ORCID Profile
0000-0001-7965-4637
Current Organisations
University of Oxford
,
North Bristol NHS Trust
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Publisher: S. Karger AG
Date: 24-11-2017
DOI: 10.1159/000481879
Abstract: b i Background: /i /b Phenobarbitone (PB) is the first-line anti-convulsant for neonatal seizures. The use of peritoneal dialysis (PD) to enhance drug elimination in cases of neonatal PB overdose has not been reported. b i Objective: /i /b To report a case of neonatal severe PB toxicity and review the elimination of PB by PD. b i Methods: /i /b Assessment of PD drug clearance. b i Results: /i /b A neonate with prolonged seizures was administered PB. Encephalopathy and myocardial failure developed, which were initially suspected to be secondary to hypoxia. At 42 h of age, the serum PB concentration was in the toxic range at 131 mg/L. Despite supportive care, the infant's condition deteriorated with escalating inotropes and the need for CPR. Enhanced PB elimination via multiple-dose activated charcoal and exchange transfusion were considered too risky. Hourly PD cycles via Tenckhoff catheter were commenced, based on reports suggesting that PD enhances PB clearance. The clinical state of the infant then improved. PD administration was continued for 60 h, recovering 20% of the estimated total PB body load. The infant survived and there were no PD complications. b i Conclusions: /i /b PD increased PB clearance in this neonate, correlating with clinical recovery. Where other techniques are not possible, PD may have a role to play in enhancing PB elimination.
Publisher: Wiley
Date: 03-06-2013
DOI: 10.1111/JPC.12258
Abstract: Positive end-expiratory pressure (PEEP) valves are used together with self-inflating bags (SIB) to provide a preset PEEP during manual ventilation. It has recently been shown that these valves deliver highly variable levels of PEEP. We hypothesised that material fatigue due to repeated thermo-sterilisation (TS) may contribute to varying reliability of PEEP valves. In a laboratory study 10 new PEEP valves were tested before and after 10, 20 and 30 cycles of routine TS (7 min at 134°C) by using a neonatal lung model (compliance 0.2 mL/kPa). Settings were positive inflation pressure = 20 and 40 cm H(2)O, PEEP = 5 and 10 cm H(2)O, respiratory rate = 40 and 60/min, flow = 8l/min. PEEP was recorded using a respiratory function monitor. Before TS, a mean (standard deviation) PEEP of 4.0 (0.9) and 7.7 (1.0) cm H(2)O was delivered by the 10 valves when the PEEP was set to 5 and 10 cm H(2)O, respectively. One new valve only delivered 2.0 (0.0) and 5.0 (0.0) cm H(2)O when the PEEP was adjusted to 5 and 10 cm H(2)O, respectively. Four of the 10 investigated valves showed significant variations in PEEP (coefficient of variation >10%) throughout the autoclaving process. One valve completely lost its function after the 20th TS. Common defects were tears in the softer materials or displacement of the rubber seal. Six of the 10 valves continued to provide PEEP in spite of repeated TS. The reliability of PEEP valves is affected by repeated TS. Multi-use PEEP valves should be tested for reliable PEEP provision following TS.
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2012
Abstract: Extremely low gestational age neonates are likely to require help with breathing. Strategies to enhance uncomplicated pulmonary transition are critically evaluated in this article. These strategies include antenatal corticosteroid treatment and different respiratory support options immediately after birth. Important techniques for providing early neonatal support include the careful monitoring of the postnatal progression of heart rate and oxygenation in the delivery room, the provision of continuous distending positive airway pressure with avoidance of high tidal volumes, surfactant treatment without intubation, and options for avoiding endotracheal intubation by giving nasal continuous positive airway pressure from birth. We discuss how the less invasive strategies are likely to reduce iatrogenic neonatal lung injury and may indeed help to reduce the incidence of bronchopulmonary dysplasia.
