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Ouedraogo P, Villani PE, Natalizi A, Zagre N, Rodrigues PAB, Traore OL, Gatto D, Scalmani E, Putoto G, Cavallin F, Trevisanuto D. A multicentre neonatal manikin study showed a large heterogeneity in tactile stimulation for apnoea of prematurity. Acta Paediatr 2024. [PMID: 38563520 DOI: 10.1111/apa.17234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
AIM Apnoea of prematurity requires prompt intervention to prevent long-term adverse outcomes, but specific recommendations about the stimulation approach are lacking. Our study investigated the modalities of tactile stimulation for apnoea of prematurity in different settings. METHODS In this multi-country observational prospective study, nurses and physicians of the neonatal intensive care units were asked to perform a tactile stimulation on a preterm neonatal manikin simulating an apnoea. Features of the stimulation (body location and hand movements) and source of learning (training course or clinical practice) were collected. RESULTS Overall, 112 healthcare providers from five hospitals participated in the study. During the stimulation, the most frequent location were feet (72%) and back (61%), while the most frequent techniques were rubbing (64%) and massaging (43%). Stimulation modalities different among participants according to their hospitals and their source of learning of the stimulation procedures. CONCLUSION There was a large heterogeneity in stimulation approaches adopted by healthcare providers to counteract apnoea in a simulated preterm infant. This finding may be partially explained by the lack of specific guidelines and was influenced by the source of learning for tactile stimulation.
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Affiliation(s)
- Paul Ouedraogo
- Hopital Saint Camille de Ouagadougou (HOSCO), Ouagadougou, Burkina Faso
| | - Paolo Ernesto Villani
- Health Mother and Child Department NICU, Poliambulanza Foundation Hospital Brescia, Brescia, Italy
| | - Alessia Natalizi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Nicaise Zagre
- Hopital Saint Camille de Ouagadougou (HOSCO), Ouagadougou, Burkina Faso
| | | | | | - Daniela Gatto
- Pediatric and Neonatology Unit, Iglesias Hospital, Iglesias, Italy
| | - Emanuela Scalmani
- Health Mother and Child Department NICU, Poliambulanza Foundation Hospital Brescia, Brescia, Italy
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Maglio S, Cavallin F, Sala C, Bua B, Villani PE, Menciassi A, Tognarelli S, Trevisanuto D. Neonatal intubation: what are we doing? Eur J Pediatr 2024; 183:1811-1817. [PMID: 38260994 PMCID: PMC11001655 DOI: 10.1007/s00431-023-05418-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope. Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure. What is Known: • Neonatal intubation is a life-saving procedure that requires a skilled operator and may cause direct trauma to the tissues and precipitate adverse reactions. • Intubation with a videolaryngoscope requires less force than with a direct laryngoscope, but how and when the forces are applied during the whole neonatal intubation procedure are currently unknown. What is New: • Forces applied to the epiglottis during intubation can be divided into three sections: (i) an initial increase, (ii) a sort of plateau, and (iii) a decrease. • The pattern of each section shows some differences in relation to the laryngoscope (direct or videolaryngoscope) that is used during the procedure.
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Affiliation(s)
- Sabina Maglio
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Chiara Sala
- Department of Pediatric Anesthesia and Intensive Care "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Benedetta Bua
- Department of Women and Children Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy
| | - Paolo Ernesto Villani
- Department of Woman's and Child's Health, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Selene Tognarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniele Trevisanuto
- Department of Women and Children Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy.
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Ouedraogo P, Zagre N, Ouattara M, Scalmani E, Cavallin F, Chiesi MP, Trevisanuto D, Villani PE. Implementation of neonatal continuous positive airway pressure in a low-resource setting: Technology is not enough. Acta Paediatr 2023; 112:2102-2103. [PMID: 37376948 DOI: 10.1111/apa.16892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Paul Ouedraogo
- Hopital Saint Camille de Ouagadougou (HOSCO), Ouagadougou, Burkina Faso
| | - Nicaise Zagre
- Hopital Saint Camille de Ouagadougou (HOSCO), Ouagadougou, Burkina Faso
| | - Martine Ouattara
- Hopital Saint Camille de Ouagadougou (HOSCO), Ouagadougou, Burkina Faso
| | - Emanuela Scalmani
- Health Mather and Child Department NICU, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | | | - Paolo Ernesto Villani
- Health Mather and Child Department NICU, Poliambulanza Foundation Hospital, Brescia, Italy
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Zanetto L, Cavallin F, Doglioni N, Bua B, Savino S, Bernardo GD, Pratesi S, Villani PE, Weiner GM, Trevisanuto D. A Simulation Competition on Neonatal Resuscitation as a New Educational Tool for Pediatric Residents. Children (Basel) 2023; 10:1621. [PMID: 37892284 PMCID: PMC10605553 DOI: 10.3390/children10101621] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants' perceptions of the educational experience. METHODS Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. RESULTS 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. CONCLUSIONS Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions.
