ORCID Profile
0000-0001-5388-0214
Current Organisations
University of Cambridge
,
Royal College of Paediatrics and Child Health
,
Royal College of Physicians
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Publisher: BMJ
Date: 09-2008
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2010
Publisher: Elsevier BV
Date: 12-1998
DOI: 10.1016/S0378-3782(98)00050-4
Abstract: This project aimed to assess the accuracy of Tempa-DOT and FeverScan for measuring children's temperatures. Tempa-DOT is a small flat chemical thermometer with 50 dots that change colour at specific temperatures. FeverScan is a liquid crystal strip thermometer with temperature sensitive colour bars that change colour when held against the forehead. Two medical students undertook this study in a hospital in Zambia. They saw most children presented to the hospital over a six-week period and on the children's ward. A mercury thermometer was placed in one axilla, a Tempa-DOT thermometer in the other, and the FeverScan was held on the child's forehead. Data were obtained from 1090 children with a median age of two years. The sensitivity of FeverScan to correctly identify febrile children was 89% and the positive predictive value to detect a fever was 57%. The sensitivity of Tempa-DOT to correctly identify febrile children was 92% and the positive predictive value for detecting febrile children was 86%. Tempa-DOT has a much better predictive value than FeverScan for detecting fever.
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: Springer Science and Business Media LLC
Date: 11-2021
Publisher: Elsevier
Date: 2012
Publisher: S. Karger AG
Date: 2015
DOI: 10.1159/000376567
Abstract: b i Background: /i /b Classifying the severity of bronchopulmonary dysplasia (BPD) by continuous numerical variables would facilitate follow-up of disease progression and quantified analysis of disease determinants. b i Objectives: /i /b To non-invasively measure oxygenation impairment in BPD by the degree of right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and ventilation erfusion (V sub A /sub /Q) inequality and to explore their relation with clinical parameters. b i Methods: /i /b Prospective cohort study of 24 infants with a median (interquartile range, IQR) gestation of 25 weeks (24-27) and a birth weight of 0.70 kg (0.63-0.93), studied at 36 days (30-66), at a postmenstrual age (PMA) of 33 weeks (29-36). Inspired oxygen (F sub I /sub O sub /sub ) was varied to obtain three to five transcutaneous oxygen saturation (SpO sub /sub ) values between 85 and 96%. Values of shunt, shift and V sub A /sub /Q were obtained by plotting the paired data of SpO sub /sub against F sub I /sub O sub /sub for each infant using a unique program. Right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and V sub A /sub /Q were measured in infants born weeks PMA receiving oxygen at 28 days. b i Results: /i /b The median (IQR) shunt was 8% (0.3-16.5), shift 14.5 kPa (10.9-19.4) and V sub A /sub /Q 0.40 (0.30-0.48). Shunt, shift and V sub A /sub /Q were significantly related to gestational age (GA) at birth, PMA at study, weight at study and weight gain per week. b i Conclusions: /i /b Severity of pulmonary oxygenation impairment in BPD can be quantified at the cot-side by non-invasive measurement of shunt, shift and V sub A /sub /Q. Low GA at birth, low weight at birth and at the time of study and impaired weight gain are significantly associated with the severity of oxygen-exchange impairment in infants with BPD.
Publisher: BMJ
Date: 07-1990
DOI: 10.1136/ADC.65.7_SPEC_NO.667
Abstract: Of 235 survivors who had taken part in a randomised trial of artificial surfactant and who were born in Cambridge, follow up information was available for 231 (98%) infants. In 12 cases information came from local doctors all others were assessed at 9 and 18 months (n = 212) or 9 months only (n = 7). There was no difference between those who had been treated with surfactant and control babies in the incidence of neurological impairment, mental impairment, respiratory infections, allergies, or hospital admissions up to 18 months after full term. In those born before 30 weeks' gestation (where surfactant most improves survival) the number of surviving randomised children who were normal was 35 of 61 in the treated group (57%) compared with 25 of 61 in the control group (41%). Improved neonatal survival after prophylactic surfactant treatment is not associated with an increased incidence of neurodevelopmental impairment.
Publisher: Springer Science and Business Media LLC
Date: 07-2011
Publisher: Elsevier
Date: 2006
Publisher: BMJ
Date: 13-10-2006
Publisher: BMJ
Date: 08-1987
DOI: 10.1136/ADC.62.8.825
Abstract: The activity of the right external abdominal oblique muscle, in relation to respiration, in newborn babies from 25 to 34 weeks' gestation was studied, using surface electrodes. Babies without respiratory difficulties showed no activity associated with respiration in these muscles. Grunting babies with respiratory disease showed pronounced activity during expiration. This activity continued when the babies were endotracheally intubated if the babies were ventilated it sometimes disturbed the tidal ventilation delivered by the machines. When the baby expired during a ventilator inflation, so that gas came up the endotracheal tube against the inflating pressure, the abdominal oblique muscles contracted in 98% of the breaths.
Publisher: Wiley
Date: 09-03-2020
DOI: 10.1002/PPUL.24724
Publisher: American Medical Association (AMA)
Date: 08-2011
DOI: 10.1001/ARCHPEDIATRICS.2011.43
Abstract: To determine the effectiveness and safety of moderate whole-body hypothermia in newborns with hypoxic-ischemic encephalopathy born in hospitals with and without newborn intensive care facilities or complicated hypothermia equipment. Multicenter, international, randomized controlled trial. Neonatal intensive care units in Australia, New Zealand, Canada, and the United States (N = 28) from February 2001 through July 2007. Newborns of 35 weeks' gestation or more, with indicators of peripartum hypoxia-ischemia and moderate to severe clinical encephalopathy, randomly allocated to hypothermia (n = 110) or standard care (n = 111). Whole-body hypothermia to 33.5°C for 72 hours or standard care (37°C). Infants who received hypothermia were treated at ambient environmental temperature by turning off the radiant warmer and then applying refrigerated gel packs to maintain rectal temperature at 33°C to 34°C. Death or major sensorineural disability at 2 years of age. Therapeutic hypothermia reduced the risk of death or major sensorineural disability at 2 years of age: 55 of 107 infants (51.4%) in the hypothermia group and 67 of 101 infants (66.3%) in the control group died or had a major sensorineural disability at 2 years (risk ratio, 0.77 [95% confidence interval, 0.62-0.98] P = .03). The mortality rate decreased, and the survival rate free of any sensorineural disability increased. Adverse effects of hypothermia were minimal. Whole-body hypothermia is effective and appears to be safe when commenced within 6 hours of birth at the hospital of birth in term and near-term newborns with hypoxic-ischemic encephalopathy. This simple method of hypothermia could be used within strict protocols with appropriate training on correct diagnosis and application of hypothermia in nontertiary neonatal settings while awaiting retrieval and transport to the regional neonatal intensive care unit. anzctr.org.au Identifier: ACTRN12606000036516.
Publisher: Elsevier BV
Date: 11-1985
Publisher: Springer Science and Business Media LLC
Date: 09-2008
Publisher: Elsevier BV
Date: 1988
DOI: 10.1016/0378-3782(88)90086-2
Abstract: A technique for recording activity in the external abdominal oblique muscles of the human newborn is described. It uses simple, self-adhesive, surface electrodes arranged to reduce electrocardiographic interference. This method is applicable to studies of the respiratory patterns of very pre-term babies undergoing intensive medical care.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.RESUSCITATION.2010.02.018
Abstract: Clinical assessment and end-tidal CO(2) (ETCO(2)) detectors are routinely used to verify correct endotracheal tube (ETT) placement. However, ETCO(2) detectors may mislead clinicians by failing to correctly identify placement of an ETT under a variety of circumstances. A flow sensor measures and displays gas flow in and out of an ETT. We compared endotracheal flow sensor recordings with a colorimetric CO(2)-detector (Pedi-Cap) to detect endotracheal intubation in a preterm sheep model of neonatal resuscitation. Six preterm lambs were intubated and ventilated immediately after delivery. At 5 min the oesophagus was also intubated with a similar tube. The endotracheal tube and oesophageal tubes were attached to a Pedi-Cap and flow sensor in random order. Two observers, blinded to the positions of the tubes, used a ETCO(2) detector and the flow sensor recording to determine whether the tube was in the trachea or oesophagus. The experiment was repeated 10 times for each animal. In the last three animals (30 recordings) the number of inflations required to correctly identify the tube placement was noted. The Pedi-Cap and the flow sensor correctly identified tube placement in all studies. Thus, the sensitivity, specificity, and positive and negative predictive values of both devices were 100%. At least three, and up to 10, inflations were required to identify tube location with the Pedi-Cap compared to one or two inflations with the flow sensor. A flow sensor correctly identifies tube placement within the first two inflations. The Pedi-Cap required more inflations to correctly identify tube placement.
