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Kidman AM, Manley BJ, Boland RA, Malhotra A, Donath SM, Beker F, Davis PG, Bhatia R. Higher versus lower nasal continuous positive airway pressure for extubation of extremely preterm infants in Australia (ÉCLAT): a multicentre, randomised, superiority trial. Lancet Child Adolesc Health 2023; 7:844-851. [PMID: 38240784 DOI: 10.1016/s2352-4642(23)00235-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Extremely preterm infants often require invasive mechanical ventilation, and clinicians aim to extubate these infants as soon as possible. However, extubation failure occurs in up to 60% of extremely preterm infants and is associated with increased mortality and morbidity. Nasal continuous positive airway pressure (nCPAP) is the most common post-extubation respiratory support, but there is no consensus on the optimal nCPAP level to safely avoid extubation failure in extremely preterm infants. We aimed to determine if higher nCPAP levels compared with standard nCPAP levels would decrease rates of extubation failure in extremely preterm infants within 7 days of their first extubation. METHODS In this multicentre, randomised, open-label controlled trial done at three tertiary perinatal centres in Australia, we assigned extremely preterm infants to extubation to either higher nCPAP (10 cmH2O) or standard nCPAP (7 cmH2O). Infants were eligible if they were born at less than 28 weeks' gestation, were receiving mechanical ventilation via an endotracheal tube, and were being extubated for the first time to nCPAP. Eligible infants must have received previous treatment with exogenous surfactant and caffeine. Infants were ineligible if they were planned to be extubated to a mode of respiratory support other than nCPAP, if they had a known major congenital anomaly that might affect breathing, or if ongoing intensive care was not being provided. Parents or guardians provided prospective, written, informed consent. Infants were maintained within an assigned nCPAP range for a minimum of 24 h after extubation (higher nCPAP group 9-11 cmH2O and standard nCPAP group 6-8 cmH2O). Randomisation was stratified by both gestation (22-25 completed weeks or 26-27 completed weeks) and recruiting centre. The primary outcome was extubation failure within 7 days and analysis was by intention to treat. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12618001638224. FINDINGS Between March 3, 2019, and July 31, 2022, 483 infants were born at less than 28 weeks and admitted to the recruiting centres. 92 infants were not eligible, 172 were not approached, 65 families declined to participate, and 15 consented but were not randomly assigned. 139 infants were enrolled and randomly assigned, 70 to the higher nCPAP group and 69 to the standard nCPAP group. One infant in the higher nCPAP group was excluded from the analysis because consent was withdrawn after randomisation. 104 (75%) of 138 mothers were White. The mean gestation was 25·7 weeks (SD 1·3) and the mean birthweight was 777 grams (201). 70 (51%) of 138 infants were female. Extubation failure occurred in 24 (35%) of 69 infants in the higher nCPAP group and in 39 (57%) of 69 infants in the standard nCPAP group (risk difference -21·7%, 95% CI -38·5% to -3·7%). There were no significant differences in rates of adverse events between groups during the primary outcome period. Three patients died (two in the higher nCPAP group and one in the standard nCPAP group), pneumothorax occurred in one patient from each group, spontaneous intestinal perforation in three patients (two in the higher nCPAP group and one in the standard nCPAP group) and there were no events of pulmonary interstitial emphysema. INTERPRETATION Extubation of extremely preterm infants to higher nCPAP significantly reduced extubation failure compared with extubation to standard nCPAP, without increasing rates of adverse effects. Future larger trials are essential to confirm these findings in terms of both efficacy and safety. FUNDING National Health and Medical Research Council Centre for Research Excellence in Newborn Medicine, number 1153176.
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Affiliation(s)
- Anna M Kidman
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia; Newborn Research, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Brett J Manley
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Newborn Research, The Royal Women's Hospital, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Rosemarie A Boland
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Friederike Beker
- Neonatal Critical Care Unit, Mater Mothers' Hospital, Brisbane, QLD, Australia
| | - Peter G Davis
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Newborn Research, The Royal Women's Hospital, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Risha Bhatia
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
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Francis KL, McKinlay CJD, Kamlin COF, Cheong JLY, Dargaville PA, Dawson JA, Doyle LW, Jacobs SE, Davis PG, Donath SM, Manley BJ. Intratracheal budesonide mixed with surfactant to increase survival free of bronchopulmonary dysplasia in extremely preterm infants: statistical analysis plan for the international, multicenter, randomized PLUSS trial. Trials 2023; 24:709. [PMID: 37932774 PMCID: PMC10629198 DOI: 10.1186/s13063-023-07650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD), an inflammatory-mediated chronic lung disease, is common in extremely preterm infants born before 28 weeks' gestation and is associated with an increased risk of adverse neurodevelopmental and respiratory outcomes in childhood. Effective and safe prophylactic therapies for BPD are urgently required. Systemic corticosteroids reduce rates of BPD in the short term but are associated with poorer neurodevelopmental outcomes if given to ventilated infants in the first week after birth. Intratracheal administration of corticosteroid admixed with exogenous surfactant could overcome these concerns by minimizing systemic sequelae. Several small, randomized trials have found intratracheal budesonide in a surfactant vehicle to be a promising therapy to increase survival free of BPD. The primary objective of the PLUSS trial is to determine whether intratracheal budesonide mixed with surfactant increases survival free of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA) in extremely preterm infants born before 28 weeks' gestation. METHODS An international, multicenter, double-blinded, randomized trial of intratracheal budesonide (a corticosteroid) mixed with surfactant for extremely preterm infants to increase survival free of BPD at 36 weeks' postmenstrual age (PMA; primary outcome). Extremely preterm infants aged < 48 h after birth are eligible if (1) they are mechanically ventilated, or (2) they are receiving non-invasive respiratory support and there is a clinical decision to treat with surfactant. The intervention is budesonide (0.25 mg/kg) mixed with poractant alfa (200 mg/kg first intervention, 100 mg/kg if second intervention), administered intratracheally via an endotracheal tube or thin catheter. The comparator is poractant alfa alone (at the same doses). Secondary outcomes include the components of the primary outcome (death, BPD prior to or at 36 weeks' PMA), and potential systemic side effects of corticosteroids. Longer-term outcomes will be published separately, and include cost-effectiveness, early childhood health until 2 years of age, and neurodevelopmental outcomes at 2 years of age (corrected for prematurity). STATISTICAL ANALYSIS PLAN A sample size of 1038 infants (519 in each group) is required to provide 90% power to detect a relative increase in survival free of BPD of 20% (an absolute increase of 10%), from the anticipated event rate of 50% in the control arm to 60% in the intervention (budesonide) arm, alpha error 0.05. To allow for up to 2% of study withdrawals or losses to follow-up, PLUSS aimed to enroll a total of 1060 infants (530 in each arm). The binary primary outcome will be reported as the number and percentage of infants who were alive without BPD at 36 weeks' PMA for each randomization group. To estimate the difference in risk (with 95% CI), between the treatment and control arms, binary regression (a generalized linear multivariable model with an identity link function and binomial distribution) will be used. Along with the primary outcome, the individual components of the primary outcome (death, and physiological BPD at 36 weeks' PMA), will be reported by randomization group and, again, binary regression will be used to estimate the risk difference between the two treatment groups for survival and physiological BPD at 36 weeks' PMA.
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Affiliation(s)
- Kate L Francis
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Christopher J D McKinlay
- Department of Paediatrics, Child and Youth Health, the University of Auckland, Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - C Omar F Kamlin
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Melbourne, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Peter A Dargaville
- The Royal Hobart Hospital, Hobart, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jennifer A Dawson
- Murdoch Children's Research Institute, Melbourne, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia
| | - Lex W Doyle
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Susan E Jacobs
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Murdoch Children's Research Institute, Melbourne, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Brett J Manley
- Murdoch Children's Research Institute, Melbourne, Australia.
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia.
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia.
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Sett A, Rogerson SR, Foo GWC, Keene J, Thomas N, Kee PPL, Zayegh A, Donath SM, Tingay DG, Davis PG, Manley BJ. Estimating Preterm Lung Volume: A Comparison of Lung Ultrasound, Chest Radiography, and Oxygenation. J Pediatr 2023; 259:113437. [PMID: 37088185 DOI: 10.1016/j.jpeds.2023.113437] [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: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To determine the relationship between lung ultrasound (LUS) examination, chest radiograph (CXR), and radiographic and clinical evaluations in the assessment of lung volume in preterm infants. STUDY DESIGN In this prospective cohort study LUS was performed before CXR on 70 preterm infants and graded using (1) a LUS score, (2) an atelectasis score, and (3) measurement of atelectasis depth. Radiographic diaphragm position and radio-opacification were used to determine global and regional radiographic atelectasis. The relationship between LUS, CXR, and oxygenation was assessed using receiver operator characteristic and correlation analysis. RESULTS LUS scores, atelectasis scores, and atelectasis depth did not correspond with radiographic global atelectasis (area under receiver operator characteristics curves, 0.54 [95% CI, 0.36-0.71], 0.49 [95% CI, 0.34-0.64], and 0.47 [95% CI, 0.31-0.64], respectively). Radiographic atelectasis of the right upper, right lower, left upper, and left lower quadrants was predicted by LUS scores (0.75 [95% CI, 0.59-0.92], 0.75 [95% CI, 0.62-0.89], 0.69 [95% CI, 0.56-0.82], and 0.63 [95% CI, 0.508-0.751]) and atelectasis depth (0.66 [95% CI, 0.54-0.78], 0.65 [95% CI, 0.53-0.77], 0.63 [95% CI, 0.50-0.76], and 0.56 [95% CI, 0.44-0.70]). LUS findings were moderately correlated with oxygen saturation index (ρ = 0.52 [95% CI, 0.30-0.70]) and saturation to fraction of inspired oxygen ratio (ρ = -0.63 [95% CI, -0.76 to -0.46]). The correlation between radiographic diaphragm position, the oxygenation saturation index, and peripheral oxygen saturation to fraction of inspired oxygen ratio was very weak (ρ = 0.36 [95% CI, 0.11-0.59] and ρ = -0.32 [95% CI, -0.53 to -0.07], respectively). CONCLUSIONS LUS assessment of lung volume does not correspond with radiographic diaphragm position preterm infants. However, LUS predicted radiographic regional atelectasis and correlated with oxygenation. The relationship between radiographic diaphragm position and oxygenation was very weak. Although LUS may not replace all radiographic measures of lung volume, LUS more accurately reflects respiratory status in preterm infants. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12621001119886.
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Affiliation(s)
- Arun Sett
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia.
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia
| | - Gillian W C Foo
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia
| | - Jacqui Keene
- Department of Radiology, The Royal Women's Hospital, Melbourne, Australia
| | - Niranjan Thomas
- Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Penny P L Kee
- Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia
| | - Amir Zayegh
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Victoria, Australia
| | - David G Tingay
- Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Brett J Manley
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
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Sett A, Kenna KR, Sutton RJ, Perkins EJ, Sourial M, Chapman JD, Donath SM, Sasi A, Rogerson SR, Manley BJ, Davis PG, Pereira-Fantini PM, Tingay DG. Lung ultrasound of the dependent lung detects real-time changes in lung volume in the preterm lamb. Arch Dis Child Fetal Neonatal Ed 2023; 108:51-56. [PMID: 35750468 PMCID: PMC9763221 DOI: 10.1136/archdischild-2022-323900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/26/2022] [Accepted: 06/03/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Effective lung protective ventilation requires reliable, real-time estimation of lung volume at the bedside. Neonatal clinicians lack a readily available imaging tool for this purpose. OBJECTIVE To determine the ability of lung ultrasound (LUS) of the dependent region to detect real-time changes in lung volume, identify opening and closing pressures of the lung, and detect pulmonary hysteresis. METHODS LUS was performed on preterm lambs (n=20) during in vivo mapping of the pressure-volume relationship of the respiratory system using the super-syringe method. Electrical impedance tomography was used to derive regional lung volumes. Images were blindly graded using an expanded scoring system. The scores were compared with total and regional lung volumes, and differences in LUS scores between pressure increments were calculated. RESULTS Changes in LUS scores correlated moderately with changes in total lung volume (r=0.56, 95% CI 0.47-0.64, p<0.0001) and fairly with right whole (r=0.41, CI 0.30-0.51, p<0.0001), ventral (r=0.39, CI 0.28-0.49, p<0.0001), central (r=0.41, CI 0.31-0.52, p<0.0001) and dorsal (r=0.38, CI 0.27-0.49, p<0.0001) regional lung volumes. The pressure-volume relationship of the lung exhibited hysteresis in all lambs. LUS was able to detect hysteresis in 17 (85%) lambs. The greatest changes in LUS scores occurred at the opening and closing pressures. CONCLUSION LUS was able to detect large changes in total and regional lung volume in real time and correctly identified opening and closing pressures but lacked the precision to detect small changes in lung volume. Further work is needed to improve precision prior to translation to clinical practice.
