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Ramanathan R, Biniwale M. NON-pharmacological Approach Less Invasive Surfactant Administration (NONA-LISA) trial: protocol for a randomised controlled trial. Pediatr Res 2024:10.1038/s41390-024-03263-8. [PMID: 38734815 DOI: 10.1038/s41390-024-03263-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Rangasamy Ramanathan
- Professor of Pediatrics, Division of Neonatology, Cedars Sinai Guerin Children's, Cedars Sinai Medical Center, Los Angeles, California, 90048, USA.
| | - Manoj Biniwale
- Professor of Pediatrics, Division of Neonatology, Cedars Sinai Guerin Children's, Cedars Sinai Medical Center, Los Angeles, California, 90048, USA
- Division of Neonatology, Cedars Sinai Guerin Children's, Cedars Sinai Medical Center, Los Angeles, USA
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Ramanathan R, Biniwale M. Noninvasive Ventilation. Crit Care Nurs Clin North Am 2024; 36:51-67. [PMID: 38296376 DOI: 10.1016/j.cnc.2023.11.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Systematic Reviews and Randomized clinical trials have shown that the use of noninvasive ventilation (NIV) compared to invasive mechanical ventilation reduces the risk of bronchopulmonary dysplasia and or mortality. Most commonly used NIV modes include nasal continuous positive airway pressure, bi-phasic modes, such as, bi-level positive airway pressure, nasal intermittent positive pressure ventilation, high flow nasal cannula, noninvasive neurally adjusted ventilatory assist, and nasal high frequency ventilation are discussed in this review.
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Affiliation(s)
- Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles General Medical Center, 1200 North State Street, IRD-820, Los Angeles, CA 90033, USA.
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles General Medical Center, 1200 North State Street, IRD-820, Los Angeles, CA 90033, USA
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Roshon M, Khandhar PB, Biniwale M, Ramanathan R, Frazier TP, Xu F, Zhang L, Guan X, Wenling D, Lambermont B. Evaluation of the Puritan Bennett™ 980 Ventilator System Safety and Performance in the Real-World Setting. Med Devices (Auckl) 2024; 17:37-45. [PMID: 38282718 PMCID: PMC10821633 DOI: 10.2147/mder.s433900] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024] Open
Abstract
Purpose Mechanical ventilation is a life-supporting intervention but is associated with known risks and complications. To improve the efficacy and safety profile of mechanical ventilation, manufacturers have developed advanced ventilator settings, modes, and alarm strategies to optimize ventilation for patient needs while avoiding complications. However, there is little real-world data published on the deployment of ventilator technology. The main objective of this study was to assess the clinical safety and performance of the Puritan Bennett™ 980 Ventilator System (PB980) using real-world clinical data collected from a diverse, global patient population. Methods This was a multi-center, post-market registry study that included nine sites: four in the United States of America, one in Europe, and four in China. Patients were enrolled into the registry if they were intended to be treated with a PB980. Data collection began at the start of ventilation and continued until extubation off the ventilator or up to seven days of ventilation, whichever occurred first. Subjects were divided by age into three categories: infants (0-365 days), pediatric (1-17 years), and adult (18 years and older). The primary outcome was device-related complication rate. Results Two-hundred-and-eleven subjects were enrolled (41 infants, 48 pediatric, and 122 adults). Sixteen deaths, unrelated to device deficiency, occurred during the data collection timeframe (relative frequency: 7.58, 95% CI: 4.40, 12.0). Only one device-related adverse event was reported (relative frequency: 0.47% 95% CI: 0.01%, 2.61%). Conclusion Ventilation by the PB980 was delivered safely in this multi-center observational study, which included a diverse sample of patients with broad ventilatory needs.
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Affiliation(s)
- Michael Roshon
- Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado, Springs, CO, USA
| | - Paras B Khandhar
- Pediatric Critical Care Medicine, Beaumont Children’s Hospital, Royal Oak, MI, USA
| | - Manoj Biniwale
- Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - T Patrick Frazier
- Department of Medicine, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Feng Xu
- Department of Intensive Care, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Linlin Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiangdong Guan
- Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Dai Wenling
- Department of Critical Care Medicine, Yancheng First People’s Hospital, Yancheng, People’s Republic of China
| | - Bernard Lambermont
- Department of Intensive Care, University Hospital of Liege, Liege, Belgium
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Biniwale M, Ramanathan R, Minoo P. Should nasal respiratory support in preterm infants be tailored for physiologic maturity? Pediatr Res 2024:10.1038/s41390-023-03016-z. [PMID: 38228743 DOI: 10.1038/s41390-023-03016-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Parviz Minoo
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Hastings Center for Pulmonary Research, Los Angeles, CA, 90033, USA.