Publisher: Wiley
Date: 18-01-2011
DOI: 10.1111/J.1440-1754.2010.01946.X
Abstract: The Dräger Babylog 8000plus ventilator (Dräger Medical Systems, Lübeck, Germany) can provide both conventional and high-frequency ventilation (HFV). Dräger recommends specific circuits for each of these modes. We investigated the performance of the Babylog ventilator in HFV mode when used with the recommended circuits for both conventional and HFV. The Fisher and Paykel RT235 (conventional Fisher and Paykel Healthcare, Auckland, New Zealand) and Hytrel (HFV Fisher and Paykel Healthcare) circuits were studied using a 50-mL test lung. Tidal volume, high-frequency minute volume and ventilator alarms were compared at 100 combinations of mean airway pressures (10-16 cm H₂O), frequencies (6-14 Hz) and litudes (20-60%). Tidal volume with the two circuits differed by < 5% for tidal volumes ≤ 2.5 mL. Above this, tidal volumes delivered with the HFV circuit were up to 15% more than that obtained with the conventional ventilation circuit, and high-frequency minute volume differed by up to 30%. With the exception of the highest tidal/minute volumes, the tidal volume delivered using the HFV circuit could also be achieved with adjusted frequency or litude when using the conventional circuit. More 'pressure measurement out of range' alarms were noted with the conventional ventilation circuit, particularly at mean airway pressure ≥ 14 cm H₂O and frequency ≤ 10 Hz. The conventional ventilation circuit may allow delivery of adequate tidal volume for some infants. Where requirements are higher, the HFV circuit allows the Babylog to deliver higher tidal volumes and higher minute volume, and reduce alarms.
Publisher: Wiley
Date: 2010
DOI: 10.1111/J.1440-1754.2009.01617.X
Abstract: Background: Self‐inflating bags are used to provide ventilation during neonatal resuscitation. However, they cannot provide positive end expiratory pressure (PEEP) unless a PEEP valve is attached. The ability of Laerdal neonatal self‐inflating bags fitted with PEEP valves to reliably deliver PEEP is unclear. The aim of this study was to measure the delivered PEEP at different set PEEP levels and inflation rates. Methods: We connected disposable and non‐disposable 240 mL Laerdal self‐inflating resuscitation bags fitted with PEEP valves to a leak‐free test lung. We measured PEEP delivered with the valve set at 5, 7 and 10 cm H 2 O whilst inflating the test lung at rates of 20, 40 and 60 min. Studies were done with 8 L/min of gas flow and with no gas flow. Results: The PEEP delivered was close to the set level immediately after inflation but declined rapidly between inflations. The mean PEEP was higher with faster ventilation rates. When PEEP was set at 7 cm H 2 O, using a non‐disposable bag, and an inflation rate of 60/min the mean (SD) PEEP was 5.4 (0.19) cm H 2 O. The PEEP delivered was unrelated to the gas flow into the device. Conclusion: The 240 mL Laerdal self‐inflating bag with a PEEP valve delivers PEEP that loses pressure quickly. The level of PEEP delivered is less than that set, particularly at rates below 40/min.
Publisher: BMJ
Date: 12-2011
Abstract: The International Liaison Committee on Resuscitation recommends starting positive pressure ventilation (PPV) in the delivery room when heart rate (HR) <100 beats per min (bpm) and giving cardiac compressions when HR <60 bpm. To describe the effect of PPV on HR in infants <30 weeks gestation with HR <100 bpm in the first minutes after birth. Retrospective observational study of infants, <30 weeks gestation, born between 14 February 2007 and 28 February 2009 with HR <100 bpm soon after birth. Infants with a HR <100 bpm receiving PPV at birth were eligible for the study. Video recordings and respiratory physiological data were obtained during delivery room resuscitation and analysed to determine if the rate of change in HR varied with measures of PPV, for ex le, expiratory tidal volume. It took a median (IQR) 73 (24-165) seconds of PPV for infants' HR to rise above 100 bpm and a median (IQR) 243 (191-351) seconds to rise above 120 bpm. There were large fluctuations in HR after reaching 100 bpm and before reaching 120 bpm. In 18/27 (67%) of infants the HR did not remain stable until a threshold of approximately 150 bpm was reached. In 6/27 (20%) of the infants the rise in HR was almost instantaneous. In the remaining 21/27 (80%) HR rise was more gradual. There was a poor correlation between time of HR increase to 120 bpm and tidal volume (p=0.13). It takes more than a minute for newly born infants <30 weeks gestation with a HR <100 bpm to achieve a HR above 100 bpm. In these infants HR does not stabilise until it reaches 120 bpm.
Publisher: BMJ
Date: 10-1980
Abstract: Premature newborn rabbits, delivered on day 27 of gestation, were treated with tracheal deposition of dry artificial surfactant containing dipalmitoyl phosphatidylcholine and unsaturated phosphatidylglycerol (7:3), or crude natural surfactant prepared by centrifugation of lung wash from adult rabbits. Before receiving surfactant, the animals were allowed to breathe for 7--27 min they were then subjected to artificial ventilation under standardised conditions. In comparison with littermate controls, both groups of surfactant-treated animals showed statistically significant improvement in lung-compliance 30 and 60 min after onset of ventilation. However, necrosis of bronchiolar epithelium and hyaline membranes was present in nearly all animals, even in those treated with natural surfactant this suggests that in order to prevent epithelial lesions, surfactant should be given as soon as possible and preferably at birth. Our findings confirm earlier observations that treatment with supplementary surfactant has a beneficial effect on lung mechanics in the premature neonate. The fact that this effect can be obtained not only with natural surfactant but also with dry artificial surfactant should increase the possibility of clinical application.
Publisher: BMJ
Date: 18-07-2007
Abstract: Less invasive techniques of respiratory support are increasingly popular. To determine how widespread the use of neonatal nasal intermittent positive airway pressure (NIPPV) has become and describe the range of practice used in NIPPV in England. 95 English Neonatal intensive care units were asked to provide information about NIPPV devices, interfaces, indications, guidelines, use of synchronisation, complications, settings and weaning. 91 (96%) units replied. NIPPV was used by 44/91 (48%) units few complications were seen. 34/44 (77%) used a synchronising device, 35/44 (80%) used NIPPV for "rescuing" babies for whom continuous positive airway pressure failed-59% routinely after extubation and 16% as a first-line treatment. A wide range of pressure and rate settings were used. In England, NIPPV is commonly used, with considerable variability in the techniques applied. The wide range of clinical approaches highlights the paucity of evidence available. More evidence is needed to establish best practice.
Publisher: Springer Science and Business Media LLC
Date: 04-08-2011
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: Wiley
Date: 05-2008
DOI: 10.1111/J.1440-1754.2007.01250.X
Abstract: To determine the accuracy of pulse oximetry measurement of heart rate in the neonatal intensive care unit. Stable preterm infants were monitored with a pulse oximeter and an ECG. The displays of both monitors were captured on video. Heart rate data from both monitors, including measures of signal quality, were extracted and analysed using Bland Altman plots. In 30 infants the mean (SD) difference between heart rate measured by pulse oximetry and electrocardiography was -0.4 (12) beats per minute. Accuracy was maintained when the signal quality or perfusion was low. Pulse oximetry may provide a useful measurement of heart rate in the neonatal intensive care unit. Studies of this technique in the delivery room are indicated.
Publisher: Springer Science and Business Media LLC
Date: 03-1983
DOI: 10.1007/BF00661913
Publisher: American Physiological Society
Date: 10-2005
DOI: 10.1152/JAPPLPHYSIOL.00055.2005
Abstract: In mature lungs, elevated positive end-expiratory pressure (PEEP) reduces pulmonary blood flow (PBF) and increases pulmonary vascular resistance (PVR). However, the effect of PEEP on PBF in preterm infants with immature lungs and a patent ductus arteriosus is unknown. Fetal sheep were catheterized at 124 days of gestation (term ∼147 days), and a flow probe was placed around the left pulmonary artery to measure PBF. At 127 days, lambs were delivered and ventilated from birth with a tidal volume of 5 ml/kg and 4-cmH 2 O PEEP PEEP was changed to 0, 8, and 12 cmH 2 O in random order, returning to 4 cmH 2 O between each change. Increasing PEEP from 4 to 8 cmH 2 O and from 4 to 12 cmH 2 O decreased PBF by 20.5 and 41.0%, respectively, and caused corresponding changes in PVR reducing PEEP from 4 to 0 cmH 2 O did not affect PBF. Despite decreasing PBF, increasing PEEP from 4 to 8 cmH 2 O and 12 cmH 2 O improved oxygenation of lambs. Increasing and decreasing PEEP from 4 cmH 2 O significantly changed the contour of the PBF waveform at a PEEP of 12 cmH 2 O, end-diastolic flow was reduced by 82.8% and retrograde flow was reestablished. Although increasing PEEP improves oxygenation, it adversely affects PBF and PVR shortly after birth, alters the PBF waveform, and reestablishes retrograde flow during diastole.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2013
DOI: 10.1038/PR.2013.48
Abstract: We investigated the effects of positive end-expiratory pressure (PEEP) and tidal volume (VT) on lung aeration, pulmonary mechanics, and the distribution of ventilation immediately after birth using a preterm rabbit model. Sixty preterm rabbits (27 d) received volume-targeted positive pressure ventilation from birth, with one of the 12 combinations of PEEP (0, 5, 8, or 10 cm H2O) and VT (4, 8, or 12 ml/kg). Outcomes included functional residual capacity (FRC), peak inflating pressure (PIP), dynamic compliance (Cd), and distribution of ventilation. Increasing PEEP from 0 to 10 cm H2O increased FRC by 4 ml/kg, increased Cd by 0.2 ml/kg/cm H2O, and reduced PIP by 5 cm H2O. Increasing VT from 4 to 12 ml/kg increased FRC by 2 ml/kg, increased Cd by 0.3 ml/kg/cm H2O, and increased PIP by 4 cmH2O. No effect of VT on FRC occurred at 0 or 5 PEEP, and no effect of PEEP occurred at VT = 4 ml/kg. At 0 PEEP, increasing VT increased the proportion of gas entering the smaller apical regions, whereas at 10 PEEP, increasing VT increased the proportion of gas entering basal regions, from 47% to 63%. Both PEEP and VT have independent, additive effects on FRC, lung mechanics, and the distribution of ventilation during the immediate newborn period.