Publisher: Elsevier BV
Date: 10-2015
Publisher: Springer Science and Business Media LLC
Date: 2022
DOI: 10.1038/S41372-021-01274-5
Abstract: Considerable variation in the care of extremely low gestational age infants (ELGAN) contributes to the variation in incidence of bronchopulmonary dysplasia (BPD). We compared management and outcomes of two neonatal centres with different respiratory support strategies. Retrospective cohort study of infants <28 weeks gestational age treated at two units in Australia and the UK between 2015 and 2017. Of 492 infants, the overall incidence of BPD for extremely preterm infants was 62.20% and was similar across both sites (64.84% at Monash vs. 60.65% at Oxford). Independent predictors for the development of BPD or mortality included the days on mechanical ventilation (MV, adjusted OR 1.13, 95% Cl 1.07-1.19) and use of inhaled nitric oxide (adjusted OR 13.42, 95% Cl 1.75-103.28). Primary choice of non-invasive respiratory support had no significant impact on BPD development. Duration of MV and using nitric oxide were independent predictors for death or BPD.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2022
DOI: 10.1038/S41390-022-01988-Y
Abstract: Advances in neonatal care have resulted in improved outcomes for high-risk newborns with technologies playing a significant part although many were developed for the neonatal intensive care unit. The care provided in the delivery room (DR) during the first few minutes of life can impact short- and long-term neonatal outcomes. Increasingly, technologies have a critical role to play in the DR particularly with monitoring and information provision. However, the DR is a unique environment and has major challenges around the period of foetal to neonatal transition that need to be overcome when developing new technologies. This review focuses on current DR technologies as well as those just emerging and further over the horizon. We identify what key opinion leaders in DR care think of current technologies, what the important DR measures are to them, and which technologies might be useful in the future. We link these with key technologies including respiratory function monitors, electoral impedance tomography, videolaryngoscopy, augmented reality, video recording, eye tracking, artificial intelligence, and contactless monitoring. Encouraging funders and industry to address the unique technological challenges of newborn care in the DR will allow the continued improvement of outcomes of high-risk infants from the moment of birth. Technological advances for newborn delivery room care require consideration of the unique environment, the variable patient characteristics, and disease states, as well as human factor challenges. Neonatology as a speciality has embraced technology, allowing its rapid progression and improved outcomes for infants, although innovation in the delivery room often lags behind that in the intensive care unit. Investing in new and emerging technologies can support healthcare providers when optimising care and could improve training, safety, and neonatal outcomes.
Publisher: BMJ
Date: 20-10-2018
DOI: 10.1136/ARCHDISCHILD-2017-312681
Abstract: Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction. We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open. Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung. The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth. Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.
Publisher: Wiley
Date: 04-09-2020
DOI: 10.1002/PPUL.25011
Publisher: BMJ
Date: 02-03-2018
DOI: 10.1136/ARCHDISCHILD-2017-314064
Abstract: In neonatal resuscitation, a ventilation device providing positive end-expiratory pressure (PEEP) is recommended. There is limited information about PEEP delivery in vivo, using different models of self-inflating bag (SIB) at different inflation rates and PEEP settings. We compared PEEP delivery to intubated preterm lambs using four commonly available models of paired SIBs and PEEP valves, with a T-piece, with gas flow of 8 L/min. Peak inspiratory pressure inflations of 30 cmH 2 O, combined with set PEEP of 5, 7 and 10 cmH 2 O, were delivered at rates of 20, 40 and 60/min. These combinations were repeated without gas flow. We measured mean PEEP, maximum and minimum PEEP, and its difference (PEEP reduction). A total of 3288 inflations were analysed. The mean PEEP delivered by all SIBs was lower than set PEEP (P .001), although some differences were .5 cmH 2 O. In 55% of combinations, the presence of gas flow resulted in increased PEEP delivery (range difference 0.3–2 cmH 2 O). The mean PEEP was closer to set PEEP with faster inflation rates and higher set PEEPs. The mean (SD) PEEP reduction was 3.9 (1.6), 8.2 (1.8), 2 (0.6) and 1.1 (0.6) cmH 2 O with the four SIBs, whereas it was 0.5 (0.2) cmH 2 O with the T-piece. PEEP delivery with SIBs depends on the set PEEP, inflation rate, device model and gas flow. At recommended inflation rates of 60/min, some devices can deliver PEEP close to the set level, although the reduction in PEEP makes some SIBs potentially less effective for lung recruitment than a T-piece.