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Katheria A, Szychowski J, Carlo WA, Subramaniam A, Reister F, Essers J, Vora F, Martin C, Schmölzer GM, Law B, Dempsey E, O'Donoghue K, Kaempf J, Tomlinson M, Fulford K, Folsom B, Karam S, Morris R, Yanowitz T, Beck S, Clark E, DuPont T, Biniwale M, Ramanathan R, Bhat S, Hoffman M, Chouthai N, Bany-Mohammed F, Mydam J, Narendran V, Wertheimer F, Gollin Y, Vaucher Y, Arnell K, Varner M, Cutter G, Wilson N, Rich W, Finer N. Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial. Pediatrics 2023; 152:e2023063113. [PMID: 37941523 DOI: 10.1542/peds.2023-063113] [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: 08/02/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES To determine whether rate of severe intraventricular hemorrhage (IVH) or death among preterm infants receiving placental transfusion with UCM is noninferior to delayed cord clamping (DCC). METHODS Noninferiority randomized controlled trial comparing UCM versus DCC in preterm infants born 28 to 32 weeks recruited between June 2017 through September 2022 from 19 university and private medical centers in 4 countries. The primary outcome was Grade III/IV IVH or death evaluated at a 1% noninferiority margin. RESULTS Among 1019 infants (UCM n = 511 and DCC n = 508), all completed the trial from birth through initial hospitalization (mean gestational age 31 weeks, 44% female). For the primary outcome, 7 of 511 (1.4%) infants randomized to UCM developed severe IVH or died compared to 7 of 508 (1.4%) infants randomized to DCC (rate difference 0.01%, 95% confidence interval: (-1.4% to 1.4%), P = .99). CONCLUSIONS In this randomized controlled trial of UCM versus DCC among preterm infants born between 28 and 32 weeks' gestation, there was no difference in the rates of severe IVH or death. UCM may be a safe alternative to DCC in premature infants born at 28 to 32 weeks who require resuscitation.
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Affiliation(s)
- Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | | | | | | | - Frank Reister
- Department of Pediatrics and Obstetrics, University of Ulm, Ulm, Germany
| | - Jochen Essers
- Department of Pediatrics and Obstetrics, University of Ulm, Ulm, Germany
| | - Farha Vora
- Department of Pediatrics and Obstetrics, Loma Linda University, Loma Linda, California
| | - Courtney Martin
- Department of Pediatrics and Obstetrics, Loma Linda University, Loma Linda, California
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Eugene Dempsey
- Department of Pediatrics and Obstetrics, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Pediatrics and Obstetrics, University College Cork, Cork, Ireland
| | - Joseph Kaempf
- Women and Children's Services, Providence St Vincent Medical Center, Portland, Oregon
| | - Mark Tomlinson
- Women and Children's Services, Providence St Vincent Medical Center, Portland, Oregon
| | - Kevin Fulford
- Department of Pediatrics and Obstetrics, Sharp Grossmont Hospital, La Mesa, California
| | - Bergen Folsom
- Department of Pediatrics and Obstetrics, Sharp Grossmont Hospital, La Mesa, California
| | - Simon Karam
- Department of Pediatrics and Obstetrics, University of Mississippi Medical CenterJackson, Mississippi
| | - Rachael Morris
- Department of Pediatrics and Obstetrics, University of Mississippi Medical CenterJackson, Mississippi
| | - Toby Yanowitz
- Department of Pediatrics and Obstetrics, Magee Women's Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Stacy Beck
- Department of Pediatrics and Obstetrics, Magee Women's Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Erin Clark
- University of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah
| | - Tara DuPont
- University of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah
| | - Manoj Biniwale
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shazia Bhat
- Department of Pediatrics and Obstetrics, Christiana Care Health System, Newark, Delaware
| | - Matthew Hoffman
- Department of Pediatrics and Obstetrics, Christiana Care Health System, Newark, Delaware
| | - Nitin Chouthai
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri
| | - Fayez Bany-Mohammed
- Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, California
| | - Janardhan Mydam
- Department of Pediatrics, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Vivek Narendran
- Department of Pediatrics and Obstetrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Fiona Wertheimer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yvonne Gollin
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Yvonne Vaucher
- Department of Pediatrics, University of California at San Diego, San Diego, California
| | - Kathy Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Michael Varner
- University of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah
| | - Gary Cutter
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicole Wilson
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
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Dargaville PA, Kamlin COF, Orsini F, Wang X, De Paoli AG, Kanmaz Kutman HG, Cetinkaya M, Kornhauser-Cerar L, Derrick M, Özkan H, Hulzebos CV, Schmölzer GM, Aiyappan A, Lemyre B, Kuo S, Rajadurai VS, O'Shea J, Biniwale M, Ramanathan R, Kushnir A, Bader D, Thomas MR, Chakraborty M, Buksh MJ, Bhatia R, Sullivan CL, Shinwell ES, Dyson A, Barker DP, Kugelman A, Donovan TJ, Goss KCW, Tauscher MK, Murthy V, Ali SKM, Clark HW, Soll RF, Johnson S, Cheong JLY, Carlin JB, Davis PG. Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial. JAMA 2023; 330:1054-1063. [PMID: 37695601 PMCID: PMC10495923 DOI: 10.1001/jama.2023.15694] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Received: 05/22/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023]
Abstract
Importance The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified. Objective To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age. Design, Setting, and Participants Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022. Interventions Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment. Main Outcomes and Measures The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years. Results Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]). Conclusions and Relevance In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life. Trial Registration anzctr.org.au Identifier: ACTRN12611000916943.