Publisher: Springer Science and Business Media LLC
Date: 09-2009
Publisher: Elsevier BV
Date: 12-1985
DOI: 10.1016/S0140-6736(85)91586-7
Abstract: Reinforcement learning is ubiquitous. Unlike other forms of learning, it involves the processing of fast yet content-poor feedback information to correct assumptions about the nature of a task or of a set of stimuli. This feedback information is often delivered as generic rewards or punishments, and has little to do with the stimulus features to be learned. How can such low-content feedback lead to such an efficient learning paradigm? Through a review of existing neuro-computational models of reinforcement learning, we suggest that the efficiency of this type of learning resides in the dynamic and synergistic cooperation of brain systems that use different levels of computations. The implementation of reward signals at the synaptic, cellular, network and system levels give the organism the necessary robustness, adaptability and processing speed required for evolutionary and behavioral success.
Publisher: Jornal de Pediatria
Date: 12-12-2011
DOI: 10.2223/JPED.2146
Publisher: Springer Science and Business Media LLC
Date: 03-2010
Publisher: Elsevier BV
Date: 08-2021
Publisher: BMJ
Date: 07-06-2005
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.JPEDS.2006.05.040
Abstract: To assess interobserver variability of Apgar scores assigned with video recordings of neonatal resuscitation (AS(video)) and compare the scores assigned by observers of videos to the Apgar score given by staff attending the delivery (AS(del)). Ten-second clips of 30 newborns taken at 5 minutes were shown to observers. Infants were 23 to 40 weeks' gestation, received varying degrees of resuscitation, and were monitored with pulse oximetry. Forty-two observers (neonatal/obstetric medical/nursing staff) scored infants' respiratory effort, muscle tone, reflex irritability, and color. The value for heart rate was assigned from the oximeter, which was masked in all clips. All 42 AS(video) and the AS(del) were represented graphically for each infant. Interobserver reliability was assessed by use of a variance components model. AS(video) varied widely between observers. Variability was large for all 4 elements of the score observers assigned and was seen irrespective of the infant's level of illness. AS(del) was greater than AS(video) in most cases, on average by 2.4 points. There was no evidence that the level of discrepancy was substantially different between groupings of staff. The Apgar score has poor interobserver reliability. More objective and precise measures of newborns' condition are required.
Publisher: Elsevier BV
Date: 11-1983
DOI: 10.1016/S0022-3476(83)80483-1
Abstract: During a four-month period, all babies who received mechanical ventilation in the Neonatal Intensive Care Unit were studied to determine the effects of artificial ventilation on spontaneous respiratory activity. The babies were either totally apneic or ventilator inflation stimulated one of four distinct spontaneous respiratory patterns: synchronous breathing, Hering-Breuer reflex, augmented inspiration, or active expiration against ventilator inflation. The particular interaction evoked was dependent on the frequency of ventilation and the clinical condition of the baby. Only one pattern, active expiration against ventilator inflation, was consistently recorded before the development of pneumothorax. Preliminary evidence indicates that immediate paralysis of the baby as soon as that pattern is demonstrated may prevent the occurrence of pneumothoraces.
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.JPEDS.2010.01.007
Abstract: We reviewed videos of 61 extremely preterm infants taken immediately after birth. The majority cried (69%) and breathed (80%) without intervention. Most preterm infants are not apneic at birth.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/SH10067
Abstract: Background: The aim of this study was to follow a cohort of HIV-positive in iduals for 3 years in order to assess changes in depression, adherence, unsafe sex and emotional strains from living with HIV. Methods: Participants were assessed for depression, adherence, emotional strain and unsafe sex via a questionnaire. The Beck Depression Inventory II (BDI) was used to assess the prevalence and severity of depressive symptoms. Patients with a BDI score of 20 or above (moderate to major depression) were offered a clinical evaluation by a consultant psychiatrist. Results: In 2005, 205 HIV-positive in iduals participated in the study. Symptoms of depression (BDI ) were observed in 77 (38%) and major depression (BDI ≥20) in 53 (26%) in iduals. In 2008, 148 participants were retested (72% of original s le). Depression (BDI ) was observed in 38 (26%) and symptoms of major depression (BDI ≥20) in 24 (16%) in iduals. Patients at risk of moderate to major depression were more likely to be non-adherent to medications, to practice unsafe sex and to suffer from emotional strains compared with patients not at risk of depression, both at baseline (2005) and follow-up (2008). Conclusion: This study demonstrated a decline in depression scores over time and an association between the risk of depression and low medication adherence, stress and unsafe sex. We recommend routine screening for depression to be conducted regularly to provide full evaluations and relevant psychiatric treatment.
Publisher: BMJ
Date: 2005
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.SINY.2010.03.004
Abstract: Pulse oximetry is commonly used to assist clinicians in assessment and management of newly born infants in the delivery room (DR). In many DRs, pulse oximetry is now the standard of care for managing high risk infants, enabling immediate and dynamic assessment of oxygenation and heart rate. However, there is little evidence that using pulse oximetry in the DR improves short and long term outcomes. We review the current literature on using pulse oximetry to measure oxygen saturation and heart rate and how to apply current evidence to management in the DR.
Publisher: BMJ
Date: 11-1989
Abstract: Among 320 low birthweight infants seen at nine months post term those using a soft object, thumb, or fingers as comforter were significantly less likely to wake at night (9/96, 9%) than those with no comforter or using a dummy (66/224, 29%). Dummy users were as likely to wake (27/93, 29%) as those without a comforter (39/131, 30%).
Publisher: Elsevier BV
Date: 11-2003
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.CLP.2005.11.010
Abstract: Despite the large body of information regarding the beneficial effects of continuous positive airway pressure (CPAP) in infants with respiratory distress syndrome (RDS) data are insufficient at this time to support or refute its use during neonatal resuscitation. An in idualized approach to infants with respiratory distress is recommended.
Publisher: Walter de Gruyter GmbH
Date: 1987
DOI: 10.1515/JPME.1987.15.5.469
Abstract: A protein-free artificial surfactant (ALEC) composed of two phospholipids when given as a prophylactic treatment at birth to very premature babies in randomized controlled trials. It was shown to reduce the severity of RDS, the ventilator pressure, the inspired oxygen requirements, the compliance of the respiratory system, the neonatal mortality and the incidence of ventricular hemorrhage. There are no apparent side effects from this treatment.
Publisher: Massachusetts Medical Society
Date: 14-02-2008
DOI: 10.1056/NEJMOA072788
Publisher: BMJ
Date: 09-2005
Publisher: BMJ
Date: 05-2008
Abstract: Positive pressure ventilation (PPV) via a face mask is an important skill taught using manikins. There have been few attempts to assess the effectiveness of different face mask designs. To determine whether leak at the face mask during simulated neonatal resuscitation differed between a new round mask design and the current most widely used model. 50 participants gave PPV to a modified manikin designed to measure leak at the face mask. Leak was calculated from the difference between the inspired and expired tidal volumes. Mask leak varied widely with no significant difference between devices mean (SD) percentage leak for the Laerdal round mask was 55% (31) and with the Fisher & Paykel mask it was 57% (25). We compared a new neonatal face mask with an established design and found no difference in leak. On average the mask leak was >50% irrespective of operator experience or technique.