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Affiliation(s)
- Lorenzo Zanetto
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | | | - Nicoletta Doglioni
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | - Benedetta Bua
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | - Sandro Savino
- Department of Medicine–DIMED, University of Padua, 35121 Padua, Italy;
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, 80122 Naples, Italy;
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, 50141 Florence, Italy;
| | | | - Gary M. Weiner
- Department of Pediatrics-Neonatology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Daniele Trevisanuto
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
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Cavallin F, Brombin L, Turati M, Sparaventi C, Doglioni N, Villani PE, Trevisanuto D. Laryngeal mask airway in neonatal stabilization and transport: a retrospective study. Eur J Pediatr 2023; 182:4069-4075. [PMID: 37401979 PMCID: PMC10570173 DOI: 10.1007/s00431-023-05089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Abstract
Laryngeal mask airway (LMA) may be considered by health caregivers of level I-II hospitals for neonatal resuscitation and stabilization before and during interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA during stabilization and transport in a large series of neonates. This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms, and hospital charts. In total, 64/3252 transferred neonates (2%) received positive pressure ventilation with an LMA, with increasing trend over time (p = 0.001). Most of these neonates were transferred after birth (97%), due to a respiratory or neurologic disease (95%). LMA was used before the transport (n = 60), during the transport (n = 1), or both (n = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the receiving center. CONCLUSION In a large series of transferred neonates, LMA use during stabilization and transport was rare but increasing over time, and showed some heterogeneity among referring centers. In our series, LMA was safe and lifesaving in "cannot intubate, cannot oxygenate" situations. Future prospective, multicenter research may provide detailed insights on LMA use in neonates needing postnatal transport. WHAT IS KNOWN • A supraglottic airway device may be used as an alternative to face mask and endotracheal tube during neonatal resuscitation. • The laryngeal mask may be considered by health caregivers of low-level hospitals with limited exposure on airway management, but literature provides little information on this aspect. WHAT IS NEW • In a large series of transferred neonates, laryngeal mask use was rare but increasing over time, and showed some heterogeneity among referring centers. • The laryngeal mask was safe and lifesaving in "cannot intubate, cannot oxygenate" situations.
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Affiliation(s)
| | - Laura Brombin
- Department of Women's and Children's Health, University Hospital of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | - Marialuisa Turati
- Department of Women's and Children's Health, University Hospital of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | - Chiara Sparaventi
- Department of Women's and Children's Health, University Hospital of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | - Nicoletta Doglioni
- Department of Women's and Children's Health, University Hospital of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | - Paolo Ernesto Villani
- Department of Pediatrics, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, University Hospital of Padova, Via Giustiniani, 3, 35128, Padua, Italy.
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Cavallin F, Beltrame F, Bua B, Margarita T, Pasta E, Villani PE, Trevisanuto D. Marked versus unmarked tip catheter for less invasive surfactant administration: A crossover randomised controlled manikin trial. J Paediatr Child Health 2023; 59:857-862. [PMID: 37026604 DOI: 10.1111/jpc.16401] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/22/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
AIM Less invasive surfactant administration is becoming increasingly popular, but health-care providers may experience some difficulties in achieving the correct positioning of the catheter in the trachea. We compared catheters with marked versus unmarked tips in terms of correct depth positioning in the trachea, total time, number of attempts and participant's opinion on using the device in a manikin model. METHODS A randomised controlled crossover trial of surfactant administration with less invasive surfactant administration catheters with marked versus unmarked tip in a preterm infant manikin. Fifty tertiary hospital consultants and paediatric residents with previous experience in surfactant administration participated. The primary outcome measure was the positioning of the device at the correct depth in the trachea. The secondary outcome measures were the total time and the number of attempts for positioning the device in the trachea, and participant's opinion on using the device. RESULTS Correct depth in the trachea was achieved by 38 (76%) and 28 (56%) participants using the catheters with marked and unmarked tip, respectively (P = 0.04). Median time of device positioning (P = 0.08) and number of attempts (P = 0.13) were not statistically different between the two catheters. Participants found the catheter with the marked tip easier to use (P = 0.007), especially concerning the insertion in the trachea (P = 0.04) and the positioning at the correct depth (P = 0.004). CONCLUSIONS In a preterm manikin model, the marked tip catheter offered a higher chance of achieving the correct depth of the device in the trachea and was favoured by the participants.
