mm (17.1%). For infants in these 2 weight subgroups, selection of ETTs 0.5 mm smaller than NRP recommendations was independently associated with lower odds of adverse outcomes compared with NRP-recommended sizes. Among infants weighing 1000 to 1199 g: any tracheal intubation associated event, 20.8% with 2.5 mm versus 21.9% with 3.0 mm (adjusted OR [aOR] 0.62, 95% confidence interval [CI] 0.41-0.94); severe oxygen desaturation, 35.2% with 2.5 mm vs 52.9% with 3.0 mm (aOR 0.53, 95% CI 0.38-0.75). Among infants weighing 2000 to 2199 g: severe oxygen desaturation, 41% with 3.0 mm versus 56% with 3.5mm (aOR 0.55, 95% CI 0.34-0.89). CONCLUSIONS For infants weighing 1000 to 1199 g and 2000 to 2199 g, the recommended ETT size was frequently downsized during the procedure, whereas 0.5 mm smaller ETT sizes were associated with fewer adverse events and were rarely upsized.
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Affiliation(s)
- Patrick J. Peebles
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erik A. Jensen
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Jennifer Rumpel
- Univeristy of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ahmed Moussa
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Neetu Singh
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | | | | | | | - David G. Tingay
- Neonatal Research, Murdoch Children’s Research Institute, Melbourne, Australia; Royal Children’s, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | | | | | | | | | - Philipp Jung
- University Hospital Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Jennifer Unrau
- Alberta Children’s Hospital, University of Calgary, Alberta, Canada
| | - Jae H. Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Barry
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Akira Nishisaki
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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2
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Whalen AM, Merves MH, Kharayat P, Barry JS, Glass KM, Berg RA, Sawyer T, Nadkarni V, Boyer DL, Nishisaki A. Validity Evidence for a Novel, Comprehensive Bag-Mask Ventilation Assessment Tool. J Pediatr 2022; 245:165-171.e13. [PMID: 35181294 DOI: 10.1016/j.jpeds.2022.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/21/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To develop a comprehensive competency assessment tool for pediatric bag-mask ventilation (pBMV) and demonstrate multidimensional validity evidence for this tool. STUDY DESIGN A novel pBMV assessment tool was developed consisting of 3 components: a 22-item-based checklist (trichotomized response), global rating scale (GRS, 5-point), and entrustment assessment (4-point). Participants' performance in a realistic simulation scenario was video-recorded and assessed by blinded raters. Multidimensional validity evidence for procedural assessment, including evidence for content, response-process, internal structure, and relation to other variables, was assessed. The scores of each scale were compared with training level. Item-based checklist scores also were correlated with GRS and entrustment scores. RESULTS Fifty-eight participants (9 medical students, 10 pediatric residents, 18 critical care/neonatology fellows, 21 critical care/neonatology attendings) were evaluated. The pBMV tool was supported by high internal consistency (Cronbach α = 0.867). Inter-rater reliability for the item-based checklist component was acceptable (r = 0.65, P < .0001). The item-based checklist scores differentiated between medical students and other providers (P < .0001), but not by other trainee level. GRS and entrustment scores significantly differentiated between training levels (P < .001). Correlation between skill item-based checklist and GRS was r = 0.489 (P = .0001) and between item-based checklist and entrustment score was r = 0.52 (P < .001). This moderate correlation suggested each component measures pBMV skills differently. The GRS and entrustment scores demonstrated moderate inter-rater reliability (0.42 and 0.46). CONCLUSIONS We established evidence of multidimensional validity for a novel entrustment-based pBMV competence assessment tool, incorporating global and entrustment-based assessments. This comprehensive tool can provide learner feedback and aid in entrustment decisions as learners progress through training.