Publisher: American Academy of Pediatrics (AAP)
Date: 2006
Abstract: OBJECTIVE. Endotracheal intubation of newborn infants is a mandatory competence for many pediatric trainees. The Neonatal Resuscitation Program recommends a 20-second limit for intubation attempts. Intubation attempts by junior doctors are frequently unsuccessful, and many infants are intubated between 20 and 30 seconds without apparent adverse effect. Little is known about the proficiency of more senior medical staff, the time taken to determine endotracheal tube (ETT) position, or the effects of attempted intubation on infants' heart rate (HR) and oxygen saturation (Spo2) in the delivery room (DR). The objectives of this study were to determine (1) the success rates and duration of intubation attempts during DR resuscitation, (2) whether experience is associated with greater success rates and shorter time taken to intubate, (3) the time taken to identify ETT position after intubation, and (4) the frequency with which infants deteriorated during intubation attempts and the time at which this occurred. METHODS. We reviewed videos of DR resuscitations identified whether intubation was attempted and, when attempted, whether intubation was attempted by a resident, a fellow, or a consultant. We defined the duration of an intubation attempt as the time from the introduction of the laryngoscope blade to the mouth to its removal, regardless of whether an ETT was introduced. We determined the time from removal of the laryngoscope to the clinicians' decision as to whether the intubation was successful and noted the basis on which this decision was made (clinical assessment, flow signals, or exhaled carbon dioxide [ETCO2] detection). We determined success according to clinical signs in all cases and used flow signals that were obtained during ventilation via the ETT or ETCO2 when available. When neither was available, the chest radiograph on admission to the NICU was reviewed. For infants who were monitored with pulse oximetry, we determined their HR and Spo2 before the intubation attempt. We then determined whether either or both fell by ≥10% during the attempt and, if so, at what time it occurred. RESULTS. We reviewed 122 video recordings in which orotracheal intubation was attempted 60 times in 31 infants. We secondarily verified ETT position using flow signals, ETCO2, or chest radiographs after 94% of attempts in which an ETT was introduced. Thirty-seven (62%) attempts were successful. Success rates and mean (SD) time to intubate successfully by group were as follows: residents: 24%, 49 seconds (13 seconds) fellows: 78%, 32 seconds (13 seconds) and consultants: 86%, 25 seconds (17 seconds). Of the 23 unsuccessful attempts, 13 were abandoned without an attempt to pass an ETT and 10 were placed incorrectly. The time to determine ETT position in the DR was longer when clinical assessment alone was used. Infants who were monitored with oximetry deteriorated during nearly half of the intubation attempts. Deterioration seemed more likely when HR and Spo2 were low before the attempt. CONCLUSIONS. Intubation attempts often are unsuccessful, and successful attempts frequently take & seconds. Greater experience is associated with greater success rates and shorter duration of successful attempts. Flow signals and ETCO2 may be useful in determining ETT position more quickly than clinical assessment alone. Infants frequently deteriorate during intubation attempts. Improved monitoring of infants who are resuscitated in the DR is desirable.
Publisher: S. Karger AG
Date: 2003
DOI: 10.1159/000071008
Abstract: Neonatal resuscitation is based on experience with little evidence to support the methods advocated. Current guidelines make no distinction between the techniques for term and very premature infants. The guidelines support the use of 100%, cold, dry oxygen delivered with devices that provide variable peak inspiratory pressures and tidal volumes with no positive end-expiratory pressure (PEEP). It is possible that these techniques damage the lungs. Self-inflating resuscitation bags give no indication about leaks, produce variable inflating pressures, do not provide PEEP and cannot deliver prolonged inflations. Flow-inflating bags will not work if there is leak at the facemask and also have variable inflating pressures. Although they can provide PEEP and deliver prolonged inflations, they require considerable skill to use. The Neopuff sup ® /sup is relatively easy to use, provides PEEP and steady inflating pressure and does not achieve the set pressures if there is a mask leak. Continuous positive airway pressure and PEEP are used in the neonatal intensive care unit to maintain lung volume. It is surprising they are not routinely recommended for resuscitation when establishing the lung volume is paramount. Volutrauma is a potential problem in neonatal resuscitation and yet none of the devices give any indication of the tidal volume delivered. There is considerable potential for improvement in techniques of neonatal resuscitation through the application of evidence already available and much scope for further research in this field.
Publisher: S. Karger AG
Date: 2011
DOI: 10.1159/000326080
Abstract: i Background: /i The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume. i Objectives: /i To determine whether volume-targeted neonatal ventilation, compared with PLV, reduces death or BPD. i Methods: /i We performed a systematic review and meta-analysis using the methodology of the Neonatal Review Group of the Cochrane Collaboration. A comprehensive literature search was undertaken, and data for prespecified outcomes were combined where appropriate using the fixed effects model. i Results: /i Nine trials were eligible. Volume-targeted ventilation resulted in a reduction in: the combined outcome of death or BPD [typical relative risk, RR, 0.73 (95% confidence interval, 0.57–0.93), numbers needed to treat, NNT, 8 (95% CI 5–33)], the incidence of pneumothorax [typical RR 0.46 (95% CI 0.25–0.84), NNT 17 (95% CI 10–100)], days of ventilation [weighted mean difference 0.8 days (log-transformed data, p = 0.05)], hypocarbia (pCO sub /sub mm Hg/4.7 kPa) [typical RR 0.56 (95% CI 0.33–0.96), NNT 4 (95% CI 2–25)], and the combined outcome of periventricular leukomalacia or grade 3–4 intraventricular hemorrhage [typical RR 0.48 (95% CI 0.28–0.84), NNT 11 (95% CI 7–50)]. i Conclusions: /i Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
Publisher: Elsevier BV
Date: 07-1987
DOI: 10.1016/0378-3782(87)90077-6
Abstract: Twenty preterm infants ventilated for the respiratory distress syndrome were studied on 44 occasions to identify the pattern of interaction between their spontaneous respiratory efforts and the ventilator, using three techniques: (1) an oesophageal balloon and pneumotachograph, (2) impedance respirography and (3) clinical scoring. The information was in agreement on 23 of the occasions. In 7 infants the balloon and pneumotachograph showed active expiration which was not detected by the other methods. Four of these infants sustained a pneumothorax, one after paralysis with pancuronium. This study shows that only a system incorporating an accurate assessment of the baby's own respiratory pattern is able to detect different patterns of interaction. Impedance respirography and clinical observation appear to be unsatisfactory in this context.
Publisher: Elsevier BV
Date: 02-1984
DOI: 10.1016/0378-3782(84)90091-4
Abstract: The stimulating and moderating factors of augmented inspirations provoked by artificial ventilation have been studied in 40 preterm babies on 182 different occasions. Provoked augmented inspirations were demonstrated by recording spontaneous respiratory activity during artificial ventilation by means of an oesophageal balloon and a pneumotachograph. Augmented inspirations were only seen during 18% of the study occasions. The frequency of this reflex was inversely related to the lung compliance as was the ventilator pressure necessary to provoke the augmented inspiration. The inflating volume which stimulated the reflex, when related to body weight, was similar in all the babies. Augmented inspirations were always provoked during the rapid rise in ventilator pressure at the onset of each inflation. Neonates who were recovering from paralysis by pancuronium and others being treated with theophylline both showed an increased frequency of augmented inspirations. It is possible that theophylline could be used to harness this advantageous reflex for the benefit of the ventilated preterm neonate.
Publisher: Springer Science and Business Media LLC
Date: 10-2009
Publisher: Elsevier BV
Date: 11-2006
DOI: 10.1016/J.JPEDS.2005.07.025
Abstract: Application of the sensor to newly born infants before connection to a pulse oximeter increases the reliability and speed with which data are displayed. Data are available in most infants within 90 seconds of birth. Oximetry may be useful in guiding interventions during resuscitation.
Publisher: Public Library of Science (PLoS)
Date: 12-08-2013
Publisher: Springer Science and Business Media LLC
Date: 28-02-2007
DOI: 10.1007/S00134-007-0541-2
Abstract: To describe the pattern and magnitude of lung volume change during open endotracheal tube (ETT) suction in infants receiving high-frequency oscillatory ventilation (HFOV). Prospective observational clinical study. Tertiary neonatal intensive care unit. Seven intubated and muscle-relaxed newborn infants receiving HFOV. Open ETT suction was performed for 6 s at -100 mmHg using a 6-F catheter passed to the ETT tip after disconnection from HFOV. The HFOV was then recommenced at the same settings as prior to ETT suction. Change in lung volume (DeltaV (L)) referenced to baseline lung volume before suction was measured with a calibrated respiratory inductive plethysmography recording from 30 s before until 60 s after ETT suction. In all infants ETT suction resulted in significant loss of lung volume. The mean DeltaV (L) during suctioning was -13 ml/kg (SD 4 ml/kg) (p 0.05, Tukey post-test). Open ETT suction caused a significant but transient loss of lung volume in muscle-relaxed newborn infants receiving HFOV.
Publisher: BMJ
Date: 14-06-2010
Abstract: The aim was to compare resuscitators' estimates of tidal volume (V(T)) and face mask leak with measured values during positive pressure ventilation (PPV) of newborn infants in the delivery room. The authors measured inflating pressures and V(T) delivered using a respiratory function monitor, and calculated face mask leak. After 60 s of PPV, resuscitators were asked to estimate V(T) and face mask leak. These estimates were compared with measurements taken during the previous 30 s. The authors studied 20 infants who received a mean (SD) of 21 (6) inflations during the 30 s. The median (IQR) expired tidal volume (V(Te)) delivered was 8.7 ml/kg (5.3-11.3). V(Te) varied widely during each resuscitation and between resuscitators. Five resuscitators could not estimate V(Te), one overestimated and 14 underestimated their median delivered V(Te). The median (IQR) face mask leak was 29% (16-63%). Leak also varied widely during each resuscitation and between resuscitators. One resuscitator could not estimate mask leak, four overestimated leak and 15 underestimated leak. During face mask ventilation in the delivery room, V(T) and face mask leak were large and variable. The resuscitators were unable to accurately assess their face mask leak or delivered V(T).