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Affiliation(s)
- Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia .,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kelly R Kenna
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rebecca J Sutton
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Translational Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Magdy Sourial
- Translational Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jack D Chapman
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Donath
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Arun Sasi
- Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Brett J Manley
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia,Department of Neonatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Hodgson KA, Owen LS, Kamlin COF, Roberts CT, Newman SE, Francis KL, Donath SM, Davis PG, Manley BJ. Nasal High-Flow Therapy during Neonatal Endotracheal Intubation. N Engl J Med 2022; 386:1627-1637. [PMID: 35476651 DOI: 10.1056/nejmoa2116735] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 01/09/2023]
Abstract
BACKGROUND Neonatal endotracheal intubation often involves more than one attempt, and oxygen desaturation is common. It is unclear whether nasal high-flow therapy, which extends the time to desaturation during elective intubation in children and adults receiving general anesthesia, can improve the likelihood of successful neonatal intubation on the first attempt. METHODS We performed a randomized, controlled trial to compare nasal high-flow therapy with standard care (no nasal high-flow therapy or supplemental oxygen) in neonates undergoing oral endotracheal intubation at two Australian tertiary neonatal intensive care units. Randomization of intubations to the high-flow group or the standard-care group was stratified according to trial center, the use of premedication for intubation (yes or no), and postmenstrual age of the infant (≤28 or >28 weeks). The primary outcome was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from the preintubation baseline level or bradycardia with a heart rate of <100 beats per minute) in the infant. RESULTS The primary intention-to-treat analysis included the outcomes of 251 intubations in 202 infants; 124 intubations were assigned to the high-flow group and 127 to the standard-care group. The infants had a median postmenstrual age of 27.9 weeks and a median weight of 920 g at the time of intubation. A successful intubation on the first attempt without physiological instability was achieved in 62 of 124 intubations (50.0%) in the high-flow group and in 40 of 127 intubations (31.5%) in the standard-care group (adjusted risk difference, 17.6 percentage points; 95% confidence interval [CI], 6.0 to 29.2), for a number needed to treat of 6 (95% CI, 4 to 17) for 1 infant to benefit. Successful intubation on the first attempt regardless of physiological stability was accomplished in 68.5% of the intubations in the high-flow group and in 54.3% of the intubations in the standard-care group (adjusted risk difference, 15.8 percentage points; 95% CI, 4.3 to 27.3). CONCLUSIONS Among infants undergoing endotracheal intubation at two Australian tertiary neonatal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12618001498280.).
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Affiliation(s)
- Kate A Hodgson
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Louise S Owen
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - C Omar F Kamlin
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Calum T Roberts
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Sophie E Newman
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Kate L Francis
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Susan M Donath
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Peter G Davis
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
| | - Brett J Manley
- From the Newborn Research Centre, Royal Women's Hospital (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.), Monash Newborn, Monash Children's Hospital (C.T.R.), the Department of Paediatrics, Monash University (C.T.R.), the Ritchie Centre, Hudson Institute of Medical Research (C.T.R.), and the Department of Neonatal Medicine, Royal Children's Hospital (S.E.N.), Melbourne, VIC, and the Departments of Obstetrics and Gynaecology (K.A.H., L.S.O., C.O.F.K., P.G.D., B.J.M.) and Paediatrics (S.M.D.), University of Melbourne, and Murdoch Children's Research Institute (L.S.O., C.O.F.K., K.L.F., S.M.D., P.G.D., B.J.M.), Parkville, VIC - all in Australia
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Falciola V, Donath SM, Roden E, Davidson A, Vutskits L. Noninvasive cardiac output monitoring during anaesthesia and surgery in young children using electrical cardiometry: an observational study. Br J Anaesth 2022; 128:e235-e238. [PMID: 35039175 DOI: 10.1016/j.bja.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Veronique Falciola
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Susan M Donath
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Emilie Roden
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Andrew Davidson
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia; Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Australia
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Geneva Neuroscience Center, University of Geneva Medical School, Geneva, Switzerland.
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Kidman AM, Manley BJ, Boland RA, Malhotra A, Donath SM, Davis PG, Bhatia R. Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants. BMJ Open 2021; 11:e045897. [PMID: 34162644 PMCID: PMC8230987 DOI: 10.1136/bmjopen-2020-045897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Respiratory distress syndrome is a complication of prematurity and extremely preterm infants born before 28 weeks' gestation often require endotracheal intubation and mechanical ventilation. In this high-risk population, mechanical ventilation is associated with lung injury and contributes to bronchopulmonary dysplasia. Therefore, clinicians attempt to extubate infants as quickly and use non-invasive respiratory support such as nasal continuous positive airway pressure (CPAP) to facilitate the transition. However, approximately 60% of extremely preterm infants experience 'extubation failure' and require reintubation. While CPAP pressures of 5-8 cm H2O are commonly used, the optimal CPAP pressure is unknown, and higher pressures may be beneficial in avoiding extubation failure. Our trial is the Extubation CPAP Level Assessment Trial (ÉCLAT). The aim of this trial is to compare higher CPAP pressures 9-11 cm H2O with a current standard pressures of 6-8 cmH2O on extubation failure in extremely preterm infants. METHODS AND ANALYSIS 200 extremely preterm infants will be recruited prior to their first extubation from mechanical ventilation to CPAP. This is a parallel group randomised controlled trial. Infants will be randomised to one of two set CPAP pressures: CPAP 10 cmH2O (intervention) or CPAP 7 cmH2O (control). The primary outcome will be extubation failure (reintubation) within 7 days. Statistical analysis will follow standard methods for randomised trials on an intention to treat basis. For the primary outcome, this will be by intention to treat, adjusted for the prerandomisation strata (GA and centre). We will use the appropriate parametric and non-parametric statistical tests. ETHICS AND DISSEMINATION Ethics approval has been granted by the Monash Health Human Research Ethics Committees. Amendments to the trial protocol will be submitted for approval. The findings of this study will be written into a clinical trial report manuscript and disseminated via peer-reviewed journals (on-line or in press) and presented at national and international conferences.Trial registration numberACTRN12618001638224; pre-results.
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Affiliation(s)
- Anna Madeline Kidman
- Obstetrics and Gynaecology, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Brett James Manley
- Obstetrics and Gynaecology, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Rosemarie Anne Boland
- Obstetrics and Gynaecology, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Newborn at Monash Children's Hospital, Clayton, Victoria, Australia
- Paediatrics, Monash University, Clayton, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Peter G Davis
- Obstetrics and Gynaecology, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Risha Bhatia
- Monash Newborn, Monash Newborn at Monash Children's Hospital, Clayton, Victoria, Australia
- Paediatrics, Monash University, Clayton, Victoria, Australia
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Hodgson KA, Owen LS, Kamlin CO, Roberts CT, Donath SM, Davis PG, Manley BJ. A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol. BMJ Open 2020; 10:e039230. [PMID: 33020105 PMCID: PMC7537449 DOI: 10.1136/bmjopen-2020-039230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Neonatal endotracheal intubation is an essential but potentially destabilising procedure. With an increased focus on avoiding mechanical ventilation, particularly in preterm infants, there are fewer opportunities for clinicians to gain proficiency in this important emergency skill. Rates of successful intubation at the first attempt are relatively low, and adverse event rates are high, when compared with intubations in paediatric and adult populations. Interventions to improve operator success and patient stability during neonatal endotracheal intubations are needed. Using nasal high flow therapy extends the safe apnoea time of adults undergoing upper airway surgery and during endotracheal intubation. This technique is untested in neonates. METHODS AND ANALYSIS The Stabilisation with nasal High flow during Intubation of NEonates (SHINE) trial is a multicentre, randomised controlled trial comparing the use of nasal high flow during neonatal intubation with standard care (no nasal high flow). Intubations are randomised individually, and stratified by site, use of premedications, and postmenstrual age (<28 weeks' gestation; ≥28 weeks' gestation). The primary outcome is the incidence of successful intubation on the first attempt without physiological instability of the infant. Physiological instability is defined as an absolute decrease in peripheral oxygen saturation >20% from preintubation baseline and/or bradycardia (<100 beats per minute). ETHICS AND DISSEMINATION The SHINE trial received ethical approval from the Human Research Ethics Committees of The Royal Women's Hospital, Melbourne, Australia and Monash Health, Melbourne, Australia. The trial is currently recruiting in these two sites. The findings of this study will be disseminated via peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12618001498280.
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Affiliation(s)
- Kate A Hodgson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louise S Owen
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Camille Omar Kamlin
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Calum T Roberts
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Brett James Manley
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Kamlin COF, Schmölzer GM, Dawson JA, McGrory L, O’Shea J, Donath SM, Lorenz L, Hooper SB, Davis PG. A randomized trial of oropharyngeal airways to assist stabilization of preterm infants in the delivery room. Resuscitation 2019; 144:106-114. [DOI: 10.1016/j.resuscitation.2019.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/20/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
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10
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O'Currain E, Thio M, Dawson JA, Donath SM, Davis PG. Respiratory monitors to teach newborn facemask ventilation: a randomised trial. Arch Dis Child Fetal Neonatal Ed 2019; 104:F582-F586. [PMID: 30636691 DOI: 10.1136/archdischild-2018-316118] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 08/27/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The International Liaison Committee on Resuscitation has found that there is a need for high-quality randomised trials of training interventions that improve the effectiveness of resuscitation skills. The objective of this study was to determine whether using a respiratory function monitor (RFM) during mask ventilation training with a manikin reduces facemask leak. DESIGN Stratified, parallel-group, randomised controlled trial. Outcome assessors were blinded to group allocation. SETTING Thirteen hospitals in Australia, including non-tertiary sites. PARTICIPANTS Consecutive sample of healthcare professionals attending a structured newborn resuscitation training course. INTERVENTIONS An RFM providing real-time, objective, leak, flow and volume information was attached to the facemask during 1.5 hours of newborn ventilation and simulation training using a manikin. Participants were randomised to have the RFM display visible (intervention) or masked (control), using a computer-generated randomisation sequence. MAIN OUTCOME MEASURES The primary outcome was facemask leak measured after neonatal facemask ventilation training. Tidal volume was an important secondary outcome measure. RESULTS Participants were recruited from May 2016 to November 2017. Of 402 eligible participants, two refused consent. Four hundred were randomised, 200 to each group, of whom 194 in each group underwent analysis. The median (IQR) facemask leak was 23% (8%-41%) in the RFM visible group compared with 35% (14%-67%) in the masked group, p<0.0001, difference (95% CI) in medians 12 (4 to 22). CONCLUSIONS The display of information from an RFM improved the effectiveness of newborn facemask ventilation training. TRIAL REGISTRATION NUMBER ACTRN12616000542493, pre-results.