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Affiliation(s)
- Peter A Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Omar F Kamlin
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Xiaofang Wang
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Antonio G De Paoli
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - H Gozde Kanmaz Kutman
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Merih Cetinkaya
- Division of Neonatology, Department of Pediatrics, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Lilijana Kornhauser-Cerar
- Division of Gynaecology and Obstetrics, Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | - Matthew Derrick
- Division of Neonatology, Northshore University Health System, Evanston, Illinois
| | - Hilal Özkan
- Division of Neonatology, Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Christian V Hulzebos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Georg M Schmölzer
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ajit Aiyappan
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Brigitte Lemyre
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheree Kuo
- Department of Pediatrics, Kapi'olani Medical Center for Women and Children, Honolulu, Hawai'i
| | - Victor S Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - Joyce O'Shea
- Neonatal Unit, Royal Hospital for Children, Glasgow, United Kingdom
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, Los Angeles County + USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Los Angeles County + USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, California
| | - Alla Kushnir
- Department of Pediatrics, Children's Regional Hospital, Cooper University Health Care, Camden, New Jersey
| | - David Bader
- Rappaport Faculty of Medicine, Department of Neonatology, Bnai Zion Medical Center, Technion, Haifa, Israel
| | - Mark R Thomas
- Department of Neonatal Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Mariam J Buksh
- Newborn Service, Starship Child Health, Auckland Hospital, Auckland, New Zealand
| | - Risha Bhatia
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Carol L Sullivan
- Department of Neonatology, Singleton Hospital, Swansea, United Kingdom
| | - Eric S Shinwell
- Faculty of Medicine, Department of Neonatology, Ziv Medical Center, Bar-Ilan University, Tsfat, Israel
| | - Amanda Dyson
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, New South Wales, Australia
| | - David P Barker
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Amir Kugelman
- Rappaport Faculty of Medicine, Department of Neonatology, Rambam Medical Center, Technion, Haifa, Israel
| | - Tim J Donovan
- Division of Neonatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Kevin C W Goss
- Neonatal Intensive Care Unit, Princess Anne Hospital, Southampton, United Kingdom
| | - Markus K Tauscher
- Division of Neonatology, Peyton Manning Children's Hospital, Ascension St Vincent, Indianapolis, Indiana
| | - Vadivelam Murthy
- Neonatal Intensive Care Centre, The Royal London Hospital-Barts Health NHS Foundation Trust, London, United Kingdom
| | - Sanoj K M Ali
- Division of Neonatology, Sidra Medicine, Doha, Qatar
| | - Howard W Clark
- Faculty of Population Health Sciences, Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Roger F Soll
- Division of Neonatal-Perinatal Medicine, Larner College of Medicine, The University of Vermont, Burlington
| | - Samantha Johnson
- Infant Mortality and Morbidity Studies Research Group, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Sankar MN, Ramanathan R, Joe P, Katheria AC, Villosis MFB, Cortes M, Bhatt DR, Truong H, Paje V, Tan RC, Arora V, Nguyen M, Biniwale M. Transcutaneous bilirubin levels in extremely preterm infants less than 30 weeks gestation. J Perinatol 2023; 43:220-225. [PMID: 35931798 DOI: 10.1038/s41372-022-01477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/19/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The primary objective of this study was to determine the relationship between transcutaneous bilirubin (TcB) levels and total serum bilirubin (TSB) levels in extremely preterm infants. STUDY DESIGN We conducted a prospective multicenter study of extremely preterm infants less than 30 weeks gestation in California. Difference between paired TcB and TSB values were compared based on gestational age, birth weight, maternal race/ethnicity, chronological age as well as during and after phototherapy. RESULTS TSB values ranged from 0 to 12.6 mg/dl and the TcB values ranged from 0 to 14.2 mg/dl. TSB was predicted with a high degree of accuracy at TSB = 2.37 + 0.54 (TcB) with r = 0.786. There was good correlation across gestational age, birth weight, race/ethnic, chronological age subgroups as well as during and after phototherapy. CONCLUSION Our study supports the use of TcB as a screening tool for monitoring jaundice in extremely preterm infants.
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Affiliation(s)
- Meera N Sankar
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA.
| | - Rangasamy Ramanathan
- Division of Neonatology, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Priscilla Joe
- Neonatology, UCSF Benioff Children's Oakland, Oakland, CA, USA
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | | | - Maria Cortes
- Department of Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Dilip R Bhatt
- Neonatology, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Huy Truong
- Neonatology, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Virna Paje
- Neonatology, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Rosemarie C Tan
- Neonatology, Miller Children's Hospital, Long Beach, CA, USA
| | - Vasudha Arora
- Neonatology, Kaiser Foundation Hospital, Downey, CA, USA
| | - Marielle Nguyen
- Neonatology, Kaiser Permanente Southern California Orange County, Anaheim, CA, USA
| | - Manoj Biniwale
- Division of Neonatology, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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8
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Muniraman HK, Kibe R, Namjoshi A, Song AY, Lakshmanan A, Ramanathan R, Biniwale M. Evaluation of Correlation and Agreement between SpO2/FiO2 ratio and PaO2/FiO2 ratio in Neonates. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1756716] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Objectives This article evaluates correlation and agreement between oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF) ratio and partial pressure of oxygen (PaO2)/FiO2 (PF) ratio. It also derives and validates predictive PF ratio from noninvasive SF ratio measurements for clinically relevant PF ratios and derives SF ratio equivalent of PF ratio cutoffs used to define acute lung injury (ALI, PF < 300) and acute respiratory distress syndrome (ARDS, PF < 200).