Publisher: Elsevier BV
Date: 11-2020
DOI: 10.1016/S0140-6736(83)91522-2
Abstract: Two phase 3 placebo-controlled trials of the CYD-TDV vaccine, evaluated in children aged 2-14 y (CYD14) and 9-16 y (CYD15), demonstrated vaccine efficacy (VE) of 56.5% and 60.8%, respectively, against symptomatic virologically confirmed dengue (VCD). Sieve analyses were conducted to evaluate whether and how VE varied with amino acid sequence features of dengue viruses (DENVs). DENV premembrane/envelope amino acid sequences from VCD endpoint cases were aligned with the vaccine insert sequences, and extensions of the proportional hazards model were applied to assess variation in VE with amino acid mismatch proportion distances from vaccine strains, in idual amino acid residues, and phylogenetic genotypes. In CYD14, VE against VCD of any serotype (DENV-Any) decreased significantly with increasing amino acid distance from the vaccine, whereas in CYD15, VE against DENV-Any was distance-invariant. Restricting to the common age range and amino acid distance range between the trials and accounting for differential VE by serotype, however, showed no evidence of VE variation with distance in either trial. In serotype-specific analyses, VE against DENV4 decreased significantly with increasing amino acid distance from the DENV4 vaccine insert and was significantly greater against residue-matched DENV4 at eight signature positions. These effects were restricted to 2- to 8-y-olds, potentially because greater seropositivity of older children at baseline might facilitate a broader protective immune response. The relevance of an antigenic match between vaccine strains and circulating DENVs was also supported by greater estimated VE against serotypes and genotypes for which the circulating DENVs had shorter amino acid sequence distances from the vaccine.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.RESUSCITATION.2010.11.008
Abstract: Clinical assessment and end-tidal CO(2) (ETCO(2)) detectors are routinely used to verify endotracheal tube (ETT) placement. However, ETCO(2) detectors may mislead clinicians by failing to identify correct placement under a variety of conditions. A flow sensor measures gas flow in and out of an ETT. We reviewed video recordings of neonatal resuscitations to compare a colorimetric CO(2) detector (Pedi-Cap®) with flow sensor recordings for assessing ETT placement. We reviewed recordings of infants <32 weeks gestation born between February 2007 and January 2010. Airway pressures and gas flow were recorded with a respiratory function monitor. Video recording were used (i) to identify infants who were intubated in the delivery room and (ii) to observe colour change of the ETCO(2) detector. Flow sensor recordings were used to confirm whether the tube was in the trachea or not. Of the 210 infants recorded, 44 infants were intubated in the delivery room. Data from 77 intubation attempts were analysed. In 35 intubations of 20 infants both a PediCap® and flow sensor were available for analysis. In 21 (60%) intubations, both methods correctly identified successful ETT placement and in 3 (9%) both indicated the ETT was not in the trachea. In the remaining 11 (31%) intubations the PediCap® failed to change colour despite the flow wave indicating correct ETT placement. Colorimetric CO(2) detectors may mislead clinicians intubating very preterm infants in the delivery room. They may fail to change colour in spite of correct tube placement in up to one third of the cases.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.JPEDS.2013.06.007
Abstract: To determine the proportion of infants who had the tasks recommended in the neonatal resuscitation guidelines performed within 30 and 60 seconds of birth, and the time taken to perform each task. From video recordings in delivery rooms, we determined the time from birth and arrival on a resuscitation table to warm, assess heart rate (HR), attach an oximeter, and provide respiratory support for each infant. We determined the proportion of infants who had these tasks completed by 30 and 60 seconds, and the median time taken to perform each task. We reviewed and analyzed data from 189 infants (median gestational age, 29 weeks [IQR, 27-34 weeks] median birth weight, 1220 g [IQR, 930-2197 g]). Twelve infants (6%) were not on the resuscitation table within 30 seconds of birth. Less than 10% of infants were placed in polyethylene bags or had their HR determined by 30 seconds. By 60 seconds, 48% were in polyethylene bags, 33% had their HR determined, 38% received respiratory support, and 60% had an oximeter attached. The median time taken to perform all tasks was greater than that recommended in the guidelines. Most newborns were not managed within the time frame recommended in resuscitation guidelines. The recommended 30- and 60-second intervals may be too short.
Publisher: BMJ
Date: 21-10-2009
Publisher: American Physical Society (APS)
Date: 31-01-2011
Publisher: S. Karger AG
Date: 2013
DOI: 10.1159/000353363
Abstract: b i Background: /i /b Very preterm infants can be treated with nasal continuous positive airway pressure (CPAP) from birth, but some fail. A rapid test, such as the stable microbubble test (SMT) on gastric aspirate, may identify those who can be managed successfully using CPAP. b i Objective: /i /b To determine if SMT can identify soon after birth, very preterm infants who may be successfully managed on CPAP alone. b i Methods: /i /b Stable microbubbles (diameter µm) were counted in gastric aspirates taken h of age from infants weeks' gestation, who received CPAP from birth. Infants failed CPAP if intubated at h of age. Clinicians were masked to SMT results. A receiver operating characteristic curve was generated to determine the relationship between number of microbubbles/mm sup /sup and subsequent intubation. b i Results: /i /b 68 infants of mean (SD) 28.1 (1.4) weeks' gestation received CPAP in the delivery room at a median (interquartile range) pressure 7 (6-8) cmH sub /sub O and FiO sub /sub 0.25 (0.21-0.3). Gastric aspirates were taken at a median (interquartile range) age of 0.5 (0.3-0.6) hours. The best cut-off point for predicting CPAP success or failure was a SMT count of 8 microbubbles/mm sup /sup . The area under the receiver operating characteristic curve was 0.8 (95% CI 0.7-0.9). A SMT count ≥8 microbubbles/mm sup /sup had a sensitivity of 53%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 60% for predicting CPAP success. b i Conclusion: /i /b Infants treated with CPAP from birth, who had b /b SMT counts ≥8 microbubbles/mm sup /sup on their gastric aspirate, did not fail CPAP.
Publisher: Wiley
Date: 08-2008
DOI: 10.1111/J.1651-2227.2008.00867.X
Abstract: To determine if selective intubation, use of early nasal continuous positive airway pressure (NCPAP) at birth with a low threshold for early surfactant treatment, reduces the need for intubation in very preterm infants in the first days after birth. Two cohorts of very preterm infants or = 0.40 was used as criterion for intubation. Primary outcome measure was intubation < 72 h of age. Bronchopulmonary dysplasia (BPD) was a secondary outcome. The rate of intubation in the delivery room (69% vs. 46%, p < 0.001) and within 72 h of age (73% vs. 57%, p < 0.001) was lower following the change in policy. Early NCPAP was, in 2003-2004, increasingly used as primary treatment (10% vs. 33%, p < 0.001) with higher maximum NCPAP levels (4.0 (0.9) vs. 5.8 (1.5), p < 0.001). There was no change in BPD (14.3% vs. 15.2%, p = 0.82). Avoiding intubation by using early NCPAP while maintaining a low-threshold for surfactant treatment decreased the need for intubation.
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2006
Publisher: American Physical Society (APS)
Date: 30-03-2009
Publisher: Elsevier BV
Date: 05-2008
Publisher: Elsevier BV
Date: 03-1988
DOI: 10.1016/0378-3782(88)90095-3
Abstract: The lung surfactant phospholipid composition of lavage s les from 102 babies dying from Sudden Infant Death Syndrome (SIDS) (one-third with minor signs of inflammation) was compared with that of: 34 babies dying from Hyaline Membrane Disease (HMD), 15 mature babies dying soon after birth, 16 mature babies dying in the same age range as the sudden infant death syndrome cases, 13 babies dying from pneumonia and 6 from septicaemia. The surfactant of the two groups of babies dying from SIDS was identical and approximated that obtained from babies dying from HMD, pneumonia or septicaemia. Compared to that obtained from mature babies, the surfactant of babies dying from SIDS contained significantly lower proportions of phosphatidylcholine (PC) and significantly higher proportions of lyso-PC and sphingomyelin. The proportion of disaturated PC was similar to that of the surfactant of the age-matched mature babies. The surfactant composition of the babies dying from SIDS did not change appreciably after death nor vary with age at death. The surfactant phospholipid composition of postmortem s les from mature babies was similar to that of aspirates from living babies and infants and to that of bronchoalveolar lavage s les from living adults.
Publisher: BMJ
Date: 18-09-2008
Publisher: BMJ
Date: 07-1984
DOI: 10.1136/ADC.59.7.689
Publisher: American Physical Society (APS)
Date: 29-07-2013
Publisher: Elsevier BV
Date: 2004
Publisher: BMJ
Date: 1990
DOI: 10.1136/ADC.65.1_SPEC_NO.3
Abstract: Treatment of posthaemorrhagic ventricular dilatation by early repeated cerebrospinal fluid taps was compared with conservative management in a randomised controlled trial of 157 infants in 15 centres. Thirty infants died and six moved abroad before follow up. During the first 14 days after randomisation, the early treatment group had five times more taps, and 12 times more cerebrospinal fluid removed. Infection of the cerebrospinal fluid occurred in seven of the early treated and four of the conservatively managed infants. Of survivors, 62% in both groups ultimately had ventricular shunts. Neurodevelopmental assessment of survivors at 12 months was carried out by a single experienced examiner. Of survivors, 103 (85%) had abnormal neuromotor signs and 88 (73%) had disabilities. There was no detectable benefit of early treatment for children who did not have parenchymal lesions at the time they entered the trial. Nearly all those with parenchymal lesions had neuromotor impairment, but early treatment was associated with a significant reduction in other impairments.