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Affiliation(s)
- Eoin O'Currain
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,School of Medicine, University College Dublin, Dublin, Ireland.,Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Anne Dawson
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Hoq M, Karlaftis V, Mathews S, Burgess J, Donath SM, Carlin J, Monagle P, Ignjatovic V. A prospective, cross-sectional study to establish age-specific reference intervals for neonates and children in the setting of clinical biochemistry, immunology and haematology: the HAPPI Kids study protocol. BMJ Open 2019; 9:e025897. [PMID: 30948591 PMCID: PMC6500200 DOI: 10.1136/bmjopen-2018-025897] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The clinical interpretation of laboratory tests is reliant on reference intervals. However, the accuracy of a reference interval is dependent on the selected reference population, and in paediatrics, the ability of the reference interval to reflect changes associated with growth and age, as well as sex and ethnicity. Differences in reagent formulations, methodologies and analysers can also impact on a reference interval. To date, no direct comparison of reference intervals for common analytes using different analysers in children has been published. The Harmonising Age Pathology Parameters in Kids (HAPPI Kids) study aims to establish age-appropriate reference intervals for commonly used analytes in the routine clinical care of neonates and children, and to determine the feasibility of paediatric reference interval harmonisation by comparing age-appropriate reference intervals in different analysers for multiple analytes. METHODS AND ANALYSIS The HAPPI Kids study is a prospective cross-sectional study, collecting paediatric blood samples for analysis of commonly requested biochemical, immunological and haematological tests. Venous blood samples are collected from healthy premature neonates (32-36 weeks of gestation), term neonates (from birth to a maximum of 72 hours postbirth) and children aged 30 days to ≤18 years (undergoing minor day surgical procedures). Blood samples are processed according to standard laboratory procedures and, if not processed immediately, stored at -80°C. A minimum of 20 samples is analysed for every analyte for neonates and then each year of age until 18 years. Analytical testing is performed according to the standard operating procedures used for clinical samples. Where possible, sample aliquots from the same patients are analysed for an analyte across multiple commercially available analysers. ETHICS AND DISSEMINATION The study protocol was approved by The Royal Children's Hospital, Melbourne, Ethics in Human Research Committee (34183 A). The study findings will be published in peer-reviewed journals and shared with clinicians, laboratory scientists and laboratories.
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Affiliation(s)
- Monsurul Hoq
- Department of Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Vicky Karlaftis
- Department of Haematology Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Susan Mathews
- Department of Biochemistry, Laboratory Services, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Janet Burgess
- Department of Pathology Collection, Laboratory Services, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Susan M Donath
- Department of Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - John Carlin
- Department of Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul Monagle
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Haematology Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Haematology Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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Gwee A, Cranswick N, Donath SM, Hunt R, Curtis N. Protocol for a randomised controlled trial of continuous infusions of vancomycin to improve the attainment of target vancomycin levels in young infants: The VANC trial. BMJ Open 2018; 8:e022603. [PMID: 30391914 PMCID: PMC6231575 DOI: 10.1136/bmjopen-2018-022603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Vancomycin is frequently used in the treatment of late-onset sepsis in young infants and is routinely administered as intermittent infusions (IIV); however, existing IIV dosing guidelines achieve target vancomycin levels in less than half of infants. Continuous infusions of vancomycin (CIV) are an attractive alternative as adult studies report a higher attainment of target vancomycin levels, simpler drug monitoring and fewer drug side effects. METHODS This is a multicentre, randomised controlled trial in which 200 young infants (aged 0-90 days) requiring vancomycin will be randomised to CIV or IIV for a duration determined by the treating clinician. Vancomycin levels will be measured immediately after the first dose in both arms. Trough and peak levels will be determined in the IIV arm and steady-state levels 18-30 hours after commencement of infusion will be measured in the CIV arm. Full blood count, urea and electrolytes, and C reactive protein level will be monitored throughout treatment. For all Gram-positive bacteria isolated from blood culture, a vancomycin Etest will be done to determine the minimum inhibitory concentration of the bacterium. ANALYSIS Primary outcome: the proportion of infants with levels within target range at their first steady-state concentration. SECONDARY OUTCOMES (1) the proportion of drug-related adverse effects; (2) the time to achieve target levels in the blood; (3) the pharmacodynamics of vancomycin (using non-linear mixed effect modelling). ETHICS AND DISSEMINATION The study has been approved by The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) (No. 34030) and the South Eastern Sydney Local Health District HREC (SSA 16/G/335). Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02210169.
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Affiliation(s)
- Amanda Gwee
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Noel Cranswick
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Donath
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rodney Hunt
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Lorenz L, Rüegger CM, O'Currain E, Dawson JA, Thio M, Owen LS, Donath SM, Davis PG, Kamlin COF. Suction Mask vs Conventional Mask Ventilation in Term and Near-Term Infants in the Delivery Room: A Randomized Controlled Trial. J Pediatr 2018; 198:181-186.e2. [PMID: 29705115 DOI: 10.1016/j.jpeds.2018.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/06/2018] [Accepted: 03/08/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the suction mask, a new facemask that uses suction to create a seal between the mask and the infant's face, with a conventional soft, round silicone mask during positive pressure ventilation (PPV) in the delivery room in newborn infants >34 weeks of gestation. STUDY DESIGN Single-center randomized controlled trial in the delivery room. The primary outcome was mask leak. RESULTS Forty-five infants were studied at a median gestational age of 38.1 weeks (IQR, 36.4-39.0 weeks); 22 were randomized to the suction mask and 23 to the conventional mask. The suction mask did not reduce mask leak (49.9%; IQR, 11.0%-92.7%) compared with the conventional mask (30.5%; IQR, 10.6%-48.8%; P = .51). The suction mask delivered lower peak inspiratory pressure (27.2 cm H2O [IQR, 25.0-28.7 cm H2O] vs 30.4 cm H2O [IQR, 29.4-32.5 cm H2O]; P < .05) and lower positive end expiratory pressure (3.7 cm H2O [IQR, 3.1-4.5 cm H2O] vs 5.1 cm H2O [IQR, 4.2-5.7 cm H2O ]; P < .05). There was no difference in the duration of PPV or rates of intubation or admission to the neonatal intensive care unit. In 5 infants (23%), the clinician switched from the suction to the conventional mask, 2 owing to intermittently low peak inspiratory pressure, 2 owing to failure to respond to PPV, and 1 owing to marked facial bruising after 6 minutes of PPV. CONCLUSIONS The use of the suction mask to provide PPV in newborn infants did not reduce facemask leak. Adverse effects such as the inability to achieve the set pressures and transient skin discoloration are concerning. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ACTRN12616000768493.
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Affiliation(s)
- Laila Lorenz
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Christoph M Rüegger
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Newborn Research, Department of Neonatology, University Hospital and University of Zürich, Zürich, Switzerland
| | - Eoin O'Currain
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; University College Dublin, Dublin, Ireland
| | - Jennifer A Dawson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; PIPER-Neonatal Retrieval Services Victoria, The Royal Children's Hospital, Melbourne, Australia
| | - Louise S Owen
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - C Omar F Kamlin
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
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Lorenz L, Marulli A, Dawson JA, Owen LS, Manley BJ, Donath SM, Davis PG, Kamlin COF. Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support. Arch Dis Child Fetal Neonatal Ed 2018; 103:F137-F142. [PMID: 28747364 DOI: 10.1136/archdischild-2016-312471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/06/2016] [Revised: 05/19/2017] [Accepted: 05/20/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Skin-to-skin care (SSC) has proven benefits in preterm infants, but increased hypoxic and bradycardic events have been reported. This may make clinicians hesitant to recommend SSC as standard care. We hypothesised that regional cerebral oxygenation (rStO2) measured with near infrared spectroscopy is not worse during SSC compared with standard incubator care. DESIGN Prospective, observational, non-inferiority study. SETTING Single tertiary perinatal centre in Australia. PATIENTS Forty preterm infants (median (IQR) 30.6 (29.1-31.7) weeks' gestation) not receiving respiratory support were studied on day 14 (8-38). INTERVENTIONS Recordings during 90 min of incubator care, followed by 90 min of SSC. Each infant acted as their own control and caregivers were blinded to the rStO2 measurements. MAIN OUTCOME MEASURES The primary outcome was the mean difference in rStO2 between SSC and incubator care. The prespecified margin of non-inferiority was -1.5%. Secondary outcomes included heart rate (HR), peripheral oxygen saturation (SpO2), time in quiet sleep, temperature and hypoxic (SpO2 <80% for >5 s) or bradycardic events (HR <80 bpm for >5 s) and time spent in cerebral hypoxia (rStO2<55%) and hyperoxia (rStO2>85%). RESULTS Mean (SD) rStO2 was lower during SSC compared with incubator care: 73.6 (6.0)% vs 74.8 (4.6)%, mean difference (95% CI) 1.3 (2.2 to 0.4)%. HR was 5 bpm higher, SpO2 1% lower and time in quiet sleep 24% longer during SSC. Little evidence of a difference was observed in temperature. The number of hypoxic or bradycardic events as well as the proportion of time spent in cerebral hypoxia and hyperoxia was very low in both periods. CONCLUSIONS Mean rStO2 was marginally lower during SSC without observed differences in hypoxic or bardycardic events but an increase in time spent in quiet sleep. TRIAL REGISTRATION NUMBER This trial is linked to Australian New Zealand Clinical Trials Registry: identifier 12616000240448. It was registered pre-results.
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Affiliation(s)
- Laila Lorenz
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Adriana Marulli
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Jennifer A Dawson
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Louise S Owen
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Brett J Manley
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - C Omar F Kamlin
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
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Marulli A, Kamlin COF, Dawson JA, Donath SM, Davis PG, Lorenz L. The effect of skin-to-skin care on cerebral oxygenation during nasogastric feeding of preterm infants. Acta Paediatr 2018; 107:430-435. [PMID: 29168250 DOI: 10.1111/apa.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 11/28/2022]
Abstract
AIM To describe cerebral oxygenation during gavage feeding of preterm infants during incubator and skin-to-skin care. METHODS Further analysis of data from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin-to-skin care with incubator care. Data were analysed in three epochs; 10 minutes prefeed, during-feed and 10 minutes postfeed. Measurements from infants fed during incubator care were compared with those obtained during skin-to-skin care. RESULTS In 39 infants [median (IQR) 27.8 (26.1-30.0) weeks' gestation], there was no difference in cerebral oxygenation between pre-, during- and postfeed. Heart rate increased by three beats per minute postfeed compared with during-feed. Twenty infants received two gavage feeds, one feed in the incubator and another during skin-to-skin care. There was no difference in cerebral oxygenation and heart rate; peripheral oxygen saturation decreased by 3% during feeding whilst skin-to-skin care compared with feeding in the incubator. CONCLUSION Cerebral oxygenation remained stable before, during and after gavage feeding in an incubator and during skin-to-skin care. The small decrease in oxygen saturation whilst receiving gavage feeding during skin-to-skin care is unlikely to be clinically important, providing reassurance that preterm infants maintain physiological stability during skin-to-skin care.