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000444918
Abstract: Mechanical ventilation is a risk factor for cerebral inflammation and brain injury in preterm neonates. The risk increases proportionally with the intensity of treatment. Recent studies have shown that cerebral inflammation and injury can be initiated in the delivery room. At present, initiation of intermittent positive pressure ventilation (IPPV) in the delivery room is one of the least controlled interventions a preterm infant will likely face. Varying pressures and volumes administered shortly after birth are sufficient to trigger pathways of ventilation-induced lung and brain injury. The pathways involved in ventilation-induced brain injury include a complex inflammatory cascade and haemodynamic instability, both of which have an impact on the brain. However, regardless of the strategy employed to deliver IPPV, any ventilation has the potential to have an impact on the immature brain. This is particularly important given that preterm infants are already at a high risk for brain injury simply due to immaturity. This highlights the importance of improving the initial respiratory support in the delivery room. We review the mechanisms of ventilation-induced brain injury and discuss the need for, and the most likely, current therapeutic agents to protect the preterm brain. These include therapies already employed clinically, such as maternal glucocorticoid therapy and allopurinol, as well as other agents, such as erythropoietin, human amnion epithelial cells and melatonin, already showing promise in preclinical studies. Their mechanisms of action are discussed, highlighting their potential for use immediately after birth.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Springer Science and Business Media LLC
Date: 30-12-2021
Publisher: Georg Thieme Verlag KG
Date: 31-05-2011
Abstract: We describe how a Respiratory Function Monitor (RFM) can aid during simulation-based manikin training. We demonstrate how a RFM can provide quantitative and qualitative assessment of the trainee's resuscitation technique. A RFM can assist i) to identify correct mask hold and positioning techniques ii) to assess the delivered airway pressures and adjust the inflating pressures to deliver the appropriate tidal volume.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.RESUSCITATION.2012.11.028
Abstract: Tracheal intubation remains a common procedure during neonatal intensive care. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes. The current gold standard test to confirm tube position is a chest radiograph, however this is often delayed until after ventilation has commenced. Hence, point of care methods to confirm correct tube placement have been developed. The aim of this article is to review the available literature on tube placement in newborn infants. We reviewed books, resuscitation manuals and articles from 1830 to the present with the search terms "Infant, Newborn", "Endotracheal intubation", "Resuscitation", "Clinical signs", "Radiography", "Respiratory Function Tests", "Laryngoscopy", "Ultrasonography", and "Bronchoscopy". Various techniques have been studied to help clinicians assess tube placement. However, despite 85 years of clinical practice, the search for higher success rates and quicker intubation continues. Currently, chest radiography remains the gold standard test to confirm tube position. However, rigorous evaluation of new techniques is required to ensure the safety of newborn infants.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 19-06-2019
DOI: 10.1038/S41390-019-0468-7
Abstract: Most preterm infants breathe at birth, but need additional respiratory support due to immaturity of the lung and respiratory control mechanisms. To avoid lung injury, the focus of respiratory support has shifted from invasive towards non-invasive ventilation. However, applying effective non-invasive ventilation is difficult due to mask leak and airway obstruction. The larynx has been overlooked as one of the causes for obstruction, preventing face mask ventilation from inflating the lung. The larynx remains mostly closed at birth, only opening briefly during a spontaneous breath. Stimulating and supporting spontaneous breathing could enhance the success of non-invasive ventilation by ensuring that the larynx remains open. Maintaining adequate spontaneous breathing and thereby reducing the need for invasive ventilation is not only important directly after birth, but also in the first hours after admission to the NICU. Respiratory distress syndrome is an important cause of respiratory failure. Traditionally, treatment of RDS required intubation and mechanical ventilation to administer exogenous surfactant. However, new ways have been implemented to administer surfactant and preserve spontaneous breathing while maintaining non-invasive support. In this narrative review we aim to describe interventions focused on stimulation and maintenance of spontaneous breathing of preterm infants in the first hours after birth.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