Methods Retrospective cohort study including neonates with respiratory failure over a 6-year study period. Correlation and agreement between PF ratio with SF ratio was analyzed by Pearson's correlation coefficient and Bland–Altman analysis. Generalized estimating equation was used to derive PF ratio from measured PF ratio and derive corresponding SF ratio for PF ratio cutoffs for ALI and ARDS.
Results A total of 1,019 paired measurements from 196 neonates with mean 28 (± 4.7) weeks' gestational age and 925 (± 1111) g birth weight were analyzed. Strong correlation was noted between SF ratio and PF ratio (r = 0.90). Derived PF ratios from regression (1/PF = –0.0004304 + 2.0897987/SF) showed strong accuracy measures for PF ratio cutoffs < 200 (area under the curve [AUC]: 0.85) and < 100 (AUC: 0.92) with good agreement. Equivalent SF ratio to define ALI was < 450, moderate ARDS was < 355, and severe ARDS was < 220 with strong accuracy measures (AUC > 0.81, 0.84, and 0.93, respectively).
Conclusion SF ratio correlated strongly with PF ratio with good agreement between derived PF ratio from noninvasive SpO2 source and measure PF ratio. Derived PF ratio may be useful to reliably assess severity of respiratory failure in neonates. Further studies are needed to validate SF ratio with clinical illness severity and outcomes.
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Affiliation(s)
- Hemananda K. Muniraman
- Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, United States
- Department of Pediatrics, Creighton University School of Medicine, Phoenix, Arizona, United States
| | - Rutuja Kibe
- Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Abhijeet Namjoshi
- Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, United States
| | - Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Ashwini Lakshmanan
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Fetal and Neonatal Institute, Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Dargaville PA, Kamlin COF, Orsini F, Wang X, De Paoli AG, Kanmaz Kutman HG, Cetinkaya M, Kornhauser-Cerar L, Derrick M, Özkan H, Hulzebos CV, Schmölzer GM, Aiyappan A, Lemyre B, Kuo S, Rajadurai VS, O’Shea J, Biniwale M, Ramanathan R, Kushnir A, Bader D, Thomas MR, Chakraborty M, Buksh MJ, Bhatia R, Sullivan CL, Shinwell ES, Dyson A, Barker DP, Kugelman A, Donovan TJ, Tauscher MK, Murthy V, Ali SKM, Yossuck P, Clark HW, Soll RF, Carlin JB, Davis PG. Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA 2021; 326:2478-2487. [PMID: 34902013 PMCID: PMC8715350 DOI: 10.1001/jama.2021.21892] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [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] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The benefits of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome are uncertain. OBJECTIVE To examine the effect of selective application of MIST at a low fraction of inspired oxygen threshold on survival without bronchopulmonary dysplasia (BPD). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial including 485 preterm infants with a gestational age of 25 to 28 weeks who were supported with continuous positive airway pressure (CPAP) and required a fraction of inspired oxygen of 0.30 or greater within 6 hours of birth. The trial was conducted at 33 tertiary-level neonatal intensive care units around the world, with blinding of the clinicians and outcome assessors. Enrollment took place between December 16, 2011, and March 26, 2020; follow-up was completed on December 2, 2020. INTERVENTIONS Infants were randomized to the MIST group (n = 241) and received exogenous surfactant (200 mg/kg of poractant alfa) via a thin catheter or to the control group (n = 244) and received a sham (control) treatment; CPAP was continued thereafter in both groups unless specified intubation criteria were met. MAIN OUTCOMES AND MEASURES The primary outcome was the composite of death or physiological BPD assessed at 36 weeks' postmenstrual age. The components of the primary outcome (death prior to 36 weeks' postmenstrual age and BPD at 36 weeks' postmenstrual age) also were considered separately. RESULTS Among the 485 infants randomized (median gestational age, 27.3 weeks; 241 [49.7%] female), all completed follow-up. Death or BPD occurred in 105 infants (43.6%) in the MIST group and 121 (49.6%) in the control group (risk difference [RD], -6.3% [95% CI, -14.2% to 1.6%]; relative risk [RR], 0.87 [95% CI, 0.74 to 1.03]; P = .10). Incidence of death before 36 weeks' postmenstrual age did not differ significantly between groups (24 [10.0%] in MIST vs 19 [7.8%] in control; RD, 2.1% [95% CI, -3.6% to 7.8%]; RR, 1.27 [95% CI, 0.63 to 2.57]; P = .51), but incidence of BPD in survivors to 36 weeks' postmenstrual age was lower in the MIST group (81/217 [37.3%] vs 102/225 [45.3%] in the control group; RD, -7.8% [95% CI, -14.9% to -0.7%]; RR, 0.83 [95% CI, 0.70 to 0.98]; P = .03). Serious adverse events occurred in 10.3% of infants in the MIST group and 11.1% in the control group. CONCLUSIONS AND RELEVANCE Among preterm infants with respiratory distress syndrome supported with CPAP, minimally invasive surfactant therapy compared with sham (control) treatment did not significantly reduce the incidence of the composite outcome of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age. However, given the statistical uncertainty reflected in the 95% CI, a clinically important effect cannot be excluded. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12611000916943.