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Affiliation(s)
- A Marulli
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - COF Kamlin
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - JA Dawson
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - SM Donath
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - PG Davis
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - L Lorenz
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- Department of Neonatology; University Children's Hospital of Tübingen; Tübingen Germany
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16
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Rüegger CM, Dawson JA, Donath SM, Owen LS, Davis PG. Nonpublication and discontinuation of randomised controlled trials in newborns. Acta Paediatr 2017; 106:1940-1944. [PMID: 28871629 DOI: 10.1111/apa.14062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/01/2017] [Accepted: 08/31/2017] [Indexed: 12/24/2022]
Abstract
AIM To determine the rate of nonpublication and discontinuation of randomised controlled trials (RCTs) in newborns. METHODS This was a retrospective, cross-sectional study of RCTs registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR) between 2008 and 2012. RESULTS Fifty trials were identified, of which 23 (46%) were retrospectively registered. Thirty trials (60%) were published. After a median follow-up of 8.0 (range 4.6-17.4) years from Research Ethics Committee approval, 15 of 41 completed trials (37%) remained unpublished, representing 5422 neonatal trial participants. Nine trials (18%) were discontinued, including four that were published. The most frequent reason for discontinuation was poor recruitment (n = 4). Sample size discrepancies between registration and publication were found in 17 (65%) of the 26 completed, published trials. In nine (35%) of these trials, the calculated sample size in the method section of the published article differed from the planned sample size in the trial registry (relative difference -20% to +33%). CONCLUSION Nonpublication and discontinuation of RCTs conducted in newborns is common. Additional efforts are needed to minimise the number of neonatal trial participants that are exposed to interventions without subsequent publication.
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Affiliation(s)
- Christoph M. Rüegger
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Newborn Research; Department of Neonatology; University Hospital and University of Zürich; Zürich Switzerland
| | - Jennifer A. Dawson
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
| | - Susan M. Donath
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
| | - Louise S. Owen
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
| | - Peter G. Davis
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
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17
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Lorenz L, Dawson JA, Jones H, Jacobs SE, Cheong JL, Donath SM, Davis PG, Kamlin COF. Skin-to-skin care in preterm infants receiving respiratory support does not lead to physiological instability. Arch Dis Child Fetal Neonatal Ed 2017; 102:F339-F344. [PMID: 28096239 DOI: 10.1136/archdischild-2016-311752] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 08/04/2016] [Accepted: 12/01/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Providing skin-to-skin care (SSC) to preterm infants is standard practice in many neonatal intensive care units. There are conflicting reports on the stability of oxygen saturation (SpO2) during SSC, which may create a barrier to a wider implementation of SSC to infants receiving respiratory support. Regional cerebral oxygenation (rcO2) measured using near-infrared spectroscopy can serve as a surrogate parameter for cerebral oxygen delivery and consumption. We hypothesised that rcO2 during SSC would be similar to standard care in preterm infants receiving respiratory support. DESIGN Prospective observational non-inferiority study. SETTING Single tertiary perinatal centre in Australia. PATIENTS Forty preterm infants (median (IQR) of 27.6 (26.0-28.9) weeks' gestation) receiving respiratory support were studied on day 8 (5-18). INTERVENTIONS Ninety minutes of SSC, with infants in incubators acting as their own control. Parents and caregivers were blinded to the measurements. MAIN OUTCOME MEASURES Mean difference in rcO2 between SSC and incubator care; as well as heart rate (HR), SpO2, fraction of inspired oxygen (FiO2) and temperature, were compared using a paired t-test. RESULTS rcO2 was similar during SSC (mean (SD) 74.9 (6.5)%)% compared with incubator care (74.7 (6.1)%, mean difference (95% CI) 0.2 (-0.8 to 1.1)%, p=0.71). No clinically important differences in HR, SpO2, FiO2 or temperature were observed in the whole cohort and by mode of respiratory support (endotracheal tube mechanical ventilation, continuous positive airway pressure and high-flow nasal cannulae). CONCLUSIONS Cerebral oxygenation and other physiological measurements in ventilated preterm infants did not differ between SSC and incubator care. TRIAL REGISTRATION NUMBER 12615000959572.
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Affiliation(s)
- Laila Lorenz
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Jennifer A Dawson
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Hannah Jones
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
| | - Susan E Jacobs
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Jeanie L Cheong
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - C Omar F Kamlin
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
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18
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Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. Lancet 2017; 389:2204-2213. [PMID: 28589894 DOI: 10.1016/s0140-6736(17)31373-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 02/13/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy. METHODS We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909. FINDINGS Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315). INTERPRETATION There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia.
| | - Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
| | - Susan E Jacobs
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Peter G Davis
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | | | - Gillian F Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | | | - Christine East
- School of Nursing and Midwifery, Monash University and Monash Health, Clayton, VIC, Australia
| | - Rachael Ford
- Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
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Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ 2017; 357:j1341. [PMID: 28389435 PMCID: PMC6284210 DOI: 10.1136/bmj.j1341] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 01/23/2023]
Abstract
Objective To determine if a simple stimulation method increases the rate of infant voiding for clean catch urine within five minutes.Design Randomised controlled trial.Setting Emergency department of a tertiary paediatric hospital, Australia.Participants 354 infants (aged 1-12 months) requiring urine sample collection as determined by the treating clinician. 10 infants were subsequently excluded.Interventions Infants were randomised to either gentle suprapubic cutaneous stimulation (n=174) using gauze soaked in cold fluid (the Quick-Wee method) or standard clean catch urine with no additional stimulation (n=170), for five minutes.Main outcome measures The primary outcome was voiding of urine within five minutes. Secondary outcomes were successful collection of a urine sample, contamination rate, and parental and clinician satisfaction with the method.Results The Quick-Wee method resulted in a significantly higher rate of voiding within five minutes compared with standard clean catch urine (31% v 12%, P<0.001), difference in proportions 19% favouring Quick-Wee (95% confidence interval for difference 11% to 28%). Quick-Wee had a higher rate of successful urine sample collection (30% v 9%, P<0.001) and greater parental and clinician satisfaction (median 2 v 3 on a 5 point Likert scale, P<0.001). The difference in contamination between Quick-Wee and standard clean catch urine was not significant (27% v 45%, P=0.29). The number needed to treat was 4.7 (95% confidence interval 3.4 to 7.7) to successfully collect one additional urine sample within five minutes using Quick-Wee compared with standard clean catch urine.Conclusions Quick-Wee is a simple cutaneous stimulation method that significantly increases the five minute voiding and success rate of clean catch urine collection.Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000754549.
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Affiliation(s)
- Jonathan Kaufman
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Fitzpatrick
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shidan Tosif
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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20
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Roberts CT, Owen LS, Manley BJ, Frøisland DH, Donath SM, Dalziel KM, Pritchard MA, Cartwright DW, Collins CL, Malhotra A, Davis PG. Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants. N Engl J Med 2016; 375:1142-51. [PMID: 27653564 DOI: 10.1056/nejmoa1603694] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment with nasal high-flow therapy has efficacy similar to that of nasal continuous positive airway pressure (CPAP) when used as postextubation support in neonates. The efficacy of high-flow therapy as the primary means of respiratory support for preterm infants with respiratory distress has not been proved. METHODS In this international, multicenter, randomized, noninferiority trial, we assigned 564 preterm infants (gestational age, ≥28 weeks 0 days) with early respiratory distress who had not received surfactant replacement to treatment with either nasal high-flow therapy or nasal CPAP. The primary outcome was treatment failure within 72 hours after randomization. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the chosen margin of noninferiority was 10 percentage points. Infants in whom high-flow therapy failed could receive rescue CPAP; infants in whom CPAP failed were intubated and mechanically ventilated. RESULTS Trial recruitment stopped early at the recommendation of the independent data and safety monitoring committee because of a significant difference in the primary outcome between treatment groups. Treatment failure occurred in 71 of 278 infants (25.5%) in the high-flow group and in 38 of 286 infants (13.3%) in the CPAP group (risk difference, 12.3 percentage points; 95% confidence interval [CI], 5.8 to 18.7; P<0.001). The rate of intubation within 72 hours did not differ significantly between the high-flow and CPAP groups (15.5% and 11.5%, respectively; risk difference, 3.9 percentage points; 95% CI, -1.7 to 9.6; P=0.17), nor did the rate of adverse events. CONCLUSIONS When used as primary support for preterm infants with respiratory distress, high-flow therapy resulted in a significantly higher rate of treatment failure than did CPAP. (Funded by the National Health and Medical Research Council and others; Australian New Zealand Clinical Trials Registry number, ACTRN12613000303741 .).
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Affiliation(s)
- Calum T Roberts
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Louise S Owen
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Brett J Manley
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Dag H Frøisland
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Susan M Donath
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Kim M Dalziel
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Margo A Pritchard
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - David W Cartwright
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Clare L Collins
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Atul Malhotra
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
| | - Peter G Davis
- From Neonatal Services and Newborn Research Centre, Royal Women's Hospital (C.T.R., L.S.O., B.J.M., D.H.F., P.G.D.), the Departments of Obstetrics and Gynaecology (C.T.R., L.S.O., B.J.M., P.G.D.) and Paediatrics (S.M.D.) and School of Population and Global Health (K.M.D.), University of Melbourne, Critical Care and Neurosciences (L.S.O., P.G.D.) and Clinical Epidemiology and Biostatistics Unit (S.M.D.), Murdoch Children's Research Institute, Neonatal Services, Mercy Hospital for Women (C.L.C.), and Monash Newborn, Monash Children's Hospital, and Department of Paediatrics, Monash University (A.M.), Melbourne, VIC, and the School of Nursing, Midwifery and Paramedicine, Australian Catholic University (M.A.P.), Mater Research Institute (M.A.P.) and the Department of Paediatrics (D.W.C.), University of Queensland, and Women's and Newborn Services, Royal Brisbane and Women's Hospital (D.W.C.), Brisbane, QLD - all in Australia; and the Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway (D.H.F.)
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21
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Lorenz L, Maxfield DA, Dawson JA, Kamlin COF, McGrory L, Thio M, Donath SM, Davis PG. A new suction mask to reduce leak during neonatal resuscitation: a manikin study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F464-7. [PMID: 26847369 DOI: 10.1136/archdischild-2015-309772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/11/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Leak around the face mask is a common problem during neonatal resuscitation. A newly designed face mask using a suction system to enhance contact between the mask and the infant's face might reduce leak and improve neonatal resuscitation. The aim of the study is to determine whether leak is reduced using the suction mask (Resusi-sure mask) compared with a conventional mask (Laerdal Silicone mask) in a manikin model. METHODS Sixty participants from different professional categories (neonatal consultants, fellows, registrars, nurses, midwives and students) used each face mask in a random order to deliver 2 min of positive pressure ventilation to a manikin. Delivered airway pressures were measured using a pressure line. Inspiratory and expiratory flows were measured using a flow sensor, and expiratory tidal volumes and mask leaks were derived from these values. RESULTS A median (IQR) leak of 12.1 (0.6-39.0)% was found with the conventional mask compared with 0.7 (0.2-4.6)% using the suction mask (p=0.002). 50% of the participants preferred to use the suction mask and 38% preferred to use the conventional mask. There was no correlation between leak and operator experience. CONCLUSIONS A new neonatal face mask based on the suction system reduced leak in a manikin model. Clinical studies to test the safety and effectiveness of this mask are needed.
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Affiliation(s)
- Laila Lorenz
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Dominic A Maxfield
- Department of Medicine, University of Newcastle-upon-Tyne, Newcastle, UK
| | - Jennifer A Dawson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - C Omar F Kamlin
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Lorraine McGrory
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia PIPER-Neonatal Transport Service, The Royal Children's Hospital, Melbourne, Australia
| | - Susan M Donath
- Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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22
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Kaufman J, Tosif S, Fitzpatrick P, Hopper SM, Bryant PA, Donath SM, Babl FE. Quick-Wee: a novel non-invasive urine collection method. Emerg Med J 2016; 34:63-64. [PMID: 27565196 DOI: 10.1136/emermed-2016-206000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Clean catch urine (CCU) collection in precontinent children is often time-consuming, with associated collection failure. We hypothesise that stimulating cutaneous reflexes hastens voiding for CCU. METHODS 40 children aged 1-24 months in the ED. Standard CCU was augmented with gentle suprapubic cutaneous stimulation using saline-soaked gauze (Quick-Wee method). RESULTS 12/40 (30%) children voided within 5 min for successful CCU. Parental and clinician satisfaction was high. CONCLUSIONS Quick-Wee appears to be a simple method to speed CCU in young children.