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Affiliation(s)
| | - Francesca Beltrame
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Benedetta Bua
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Teresa Margarita
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Elisa Pasta
- Division of Neonatology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Cavallin F, Margarita T, Bua B, Beltrame F, Pasta E, Villani PE, Trevisanuto D. Rigid versus soft catheter for less invasive surfactant administration: A crossover randomized controlled manikin trial. Pediatr Pulmonol 2023. [PMID: 37154505 DOI: 10.1002/ppul.26458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/01/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND We compared surfactant administration with a rigid versus soft catheter in a manikin simulating an extremely preterm infant. METHODS Randomized controlled crossover (AB/BA) trial. Fifty tertiary hospital consultants and pediatric residents. The primary outcome was the time of device positioning. The secondary outcomes were the success of the first attempt, the number of attempts, and the participant's opinion. RESULTS Median time of device positioning was 19 s (interquartile range [IQR]: 15-25) with rigid catheter and 40 s (IQR: 28-66) with soft catheter (p < 0.0001). Success at first attempt was 92% with rigid catheter and 74% with soft catheter (p = 0.01). Median number of attempts was 1 (IQR: 1-1) with rigid catheter and 1 (IQR: 1-2) with soft catheter (p = 0.009). Participants found the rigid catheter easier to use (p < 0.0001). CONCLUSIONS In a preterm manikin model, using a rigid catheter for less invasive surfactant administration was quicker and easier to use than a soft catheter.
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Affiliation(s)
| | - Teresa Margarita
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Benedetta Bua
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Francesca Beltrame
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Cavallin F, Sala C, Maglio S, Bua B, Villani PE, Menciassi A, Tognarelli S, Trevisanuto D. Applied forces with direct versus indirect laryngoscopy in neonatal intubation: a randomized crossover mannequin study. Can J Anaesth 2023; 70:861-868. [PMID: 36788198 DOI: 10.1007/s12630-023-02402-9] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 02/16/2023] Open
Abstract
PURPOSE In adult mannequins, videolaryngoscopy improves glottic visualization with lower force applied to upper airway tissues and reduced task workload compared with direct laryngoscopy. This trial compared oropharyngeal applied forces and subjective workload during direct vs indirect (video) laryngoscopy in a neonatal mannequin. METHODS We conducted a randomized crossover trial of intubation with direct laryngoscopy, straight blade videolaryngoscopy, and hyperangulated videolaryngoscopy in a neonatal mannequin. Thirty neonatal/pediatric/anesthesiology consultants and residents participated. The primary outcome measure was the maximum peak force applied during intubation. Secondary outcome measures included the average peak force applied during intubation, time needed to intubate, and subjective workload. RESULTS Direct laryngoscopy median forces on the epiglottis were 8.2 N maximum peak and 6.8 N average peak. Straight blade videolaryngoscopy median forces were 4.7 N maximum peak and 3.6 N average peak. Hyperangulated videolaryngoscopy median forces were 2.8 N maximum peak and 2.1 N average peak. The differences were significant between direct laryngoscopy and straight blade videolaryngoscopy, and between direct laryngoscopy and hyperangulated videolaryngoscopy. Significant differences were also found in the top 10th percentile forces on the epiglottis and palate, but not in the median forces on the palate. Time to intubation and subjective workload were comparable with videolaryngoscopy vs direct laryngoscopy. CONCLUSIONS The lower force applied during videolaryngoscopy in a neonatal mannequin model suggests a possible benefit in reducing potential patient harm during intubation, but the clinical implications require assessment in future studies. REGISTRATION ClinicalTrials.gov (NCT05197868); registered 20 January 2022.
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Affiliation(s)
| | - Chiara Sala
- Department of Women and Children Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy
| | - Sabina Maglio
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Benedetta Bua
- Department of Women and Children Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy
| | - Paolo Ernesto Villani
- Department of Woman's and Child's Health, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Selene Tognarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniele Trevisanuto
- Department of Women and Children Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy.