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Affiliation(s)
- Peter A. Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia
| | - C. Omar F. Kamlin
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Xiaofang Wang
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | | | - H. Gozde Kanmaz Kutman
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Merih Cetinkaya
- Division of Neonatology, Department of Pediatrics, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Lilijana Kornhauser-Cerar
- Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre, Ljubljana, Slovenia
| | - Matthew Derrick
- Division of Neonatology, NorthShore University Health System, Evanston, Illinois
| | - Hilal Özkan
- Department of Pediatrics, Division of Neonatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Christian V. Hulzebos
- Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Georg M. Schmölzer
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Ajit Aiyappan
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Australia
| | - Brigitte Lemyre
- Department of Obstetrics, Gynecology, and Newborn Care, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheree Kuo
- Department of Pediatrics, Kapi’olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Victor S. Rajadurai
- Department of Neonatology, KK Women’s and Children’s Hospital, Duke-NUS Medical School, Singapore
| | - Joyce O’Shea
- Neonatal Unit, Royal Hospital for Children, Glasgow, Scotland
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, California
| | - Alla Kushnir
- Department of Pediatrics, Children’s Regional Hospital, Cooper University Health Care, Camden, New Jersey
| | - David Bader
- Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mark R. Thomas
- Department of Neonatal Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, England
| | | | - Mariam J. Buksh
- Newborn Service, Starship Child Health, Auckland Hospital, Auckland, New Zealand
| | - Risha Bhatia
- Monash Newborn, Monash Children’s Hospital, Clayton, Australia
| | | | - Eric S. Shinwell
- Department of Neonatology, Ziv Medical Center, Faculty of Medicine, Bar-Ilan University, Tsfat, Israel
| | - Amanda Dyson
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australia
| | - David P. Barker
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Amir Kugelman
- Department of Neonatology, Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tim J. Donovan
- Division of Neonatology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Markus K. Tauscher
- Division of Neonatology, Peyton Manning Children’s Hospital, Ascension St Vincent, Indianapolis, Indiana
| | - Vadivelam Murthy
- Neonatal Intensive Care Centre, Royal London Hospital-Barts Health NHS Foundation Trust, London, England
| | | | - Pete Yossuck
- Department of Pediatrics, WVU Medicine Children’s Hospital, Morgantown, West Virginia
| | - Howard W. Clark
- Neonatal Intensive Care Unit, Princess Anne Hospital, Southampton, England
- Department of Neonatology, EGA Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, England
| | - Roger F. Soll
- Division of Neonatal-Perinatal Medicine, Larner College of Medicine, University of Vermont, Burlington
| | - John B. Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter G. Davis
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Ramanathan R, Biniwale M, Sekar K, Hanna N, Golombek S, Bhatia J, Naylor M, Fabbri L, Varoli G, Santoro D, Del Buono D, Piccinno A, Dammann CE. Reply. J Pediatr 2020; 227:326-327. [PMID: 32818480 DOI: 10.1016/j.jpeds.2020.08.030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Rangasamy Ramanathan
- Department of Pediatrics, Division of Neonatology, LAC+USC Medical Center and Good Samaritan Hospital, Keck school of Medicine of USC, Los Angeles, CA
| | - Manoj Biniwale
- Department of Pediatrics, Division of Neonatology, LAC+USC Medical Center and Good Samaritan Hospital, Keck school of Medicine of USC, Los Angeles, CA
| | - Krishnamurthy Sekar
- Department of Pediatrics, Division of Neonatology, Oklahoma University Medical Center, Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Nazeeh Hanna
- Department of Pediatrics, Division of Neonatology, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY
| | - Sergio Golombek
- Department of Pediatrics, Division of Neonatology, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York; Current affiliation: Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, NJ
| | - Jatinder Bhatia
- Department of Pediatrics, Division of Neonatology, The Medical College of Georgia at Augusta University, Augusta, GA
| | - Martha Naylor
- Department of Pediatrics, Division of Neonatology, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Laura Fabbri
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Guido Varoli
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Debora Santoro
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