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.JPEDS.2008.09.029
Abstract: To describe the interaction of spontaneous breaths, manual ventilation, and tidal volumes (V(T)) during stabilization of infants with congenital diaphragmatic hernia (CDH) in the delivery room. We studied infants with CDH receiving respiratory support at birth. Airway pressure, flow, and volume were measured, and each breath or inflation was analyzed. Each V(T) was classified as a manual inflation, a spontaneous breath, or a spontaneous breath coinciding with manual inflation on the basis of the timing of the pressure and flow waves. Twelve infants had 2957 breaths suitable for analysis, with spontaneous breathing in 11 infants (92%). The mean (+/-SD) proportion of manual inflations was 41% (+/-24%), spontaneous breaths 43% (+/-25%), spontaneous but coinciding with manual inflation 16% (+/-12%). V(T) was significantly different for spontaneous breaths (3.8 +/- 1.9 mL/kg), spontaneous breaths coinciding with manual inflation (4.7 +/- 2.5 mL/kg), and manual inflations alone (2.6 +/- 1.6 mL/kg). Most infants with CDH breathed spontaneously, and manual ventilation was mostly asynchronous. We observed large differences in tidal volumes between spontaneous breaths, manual inflations, or where these coincided, with manual inflations having the lowest V(T). Monitoring the respiratory pattern of these infants could improve respiratory support.
Publisher: BMJ
Date: 09-2005
Publisher: BMJ
Date: 05-2010
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.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.JPEDS.2004.07.034
Abstract: Twenty-six infants with hypoxic-ischemic encephalopathy (HIE) were randomized to normothermia or to systemic hypothermia. The hypothermia group had less cortical gray matter signal abnormality on magnetic resonance imaging (MRI) (1/12 vs 7/14 infants in the normothermic group P = .036), which may indicate differing regional benefit from systemic hypothermia.
Publisher: S. Karger AG
Date: 2011
DOI: 10.1159/000322983
Abstract: i Background: /i Some national resuscitation guidelines advocate using sustained initial inflations (2–3 s) for babies requiring resuscitation. Inflation times ≧10 s have been used for preterm infants. i Objectives: /i This study examines the ability of operators of varying experience to provide a sustained inflation using three different manual ventilation devices. i Methods: /i We compared a self-inflating bag, a flow-inflating bag and a pressure-limited T-piece device. Fifty clinical staff members from five professional groups gave a sustained inflation with a target peak pressure of 30 cm H sub /sub O and target duration of 10 s to an internal leak-free manikin. We measured peak inflating pressure (PIP) and mean inflating pressure (MIP) during the sustained inflation, and the duration of inflating pressure (IP) and 25 cm H sub /sub O. i Results: /i Median (IQR) duration of IP cm H sub /sub O was: self-inflating bag 2.5 s (0.8–5.7), flow-inflating bag 10.6 s (8.4–12.9) and the T-piece 10.7 s (8.9–11.9). There was a weak correlation between experience using a self-inflating bag and longer inflation times (R = 0.290, p = 0.041). When compared with the T-piece, the flow-inflating bag had lower mean MIP (27.0 ± 1.8 vs. 28.8 ± 2.0 cm H sub /sub O) and higher mean PIP (32.3 ± 3.7 vs. 29.8 ± 1.8 cm H sub /sub O). There were no differences in performance between operator groups. i Conclusion: /i The T-piece provided consistent PIP during a single 10 s sustained inflation with less variation in pressure compared with the flow-inflating bag. Sustained inflations s were difficult to achieve with a self-inflating bag.
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2006
Publisher: Springer Science and Business Media LLC
Date: 06-10-2011
DOI: 10.1007/S00134-011-2366-2
Abstract: Reduced mortality for infants born at less than 30 weeks’ gestation after prophylactic surfactant administration has led many to advocate routine intubation and administration of surfactant in all infants at risk of respiratory distress syndrome. However, surfactant administration is associated with adverse events including bradycardia, changes in cerebral blood flow and endotracheal tube obstruction. The aim of this study was to analyse respiratory function immediately before and after surfactant administration in the delivery room. We reviewed video recordings of the initial resuscitation in the delivery room of infants born at less than 32 weeks’ gestation between February 2007 and March 2010. Positive pressure ventilation was delivered with either a Neopuff T-piece or self-inflating bag. Respiratory parameters were recorded with a respiratory function monitor (RFM). Each RFM recording was analysed for 30 s before and 2 min after surfactant administration. Of 230 infants recorded during the study period 16 infants received surfactant in the delivery room. Their mean (standard deviation, SD) gestation and birth weight were 25 (1) weeks and 757 (249) g, respectively. Complete airway obstruction was seen in 4/16 (25%) infants. The median (interquartile range, IQR) duration of this obstruction was 16 (8–27) s. The median (IQR) expired tidal volume before surfactant delivery was 8.0 (5.2–11.2) mL/kg compared to 4.6 (4.1–7.3) mL/kg (p = 0.03) after surfactant administration. Substantial tidal volume changes occur before, during and after surfactant administration in the delivery room. Complete airway obstruction is common. Monitoring respiratory function during this procedure may help to assess the delivered tidal volume and airway pressures after surfactant treatment.
Publisher: BMJ
Date: 2005
Publisher: BMJ
Date: 18-06-2015
DOI: 10.1136/ARCHDISCHILD-2013-305830
Abstract: The SiPAP flow driver (Care Fusion, Dublin, Ohio, USA) offers synchronised nasal intermittent positive pressure ventilation (sNIPPV) using an abdominal capsule. This study aims to describe the accuracy and effects of synchronised NIPPV using SiPAP in preterm infants. Ten infants, born 10% of breaths, resulting in asynchronous NIPPV delivery. Movements resulted in irregular SiPAP pressures and desaturation. When the RR was faster, >55/min, breaths irregularly triggered a SiPAP pressure peak (p=0.003). Compared with times when every breath resulted in a pressure peak, lower mean pressures were achieved, 7.9 vs 8.4 cm H2O (p=0.02). The SiPAP synchronisation system triggered rapidly with most spontaneous breaths, but did not result in larger tidal volumes. When the RR was >55/min, the SiPAP delivered fewer pressure peaks at lower pressures.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2007
DOI: 10.1007/S00134-007-0635-X
Abstract: To compare the effectiveness of open and closed endotracheal suction in recovering thin and thick secretions in normal and injured lungs during conventional and high frequency ventilation. Randomised study in a paediatric intensive care model in the animal research laboratory of a tertiary paediatric hospital. 16 New Zealand White rabbits. Anaesthetised animals were intubated with a 3.5-mm endotracheal tube. Simulated thin and thick secretions (iopamidol 2 ml, a watery radio-opaque fluid, and fluorescent mucin 1 ml) were instilled in turn 1 cm below the tube tip through a catheter placed via a tracheostomy. Open or closed suction, randomly assigned, was applied for 6s at -140 mmHg using a 6-F gauge catheter. Following lung injury with repeated saline lavage the procedure was repeated on conventional and high frequency ventilation. Iopamidol recovery was determined by digitally subtracting the post-contrast and post-suction radiographic images. Mucin recovery was determined by fluorescence assay of the aspirate. In the normal lung similar amounts were recovered by both suction methods. In the lavaged lung closed suction recovered less iopamidol during conventional (22 +/- 7.5%) and high frequency ventilation (11 +/- 2.4%) than open suction (36 +/- 2% and 22 +/- 8.1%, respectively). Mucin recovery was less with closed suction during conventional 32 +/- 28 microl) and high frequency ventilation (30 +/- 31 microl) than with open suction (382 +/- 235 microl and 24 +/- 153 microl). In the injured lung closed suction was less effective than open suction at recovering thin and thick simulated secretions, irrespective of ventilation mode.
Publisher: Wiley
Date: 03-2006
DOI: 10.1111/J.1440-1754.2006.00813.X
Abstract: To determine whether using a respiratory function monitor alters clinicians' choice of ventilator settings, tidal volumes or blood gases in the first 48 h of ventilation. Clinicians were trained to use a respiratory function monitor to optimize neonatal ventilation. Thirty-five infants, weighing < 2 kg, treated with the Infant Star ventilator were randomized to have a respiratory function monitor display visible or concealed. All reasons for altering ventilator settings were noted. Data on ventilator parameters and clinical care were collected hourly. The primary outcome was the mean peak pressure used during the first 48 h. There were no statistically significant differences in peak pressures, tidal volumes or arterial carbon dioxide levels between the two groups. Using the Florian respiratory function monitor in the first 48 h of ventilation with the Infant Star ventilator did not alter the choice of ventilator settings, tidal or minute volumes or arterial blood gases. Possible explanations for this result include lack of power due to the small numbers recruited and bias due to the unblinded nature of the trial.