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Cavallin F, Bua B, Pasta E, Savio F, Villani PE, Trevisanuto D. Device positioning with LISA vs. INSURE: a crossover randomized controlled manikin trial. J Matern Fetal Neonatal Med 2022; 35:10577-10583. [PMID: 36261132 DOI: 10.1080/14767058.2022.2134774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We aimed to compare time of device positioning, success of procedure and operator's opinion with LISA vs. INSURE in a manikin simulating an extremely low birthweight infant. METHODS A randomized controlled crossover (AB/BA) trial of surfactant administration with LISA vs. INSURE in a preterm manikin. Forty-two tertiary hospital consultants and pediatric residents with previous experience with LISA and INSURE participated. The primary outcome measure was the time of device positioning. The secondary outcome measures were: success of the first attempt, number of attempts, correct depth, and participant's opinion on difficulty in using the device. RESULTS Median time of device positioning was shorter with LISA vs. INSURE (median difference -8 s, 95% confidence interval -16 to -1 s; p = .04). Success at first attempt was 35/40 with LISA (83%) and 31/40 with INSURE (74%) (p = .42). Median number of attempts was 1 (IQR 1-1) with LISA and 1 (IQR 1-2) with INSURE (p = .08). Correct depth was achieved in 30/40 with LISA (71%) and 37/40 with INSURE (88%) (p = .12). Participants found LISA easier to insert in the trachea (p = .002) but INSURE easier to place at the correct depth (p = .008). Handling the device (p = .43), visualizing the glottis (p = .17) and overall difficulty in using the device (p = .13) were not statistically different. CONCLUSIONS In a preterm manikin model, positioning a thin catheter (LISA) was quicker and easier than a tracheal tube (INSURE), but the magnitude of the difference was unlikely to be clinically relevant and the tracheal tube was easier to place at the correct depth. REGISTRATION clinicaltrial.gov NCT04944108.
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Affiliation(s)
| | - Benedetta Bua
- Department of Woman and Child Health, University Hospital of Padua, Padua, Italy
| | - Elisa Pasta
- Department of Woman and Child Health, Fondazione Poliambulanza, Brescia, Italy
| | - Federica Savio
- Department of Woman and Child Health, University Hospital of Padua, Padua, Italy
| | | | - Daniele Trevisanuto
- Department of Woman and Child Health, University Hospital of Padua, Padua, Italy
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Trevisanuto D, Ramaswamy VV, Villani PE. Neonatal Resuscitation in Children 2021: Focus on Training, Technology, and New Clinical Approaches. Children 2022; 9:children9020175. [PMID: 35204896 PMCID: PMC8870172 DOI: 10.3390/children9020175] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3406632734
| | | | - Paolo Ernesto Villani
- Department of Pediatrics, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy;
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Ercolino O, Baccin E, Alfier F, Villani PE, Trevisanuto D, Cavallin F. Thermal servo-controlled systems in the management of VLBW infants at birth: A systematic review. Front Pediatr 2022; 10:893431. [PMID: 35979410 PMCID: PMC9377414 DOI: 10.3389/fped.2022.893431] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thermal management of the newborn at birth remains an actual challenge. This systematic review aimed to summarize current evidence on the use of thermal servo-controlled systems during stabilization of preterm and VLBW infants immediately at birth. METHODS A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database through December 2021. PRISMA guidelines were followed. Risk of bias was appraised using Cochrane RoB2 and Risk Of Bias In Non-Randomized Studies of Interventions (ROBIN-I) tools, and certainty of evidence using GRADE framework. RESULTS One randomized controlled trial and one observational study were included. Some aspects precluded the feasibility of a meaningful meta-analysis; hence, a qualitative review was conducted. Risk of bias was low in the trial and serious in the observational study. In the trial, the servo-controlled system did not affect normothermia (36.5-37.5°C) but was associated with increased mild hypothermia (from 22.2 to 32.9%). In the observational study, normothermia (36-38°C) increased after the introduction of the servo-controlled system and the extension to larger VLBW infants. CONCLUSION Overall, this review found very limited information on the use of thermal servo-controlled systems during stabilization of preterm and VLBW infants immediately at birth. Further research is needed to investigate the opportunity of including such approach in the neonatal thermal management in delivery room. REGISTRATION PROSPERO (CRD42022309323).