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Affiliation(s)
- Allison M Whalen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
| | - Matthew H Merves
- Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR
| | - Priyanka Kharayat
- Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, PA
| | - James S Barry
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Kristen M Glass
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA
| | - Robert A Berg
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Vinay Nadkarni
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Donald L Boyer
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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3
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Moussa A, Sawyer T, Puia-Dumitrescu M, Foglia EE, Ades A, Napolitano N, Glass KM, Johnston L, Jung P, Singh N, Quek BH, Barry J, Zenge J, DeMeo S, Mehrem AA, Nadkarni V, Nishisaki A. Does videolaryngoscopy improve tracheal intubation first attempt success in the NICUs? A report from the NEAR4NEOS. J Perinatol 2022; 42:1210-1215. [PMID: 35922664 PMCID: PMC9362392 DOI: 10.1038/s41372-022-01472-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/03/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We hypothesized that videolaryngoscope use for tracheal intubations would differ across NICUs, be associated with higher first attempt success and lower adverse events. STUDY DESIGN Data from the National Emergency Airway Registry for Neonates (01/2015 to 12/2017) included intubation with direct laryngoscope or videolaryngoscope. Primary outcome was first attempt success. Secondary outcomes were adverse tracheal intubation associated events and severe desaturation. RESULTS Of 2730 encounters (13 NICUs), 626 (23%) utilized a videolaryngoscope (3% to 64% per site). Videolaryngoscope use was associated with higher first attempt success (p < 0.001), lower adverse tracheal intubation associated events (p < 0.001), but no difference in severe desaturation. After adjustment, videolaryngoscope use was not associated with higher first attempt success (OR:1.18, p = 0.136), but was associated with lower tracheal intubation associated events (OR:0.45, p < 0.001). CONCLUSION Videolaryngoscope use is variable, not independently associated with higher first attempt success but associated with fewer tracheal intubation associated events.
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Affiliation(s)
- Ahmed Moussa
- Department of Pediatrics, Division of Neonatology, Université de Montréal, Montreal, Canada.
| | - Taylor Sawyer
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA USA
| | - Mihai Puia-Dumitrescu
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA USA
| | - Elizabeth E. Foglia
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Anne Ades
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Natalie Napolitano
- grid.239552.a0000 0001 0680 8770Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kristen M. Glass
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, Penn State College of Medicine, Hershey, PA USA
| | - Lindsay Johnston
- grid.47100.320000000419368710Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Philipp Jung
- grid.412468.d0000 0004 0646 2097Universitätsklinikum Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Neetu Singh
- grid.413480.a0000 0004 0440 749XDepartment of Pediatrics, Dartmouth-Hitchcock Health System, Lebanon, NH USA
| | - Bin Huey Quek
- grid.414963.d0000 0000 8958 3388KK Women’s and Children’s Hospital, Singapore, Singapore
| | - James Barry
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, CO USA
| | - Jeanne Zenge
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, CO USA
| | - Stephen DeMeo
- grid.417002.00000 0004 0506 9656Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, NC USA
| | - Ayman Abou Mehrem
- grid.22072.350000 0004 1936 7697Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Vinay Nadkarni
- grid.239552.a0000 0001 0680 8770Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Akira Nishisaki
- grid.239552.a0000 0001 0680 8770Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, Oji-Mmuo CN, Mola SJ, Murray YL, Palmer TW, Singh M, Fricchione A, Arnold J, Prentice D, Bridgeman CR, Smith BM, Gavigan PJ, Ericson JE, Miller JR, Pauli JM, Williams DC, McSherry GD, Legro RS, Iriana SM, Kaiser JR. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol 2020; 40:987-996. [PMID: 32439956 PMCID: PMC7241067 DOI: 10.1038/s41372-020-0695-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/13/2023]
Abstract
There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.
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Affiliation(s)
- Shaili Amatya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Tammy E Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chintan K Gandhi
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kristen M Glass
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mitchell J Kresch
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dennis J Mujsce
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christiana N Oji-Mmuo
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sara J Mola
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yuanyi L Murray
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Timothy W Palmer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Meenakshi Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ashley Fricchione
- Neonatal Intensive Care Unit, Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jill Arnold
- Neonatal Intensive Care Unit, Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Danielle Prentice
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Colin R Bridgeman
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Brandon M Smith
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Patrick J Gavigan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessica E Ericson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jennifer R Miller
- Division of Academic General Pediatrics, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Duane C Williams
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - George D McSherry
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sarah M Iriana
- Division of Academic General Pediatrics, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffrey R Kaiser
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA.