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Ramanathan R, Biniwale M, Sekar K, Hanna N, Golombek S, Bhatia J, Naylor M, Fabbri L, Varoli G, Santoro D, Del Buono D, Piccinno A, Dammann CE. Synthetic Surfactant CHF5633 Compared with Poractant Alfa in the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter, Double-Blind, Randomized, Controlled Clinical Trial. J Pediatr 2020; 225:90-96.e1. [PMID: 32553868 DOI: 10.1016/j.jpeds.2020.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Received: 03/18/2020] [Revised: 05/04/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare efficacy and safety of a new synthetic surfactant, CHF5633, enriched with surfactant proteins, SP-B and SP-C peptide analogues, with porcine surfactant, poractant alfa, for the treatment of respiratory distress syndrome in infants born preterm. STUDY DESIGN Neonates born preterm on respiratory support requiring fraction of inspired oxygen (FiO2) ≥0.30 from 240/7 to 266/7 weeks and FiO2 ≥0.35 from 270/7 to 296/7 weeks of gestation to maintain 88%-95% oxygen saturation were randomized to receive 200 mg/kg of CHF5633 or poractant alfa. If necessary, redosing was given at 100 mg/kg. Efficacy end points were oxygen requirement (FiO2, respiratory severity score [FiO2 × mean airway pressure]) in the first 24 hours, 7 and 28 days, discharge home, and/or 36 weeks of postmenstrual age; mortality and bronchopulmonary dysplasia at 28 days and 36 weeks of PMA. Adverse events and immunogenicity were monitored for safety. RESULTS Of the 123 randomized neonates, 113 were treated (56 and 57 in CHF5633 and poractant alfa groups, respectively). In both arms, FiO2 and respiratory severity score decreased from baseline at all time points (P < .001) with no statistically significant differences between groups. Rescue surfactant use (19 [33.9%] vs 17 [29.8%]), bronchopulmonary dysplasia (31 [55.4%] and 32 [56.1%]), and mortality at day 28 (4 [7.1%] and 3 [5.3%]) were similar in the CHF5633 and poractant alfa groups, respectively. In 2 (3.4%) and 1 (1.7%) neonates, adverse drug reactions were reported in CHF5633 and poractant alfa groups, respectively. No immunogenicity was detected. CONCLUSIONS Treatment with CHF5633 showed similar efficacy and safety as poractant alfa in neonates born preterm with moderate-to-severe respiratory distress syndrome. TRIAL REGISTRATION ClinicalTrials.gov: NCT02452476.
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Affiliation(s)
- Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, CA.
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center and Good Samaritan Hospital, Keck School of Medicine of USC, Los Angeles, CA
| | - Krishnamurthy Sekar
- Division of Neonatology, Department of Pediatrics, Oklahoma University Medical Center, Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Nazeeh Hanna
- Division of Neonatology, Department of Pediatrics, NYU Winthrop Hospital, NYU Long Island School of Medicine, New York, NY
| | - Sergio Golombek
- Division of Neonatology, Department of Pediatrics, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, NJ
| | - Jatinder Bhatia
- Division of Neonatology, Department of Pediatrics, The Medical College of Georgia at Augusta University, Augusta, GA
| | - Martha Naylor
- Division of Neonatology, Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Laura Fabbri
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Guido Varoli
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Debora Santoro
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | | | | | - Christiane E Dammann
- Division of Neonatology, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA
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Shi Y, Muniraman H, Biniwale M, Ramanathan R. A Review on Non-invasive Respiratory Support for Management of Respiratory Distress in Extremely Preterm Infants. Front Pediatr 2020; 8:270. [PMID: 32548084 PMCID: PMC7270199 DOI: 10.3389/fped.2020.00270] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 12/07/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Majority of extremely preterm infants require positive pressure ventilatory support at the time of delivery or during the transitional period. Most of these infants present with respiratory distress (RD) and continue to require significant respiratory support in the neonatal intensive care unit (NICU). Bronchopulmonary dysplasia (BPD) remains as one of the major morbidities among survivors of the extremely preterm infants. BPD is associated with long-term adverse pulmonary and neurological outcomes. Invasive mechanical ventilation (IMV) and supplemental oxygen are two major risk factors for the development of BPD. Non-invasive ventilation (NIV) has been shown to decrease the need for IMV and reduce the risk of BPD when compared to IMV. This article reviews respiratory management with current NIV support strategies in extremely preterm infants both in delivery room as well as in the NICU and discusses the evidence to support commonly used NIV modes including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), bi-level positive pressure (BI-PAP), high flow nasal cannula (HFNC), and newer NIV strategies currently being studied including, nasal high frequency ventilation (NHFV) and non-invasive neutrally adjusted ventilatory assist (NIV-NAVA). Randomized, clinical trials have shown that early NIPPV is superior to NCPAP to decrease the need for intubation and IMV in preterm infants with RD. It is also important to understand that selection of the device used to deliver NIPPV has a significant impact on its success. Ventilator generated NIPPV results in significantly lower rates of extubation failures when compared to Bi-PAP. Future studies should address synchronized NIPPV including NIV-NAVA and early rescue use of NHFV in the respiratory management of extremely preterm infants.