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Affiliation(s)
- Orietta Ercolino
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Erica Baccin
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Fiorenza Alfier
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Ernesto Villani
- Department of Woman's and Child's Health, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Cavallin F, Doglioni N, Allodi A, Battajon N, Vedovato S, Capasso L, Gitto E, Laforgia N, Paviotti G, Capretti MG, Gizzi C, Villani PE, Biban P, Pratesi S, Lista G, Ciralli F, Soffiati M, Staffler A, Baraldi E, Trevisanuto D. Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study. Arch Dis Child Fetal Neonatal Ed 2021; 106:572-577. [PMID: 33597230 DOI: 10.1136/archdischild-2020-320567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/28/2020] [Revised: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. OBJECTIVE To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. STUDY DESIGN AND SETTING Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. PARTICIPANTS Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks. INTERVENTION Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. PRIMARY OUTCOME Proportion of normothermia at NICU admission (axillary temperature 36.5°C-37.5°C). RESULTS At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C-36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01). CONCLUSIONS In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. TRIAL REGISTRATION NUMBER NCT03844204.
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Affiliation(s)
| | - Nicoletta Doglioni
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | | | - Nadia Battajon
- Pediatric Department, Ospedale Regionale Ca Foncello Treviso, Treviso, Veneto, Italy
| | - Stefania Vedovato
- Pediatric Department, Ospedale San Bortolo di Vicenza, Vicenza, Veneto, Italy
| | - Letizia Capasso
- Translational Medical Sciences, University "Federico II", Napoli, Italy
| | - Eloisa Gitto
- Department of Pediatrics, University of Messina, Neonatal Intensive Care Unit, Messina, Italy
| | | | - Giulia Paviotti
- Department of Neonatology, Azienda Ospedaliera Universitaria Integrata di Udine, Udine, Italy
| | - Maria Grazia Capretti
- Department of Medical and Surgical Sciences, Operative Unit of Neonatology, University of Bologna, Bologna, Italy
| | - Camilla Gizzi
- NICU, "S. Giovanni Calibita" Hospital - Fatebenefratelli Isola Tiberina, Rome, Italy
| | | | - Paolo Biban
- Department of Pediatrics, PICU-NICU, University Hospital of Verona, Verona, Italy
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital, Florence, Italy
| | - Gianluca Lista
- Department of Pediatrics, Ospedale dei Bambini "V.Buzzi", Milano, Italy
| | - Fabrizio Ciralli
- Dipartimento Donna-Bambino-Neonato, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Alex Staffler
- Division of Neonatology, Azienda Sanitaria dell'Alto Adige di Bolzano, Bolzano, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
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Monfredini C, Cavallin F, Villani PE, Paterlini G, Allais B, Trevisanuto D. Meconium Aspiration Syndrome: A Narrative Review. Children (Basel) 2021; 8:230. [PMID: 33802887 PMCID: PMC8002729 DOI: 10.3390/children8030230] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023]
Abstract
Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome.
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Affiliation(s)
- Chiara Monfredini
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | | | - Paolo Ernesto Villani
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | - Benedetta Allais
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University of Padova, 35128 Padova, Italy
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Ouedraogo P, Villani PE, Tubaldi L, Bua J, Uxa F, Dell'Anna C, Cavallin F, Thomson M, Plicco C, Chiesi MP. Impact of a quality improvement intervention on neonatal mortality in a regional hospital in Burkina Faso. J Matern Fetal Neonatal Med 2021; 35:4818-4823. [PMID: 33401994 DOI: 10.1080/14767058.2020.1866532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The neonatal period is the most vulnerable time in terms of a child's survival, with mortality during this period accounting for approximately half of the deaths before the age of 5 years. The Neonatal Essential Survival Technology (NEST) project is a program aiming to reduce mortality by improving the quality of neonatal care in sub-Saharan Africa. This study presents the evaluation of the first phase of the NEST intervention program at Saint Camille Hospital Ouagadougou (HOSCO), Burkina Faso, in terms of the reduction in neonatal mortality. METHODS This is a retrospective analysis, based on "pre-intervention" data collected in 2015, and "post-intervention" data collected in 2018, including all infants admitted to the neonatal unit of HOSCO. The intervention period (2016 and 2017) comprised a structured quality improvement process conducted by a multidisciplinary working group that focused on improving infrastructure, equipment, training and use of clinical protocols, team working within the neonatal unit and with other hospital departments, and communication with referring healthcare facilities. Mortality data were compared pre- vs. post-intervention using a logistic regression model. RESULTS The analysis included 1427 infants in the pre-intervention period, and 819 post-intervention. In both time periods, more than 75% of admissions were infants with low birth weight, and nearly 50% were very low birth weight. Post-intervention, while there was a decrease in overall admission, the proportion of multiple births increased from 20% to 24% (p = .01). The overall mortality rate was 44.9% (641/1427) pre-intervention, and 42.2% (346/819) post-intervention (OR 0.90, 95% confidence interval (CI) 0.76-1.07; p = .23). Adjusting for clinically relevant factors, the intervention was not associated with a change in overall mortality (OR 1.39, 95% CI 0.91-2.12; p = .13), but was associated with a reduced likelihood of mortality in outborn infants compared to inborn infants (OR 0.57, 95% CI 0.36-0.92; p = .02). CONCLUSIONS The first phase of the NEST quality improvement program was associated with a decrease in mortality in outborn infants admitted to the neonatal unit at HOSCO. Long-term assessment is expected to provide a more comprehensive evaluation of the program in a low-income setting.