DOI: 10.1161/CIR.0000000000001017
Abstract: The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems head-up cardiopulmonary resuscitation early coronary angiography after return of spontaneous circulation cardiopulmonary resuscitation in the prone patient cord management at birth for preterm and term infants devices for administering positive-pressure ventilation at birth family presence during neonatal resuscitation self-directed, digitally based basic life support education and training in adults and children coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000502212
Abstract: b i Background: /i /b The use of intraosseous (IO) access during resuscitation is widely accepted and promoted in paediatric medicine but features less prominently in neonatal training. Whilst umbilical venous catheterization (UVC) is a reliable method of delivering emergency drugs and fluids, it is not always achievable in a timely manner. IO access warrants exploration as an alternative. b i Aim: /i /b Conduct a systematic review of existing literature to examine the evidence for efficacy and safety of IO devices in neonatal patients, from birth to discharge. b i Method: /i /b A search of PubMed, Ovid, Medline, and Embase was carried out. Abstracts were screened for relevance to focus on neonatal-specific literature and studies which carried out separate analyses for neonates (infants & #x3c days of age or resident on a neonatal unit). b i Results: /i /b One case series and 12 case reports describe IO device insertion into 41 neonates, delivering a variety of drugs, including adrenaline (epinephrine) and volume resuscitation. Complications range from none to severe. Cadaveric studies show that despite a small margin for error, IO devices can be correctly sited in neonates. Simulation studies suggest that IO devices may be faster and easier to site than UVC, even in experienced hands. b i Conclusion: /i /b IO access should be available on neonatal units and considered for early use in neonates where other access routes have failed. Appropriate training should be available to staff in addition to existing life support and UVC training. Further studies are required to assess the optimal device, position, and whether medication can be delivered IO as effectively as by UVC. If IO devices provide a faster method of delivering adrenaline effectively than UVC, this may lead to changes in neonatal resuscitation practice.
Publisher: Elsevier BV
Date: 2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-12-2022
DOI: 10.1161/CIR.0000000000001095
Abstract: This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport approach to resuscitation after drowning passive ventilation minimizing pauses during cardiopulmonary resuscitation temperature management after cardiac arrest use of diagnostic point-of-care ultrasound during cardiac arrest use of vasopressin and corticosteroids during cardiac arrest coronary angiography after cardiac arrest public-access defibrillation devices for children pediatric early warning systems maintaining normal temperature immediately after birth suctioning of amniotic fluid at birth tactile stimulation for resuscitation immediately after birth use of continuous positive airway pressure for respiratory distress at term birth respiratory and heart rate monitoring in the delivery room supraglottic airway use in neonates prearrest prediction of in-hospital cardiac arrest mortality basic life support training for likely rescuers of high-risk populations effect of resuscitation team training blended learning for life support training training and recertification for resuscitation instructors and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
Publisher: BMJ
Date: 28-06-2011
Abstract: Early continuous positive airway pressure (CPAP) may reduce lung injury in preterm infants. Spontaneously breathing preterm infants were randomised immediately after birth to nasal CPAP or intubation, surfactant treatment and mechanical ventilation. Pulmonary function tests approximately 8 weeks post-term determined tidal breathing parameters, respiratory mechanics and functional residual capacity (FRC). Seventeen infants received CPAP and 22 mechanical ventilation. Infants with early CPAP had less mechanical ventilation (4 vs 7.5 days p=0.004) and less total respiratory support (30 vs 47 days p=0.017). Post-term the CPAP group had lower respiratory rate (41 vs 48/min p=0.007), lower minute ventilation (223 vs 265 ml/min/kg p=0.009), better respiratory compliance (0.99 vs 0.82 ml/cm H(2)O/kg p=0.008) and improved elastic work of breathing (p=0.004). No differences in FRC were found. Early CPAP is feasible, shortens the duration of respiratory support and results in improved lung mechanics and decreased work of breathing.