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Affiliation(s)
- Jonathan Kaufman
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Patrick Fitzpatrick
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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23
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Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Bryant PA, Donath SM, Babl FE. The QuickWee trial: protocol for a randomised controlled trial of gentle suprapubic cutaneous stimulation to hasten non-invasive urine collection from infants. BMJ Open 2016; 6:e011357. [PMID: 27515752 PMCID: PMC4985821 DOI: 10.1136/bmjopen-2016-011357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Urinary tract infections (UTIs) are common in young children. Urine sample collection is required to diagnose or exclude UTI; however, current collection methods for pre-continent children all have limitations and guidelines vary. Clean catch urine (CCU) collection is a common and favoured non-invasive collection method, despite its high contamination rates and time-consuming nature. This study aims to establish whether gentle suprapubic cutaneous stimulation with cold fluid-soaked gauze can improve the rate of voiding for CCU within 5 min in young pre-continent children. METHODS AND ANALYSIS This study is a randomised controlled trial of 354 infants (aged 1-12 months) who require urine sample collection, conducted in a single emergency department in a tertiary paediatric hospital in Melbourne, Australia. After standard urogenital cleaning, patients will be randomised to either a novel technique of suprapubic cutaneous stimulation using cold saline-soaked gauze in circular motions or no stimulation. The study period is 5 min, after which care is determined by the treating clinician if a urine sample has not been collected. PRIMARY OUTCOME whether the child voids within 5 min (yes/no). SECONDARY OUTCOMES parental and clinician satisfaction with the method, success in catching a urine sample if the child voids, and sample contamination rates. This trial will allow the definitive assessment of this novel technique, gentle suprapubic cutaneous stimulation with cold saline-soaked gauze, and its utility to hasten non-invasive urine collection in infants. ETHICS AND DISSEMINATION The study has hospital ethics approval and is registered with the Australian New Zealand Clinical Trials Registry-ACTRN12615000754549. The results of the study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12615000754549; Pre-results.
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Affiliation(s)
- Jonathan Kaufman
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Fitzpatrick
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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24
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Cullinane M, Amir LH, Donath SM, Garland SM, Tabrizi SN, Payne MS, Bennett CM. Determinants of mastitis in women in the CASTLE study: a cohort study. BMC Fam Pract 2015; 16:181. [PMID: 26674724 PMCID: PMC4681172 DOI: 10.1186/s12875-015-0396-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/09/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mastitis is an acute, debilitating condition that occurs in approximately 20 % of breastfeeding women who experience a red, painful breast with fever. This paper describes the factors correlated with mastitis and investigates the presence of Staphylococcus aureus in women who participated in the CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study. The CASTLE study was a prospective cohort study which recruited nulliparous women in late pregnancy in two maternity hospitals in Melbourne, Australia in 2009-2011. METHODS Women completed questionnaires at recruitment and six time-points in the first eight weeks postpartum. Postpartum questionnaires asked about incidences of mastitis, nipple damage, milk supply, expressing practices and breastfeeding problems. Nasal and nipple swabs were collected from mothers and babies, as well as breast milk samples. All samples were cultured for S. aureus. "Time at risk" of mastitis was defined as days between birth and first occurrence of mastitis (for women who developed mastitis) and days between birth and the last study time-point (for women who did not develop mastitis). Risk factors for incidence of mastitis occurring during the time at risk (Incident Rate Ratios [IRR]) were investigated using a discrete version of the multivariable proportional hazards regression model. RESULTS Twenty percent (70/346) of participants developed mastitis. Women had an increased risk of developing mastitis if they reported nipple damage (IRR 2.17, 95 % CI 1.21, 3.91), over-supply of breast milk (IRR 2.60, 95 % CI 1.58, 4.29), nipple shield use (IRR 2.93, 95 % CI 1.72, 5.01) or expressing several times a day (IRR 1.64, 95 % CI 1.01, 2.68). The presence of S. aureus on the nipple (IRR 1.72, 95 % CI 1.04, 2.85) or in milk (IRR 1.78, 95 % CI 1.08, 2.92) also increased the risk of developing mastitis. CONCLUSIONS Nipple damage, over-supply of breast milk, use of nipple shields and the presence of S. aureus on the nipple or in breast milk increased the mastitis risk in our prospective cohort study sample. Reducing nipple damage may help reduce maternal breast infections.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, VIC, 3000, Australia.
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, VIC, 3000, Australia.
| | - Susan M Donath
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Paediatrics, The Royal Children's Hospital, Parkville, VIC, 3052, Australia.
| | - Suzanne M Garland
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,Women's Centre for Infectious Diseases, Royal Women's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,Women's Centre for Infectious Diseases, Royal Women's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Matthew S Payne
- School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia.
| | - Catherine M Bennett
- Centre for Population Health Research, Deakin University, Burwood, VIC, 3125, Australia.
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25
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Payne MS, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Amir LH. Detection of Candida spp. in the vagina of a cohort of nulliparous pregnant women by culture and molecular methods: Is there an association between maternal vaginal and infant oral colonisation? Aust N Z J Obstet Gynaecol 2015; 56:179-84. [PMID: 26437337 DOI: 10.1111/ajo.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/31/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Most studies describing vaginal Candida spp. in pregnancy focus on symptomatic vaginitis, rather than asymptomatic colonisation, and solely utilise microbiological culture. The extent to which asymptomatic vaginal carriage may represent a reservoir for infant oral colonisation has been highly debated. MATERIALS AND METHODS This study formed part of the Candida and Staphylococcus Transmission Longitudinal Evaluation (CASTLE) study, in Melbourne, Australia, from 2009 to 2011 and used culture and molecular methods to examine vaginal swabs collected late in the third trimester of pregnancy for Candida spp. Oral swabs from infants were also examined using culture methods. RESULTS Overall, 80 of 356 (22%) women were positive for Candida spp; the majority being Candida albicans (83%). Candida glabrata and other Candida spp. were also identified, but in much lower numbers. Molecular analysis identified numerous positive samples not detected by culture, including 13 cases of C. albicans. In addition, some positive samples only recorded to genus level by culture were accurately identified as either C. albicans or C. glabrata following molecular analyses. Eighteen infants recorded positive Candida spp. cultures, predominantly C. albicans. However, there were only four (25%) mother/infant dyads where C. albicans was detected. CONCLUSIONS This study provides valuable data on asymptomatic colonisation rates of Candida spp. within an asymptomatic population of women late in pregnancy. The utilisation of molecular methods improved the rate of detection and provided a more accurate means for identification of non-albicans Candida spp. The low mother/infant colonisation rate suggests that non-maternal sources are likely involved in determining infant oral colonisation status.
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Affiliation(s)
- Matthew S Payne
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,School of Women's and Infants' Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Meabh Cullinane
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sepehr N Tabrizi
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | | | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
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26
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Cooklin AR, Amir LH, Jarman J, Cullinane M, Donath SM. Maternal Physical Health Symptoms in the First 8 Weeks Postpartum Among Primiparous Australian Women. Birth 2015; 42:254-60. [PMID: 26088503 DOI: 10.1111/birt.12168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Accepted: 02/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND To describe prospectively the extent, onset, and persistence of maternal physical health symptoms (cesarean delivery pain, perineal pain, back pain, constipation, hemorrhoids, urinary incontinence, bowel incontinence, and fatigue) in the first 8 weeks postpartum. METHODS A prospective cohort of 229 primiparous women was recruited antenatally from a public and a private maternity hospital, Melbourne, Australia, between 2009 and 2011. Data were collected by self-report questionnaires at weeks 1, 2, 3, 4, and 8. Main outcome measures were a checklist of maternal health symptoms and a standardized assessment of fatigue symptoms. RESULTS Birth-related pain was common at week 1 (n = 80/88, 91% cesarean delivery pain; n = 92/125, 74% perineal pain), and still present for one in five women who had a cesarean birth (n = 17, 18%) at week 8. Back pain was reported by approximately half the sample at each study interval, with 25 percent (n = 48) reporting a later onset at week 2 or beyond. Fatigue was not relieved between 4 and 8 weeks. CONCLUSIONS Women experience significant morbidity in the early weeks postpartum, the extent of which may have been underestimated in previous research relying on retrospective recall. Findings contribute to the growing body of evidence that supports early identification, treatment, and support for women's physical health problems in the postpartum.
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Affiliation(s)
- Amanda R Cooklin
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Jennifer Jarman
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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27
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Roberts CT, Owen LS, Manley BJ, Donath SM, Davis PG. A multicentre, randomised controlled, non-inferiority trial, comparing high flow therapy with nasal continuous positive airway pressure as primary support for preterm infants with respiratory distress (the HIPSTER trial): study protocol. BMJ Open 2015; 5:e008483. [PMID: 26109120 PMCID: PMC4479999 DOI: 10.1136/bmjopen-2015-008483] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION High flow (HF) therapy is an increasingly popular mode of non-invasive respiratory support for preterm infants. While there is now evidence to support the use of HF to reduce extubation failure, there have been no appropriately designed and powered studies to assess the use of HF as primary respiratory support soon after birth. Our hypothesis is that HF is non-inferior to the standard treatment--nasal continuous positive airway pressure (NCPAP)--as primary respiratory support for preterm infants. METHODS AND ANALYSIS The HIPSTER trial is an unblinded, international, multicentre, randomised, non-inferiority trial. Eligible infants are preterm infants of 28-36(+6) weeks' gestational age (GA) who require primary non-invasive respiratory support for respiratory distress in the first 24 h of life. Infants are randomised to treatment with either HF or NCPAP. The primary outcome is treatment failure within 72 h after randomisation, as determined by objective oxygenation, blood gas, and apnoea criteria, or the need for urgent intubation and mechanical ventilation. Secondary outcomes include the incidence of intubation, pneumothorax, bronchopulmonary dysplasia, nasal trauma, costs associated with hospital care and parental stress. With a specified non-inferiority margin of 10%, using a two-sided 95% CI and 90% power, the study requires 375 infants per group (total 750 infants). ETHICS AND DISSEMINATION Ethical approval has been granted by the relevant human research ethics committees at The Royal Women's Hospital (13/12), The Royal Children's Hospital (33144A), The Mercy Hospital for Women (R13/34), and the South-Eastern Norway Regional Health Authority (2013/1657). The trial is currently recruiting at 9 centres in Australia and Norway. The trial results will be published in peer-reviewed international journals, and presented at national and international conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ID: ACTRN12613000303741.
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Affiliation(s)
- Calum T Roberts
- The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Louise S Owen
- The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Brett J Manley
- The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- The Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
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Dawson JA, Ekström A, Frisk C, Thio M, Roehr CC, Kamlin COF, Donath SM, Davis PG. Assessing the tongue colour of newly born infants may help to predict the need for supplemental oxygen in the delivery room. Acta Paediatr 2015; 104:356-9. [PMID: 25545583 DOI: 10.1111/apa.12914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 06/24/2014] [Revised: 09/17/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
AIM It takes several minutes for infants to become pink after birth. Preductal oxygen saturation (SpO2) measurements are used to guide the delivery of supplemental oxygen to newly born infants, but pulse oximetry is not available in many parts of the world. We explored whether the pinkness of an infant's tongue provided a useful indication that supplemental oxygen was required. METHODS This was a prospective observational study of infants delivered by Caesarean section. Simultaneous recording of SpO2 and visual assessment of whether the tongue was pink or not was made at 1-7 and 10 min after birth. RESULTS The 38 midwives and seven paediatric trainees carried out 271 paired assessments on 68 infants with a mean (SD) birthweight of 3214 (545) grams and gestational age of 38 (2) weeks. When the infant did not have a pink tongue, this predicted SpO2 of <70% with a sensitivity of 26% and a specificity of 96%. CONCLUSION Tongue colour was a specific but insensitive sign that indicated when SpO2 was <70%. When the tongue is pink, it is likely that an infant has an SpO2 of more than 70% and does not require supplemental oxygen.