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Affiliation(s)
| | - Paolo Ernesto Villani
- Neonatal Intensive Care Unit, Health Department of Women and Children, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Lucia Tubaldi
- Neonatal Care Unit, Hospital of Macerata, Macerata, Italy
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Fabio Uxa
- WHO Collaborating Centre, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
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Cavallin F, Carlone G, Doglioni N, Villani PE, Vecchiato L, Lago P, Trevisanuto D. Surfactant Treatment of Late Preterm Infants during Emergency Transport: A Retrospective, Observational Study. Neonatology 2021; 118:617-623. [PMID: 34569541 DOI: 10.1159/000518986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In late preterm infants born in nontertiary hospitals, the occurrence of respiratory distress syndrome requires postnatal transport. This study aimed to investigate the impact of the timing of surfactant administration in late preterm infants needing postnatal transport. METHODS This is a retrospective study evaluating surfactant administration in late preterm infants during emergency transports by the Eastern Veneto Neonatal Emergency Transport Service between January 2005 and December 2019. The outcome measures included short-term clinical complications, stabilization time, oxygen concentration, duration of mechanical ventilation and noninvasive respiratory support, length of hospital stay, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis. RESULTS Surfactant was administered to 155/303 neonates (51.1%) at 3 different time points: at a referring hospital (50 neonates), when the transport team arrived (25 neonates), or at a referral hospital (80 neonates). Stabilization time was longer in neonates receiving surfactant by the transport team (adjusted mean difference 17 min, 95% confidence interval, 4-29 min; p = 0.01). Decrease in oxygen concentrations during the transport was larger in neonates receiving surfactant at a referring hospital (adjusted mean difference -11%, 95% confidence interval, -15 to -3%; p = 0.01). The other outcome measures were not statistically different according to the timing of surfactant administration. CONCLUSIONS In late preterm infants with respiratory distress needing postnatal transfer, stabilization time was longer when the first surfactant was administered by the transport team, but such delay did not affect safety and clinical outcomes.
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Affiliation(s)
| | - Giorgia Carlone
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicoletta Doglioni
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Paolo Ernesto Villani
- Department of Pediatrics, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Vecchiato
- Department of Pediatrics, Camposampiero Hospital, Camposampierio, Italy
| | - Paola Lago
- Department of Pediatrics, Ca' Foncello Hospital, Treviso, Italy
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
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Cavallin F, Res G, Monfredini C, Doglioni N, Villani PE, Weiner G, Trevisanuto D. Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial. Eur J Pediatr 2021; 180:247-252. [PMID: 32749547 PMCID: PMC7782398 DOI: 10.1007/s00431-020-03759-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/26/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13 s, 95% confidence interval 8 to 18 s; p < 0.0001) and neonatologists (mean difference 12 s, 95% confidence interval 8 to 16 s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference - 1 s, 95% confidence interval - 7 to 6 s; p = 0.85).Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer-but not clinically relevant-time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted.Registration: clinicaltrial.gov NCT04076189. What is Known: • Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial. • Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown. What is New: • Performing immediate ventilation without intubation was associated with shorter-but not clinically relevant-time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model. • Further studies in a clinical setting are warranted.
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Affiliation(s)
| | - Giulia Res
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy
| | | | - Nicoletta Doglioni
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy
| | | | - Gary Weiner
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Daniele Trevisanuto
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy.