Publisher: BMJ
Date: 08-08-2007
Abstract: During volume guarantee (VG) ventilation the peak inflating pressure (PIP) for each ventilator inflation is adjusted to ensure the expired tidal volume (V Te ) is close to the set V Te . Differences in the PIP between inflations triggered by the infant’s inspirations and untriggered inflations are seen. To investigate the effects of triggered and untriggered inflations on PIP and V Te . Neonates were ventilated with the Dräger Babylog 8000 using assist control (synchronous intermittent positive pressure ventilation) and VG modes. Continuous recordings of ventilator pressures and tidal volumes were made at 200 Hz for 10 minutes. In 10 infants, 6540 inflations were analysed, of which 4052 (62%) were triggered. Triggered inflations had a significantly lower mean (SD) PIP than untriggered inflations: 12.9 (4.9) vs 17.0 (3.3) cm H 2 O, (p .001). Despite this, there was no significant difference in the V Te of each type of inflation (103% and 101% of the set V Te , respectively). When a triggered inflation was immediately preceded or followed by an untriggered inflation the PIP changed by about 5 cm H 2 O. Between adjacent inflations of the same type, the change in PIP was less than 3 cm H 2 O: for triggered inflations it was 0.11 (1.50) cm H 2 O and for untriggered inflations 0.06 (1.53) cm H 2 O. During VG ventilation with the Dräger Babylog 8000 the PIP was 4 cm H 2 O lower during triggered inflations than untriggered inflations, although the expired tidal volumes were similar.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-10-2010
Publisher: American Thoracic Society
Date: 15-02-2006
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000143394
Abstract: i Background: /i Therapeutic lung lavage is an emerging treatment for meconium aspiration syndrome (MAS), but the ideal fluid volume and lavage technique remain unclear. i Objective: /i To evaluate the impact of suction technique, chest squeeze and aliquot volume on the efficacy of lung lavage in MAS. i Methods: /i MAS was induced in ventilated 2-week-old piglets using 4 ml/kg of 20% human meconium. Lung lavage with either two 8 ml/kg saline aliquots (n = 5) or a single 15 ml/kg aliquot (n = 6) was performed soon after meconium instillation. Lavage fluid was recovered by three methods performed in sequence: closed suction via a suction adaptor open suction with the ventilator disconnected, and open suction with manual vibratory chest squeezing. Return fluid was collected separately with each method. Recovery of meconium and lavage fluid was determined and expressed as a proportion of the amount instilled. i Results: /i Closed suction resulted in poor meconium and fluid returns, with recovery of meconium being only 5.2 ± (SD) 2.5% with 2 × 8 ml/kg lavage and 19 ± 11% with a single 15 ml/kg aliquot. Chest squeeze during suction increased recovery of both meconium and lavage fluid. Overall recovery of instilled meconium was greater with 15 ml/kg lavage (45 ± 17%) than with two 8 ml/kg aliquots (24 ± 4.5%, p = 0.028, repeated-measures ANOVA) the corresponding values for return of lavage fluid were 73 ± 10 and 49 ± 13%, respectively (p 0.01). i Conclusions: /i Open suction, vibratory chest squeezing and an aliquot volume of 15 ml/kg each improve the efficacy of lung lavage in MAS, and merit inclusion in the lavage technique in clinical trials of this therapy.
Publisher: Wiley
Date: 2007
DOI: 10.1111/J.1440-1754.2007.01021.X
Abstract: Abstract: New Australian Neonatal Resuscitation Guidelines highlight the recent advances in neonatal resuscitation. Resuscitation should start with air and only use oxygen if the infant does not respond. CPAP and PEEP should be considered for premature infants with meconium stained liquor. Sucking out the mouth and nose is not necessary. Infants less than 28 weeks gestation should be placed in a polyethylene bag or wrap to keep warm. Chest compressions, when required, remain at 3:1 inflation. The endotracheal tube position must be verified with a carbon dioxide detector.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JPEDS.2010.12.003
Abstract: 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). 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. 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. 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.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2009
Publisher: BMJ
Date: 09-2005
Publisher: Elsevier BV
Date: 12-2008
Publisher: BMJ
Date: 08-1984
DOI: 10.1136/ADC.59.8.798
Publisher: American Academy of Pediatrics (AAP)
Date: 05-2006
Publisher: Springer Science and Business Media LLC
Date: 07-2008
Publisher: BMJ
Date: 05-2005
Publisher: BMJ
Date: 10-06-2010
Publisher: KARGER
Date: 2010
DOI: 10.1159/000322753
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.CLP.2015.08.008
Abstract: Oxygen saturation targeting is widely used in neonatal intensive care, but the optimal target range in very preterm infants has been uncertain and is the subject of recent debate and research. This review briefly discusses the technology of oxygen monitoring and the role of oxygen toxicity in preterm infants. The background to the recent trials of oxygen saturation targeting in acute and continuing care of very preterm infants is reviewed, and the findings and implications of the recent trials, particularly with respect to bronchopulmonary dysplasia, are discussed.
Publisher: Wiley
Date: 23-01-2008
Publisher: American Academy of Pediatrics (AAP)
Date: 12-2001
Publisher: Massachusetts Medical Society
Date: 05-06-2008
DOI: 10.1056/NEJMC080634
Publisher: BMJ
Date: 08-2008
Abstract: To compare change in lung volume (DeltaV(L)), using respiratory inductive plethysmography, time to recover pre-suction lung volume (t(rec)) and the cardiorespiratory disturbances associated with open suction (OS) and closed suction (CS) in ventilated infants. Randomised blinded crossover trial. Neonatal intensive care unit. Thirty neonates, 20 receiving synchronised intermittent mandatory ventilation (SIMV) and 10 high-frequency oscillatory ventilation (HFOV, four receiving muscle relaxant). OS and CS were performed, in random order, on each infant using a 6FG catheter at -19 kPa for 6 seconds and repeated after 1 minute. DeltaV(L), oxygen saturation (Spo(2)) and heart rate were continuously recorded from 2 minutes before until 5 minutes after suction. Lowest values were identified during the 60 seconds after suction. Variations in all measures were seen during CS and OS. During SIMV no differences were found between OS and CS for maximum DeltaV(L) or t(rec) mean (95% CI) difference of 3.5 ml/kg (-2.8 to 9.7) and 4 seconds (-5 to 13), respectively. During HFOV t(rec) was longer during OS by 13 seconds (0 to 27) but there was no difference in the maximum DeltaV(L) of 0.1 mV (-0.02 to 0.22). A small reduction in SpO(2) with CS in the SIMV group mean difference 6% (2.1 to 9.8) was the only significant difference in physiological measurements. Both OS and CS produced transient variable reductions in heart rate and Spo(2). During SIMV there was no difference between OS and CS in DeltaV(L) or t(rec). During HFOV there was no difference in DeltaV(L) but a slightly longer t(rec) after OS.
Publisher: American Physical Society (APS)
Date: 12-06-2006
Publisher: BMJ
Date: 11-2007
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.RESUSCITATION.2006.04.015
Abstract: Heart rate (HR) dictates intervention during neonatal resuscitation. Guidelines recommend that HR be assessed by auscultation or palpation. We compared HRs determined clinically with electrocardiography (ECG) in healthy newborns in the delivery room. Clinical assessment by 23 observers randomly allocated to assess HR by one of two methods in 26 infants, was found to be inaccurate and underestimate ECG HR. The mean difference between HR assessed by auscultation and palpation ECG and HR using methodology recommended by the Neonatal Resuscitation Programme was 14 and 22 beats per minute respectively.
Publisher: BMJ
Date: 06-1987
DOI: 10.1136/ADC.62.6.639
Abstract: The dominant paradigm for the evolution of mutator alleles in bacterial populations is that they spread by indirect selection for linked beneficial mutations when bacteria are poorly adapted. In this paper, we challenge the ubiquity of this paradigm by demonstrating that a clinically important stressor, hydrogen peroxide, generates direct selection for an elevated mutation rate in the pathogenic bacterium Pseudomonas aeruginosa as a consequence of a trade-off between the fidelity of DNA repair and hydrogen peroxide resistance. We demonstrate that the biochemical mechanism underlying this trade-off in the case of mutS is the elevated secretion of catalase by the mutator strain. Our results provide, to our knowledge, the first experimental evidence that direct selection can favour mutator alleles in bacterial populations, and pave the way for future studies to understand how mutation and DNA repair are linked to stress responses and how this affects the evolution of bacterial mutation rates.
Publisher: BMJ
Date: 2005
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.RESUSCITATION.2012.01.036
Abstract: To evaluate compliance with neonatal resuscitation guidelines during resuscitation of preterm infants by video recording of delivery room management and monitoring physiologic parameters. The delivery room management of preterm infants at birth was recorded by an independent researcher. Physiological parameters (airway pressures, gas flow, tidal volume, heart rate and oxygen saturation) were measured, use of supplemental oxygen was noted and a video of the resuscitation was recorded. All signals were digitised and recorded using specially designed software. The delivery room management was then evaluated and compared with the local resuscitation guidelines. Thirty-four infants were included with a mean (SD) gestational age of 30.6 (3.2) weeks and birth weight of 1292 (570) g. Time from birth to initial evaluation was longer than recommended (65 (15) s). Respiratory support was started at 70 (23) s. In 7/34 infants (21%), interventions were performed according to guidelines. In 25/34 infants (74%), one or more respiratory interventions were not performed according to guidelines. In 10/34 infants (29%), one or more non-respiratory interventions (mainly related to the prevention of heat loss) were not performed according to guidelines. The presence and adequacy of spontaneous breathing was difficult to judge clinically. In almost all occasions (96%) the information from the respiratory function monitor was not used. Neonatal caregivers often deviate from resuscitation guidelines. Respiratory function monitoring parameters were often not used during resuscitation. A difficult part of neonatal resuscitation is subjectively assessing spontaneous breathing.