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Affiliation(s)
- JA Dawson
- The Royal Women's Hospital; Parkville VIC Australia
- The Murdoch Childrens Research Institute; Parkville VIC Australia
- The University of Melbourne; Melbourne VIC Australia
| | - A Ekström
- Linköping University; Linköping Sweden
| | - C Frisk
- Linköping University; Linköping Sweden
| | - M Thio
- The Royal Women's Hospital; Parkville VIC Australia
- The University of Melbourne; Melbourne VIC Australia
- Neonatal Service; Hospital Sant Joan de Deu Barcelona; Barcelona Spain
| | - CC Roehr
- The Royal Women's Hospital; Parkville VIC Australia
- Department of Neonatology; Charité University Medical Centre; Berlin Germany
- The Ritchie Centre; Monash University; Melbourne VIC Australia
| | - COF Kamlin
- The Royal Women's Hospital; Parkville VIC Australia
- The Murdoch Childrens Research Institute; Parkville VIC Australia
- The University of Melbourne; Melbourne VIC Australia
| | - SM Donath
- The Murdoch Childrens Research Institute; Parkville VIC Australia
| | - PG Davis
- The Royal Women's Hospital; Parkville VIC Australia
- The Murdoch Childrens Research Institute; Parkville VIC Australia
- The University of Melbourne; Melbourne VIC Australia
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Abstract
Background: Nipple pain and trauma are frequent complaints of new mothers, and a variety of treatments have been proposed and investigated for efficacy. Numerous studies have examined the efficacy of nipple creams, but there is no published data describing patterns of use in
breastfeeding women.Aim: To describe the use of topical nipple treatments by a cohort of first-time mothers in AustraliaMethods: A cohort of 360 nulliparous women were recruited in Melbourne, Australia, and the question, “In the last week, have you used any creams
or ointments on your nipples?” was included in a questionnaire on breastfeeding practices administered at 6 time points.Results: In the first week after giving birth, 91% (307/336) of women used a topical treatment on their nipples. The most popular treatment was purified
lanolin, with nearly three quarters of women (250/336) reporting its use. At 8 weeks postpartum, 37% (129/345) continued to use topical treatments, and 94% (320/340) of women continued to breastfeed.Conclusion: Widespread use of topical nipple creams is concerning not only because
it may indicate a high rate of nipple pain but also because this is a disruption to the natural environment where the newborn is establishing breastfeeding.
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Forster DA, Jacobs S, Amir LH, Davis P, Walker SP, McEgan K, Opie G, Donath SM, Moorhead AM, Ford R, McNamara C, Aylward A, Gold L. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial. BMJ Open 2014; 4:e006571. [PMID: 25358679 PMCID: PMC4216858 DOI: 10.1136/bmjopen-2014-006571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/02/2014] [Accepted: 10/06/2014] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact. METHODS AND ANALYSIS Women will be recruited from 34 weeks gestation to a multicentre, two arm, unblinded randomised controlled trial. The intervention starts at 36 weeks. Randomisation will be stratified by site, parity and diabetes type. Women allocated to the intervention will be taught expressing and encouraged to hand express twice daily for 10 min and keep an expressing diary. The sample size of 658 (329 per group) will detect a 10% difference in proportion of babies admitted to SCN/NICU (85% power, α 0.05). Data are collected at recruitment (structured questionnaire), after birth (abstracted from medical record blinded to group), and 2 and 12 weeks postpartum (telephone interview). DATA ANALYSIS the intervention group will be compared with the standard care group by intention to treat analysis, and the primary outcome compared using χ(2) and ORs. ETHICS AND DISSEMINATION Research ethics approval will be obtained from participating sites. Results will be published in peer-reviewed journals and presented to clinicians, policymakers and study participants. TRIAL REGISTRATION NUMBER Australian Controlled Trials Register ACTRN12611000217909.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan Jacobs
- Royal Women's Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
| | - Peter Davis
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Kerri McEgan
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gillian Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anita M Moorhead
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rachael Ford
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | | | | | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
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Greaves RF, Zacharin MR, Donath SM, Inder TE, Doyle LW, Hunt RW. Establishment of hormone reference intervals for infants born <30weeks' gestation. Clin Biochem 2014; 47:101-8. [DOI: 10.1016/j.clinbiochem.2014.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
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Neylon OM, O'Connell MA, Donath SM, Cameron FJ. Can integrated technology improve self-care behavior in youth with type 1 diabetes? A randomized crossover trial of automated pump function. J Diabetes Sci Technol 2014; 8:998-1004. [PMID: 25172877 PMCID: PMC4455386 DOI: 10.1177/1932296814539461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Abstract
Automated blood glucose (BG) and insulin pump systems allow wireless transmission of all BG readings to a user's pump. This study aimed to assess whether use of such a system, as compared with a manual BG entry insulin pump, resulted in higher mean daily frequency of BGs recorded after 6 months. A 12-month randomized crossover trial, comprising 2 phases, was conducted. All participants used insulin pump devices with automated vs manual BG entry for 6 months each; order of system use was randomly assigned. Device interactions were assessed from pump and glucometer downloads. Thirty-five participants were enrolled; 9 withdrew during the study. Use of the automated insulin pump system resulted in higher mean daily BG recorded over 6 months of use when compared to a manual BG entry system (5.8 ± 1.7 vs 5.0 ± 1.9; P = .02 [95% confidence interval, 0.14 to 1.58]). Bolus frequency was similar between groups. No HbA1c difference was observed between groups at 6 months (8.0% [64 mmol/l] ± 1.3 automated vs 7.7% [61 mmol/l] ± 0.9 manual; P = .38). Post hoc analysis demonstrated improved ΔHbA1c with automated system use in an adolescent subgroup with suboptimal baseline BG frequency (-0.9% vs + 0.5%; P = .003). Use of an automated glucometer/insulin pump resulted in higher number of BGs recorded over 6 months when compared to an insulin pump with manual BG entry. This may be especially beneficial for adolescent manual system users who enter <5 BGs per day into their pump.
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Affiliation(s)
- Orla M Neylon
- Department of Endocrinology, Murdoch Childrens Research Institute and the Royal Children's Hospital, Parkville, VIC, Australia
| | - Michele A O'Connell
- Department of Endocrinology, Murdoch Childrens Research Institute and the Royal Children's Hospital, Parkville, VIC, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Fergus J Cameron
- Department of Endocrinology, Murdoch Childrens Research Institute and the Royal Children's Hospital, Parkville, VIC, Australia
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Roberts CT, Dawson JA, Alquoka E, Carew PJ, Donath SM, Davis PG, Manley BJ. Are high flow nasal cannulae noisier than bubble CPAP for preterm infants? Arch Dis Child Fetal Neonatal Ed 2014; 99:F291-5. [PMID: 24625433 DOI: 10.1136/archdischild-2013-305033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Noise exposure in the neonatal intensive care unit is believed to be a risk factor for hearing loss in preterm neonates. Continuous positive airway pressure (CPAP) devices exceed recommended noise levels. High flow nasal cannulae (HFNC) are an increasingly popular alternative to CPAP for treating preterm infants, but there are no in vivo studies assessing noise production by HFNC. OBJECTIVE To study whether HFNC are noisier than bubble CPAP (BCPAP) for preterm infants. METHODS An observational study of preterm infants receiving HFNC or BCPAP. Noise levels within the external auditory meatus (EAM) were measured using a microphone probe tube connected to a calibrated digital dosimeter. Noise was measured across a range of frequencies and reported as decibels A-weighted (dBA). RESULTS A total of 21 HFNC and 13 BCPAP noise measurements were performed in 21 infants. HFNC gas flows were 2-5 L/min, and BCPAP gas flows were 6-10 L/min with set pressures of 5-7 cm of water. There was no evidence of a difference in average noise levels measured at the EAM: mean difference (95% CI) of -1.6 (-4.0 to 0.9) dBA for HFNC compared to BCPAP. At low frequency (500 Hz), HFNC was mean (95% CI) 3.0 (0.3 to 5.7) dBA quieter than BCPAP. Noise increased with increasing BCPAP gas flow (p=0.007), but not with increasing set pressure. There was a trend to noise increasing with increasing HFNC gas flows. CONCLUSIONS At the gas flows studied, HFNC are not noisier than BCPAP for preterm infants.
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Roberts CT, Dawson JA, Alquoka E, Carew PJ, Donath SM, Davis PG, Manley BJ. Are high flow nasal cannulae noisier than bubble CPAP for preterm infants? Arch Dis Child Fetal Neonatal Ed 2014. [PMID: 24625433 DOI: 10.1136/archdischild‐2013‐305033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Noise exposure in the neonatal intensive care unit is believed to be a risk factor for hearing loss in preterm neonates. Continuous positive airway pressure (CPAP) devices exceed recommended noise levels. High flow nasal cannulae (HFNC) are an increasingly popular alternative to CPAP for treating preterm infants, but there are no in vivo studies assessing noise production by HFNC. OBJECTIVE To study whether HFNC are noisier than bubble CPAP (BCPAP) for preterm infants. METHODS An observational study of preterm infants receiving HFNC or BCPAP. Noise levels within the external auditory meatus (EAM) were measured using a microphone probe tube connected to a calibrated digital dosimeter. Noise was measured across a range of frequencies and reported as decibels A-weighted (dBA). RESULTS A total of 21 HFNC and 13 BCPAP noise measurements were performed in 21 infants. HFNC gas flows were 2-5 L/min, and BCPAP gas flows were 6-10 L/min with set pressures of 5-7 cm of water. There was no evidence of a difference in average noise levels measured at the EAM: mean difference (95% CI) of -1.6 (-4.0 to 0.9) dBA for HFNC compared to BCPAP. At low frequency (500 Hz), HFNC was mean (95% CI) 3.0 (0.3 to 5.7) dBA quieter than BCPAP. Noise increased with increasing BCPAP gas flow (p=0.007), but not with increasing set pressure. There was a trend to noise increasing with increasing HFNC gas flows. CONCLUSIONS At the gas flows studied, HFNC are not noisier than BCPAP for preterm infants.
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Hodgson JM, Metcalfe SA, Aitken M, Donath SM, Gaff CL, Winship IM, Delatycki MB, Skene LLC, McClaren BJ, Paul JL, Halliday JL. Improving family communication after a new genetic diagnosis: a randomised controlled trial of a genetic counselling intervention. BMC Med Genet 2014; 15:33. [PMID: 24628824 PMCID: PMC3995589 DOI: 10.1186/1471-2350-15-33] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Genetic information given to an individual newly diagnosed with a genetic condition is likely to have important health implications for other family members. The task of communicating with these relatives commonly falls to the newly diagnosed person. Talking to relatives about genetic information can be challenging and is influenced by many factors including family dynamics. Research shows that many relatives remain unaware of relevant genetic information and the possible impact on their own health. This study aims to evaluate whether a specific genetic counselling intervention for people newly diagnosed with a genetic condition, implemented over the telephone on a number of occasions, could increase the number of at-risk relatives who make contact with genetics services after a new genetic diagnosis within a family. METHODS This is a prospective, multi-centre randomised controlled trial being conducted at genetics clinics at five public hospitals in Victoria, Australia. A complex genetic counselling intervention has been developed specifically for this trial. Probands (the first person in a family to present with a diagnosis of a genetic condition) are being recruited and randomised into one of two arms - the telephone genetic counselling intervention arm and the control arm receiving usual care. The number of at-risk relatives for each proband will be estimated from a family pedigree collected at the time of diagnosis. The primary outcome will be measured by comparing the proportion of at-risk relatives in each arm of the trial who make subsequent contact with genetics services. DISCUSSION This study, the first randomised controlled trial of a complex genetic counselling intervention to enhance family communication, will provide evidence about how best to assist probands to communicate important new genetic information to their at-risk relatives. This will inform genetic counselling practice in the context of future genomic testing. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000642381.