Publisher: Frontiers Media SA
Date: 22-10-2019
Publisher: BMJ
Date: 27-10-2017
DOI: 10.1136/ARCHDISCHILD-2016-310797
Abstract: This review examines devices used during newborn stabilisation. Evidence for their use to optimise the thermal, respiratory and cardiovascular management in the delivery room is presented. Mechanisms of action and rationale of use are described, current developments are presented and areas of future research are highlighted.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.RESUSCITATION.2019.10.016
Abstract: The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
Publisher: European Respiratory Society (ERS)
Date: 2017
DOI: 10.1183/23120541.00127-2016
Abstract: In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
Publisher: American Academy of Pediatrics (AAP)
Date: 2019
Abstract: The International Liaison Committee on Resuscitation prioritized to rigorously review the initial fraction of inspired oxygen (Fio2) during resuscitation of newborns. This systematic review and meta-analysis provides the scientific summary of initial Fio2 in term and late preterm newborns (≥35 weeks’ gestation) who receive respiratory support at birth. Medline, Embase, Evidence Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. Studies were selected by pairs of independent reviewers in 2 stages, with a Cohen’s κ of 0.8 and 1.0. Pairs of independent reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. Five randomized controlled trials (RCTs) and 5 quasi RCTs included 2164 patients. Room air (Fio2 0.21) was associated with a statistically significant benefit in short-term mortality compared with 100% oxygen (Fio2 1.0) (7 RCTs n = 1469 risk ratio [RR] = 0.73 95% confidence interval [CI]: 0.57 to 0.94). No significant differences were observed in neurodevelopmental impairment (2 RCTs n = 360 RR = 1.41 95% CI: 0.77 to 2.60) or hypoxic-ischemic encephalopathy (5 RCTs n = 1315 RR = 0.89 95% CI: 0.68 to 1.18). The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was low for short-term mortality and hypoxic-ischemic encephalopathy and very low for neurodevelopmental impairment. Room air has a 27% relative reduction in short-term mortality compared with Fio2 1.0 for initiating neonatal resuscitation ≥35 weeks’ gestation.
Publisher: BMJ
Date: 30-08-2021
DOI: 10.1136/ARCHDISCHILD-2021-322638
Abstract: Intraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous epinephrine administration during resuscitation of severely asphyxiated lambs at birth. Near-term lambs (139 days’ gestation) were instrumented antenatally for measurement of carotid and pulmonary blood flow and systemic blood pressure. Intrapartum asphyxia was induced by umbilical cord cl ing until asystole. Resuscitation commenced with positive pressure ventilation followed by chest compressions and the lambs received either intraosseous or central intravenous epinephrine (10 μg/kg) epinephrine administration was repeated every 3 min until return of spontaneous circulation (ROSC). The lambs were maintained for 30 min after ROSC. Plasma epinephrine levels were measured before cord cl ing, at end asphyxia, and at 3 and 15 min post-ROSC. ROSC was successful in 7 of 9 intraosseous epinephrine lambs and in 10 of 12 intravenous epinephrine lambs. The time and number of epinephrine doses required to achieve ROSC were similar between the groups, as were the achieved plasma epinephrine levels. Lambs in both groups displayed a similar marked overshoot in systemic blood pressure and carotid blood flow after ROSC. Blood gas parameters improved more quickly in the intraosseous lambs in the first 3 min, but were otherwise similar over the 30 min after ROSC. Intraosseous epinephrine administration results in similar outcomes to intravenous epinephrine during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for epinephrine administration in current guidelines.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Frontiers Media SA
Date: 18-07-2022
Abstract: Infants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the in idual patient's disease severity, but an in idualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this in idualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers. An initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts. Eligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this in idually. Infants with mild CDH might benefit from an in idualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this.
Publisher: American Academy of Pediatrics (AAP)
Date: 2019
Abstract: The International Liaison Committee on Resuscitation prioritized to review the initial fraction of inspired oxygen (Fio2) during the resuscitation of preterm newborns. This systematic review and meta-analysis provides the scientific summary of initial Fio2 in preterm newborns (& weeks’ gestation) who receive respiratory support at birth. Medline, Embase, Evidence-Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. Studies were selected by pairs of independent reviewers in 2 stages with a Cohen’s κ of 0.8 and 1.0. Pairs of independent reviewers extracted data, appraised the risk of bias (RoB), and assessed Grading of Recommendations Assessment, Development and Evaluation certainty. Ten randomized controlled studies and 4 cohort studies included 5697 patients. There are no statistically significant benefits of or harms from starting with lower compared with higher Fio2 in short-term mortality (n = 968 risk ratio = 0.83 [95% confidence interval 0.50 to 1.37]), long-term mortality, neurodevelopmental impairment, or other key preterm morbidities. A sensitivity analysis in which 1 study with a high RoB was excluded failed to reveal a reduction in mortality with initial low Fio2 (n = 681 risk ratio = 0.63 [95% confidence interval 0.38 to 1.03]). The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low for all outcomes due to RoB, inconsistency, and imprecision. The ideal initial Fio2 for preterm newborns is still unknown, although the majority of newborns ≤32 weeks’ gestation will require oxygen supplementation.