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Mardegan V, Satariano I, Doglioni N, Criscoli G, Cavallin F, Gizzi C, Martano C, Ciralli F, Torielli F, Villani PE, Di Fabio S, Quartulli L, Giannini L, Trevisanuto D. Delivery room management of extremely low birth weight infants in Italy: comparison between academic and non-academic birth centres. J Matern Fetal Neonatal Med 2015; 29:2592-5. [PMID: 26456907 DOI: 10.3109/14767058.2015.1094787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE International Guidelines provide a standardised approach to newborn resuscitation in the DR and, in their most recent versions, recommendations dedicated to management of ELBWI were progressively increased. It is expected that introduction in clinical practice and dissemination of the most recent evidence should be more consistent in academic than in non-academic hospitals. The aim of the study was to compare adherence to the International Guidelines and consistency of practice in delivery room management of extremely low birth weight infants between academic and non-academic institutions. METHODS A questionnaire was sent to the directors of all Italian level III centres between April and August 2012. RESULTS There was a 92% (n = 98/107) response rate. Apart from polyethylene wrapping to optimise thermal control, perinatal management approach was comparable between academic and non-academic centres. CONCLUSIONS There were minor differences in management of extremely low birth weight infants between Italian academic and non-academic institutions, apart from thermal management. Although there was a good, overall adherence to the International Guidelines for Neonatal Resuscitation, temperature management was not in accordance with official recommendations and every effort has to be done to improve this aspect.
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Affiliation(s)
- Veronica Mardegan
- a Department of Children and Women's Health , Medical School University of Padua , Padua , Italy
| | - Irene Satariano
- a Department of Children and Women's Health , Medical School University of Padua , Padua , Italy
| | - Nicoletta Doglioni
- a Department of Children and Women's Health , Medical School University of Padua , Padua , Italy
| | - Giulio Criscoli
- b Italian Army - Signals and Information Technology HQ, C4 Systems Integration Development , Treviso , Italy
| | | | - Camilla Gizzi
- d Neonatal Intensive Care Unit, Department of Pediatric and Neonatal, "S. Giovanni Calibita" Fatebenefratelli Hospital - Isola Tiberina , Camilla Gizzi , Italy , Rome
| | - Claudio Martano
- e Neonatal Intensive Care Unit, Department of Pediatric, Medical School University of Turin , Torino , Italy
| | - Fabrizio Ciralli
- f Neonatal Intensive Care Unit, Department of Mother and Infant Science, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan , Milan , Italy
| | - Flaminia Torielli
- g Neonatology Unit, University of Genova, Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research , Genova , Italy
| | - Paolo Ernesto Villani
- h Neonatal Intensive Care Unit, Department of Maternal and Pediatric, Carlo Poma Hospital , Mantova , Italy
| | - Sandra Di Fabio
- i Neonatal Intensive Care Unit, Department of Mother and Infant Science "San Salvatore" Hospital , L'aquila , Italy
| | - Lorenzo Quartulli
- j Neonatology Unit, "a. Perrino" Hospital-ASL , Brindisi , Italy , and
| | - Luigi Giannini
- k Department of Pediatric , Medical School University "La Sapienza" Rome Azienda Ospedaliera Policlinico Umberto , Rome , Italy
| | - Daniele Trevisanuto
- a Department of Children and Women's Health , Medical School University of Padua , Padua , Italy
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Trevisanuto D, Gizzi C, Martano C, Dal Cengio V, Ciralli F, Torielli F, Villani PE, Di Fabio S, Quartulli L, Giannini L. Oxygen administration for the resuscitation of term and preterm infants. J Matern Fetal Neonatal Med 2013; 25 Suppl 3:26-31. [PMID: 23016614 DOI: 10.3109/14767058.2012.712344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Oxygen has been widely used in neonatal resuscitation for about 300 years. In October 2010, the International Liaison Committee on Neonatal Resuscitation released new guidelines. Based on experimental studies and randomized clinical trials, the recommendations on evaluation and monitoring of oxygenation status and oxygen supplementation in the delivery room were revised in detail. They include: inaccuracy of oxygenation clinical assessment (colour), mandatory use of pulse oximeter, specific saturation targets and oxygen concentrations during positive pressure ventilation in preterm and term infants. In this review, we describe oxygen management in the delivery room in terms of clinical assessment, monitoring, treatment and the gap of knowledge.
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Affiliation(s)
- Daniele Trevisanuto
- Children and Women's Health Department, Medical School University of Padua, Azienda Ospedaliera Padova, Padua, Italy.