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Affiliation(s)
- Yuan Shi
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hemananda Muniraman
- Department of Pediatrics, Creighton School of Medicine, Omaha, NE, United States
| | - Manoj Biniwale
- Neonatology Association Limited, Obstetrix Medical Group of Phoenix, Mednax, Arizona, AZ, United States
| | - Rangasamy Ramanathan
- Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Muniraman HK, Song AY, Ramanathan R, Fletcher KL, Kibe R, Ding L, Lakshmanan A, Biniwale M. Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure. JAMA Netw Open 2019; 2:e191179. [PMID: 30924897 PMCID: PMC6450323 DOI: 10.1001/jamanetworkopen.2019.1179] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Oxygenation index (OI), an invasive measurement, is routinely used as a marker of severity of hypoxemic respiratory failure in neonates. Oxygen saturation index (OSI) is a noninvasive measurement and has been shown to be a reliable surrogate marker of OI in children and adults with respiratory failure. OBJECTIVES To evaluate the correlation of OI with OSI and to derive and validate predictive OI from noninvasive OSI measurements for clinically relevant OI values. DESIGN, SETTING, AND PARTICIPANTS For this retrospective cohort study, 220 neonates requiring invasive mechanical ventilation for hypoxic respiratory failure during the first 3 days of admission were recruited from a level III neonatal intensive care unit during a 6-year period, from January 1, 2012, to December 31, 2017. Data were analyzed from January 2017 to December 2017. MAIN OUTCOMES AND MEASURES The primary outcome was correlation of OI with OSI, analyzed using Pearson correlation coefficient. The secondary outcome was derivation and validation of OI from OSI. The data were split into derivative samples, from which a predictive equation for OI was derived using generalized linear model, and a validation sample was used to assess the predictive ability of the derived OI. Bland-Altman plot was used to assess agreement between derived OI and measured OI. RESULTS A total of 1442 paired OI and OSI measurements from 220 infants (190 preterm and 30 term; median [interquartile range] gestational age, 29 [26-33] weeks; mean [SD] birth weight, 1602 [1092] g) were recorded during the study. The median (interquartile range) number of samples was 5 (3-9) per patient. Overall, OI and OSI showed strong correlation (r = 0.89). The correlation was stronger in preterm infants (<28 weeks, r = 0.93; 28-33 weeks, r = 0.93) and within an oxygen saturation range of 85% to 95% (r = 0.94). The predictive derivative equation showed a strong linear association and good agreement in both derivation and validation data sets, with strong accuracy measures of derived OI for OI cutoffs of 5, 10, 15, 20, and 25. CONCLUSIONS AND RELEVANCE A strong correlation of OI with OSI was found. Derived OI from OSI was in good agreement and strongly predictive of clinically relevant OI cutoffs from 5 to 25. Oxygenation index derived from noninvasive sources may be useful to reliably assess severity of respiratory failure and response to therapy on a continuous basis.
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Affiliation(s)
- Hemananda K. Muniraman
- Neonatology Association Limited, Obstetrix Medical Group of Phoenix, Mednax, Phoenix, Arizona
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Ashley Y. Song
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rangasamy Ramanathan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Kathryn L. Fletcher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rutuja Kibe
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Ashwini Lakshmanan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Manoj Biniwale
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
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Biniwale M, Weiner A, Sardesai S, Cayabyab R, Barton L, Ramanathan R. Early postnatal weight gain as a predictor for the development of retinopathy of prematurity. J Matern Fetal Neonatal Med 2017; 32:429-433. [DOI: 10.1080/14767058.2017.1381902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Manoj Biniwale
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Angela Weiner
- Division of Neonatal Medicine, Department of Pediatrics, Sunrise Hospital & Medical Center, Las Vegas, NV, USA
| | - Smeeta Sardesai
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Rowena Cayabyab
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Lorayne Barton
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
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Biniwale M, Wertheimer F. Decrease in delivery room intubation rates after use of nasal intermittent positive pressure ventilation in the delivery room for resuscitation of very low birth weight infants. Resuscitation 2017; 116:33-38. [DOI: 10.1016/j.resuscitation.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/11/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
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Sardesai S, Biniwale M, Wertheimer F, Garingo A, Ramanathan R. Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future. Pediatr Res 2017; 81:240-248. [PMID: 27706130 DOI: 10.1038/pr.2016.203] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [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: 05/13/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022]
Abstract
Respiratory distress syndrome (RDS) due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future.
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Affiliation(s)
- Smeeta Sardesai
- Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Manoj Biniwale
- Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Fiona Wertheimer
- Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Arlene Garingo
- Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Abstract
OBJECTIVE The aim of the study was to describe our experience using a modified nasal cannula to deliver nasal continuous positive airway pressure and/or nasal intermittent positive pressure ventilation during primary neonatal resuscitation of preterm and term newborns. STUDY DESIGN Data were collected retrospectively for all neonates resuscitated with nasal cannula in the delivery room. The primary outcome was the number of newborns intubated in the delivery room. Secondary outcomes included need for chest compressions, intubations in the first 24 hours, air-leaks, and surfactant administration. RESULTS A total of 102 infants were resuscitated using nasal cannula. Eight (7.8%) were intubated in the delivery room, five (4.9%) required chest compressions, and five (4.9%) had pneumothorax noted on chest X-ray. No deaths occurred in the delivery room. Twenty-eight patients (27.5%) received early rescue surfactant after admission to the neonatal intensive care unit. CONCLUSION Neonatal resuscitation can be effectively performed in preterm and term newborns using a modified nasal cannula in the delivery room.