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Speer RR, Ezeanya UC, Beaudoin SJ, Glass KM, Oji-Mmuo CN. Term Neonate Presenting with the Combined Occurrence of Mucolipidosis Type II and Leigh Syndrome. J Pediatr Genet 2020; 9:137-141. [PMID: 32341820 PMCID: PMC7183396 DOI: 10.1055/s-0039-1700519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
Mucolipidosis II α/beta (MLII) is an autosomal recessive disease in which a gene mutation leads to improper targeting of lysosomal enzymes with an end result of accumulation of lysosomes in the mitochondria resulting in a dysfunctional mitochondria. 1 Leigh syndrome (LS) is a rare progressive neurodegenerative disorder associated with dysfunctional mitochondria and oxidative phosphorylation. 4 Both disease processes typically present in infancy. 3 7 Herein, we present a case of an infant diagnosed with both mucolipidosis II and Leigh syndrome. Genetic analysis in this case revealed two mutations (NDUFA12 c.178C > T p.Arg60* and GNPTAB c.732_733delAA) on the long arm of chromosome 12 as the etiology of MLII and LS in this neonate, respectively. We are unaware of any previously published cases of the presence of these two diseases occurring in the same patient. The complex clinical presentation of this case led to a delay in the diagnosis, and we believe that the clinical phenotypes of these two conditions were likely worsened. The genetic alterations presented in this case occurred as a result of mutations on chromosome 12. We suggest further investigation into the potential overlap in the pathophysiology, specifically the inheritance pattern, linkage disequilibrium, mitochondrial-lysosomal interaction, or crosstalk contributing to both diseases.
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Affiliation(s)
- Rebecca R. Speer
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Uzoamaka C. Ezeanya
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Sarah J. Beaudoin
- Department of Pediatrics/Neonatology, John Muir Health Medical Center, Oakland, California, United States
| | - Kristen M. Glass
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Christiana N. Oji-Mmuo
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States
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6
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Herrick HM, Glass KM, Johnston LC, Singh N, Shults J, Ades A, Nadkarni V, Nishisaki A, Foglia EE. Comparison of Neonatal Intubation Practice and Outcomes between the Neonatal Intensive Care Unit and Delivery Room. Neonatology 2020; 117:65-72. [PMID: 31563910 PMCID: PMC7098841 DOI: 10.1159/000502611] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Characteristics of neonatal tracheal intubations (TI) may vary between the neonatal intensive care unit (NICU) and delivery room (DR). The impact of the setting on TI outcomes is not well characterized. OBJECTIVE The aim of this study was to define variation in neonatal TI practice between settings, and identify the association between setting and TI success and safety outcomes. DESIGN This was a retrospective cohort study of TIs in the National Emergency Airway Registry for Neonates from October 2014 to September 2017. The setting (NICU vs. DR) was the exposure of interest. The outcomes were first attempt success, course success, success within 4 attempts, adverse TI-associated events, severe desaturation, and bradycardia. We compared TI characteristics and outcomes between settings in univariable analysis. Factors significant in univariable analysis (p < 0.1) were included in a logistic regression model, with adjustment for clustering by center, to identify the independent impact of the setting on TI outcomes. RESULTS There were 3,145 TI encounters (2279 NICU, 866 DR) in 9 centers. Almost all baseline characteristics significantly varied between settings. First attempt success rates were 48% (NICU) and 46% (DR). In multivariable analysis, the setting was not associated with first attempt success. DR was associated with a higher adjusted OR (aOR) of success within 4 attempts (1.48, 95% CI 1.06-2.08) and a lower aOR for bradycardia (0.43, 95% CI 0.26-0.71). CONCLUSION Significant differences in patient, provider, and practice characteristics exist between NICU and DR TIs. There is substantial room for improvement in first attempt success rates. These results suggest interventions to improve safety and success need to be targeted to the distinct setting.