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Villani PE, Ricchini A, Thombiano A, Ouedraogo P, Cattarelli D, Chiesi MP, Pignatelli S, Pietra V, Beatrice A, Mescoli G, Schumacher RF. Improved neonatal survival through economically sustainable reorganization of a neonatal care unit in a developing country: 7-year experience in the Centre Medical Saint Camille (CMSC) of Ouagadougou, Burkina Faso. ACTA ACUST UNITED AC 2012; 11:123-127. [PMID: 24319569 PMCID: PMC3843742 DOI: 10.1007/s12682-012-0133-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/18/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Ernesto Villani
- Dipartimento Materno-Infantile, UO TIN, Neonatologia e Nido, AO "C.Poma", Mantua, Italy ; Medicus Mundi Italia, Brescia, Italy
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Trevisanuto D, Martano C, Giannini L, Ciralli F, Di Fabio S, Gizzi C, Quartulli L, Torielli F, Ernesto Villani P. 2010 guidelines for neonatal resuscitation: does the algorithm require a clarification? Pediatrics 2011; 128:e471; author reply e471. [PMID: 21807701 DOI: 10.1542/peds.2011-1909a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Daniele Trevisanuto
- Pediatric Department Medical School University of Padua Azienda Ospedaliera Padova 35128 Padua, Italy
| | - Claudio Martano
- Neonatal Intensive Care Unit Pediatric Department Medical School University of Turin, Azienda Ospedaliera OIRM-S.Anna 10126 Torino, Italy
| | - Luigi Giannini
- Pediatric Department Medical School University “La Sapienza” Rome Azienda ospedaliera Policlinico Umberto I 00161 Rome, Italy
| | - Fabrizio Ciralli
- Neonatal Intensive Care Unit Department of Mother and Infant Science Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico University of Milan 20122 Milan, Italy
| | - Sandra Di Fabio
- Neonatal Intensive Care Unit Department of Mother and Infant Scienze “San Salvatore” Hospital ASL 1 67100 L'Aquila, Italy
| | - Camilla Gizzi
- Neonatal Intensive Care Unit “S. Giovanni Calibita” Fatebenefratelli Hospital Isola Tiberina 00186 Rome, Italy
| | | | - Flaminia Torielli
- Neonatology Unit San Martino University Hospital 16100 Genova, Italy
| | - Paolo Ernesto Villani
- Emergency Department Neonatology and Pediatric Unit Vaio Hospital, AUSL 43036 Parma, Italy
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Villani GQ, del Giudice S, Gandolfini A, Villani PE, Rosi A, Gazzola U. [Usefulness of the ECG in the evaluation of left ventricular function in post-acute myocardial infarction]. Minerva Cardioangiol 1987; 35:615-9. [PMID: 3444536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Villani GQ, Rosi A, Villani PE, Gandolfini A, Del Giudice S, Gazzola U. [Early peak of CPK in acute myocardial infarct: a marker of clinical instability?]. G Ital Cardiol 1987; 17:385-90. [PMID: 3653595] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The evaluation of the CPK-peak time (CPK-p) during Acute Myocardial Infarction (AMI) is now considered as a reliable method to identify ischemic myocardial tissue reperfusion both spontaneous and pharmacologically-induced. The purpose of this study is to assess the clinical significance of this index over a non selected group of patients (pts) affected by a first episode of AMI looking for some variables possibly connected with it. This study includes 114 pts hospitalized in our Unit Coronary Care (UCC) and diagnosed as affected by AMI and not treated with anticoagulant and/or fibrinolytic drugs. They were divided according to CPK-p into 2 groups: group A (23 pts, 18M 5F, mean age 64.2 +/- 10.1y; CPK-p 11.9 +/- 3.3h, AMI Anterior 14/AMI Inferior 9) and group B (91 pts, 85M 6F, mean age 64 +/- 10.3y; CPK-p 25.7 +/- 4.5h, AMI Anterior 50/AMI Inferior 41). Moreover, a third group C has been studied including pts with similar clinical characteristics who underwent thrombolysis by intravenous infusion of Streptokinase (48 pts, 39M 9F, mean age 62.7 +/- 10.6y; CPK-p 15.2 +/- 7h, AMI Anterior 28/AMI Inferior 20). For each pt CKP-p has been evaluated as well as the pre-UCC time (T-pc), the maximum value of released CPK (CPK-max), the incidence of new coronary events such as angina, re-AMI, sudden death detected between the 1st (NEC-I) and the 6th month (NEC-II) after the acute event.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Q Villani
- Servizio di Cardiologia, Unità Coronarica, Ospedale Civile Piacenza
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