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Affiliation(s)
- Pedro Paz
- Division of Neonatal Medicine, LAC + USC Medical Center, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatal Medicine, LAC + USC Medical Center, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Richard Hernandez
- Neonatal Respiratory Therapy Department, LAC + USC Medical Center, Los Angeles, California
| | - Manoj Biniwale
- Division of Neonatal Medicine, LAC + USC Medical Center, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
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18
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Rayjada N, Barton L, Chan LS, Plasencia S, Biniwale M, Bui KC. Decrease in incidence of bronchopulmonary dysplasia with erythropoietin administration in preterm infants: a retrospective study. Neonatology 2012; 102:287-92. [PMID: 22922736 DOI: 10.1159/000341615] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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: 01/12/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite advances in clinical care, the incidence of bronchopulmonary dysplasia (BPD) remains high in premature infants. Erythropoietin (EPO) is used for the treatment of anemia of prematurity (AOP) to decrease blood transfusion needs. EPO has been shown to mobilize circulating endothelial progenitor cells and to enhance lung repair in animal models. OBJECTIVE To determine whether EPO treatment for AOP was associated with a reduced incidence of BPD in premature infants. METHODS This retrospective study was performed on all live-born neonates with birth weights from 500 to 1,500 g and gestational age (GA) from 22 to 32 weeks admitted from 1994 to 2002. Infants who received EPO and those who did not receive EPO were compared for incidence of BPD and other morbidities. RESULTS Of 478 patients, 297 received EPO before 36 weeks' postmenstrual age (group 1) and 181 did not receive EPO (group 2). Group 1 was of similar birth weight but lower GA than group 2. The incidence of BPD was lower in group 1 than group 2 (26 vs. 36%, p = 0.03); after adjusting for significant risk factors, the adjusted odds ratio for BPD was 0.50 (95% CI 0.32, 0.79), p = 0.0028. The BPD rate was much lower when EPO was initiated before 4 weeks of age (16%) as compared to later initiation (44%). CONCLUSIONS This study shows an association between EPO treatment and reduced incidence of BPD in preterm infants, particularly when EPO treatment was initiated within the first 4 weeks of life.
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Affiliation(s)
- Niti Rayjada
- Center for Fetal and Neonatal Medicine and USC Division of Neonatal Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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19
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Biniwale M, Kleinman M. Safety of surfactant administration before transport of premature infants. Air Med J 2010; 29:170-177. [PMID: 20599151 DOI: 10.1016/j.amj.2010.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/16/2010] [Accepted: 04/11/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the safety of surfactant administration prior to transport of premature infants. DESIGN/METHODS We performed a retrospective review of 24- to 34-weeks premature infants admitted to the Newborn Intensive Care Unit (NICU) between July 1, 1999 and September 30, 2004. Outcome measures were the presence of hyperventilation (PCO2 <40 mm Hg) and/or pneumothorax on admission to the NICU. Factors associated with the presence of hyperventilation and pneumothorax were identified. RESULTS 955 infants born at 24 to 34 weeks' gestation were admitted to the NICU during the study period. 217 (22.7%) received surfactant prior to transport within 48 hours of birth. The incidence of hyperventilation was 18.9%. Hyperventilated infants had longer transport times, lower birth weights, and lower PCO2 on blood gases obtained prior to transport. Pneumothorax occurred in six subjects (2.9%). Neonates with pneumothorax had lower APGAR scores. CONCLUSIONS We found the administration of surfactant prior to transport to be safe as evidenced by a low incidence of pneumothorax. Pneumothorax was more likely to occur in infants who needed significant resuscitation at birth. The incidence of hyperventilation appeared to be high and was inversely associated with birth weight.
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Affiliation(s)
- Manoj Biniwale
- Center for Fetal and Neonatal Medicine and the USC Division of Neonatal Medicine, Los Angeles, CA, USA.
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Abstract
The genomics revolution offers novel approaches to scientific investigation. Application of genomics technologies including microarray gene chips will provide a more complete picture of biological phenomena and help define the genetic contribution to disease by monitoring changes in expression across thousands of genes in physiological and clinical contexts. We briefly summarize identified genetic components that contribute to the genesis of neonatal hyperbilirubinaemia with a focus on inborn errors of hepatic bilirubin conjugation and discuss the potential use of microarray gene expression profiling technology to enhance our understanding of the pathogenesis of hyperbilirubinaemic neuronal cell injury. Expanded study using the tools of genomics will shed insights into the genetics of newborn jaundice and the pathogenesis of hyperbilirubinaemic encephalopathy.
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Affiliation(s)
- Jon F Watchko
- Division of Neonatology and Developmental Biology, Department of Pediatrics, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, Pennsylvania 15213, USA.
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