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Affiliation(s)
- Jan M Hodgson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Sylvia A Metcalfe
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - MaryAnne Aitken
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Susan M Donath
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Clara L Gaff
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Ingrid M Winship
- Genetic Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Martin B Delatycki
- Bruce LeFroy Centre for Genetic Health Research, MCRI, Melbourne, Australia
- Department of Genetics, Austin Health, Melbourne, Australia
| | - Loane LC Skene
- Melbourne Law School, University of Melbourne, Melbourne, Australia
| | - Belinda J McClaren
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Jean L Paul
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Jane L Halliday
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
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Abstract
BACKGROUND Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage. SUBJECTS AND METHODS A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study. RESULTS After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage. CONCLUSIONS Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.
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Affiliation(s)
- Miranda L Buck
- 1 Mother and Child Health Research, La Trobe University , Melbourne, Victoria, Australia
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Abstract
BACKGROUND The use of high-flow nasal cannulae is an increasingly popular alternative to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, <32 weeks) after extubation. However, data on the efficacy or safety of such cannulae in this population are lacking. METHODS In this multicenter, randomized, noninferiority trial, we assigned 303 very preterm infants to receive treatment with either high-flow nasal cannulae (5 to 6 liters per minute) or nasal CPAP (7 cm of water) after extubation. The primary outcome was treatment failure within 7 days. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the margin of noninferiority was 20 percentage points. Infants in whom treatment with high-flow nasal cannulae failed could be treated with nasal CPAP; infants in whom nasal CPAP failed were reintubated. RESULTS The use of high-flow nasal cannulae was noninferior to the use of nasal CPAP, with treatment failure occurring in 52 of 152 infants (34.2%) in the nasal-cannulae group and in 39 of 151 infants (25.8%) in the CPAP group (risk difference, 8.4 percentage points; 95% confidence interval, -1.9 to 18.7). Almost half the infants in whom treatment with high-flow nasal cannulae failed were successfully treated with CPAP without reintubation. The incidence of nasal trauma was significantly lower in the nasal-cannulae group than in the CPAP group (P=0.01), but there were no significant differences in rates of serious adverse events or other complications. CONCLUSIONS Although the result for the primary outcome was close to the margin of noninferiority, the efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Network number, ACTRN12610000166077.).
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Affiliation(s)
- Brett J Manley
- Newborn Research Centre, Royal Women's Hospital, Melbourne, VIC, Australia.
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Kamlin COF, Schilleman K, Dawson JA, Lopriore E, Donath SM, Schmölzer GM, Walther FJ, Davis PG, Te Pas AB. Mask versus nasal tube for stabilization of preterm infants at birth: a randomized controlled trial. Pediatrics 2013; 132:e381-8. [PMID: 23897918 DOI: 10.1542/peds.2013-0361] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Positive-pressure ventilation (PPV) using a manual ventilation device and a face mask is recommended for compromised newborn infants in the delivery room (DR). Mask ventilation is associated with airway obstruction and leak. A nasal tube is an alternative interface, but its safety and efficacy have not been tested in extremely preterm infants. METHODS An unblinded randomized controlled trial was conducted in Australia, and the Netherlands. Infants were stratified by gestational age (24-25/26-29 weeks) and center. Immediately before birth infants were randomly assigned to receive PPV and/or continuous positive airway pressure with either a nasal tube or a size 00 soft, round silicone mask. Resuscitation protocols were standardized; respiratory support was provided using a T-piece device commencing in room air. Criteria for intubation included need for cardiac compressions, apnea, continuous positive airway pressure >7 cm H2O, and fraction of inspired oxygen >0.4. Primary outcome was endotracheal intubation in the first 24 hours from birth. RESULTS Three hundred sixty-three infants were randomly assigned; the study terminated early on the grounds of futility. Baseline variables were similar between groups. Intubation rates in the first 24 hours were 54% and 55% in the nasal tube and face mask groups, respectively (odds ratio: 0.97; 95% confidence interval: 0.63-1.50). There were no important differences in any of the secondary outcomes within the whole cohort or between the 2 gestational age subgroups. CONCLUSIONS In infants at <30 weeks' gestation receiving PPV in the DR, there were no differences in short-term outcomes using the nasal tube compared with the face mask.
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Affiliation(s)
- C Omar F Kamlin
- Newborn Services, The Royal Women’s Hospital, Melbourne, Australia.
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Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, Payne MS. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open 2013; 3:e002351. [PMID: 23474794 PMCID: PMC3612759 DOI: 10.1136/bmjopen-2012-002351] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 11/15/2012] [Revised: 01/31/2013] [Accepted: 02/08/2013] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate Candida species and Staphylococcus aureus and the development of 'nipple and breast thrush' among breastfeeding women. DESIGN Prospective longitudinal cohort study. SETTING Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community. PARTICIPANTS 360 nulliparous women recruited at ≥36 weeks' gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks. MAIN OUTCOME MEASURES Case definition 'nipple and breast thrush': burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother's nipple or breast milk. RESULTS Women with the case definition of nipple/breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.
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Affiliation(s)
- Lisa H Amir
- Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia
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Kamlin COF, O'Connell LAF, Morley CJ, Dawson JA, Donath SM, O'Donnell CPF, Davis PG. A randomized trial of stylets for intubating newborn infants. Pediatrics 2013; 131:e198-205. [PMID: 23230069 DOI: 10.1542/peds.2012-0802] [Citation(s) in RCA: 22] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Endotracheal intubation of newborn infants is a common and potentially lifesaving procedure but a skill that trainees find difficult. Despite widespread use, no data are available on whether the use of a stylet (introducer) improves success rates. We aimed to determine whether pediatric trainees were more successful at neonatal orotracheal intubation when a stylet was used. METHODS An unblinded randomized controlled trial conducted between July 2006 and January 2009 at a tertiary perinatal center, the Royal Women's Hospital, Melbourne, Australia. Eligible participants were newborn infants in the delivery room or NICU requiring endotracheal intubation for respiratory support. Infants were intubated by pediatric residents or fellows. Infants were randomized to have the procedure performed by using either an endotracheal tube alone or with a stylet. Successful intubation at the first attempt assessed by colorimetric detection of expired carbon dioxide was the primary outcome. RESULTS Three hundred two intubations were performed in 232 infants (residents performed 75%, fellows 25%). Intubation was successful in 57% of the stylet group and 53% of the no stylet group (P = .47); odds ratio 1.18 (95% confidence interval 0.75-1.86). There were no differences in the duration of attempts or in the rate of upper airway trauma between the 2 groups. These results were consistent across subgroups of infants based on birth weight, gestational age, and site of intubation (delivery room or NICU). CONCLUSIONS Using an endotracheal stylet did not significantly improve the success rate of pediatric trainees at neonatal orotracheal intubation.
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Affiliation(s)
- C Omar F Kamlin
- Newborn Services, The Royal Women’s Hospital, Melbourne, Australia.
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Schmölzer GM, Morley CJ, Wong C, Dawson JA, Kamlin COF, Donath SM, Hooper SB, Davis PG. Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. J Pediatr 2012; 160:377-381.e2. [PMID: 22056350 DOI: 10.1016/j.jpeds.2011.09.017] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [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: 05/24/2011] [Revised: 08/01/2011] [Accepted: 09/06/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To investigate whether using a respiratory function monitor (RFM) during mask resuscitation of preterm infants reduces face mask leak and improves tidal volume (V(T)). STUDY DESIGN Infants receiving mask resuscitation were randomized to have the display of an RFM (airway pressure, flow, and V(T) waves) either visible or masked. RESULT Twenty-six infants had the RFM visible, and 23 had the RFM masked. The median mask leak was 37% (IQR, 21%-54%) in the visible RFM group and 54% (IQR, 37%-82%) in the masked RFM group (P = .01). Mask repositioning was done in 19 infants (73%) of the visible group and in 6 infants (26%) of the masked group (P = .001). The median expired V(T) was similar in the 2 groups. Oxygen was provided to 61% of the visible RFM group and 87% of the RFM masked group (P = .044). Continuous positive airway pressure use was greater in the visible RFM group (73% vs 43%; P = .035). Intubation in the delivery room was done in 21% of the visible group and in 57% of the masked group (P = .035). CONCLUSION Using an RFM was associated with significantly less mask leak, more mask adjustments, and a lower rate of excessive V(T).
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Affiliation(s)
- Georg M Schmölzer
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
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Mawson IE, Dawson JA, Donath SM, Davis PG. A comparison of oxygen saturation measurements obtained from a 'blue sensor' with a standard sensor. J Paediatr Child Health 2011; 47:693-7. [PMID: 21449897 DOI: 10.1111/j.1440-1754.2011.02035.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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The study aims to investigate pulse oximetry measurements from a 'blue' pulse oximeter sensor against measurements from a 'standard' pulse oximeter sensor in newly born infants. METHODS Immediately after birth, both sensors were attached to the infant, one to each foot. SpO₂ measurements were recorded simultaneously from each sensor for 10 min. Agreement between pairs of SpO₂ measurements were calculated using Bland-Altman analysis. RESULTS Thirty-one infants were studied. There was good correlation between simultaneous SpO₂ measurements from both sensors (r² = 0.75). However, the mean difference between 'blue' and 'standard' sensors was -1.6%, with wide 95% limits of agreement +18.4 to -21.6%. The range of mean difference between sensors from each infant ranged from -20 to +20. CONCLUSION The mean difference between the blue and standard sensor SpO₂ measurements is not clinically important.
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Amir LH, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Cooklin AR, Fisher JRW, Payne MS. The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol. BMC Pregnancy Childbirth 2011; 11:54. [PMID: 21777483 PMCID: PMC3151214 DOI: 10.1186/1471-2393-11-54] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and "breast thrush" among breastfeeding women. To date, the organism(s) associated with the development of breast thrush have not been identified. The CASTLE study will also investigate the impact of physical health problems and breastfeeding problems on maternal psychological health in the early postpartum period. METHODS/DESIGN The CASTLE study is a longitudinal descriptive study designed to investigate the role of Staphylococcus spp (species) and Candida spp in breast pain and infection among lactating women, and to describe the transmission dynamics of S. aureus and Candida spp between mother and infant. The relationship between breastfeeding and postpartum health problems as well as maternal psychological well-being is also being investigated. A prospective cohort of four hundred nulliparous women who are at least thirty six weeks gestation pregnant are being recruited from two hospitals in Melbourne, Australia (November 2009 to June 2011). At recruitment, nasal, nipple (both breasts) and vaginal swabs are taken and participants complete a questionnaire asking about previous known staphylococcal and candidal infections. Following the birth, participants are followed-up six times: in hospital and then at home weekly until four weeks postpartum. Participants complete a questionnaire at each time points to collect information about breastfeeding problems and postpartum health problems. Nasal and nipple swabs and breast milk samples are collected from the mother. Oral and nasal swabs are collected from the baby. A telephone interview is conducted at eight weeks postpartum to collect information about postpartum health problems and breastfeeding problems, such as mastitis and nipple and breast pain. DISCUSSION This study is the first longitudinal study of the role of both staphylococcal and candidal colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida spp between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.