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Affiliation(s)
- Heidi Meredith Herrick
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Kristen M Glass
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Children's Hospital and Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lindsay C Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Neetu Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Justine Shults
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Foglia EE, Ades A, Sawyer T, Glass KM, Singh N, Jung P, Quek BH, Johnston LC, Barry J, Zenge J, Moussa A, Kim JH, DeMeo SD, Napolitano N, Nadkarni V, Nishisaki A. Neonatal Intubation Practice and Outcomes: An International Registry Study. Pediatrics 2019; 143:peds.2018-0902. [PMID: 30538147 PMCID: PMC6317557 DOI: 10.1542/peds.2018-0902] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [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: 09/28/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal tracheal intubation is a critical but potentially dangerous procedure. We sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. METHODS We developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. Safety outcomes included adverse tracheal intubation-associated events (TIAEs) and severe oxygen desaturation (≥20% decline in oxygen saturation). We examined the relationship between intubation characteristics and adverse events with univariable tests and multivariable logistic regression. RESULTS We captured 2009 NICU intubations and 598 DR intubations from 10 centers. Pediatric residents attempted 15% of NICU and 2% of DR intubations. In the NICU, the first attempt success rate was 49%, adverse TIAE rate was 18%, and severe desaturation rate was 48%. In the DR, 46% of intubations were successful on the first attempt, with 17% TIAE rate and 31% severe desaturation rate. Site-specific TIAE rates ranged from 9% to 50% (P < .001), and severe desaturation rates ranged from 29% to 69% (P = .001). Practices independently associated with reduced TIAEs in the NICU included video laryngoscope (adjusted odds ratio 0.46, 95% confidence interval 0.28-0.73) and paralytic premedication (adjusted odds ratio 0.38, 95% confidence interval 0.25-0.57). CONCLUSIONS We implemented a novel multisite neonatal intubation registry and identified potentially modifiable factors associated with adverse events. Our results will inform future interventional studies to improve neonatal intubation safety.
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Affiliation(s)
- Elizabeth E. Foglia
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Taylor Sawyer
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Kristen M. Glass
- Penn State Health Children’s Hospital and Penn State College of Medicine, Hershey, Pennsylvania
| | - Neetu Singh
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Bin Huey Quek
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Lindsay C. Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - James Barry
- Department of Pediatrics, Section of Neonatology, School of Medicine, University of Colorado, Aurora, Colorado
| | - Jeanne Zenge
- Department of Pediatrics, Section of Neonatology, School of Medicine, University of Colorado, Aurora, Colorado
| | - Ahmed Moussa
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Jae H. Kim
- Division of Neonatology, Department of Pediatrics, University of California, San Diego and Rady Children’s Hospital of San Diego, San Diego, California
| | | | - Natalie Napolitano
- Departments of Nursing, Respiratory Care and Neurodiagnostic Services and
| | - Vinay Nadkarni
- Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Akira Nishisaki
- Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
AIM Oropharyngeal administration of colostrum (OAC) has been proposed to provide mother's early milk to very low-birth-weight (VLBW) infants in the first few days of life. The aim of this study was to test the hypothesis that OAC would increase salivary secretory IgA (SsIgA). METHODS Overall, 30 VLBW infants randomized to receive OAC or sterile water had salivary sampling for SsIgA on the day of life (DOL) 2,7, and 14. The incidence of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) was determined prospectively. Within and between-group comparisons were made by paired and independent samples t-tests. RESULTS Baseline characteristics were similar between groups. SsIgA was higher in OAC versus the control group (p < 0.05) on DOL 7, but not subsequently on DOL 14. There was no difference in LOS or NEC. CONCLUSION OAC increased SsIgA at DOL 7. A large, multicenter trial is needed to determine if OAC decreases LOS or NEC in VLBW infants.
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Affiliation(s)
- Kristen M. Glass
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Coleen P. Greecher
- Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Kim K. Doheny
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania,Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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9
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Abstract
The purpose of this review is to explore low-cost options for simulation and training in neonatology. Numerous cost-effective options exist for simulation and training in neonatology. Lower cost options are available for teaching clinical skills and procedural training in neonatal intubation, chest tube insertion, and pericardiocentesis, among others. Cost-effective, low-cost options for simulation-based education can be developed and shared in order to optimize the neonatal simulation training experience.
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Affiliation(s)
- Christie J Bruno
- Department of Pediatrics, Yale School of Medicine, 20 York Street, WP-493, New Haven, CT.
| | - Kristen M Glass
- Department of Pediatrics, Penn State Milton S. Hershey School of Medicine, Hershey, PA
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