Publisher: Elsevier BV
Date: 05-2023
Publisher: S. Karger AG
Date: 2012
DOI: 10.1159/000341754
Abstract: b i Background: /i /b High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) in a variety of clinical situations, including post-extubation support, primary therapy from birth and ‘weaning’ from NCPAP. b i Objectives: /i /b To present and discuss the available evidence for the use of HFNC in the preterm population. b i Methods: /i /b An internet-based literature search for relevant, original research articles (both randomised studies and not) on the use of HFNC in preterm infants was undertaken. b i Results: /i /b A total of 19 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size and varies according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but probably only at flow rates litres/min. The efficacy and safety of HFNC in preterm infants remain to be determined. b i Conclusions: /i /b There is growing evidence of the feasibility of HFNC as an alternative to other forms of non-invasive ventilation in preterm infants. However, there remains uncertainty about the efficacy and safety of HFNC in this population. Until the results of larger randomised trials are known, widespread use of HFNC to treat preterm infants cannot be recommended.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 12-2021
Publisher: BMJ
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-12-2019
DOI: 10.1161/CIR.0000000000000734
Abstract: The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
Publisher: Springer Science and Business Media LLC
Date: 31-05-2017
DOI: 10.1038/PR.2017.91
Publisher: Elsevier BV
Date: 06-2015
Publisher: Elsevier BV
Date: 07-2022
Publisher: American Thoracic Society
Date: 08-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2018
Publisher: Springer Science and Business Media LLC
Date: 22-07-2022
DOI: 10.1038/S41390-021-01647-8
Abstract: Preterm infants are commonly supported with 4-8 cm H Preterm rabbits delivered at 29/32 days (~26-28 weeks human) gestation received 0, 5, 8, 12, 15 cm H FRC was lower in the 0 (6.8 (1.0-11.2) mL/kg) and 5 (10.1 (1.1-16.8) mL/kg) compared to the 15 (18.8 (10.9-22.4) mL/kg) cm H In all, 15 cm H Although preterm infants are commonly supported with 4-8 cm H
Publisher: Massachusetts Medical Society
Date: 19-07-2100
Publisher: Wiley
Date: 19-01-2015
DOI: 10.1111/APA.12914
Abstract: 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. 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. 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%. 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.
Publisher: Massachusetts Medical Society
Date: 25-02-2021
Publisher: Georg Thieme Verlag KG
Date: 21-05-2013
Abstract: Effective neonatal cardiopulmonary resuscitation (CPR) requires 3:1 coordinated manual inflations (MI) and chest compressions (CC). We hypothesized that playing a musical prompt would help coordinate CC and MI during CPR. In this pilot trial we studied the effect the "Radetzkymarsch" (110 beats per minute) on neonatal CPR. Thirty-six medical professionals performed CPR on a neonatal manikin. CC and MI were recorded with and without the music played, using a respiratory function monitor and a tally counter. Statistical analysis included Wilcoxon test. Without music, the median (interquartile range) rate of CC was 115 (100 to 129) per minute and the rate of MI was 38 (32 to 42) per minute. When listening to the auditory prompt, the rate of CC decreased significantly to 96 (96 to 100) per minute (p = 0.002) and the rate of MI to 32 (30 to 34) per minute (p = 0.001). The interquartile range of interoperator variability decreased up to 86%. Listening to an auditory prompt improved compliance with the recommended delivery rates of CC and MI during neonatal CPR.
Publisher: American Thoracic Society
Date: 15-07-2018
Publisher: Frontiers Media SA
Date: 10-11-2015
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Charles Christoph Roehr.