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Affiliation(s)
- Lisa H Amir
- Mother & Child Health Research, La Trobe University, Melbourne, VIC 3000, Australia
| | - Meabh Cullinane
- Mother & Child Health Research, La Trobe University, Melbourne, VIC 3000, Australia
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, Bio 21 Institute, Parkville, VIC 3052, Australia
- University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC 3052, Australia
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Sepehr N Tabrizi
- Women's Centre for Infectious Diseases, Bio 21 Institute, Parkville, VIC 3052, Australia
- University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC 3052, Australia
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia
- University of Melbourne Department of Paediatrics, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | | | | | - Jane RW Fisher
- Jean Hailes Research Unit, Monash University, Clayton, VIC 3168, Australia
- Centre for Women's Health, Gender and Society, University of Melbourne, Carlton, VIC 3053, Australia
| | - Matthew S Payne
- Mother & Child Health Research, La Trobe University, Melbourne, VIC 3000, Australia
- Women's Centre for Infectious Diseases, Bio 21 Institute, Parkville, VIC 3052, Australia
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Dawson JA, Schmölzer GM, Kamlin COF, Te Pas AB, O'Donnell CPF, Donath SM, Davis PG, Morley CJ. Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial. J Pediatr 2011; 158:912-918.e1-2. [PMID: 21238983 DOI: 10.1016/j.jpeds.2010.12.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [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: 12/11/2009] [Revised: 10/15/2010] [Accepted: 12/02/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV) immediately after birth with a T-piece have higher oxygen saturation (SpO₂) measurements at 5 minutes than infants ventilated with a self inflating bag (SIB). STUDY DESIGN Randomized, controlled trial of T-piece or SIB ventilation in which SpO₂ was recorded immediately after birth from the right hand/wrist with a Masimo Radical pulse oximeter, set at 2-second averaging and maximum sensitivity. All resuscitations started with air. RESULTS Forty-one infants received PPV with a T-piece and 39 infants received PPV with a SIB. At 5 minutes after birth, there was no significant difference between the median (interquartile range) SpO₂ in the T-piece and SIB groups (61% [13% to 72%] versus 55% [42% to 67%]; P = .27). More infants in the T-piece group received oxygen during delivery room resuscitation (41 [100%] versus 35 [90%], P = .04). There was no difference in the groups in the use of continuous positive airway pressure, endotracheal intubation, or administration of surfactant in the delivery room. CONCLUSION There was no significant difference in SpO₂ at 5 minutes after birth in infants < 29 weeks gestation given PPV with a T-piece or a SIB as used in this study.
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Dawson JA, Kamlin COF, Vento M, Wong C, Cole TJ, Donath SM, Davis PG, Morley CJ. Defining the reference range for oxygen saturation for infants after birth. Pediatrics 2010; 125:e1340-7. [PMID: 20439604 DOI: 10.1542/peds.2009-1510] [Citation(s) in RCA: 316] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to define reference ranges for pulse oxygen saturation (Spo(2)) values in the first 10 minutes after birth for infants who received no medical intervention in the delivery room. METHODS Infants were eligible if a member of the research team was available to record Spo(2) immediately after birth. Infants were excluded if they received supplemental oxygen or any type of assisted ventilation. Spo(2) was measured with a sensor applied to the right hand or wrist as soon as possible after birth; data were collected every 2 seconds. RESULTS We studied 468 infants and recorded 61650 Spo(2) data points. The infants had a mean + or - SD gestational age of 38 + or - 4 weeks and birth weight of 2970 + or - 918 g. For all 468 infants, the 3rd, 10th, 50th, 90th, and 97th percentile values at 1 minute were 29%, 39%, 66%, 87%, and 92%, respectively, those at 2 minutes were 34%, 46%, 73%, 91%, and 95%, and those at 5 minutes were 59%, 73%, 89%, 97%, and 98%. It took a median of 7.9 minutes (interquartile range: 5.0-10 minutes) to reach a Spo(2) value of >90%. Spo(2) values for preterm infants increased more slowly than those for term infants. We present percentile charts for all infants, term infants of > or = 37 weeks, preterm infants of 32 to 36 weeks, and extremely preterm infants of <32 weeks. CONCLUSION These data represent reference ranges for Spo(2) in the first 10 minutes after birth for preterm and term infants.
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Affiliation(s)
- Jennifer A Dawson
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
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Dawson JA, Kamlin COF, Wong C, te Pas AB, Vento M, Cole TJ, Donath SM, Hooper SB, Davis PG, Morley CJ. Changes in heart rate in the first minutes after birth. Arch Dis Child Fetal Neonatal Ed 2010; 95:F177-81. [PMID: 20444810 DOI: 10.1136/adc.2009.169102] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [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] [Indexed: 11/04/2022]
Abstract
The normal range of heart rate (HR) in the first minutes after birth has not been defined. Objective To describe the HR changes of healthy newborn infants in the delivery room (DR) detected by pulse oximetry. Study Design All inborn infants were eligible and included if a member of the research team attended the birth. Infants were excluded if they received any form of medical intervention in the DR including supplemental oxygen, or respiratory support. HR was measured using a pulse oximeter (PO) with the sensor applied to the right hand or wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). Results Data from 468 infants with 61 650 data points were included. Infants had a mean (range) gestational age of 38 (25-42) weeks and birth weight 2970 (625-5135) g. At 1 min the median (IQR) HR was 96 (65-127) beats per min (bpm) rising at 2 min and 5 min to 139 (110-166) bpm and 163 (146-175) bpm respectively. In preterm infants, the HR rose more slowly than term infants. Conclusions The median HR was <100 bpm at 1 min after birth. After 2 min it was uncommon to have a HR <100 bpm. In preterm infants and those born by caesarean section the HR rose more slowly than term vaginal births.
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Affiliation(s)
- J A Dawson
- Neonatal Services, Newborn Research, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia.
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Abstract
OBJECTIVE To determine if participation in a randomised controlled trial of different oxygen saturation targets improved compliance with oximeter alarm limit guidelines. DESIGN Eligible infants were born after the commencement of the BOOST II trial. Data on alarm limits were collected on all infants <32 weeks' gestational age or birth weight <1500 g, who were born at The Royal Women's Hospital, Melbourne between February and June 2007, and receiving supplemental oxygen at the time of the audit. The proportions of infants in oxygen with correct alarm limits (upper 94%; lower 85% or 86%) were compared, between those in the BOOST II trial and those who were not, and with an earlier audit. RESULTS Of 100 infants surveyed, 56 had received oxygen (mean gestational age at birth 26.7 weeks, mean birth weight 913 g). Compliance with lower limits was good in both periods, irrespective of post-menstrual age or participation in the trial. Compliance with upper limits improved after trial commencement, but only for infants enrolled in the trial and only whilst they were <36 weeks' post-menstrual age. CONCLUSIONS Starting a clinical trial of oxygen targeting was associated with improved compliance with upper alarm limits for participants receiving supplemental oxygen, but only whilst they were <36 weeks; with little effect outside the trial.
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Affiliation(s)
- Bernice A Mills
- Division of Newborn Services, The Royal Women's Hospital, Melbourne, Australia.
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Snookes SH, Gunn JK, Eldridge BJ, Donath SM, Hunt RW, Galea MP, Shekerdemian L. A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 2010; 125:e818-27. [PMID: 20231182 DOI: 10.1542/peds.2009-1959] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [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] [Indexed: 12/31/2022] Open
Abstract
CONTEXT Brain injury is the most common long-term complication of congenital heart disease requiring surgery during infancy. It is clear that the youngest patients undergoing cardiac surgery, primarily neonates and young infants, are at the greatest risk for brain injury. Developmental anomalies sustained early in life have lifelong repercussions. OBJECTIVE We conducted a systematic review to examine longitudinal studies of cognitive and/or motor outcome after cardiac surgery during early infancy. METHODS Electronic searches were performed in Medline, the Cumulative Index to Nursing and Allied Health Literature (Cinahl), and Embase (1998-2008). The search strategy yielded 327 articles, of which 65 were reviewed. Eight cohorts provided prospective data regarding the cognitive and/or motor outcome of infants who had undergone surgery for congenital heart disease before 6 months of age. Two authors, Ms Snookes and Dr Gunn, independently extracted data and presented results according to 3 subgroups for age of follow-up: early development (1 to <3 years); preschool age (3-5 years); and school age (>5 to 17 years). Weighted analysis was undertaken to pool the results of studies when appropriate. RESULTS All of the identified studies reported results of the Bayley Scales of Infant Development for children younger than the age of 3. Outcome data as reported by the Bayley Scales were combined for infants assessed at 1 year of age, revealing a weighted mean Mental Development Index of 90.3 (95% confidence interval: 88.9-91.6) and Psychomotor Development Index of 78.1 (95% confidence interval: 76.4-79.7). Additional analysis was limited by a lack of data at preschool and school age. CONCLUSIONS With this review we identified a limited number of prospective studies that systematically addressed outcome in patients at the highest risk. These studies consistently revealed cognitive and motor delay in children after cardiac surgery during early infancy. Additional investigation is required to ascertain the consequences of such impairment during later childhood and into adult life.
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Affiliation(s)
- Suzanne H Snookes
- Physiotherapy Department, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
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Abstract
AIM To objectively measure levels of physical activity in children, following treatment for acute lymphoblastic leukaemia (ALL). METHODS Nineteen children who had completed treatment for ALL 6 months-5 years prior to study enrollment wore an accelerometer for 2 weekdays and 2 weekend days. RESULTS The children spent an average of 141 +/- 74 min/day engaged in moderate to vigorous physical activity (MVPA), an amount similar to that previously documented in healthy children. Only three of the 19 subjects averaged less MVPA than the recommended amount (at least 60 min/day). MVPA levels were significantly higher on weekdays than weekend days (P= 0.006). Overall, boys engaged in significantly more MVPA than girls (P= 0.029). MVPA time was negatively correlated with age (r =-0.80) and age at diagnosis (r =-0.87). No trend between MVPA and time off treatment or body mass index was identified. CONCLUSIONS Survivors of childhood ALL appear to be engaging in similar amounts of MVPA as those of the healthy children and are meeting recommended levels of physical activity.
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Affiliation(s)
- John A Heath
- Children's Cancer Centre, Royal Children's Hospital, Australia.
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Heath JA, Clarke NE, Donath SM, McCarthy M, Anderson VA, Wolfe J. Symptoms and suffering at the end of life in children with cancer: an Australian perspective. Med J Aust 2010; 192:71-5. [PMID: 20078405 DOI: 10.5694/j.1326-5377.2010.tb03420.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 05/07/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the symptoms, level of suffering, and care of Australian children with cancer at the end of life. DESIGN, SETTING AND PARTICIPANTS In a study conducted at the Royal Children's Hospital, Melbourne, parents of children who had died of cancer over the period 1996-2004 were interviewed between February 2004 and August 2006. Parents also completed and returned self-report questionnaires. MAIN OUTCOME MEASURES Proportions of children suffering from and treated for various symptoms; proportion of children receiving cancer-directed therapy at the end of life; proportion of children whose treatment of symptoms was successful; location of death. RESULTS Of 193 eligible families, 96 (50%) were interviewed. All interviews were conducted in person, and occurred a mean of 4.5 years (SD, 2.1 years) after the child's death. Eighty-four per cent of parents reported that their child had suffered "a lot" or "a great deal" from at least one symptom in their last month of life--most commonly pain (46%), fatigue (43%) and poor appetite (30%). Children who received cancer-directed therapy during the end-of-life period (47%) suffered from a greater number of symptoms than those who did not receive treatment (P = 0.03), but the severity of symptoms did not differ between these groups. Of the children treated for specific symptoms, treatment was successful in 47% of those with pain, 18% of those with fatigue and 17% of those with poor appetite. Of the 61 families who felt they had time to plan where their child would die, 89% preferred to have their child die at home. The majority of children (61%) died at home. Of those who died in hospital, less than a quarter died in the intensive care unit. CONCLUSIONS Relatively high rates of death at home and low rates of unsuccessful medical interventions suggest a realistic approach at the end of life for Australian children dying of cancer. However, many suffer from unresolved symptoms, and greater attention should be paid to palliative care for these children.
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Affiliation(s)
- John A Heath
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC, Australia.
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