Publisher: BMJ
Date: 09-2008
Abstract: This study investigated whether the use of a respiratory monitor during simulated neonatal resuscitation reduced leak at the face mask. It showed the leak was more than halved, being reduced from 27% to 11% when 25 participants used the monitor to identify and correct the mask leak.
Publisher: Elsevier BV
Date: 08-1992
Publisher: Elsevier BV
Date: 08-1988
DOI: 10.1016/S0022-3476(88)80286-5
Abstract: A technique for detecting the presence of pulmonary surfactant in the tracheal aspirates obtained from preterm babies is described. The specimens were examined by means of polarized light microscopy. Surfactant could be simply and rapidly identified by its appearance as birefringent particles in volumes of aspirate as little as 1 microliter. Tracheal aspirate specimens from 108 babies, obtained on the first day of life, were examined without knowledge of the patient's clinical details. When the s les from each baby were sub ided into three groups on the basis of the amount of surfactant particles seen, this subgrouping corresponded well with the babies' ventilatory requirements at the time of s le collection. This method of detecting surfactant material may prove valuable in determining the degree of surfactant deficiency in in idual preterm babies with respiratory illness.
Publisher: Elsevier BV
Date: 07-1994
Publisher: Springer Science and Business Media LLC
Date: 06-04-2012
DOI: 10.1038/PR.2012.49
Publisher: Wiley
Date: 07-2007
DOI: 10.1111/J.1440-1754.2007.01130.X
Abstract: Aim: To explore the effects of a large volume lung lavage procedure in ventilated infants with meconium aspiration syndrome. Methods: Infants with severe meconium aspiration requiring high‐frequency ventilation underwent lung lavage using dilute bovine surfactant at a phospholipid concentration of 5 mg/mL. Lavage aliquot volumes were increased through the case series, aiming to deliver two aliquots of 15 mL/kg in rapid sequence. Physiological effects of lavage were documented, and comparison was made with a group of infants with meconium aspiration requiring high‐frequency ventilation, in whom lavage was not performed. Results: Nine episodes of lavage were performed in eight infants at a median age of 23 h (range 8–83 h). Three infants underwent a lavage that was defined as potentially therapeutic (total lavage volume of at least 25 mL/kg administered before 24 h of age). Lavage was not associated with bradycardia or hypotension. Recovery of arterial oxygen saturation to above 80% was achieved within 12 min in all but one infant in whom oxygen saturation was below 80% at the outset. Mean airway pressure was significantly lower in the Therapeutic lavage group compared with non‐lavaged infants in the first 48 h, with a trend towards improved oxygenation. Conclusion: Dilute surfactant lavage with aliquots of up to 15 mL/kg appears to be feasible in haemodynamically stable ventilated infants with meconium aspiration syndrome, and its efficacy deserves further investigation in a randomised controlled trial.
Publisher: Elsevier BV
Date: 09-1985
DOI: 10.1016/S0140-6736(85)90583-5
Abstract: Ten infants with rapidly developing and severe episodes of hypoxaemia (15-120 s duration) were studied. In infants over 2 months old most episodes occurred when awake, after a sudden noxious stimulus. In younger infants frequent yet undetected episodes occurred during sleep and feeding. Arterial PO2 fell below 20 mm Hg within 20 s, and loss of consciousness, sometimes with convulsions, occurred after 30 s. Clinical observations, measurements of respiratory movements, air flow, oesophageal pressure, external oblique surface electromyogram, and, in two cases, chest fluoroscopy and microlaryngoscopy documented episodes of no inspiratory flow but continued expiratory activity at low lung volume with partial or complete glottic closure. In five infants, episodes continued despite tracheostomy or an indwelling nasotracheal tube. No intracardiac shunt could be demonstrated and the rapid fall in arterial PO2 was attributed to lack of ventilation at a maximum expiratory position in the presence of a rapid recirculation time. In five infants tested there was a low proportion of phosphatidylcholine in the tracheal aspirate. In one infant audible expiratory braking (grunting) was present for most of the awake time. This previously unrecognised mechanism for severe hypoxaemia may be one cause of neurodevelopmental damage and sudden death in infants and young children.
Publisher: Springer Science and Business Media LLC
Date: 08-2004
Publisher: Elsevier BV
Date: 03-1983
DOI: 10.1016/0378-3782(83)90035-X
Abstract: The respiratory response to therapeutic lung inflation by artificial ventilation in premature babies has been studied. Both the Hering-Breuer and an augmented inspiratory reflex could be provoked by ventilator inflation in neonates as premature as 25 weeks gestational age. No chemo-receptor control was demonstrated on the presence of these reflexes. Augmented inspirations were only seen in the first five postnatal days regardless of gestational age, but the Hering-Breuer reflex persisted throughout the period of study of 11 days. The frequency of elicitation of augmented inspirations was shown to be inversely related to the dynamic compliance. The relative stimulation of these two respiratory reflexes may explain why some infants are easy to ventilate and others difficult.
Publisher: BMJ
Date: 04-02-2009
Abstract: To measure changes in ventilator parameters in preterm infants receiving surfactant during assist control volume guarantee (AC/VG) ventilation. 22 preterm infants (up to 32 weeks' gestation) receiving surfactant for respiratory distress syndrome were enrolled in a prospective study of ventilator parameters during AC/VG ventilation at a tertiary neonatal intensive care unit. Ventilator pressures, flow and tidal volume waveforms were recorded from the Dräger Babylog 8000 plus in real time, and compared to pre-surfactant measurements. Following surfactant administration, 21 of 22 babies experienced completely obstructed endotracheal gas flow. Peak inflation pressure (PIP) increased by a median (IQR) of 8 (4-10) cm H2O, and took 30-60 min to return to baseline. Inspired oxygen concentration was reduced from a median (IQR) of 39% (26%-44%) to 26% (21%-30%) in the first 5 min. The set maximum PIP (Pmax) limited the delivered PIP such that most babies received tidal volumes less than the target value (V(Ttarget)) immediately following surfactant delivery. Four infants, in a subgroup of 11 infants where Pmax was set to less than 10 cm H2O above baseline PIP, were still receiving <90% of V(Ttarget) 20 min post surfactant. When giving surfactant during AC/VG ventilation, complete obstruction is common. PIPs increased and remain elevated for 30-60 min. The Pmax setting may restrict tidal volume delivery.
Publisher: Elsevier BV
Date: 04-1986
DOI: 10.1016/0378-3782(86)90007-1
Abstract: We investigated the effect of increased ventilator rates on the respiratory activity of 17 infants, all actively expiring against the ventilator at conventional rates. Fast rate ventilation was rarely associated with apnoea (3 babies only) and the infant's respiratory efforts even at rates of 120/min had an important effect on tidal exchange. Seven infants altered their respiratory response to breathe in synchrony with the ventilator at 60 breaths/min and 5 maintained this at 120 breaths/min. Nine of the 17 infants continued to actively expire against positive pressure inflation at 60 breaths/min and in two this persisted at 120/min, the remaining 7 infants showed incoordinated breathing at that rate. We conclude that fast rate ventilation appears to have only limited success in suppressing respiratory activity in infants actively expiring against the ventilator.
Publisher: BMJ
Date: 12-1995
DOI: 10.1136/ADC.73.6.496
Abstract: A c aign was launched by the Department of Health late in 1991 to advise mothers how to reduce the risk of cot death. OBJECTIVE--To investigate whether mothers remember receiving this advice, their sources of information, and the advice they were given. SETTING--Questionnaires filled in by mothers of babies born in three maternity units in East Anglia. METHOD--150 mothers of full term babies born throughout 1992 were enrolled. All of them should have received the information. They were sent a questionnaire when their baby was 6 months old. RESULTS--399 (89%) questionnaires were analysable. Sources of information were: television, 72% magazines, 59% midwives, 55% health visitors, 48% and doctors, 11%. 23% said they received no advice from a health professional about reducing the risk of cot death. Doctors, who had all been informed by the Department of Health, were surprisingly poor at passing on the information. Advice on sleeping position was remembered by 72%, overheating by 60%, and smoking by 35%. Problems in following the advice were reported by only 5% of mothers. CONCLUSIONS--The media was most influential in spreading the new advice. Basic infant care advice is not the preserve of doctors.
Publisher: BMJ
Date: 04-1992
DOI: 10.1136/ADC.67.4_SPEC_NO.446
Abstract: Respiratory timing was studied in 100 babies ventilated for respiratory distress syndrome (RDS) during a brief period of continuous positive airway pressure. For the 76 spontaneously breathing babies the mean (SD) inspiratory and expiratory times were 0.31 (0.06) and 0.41 (0.12) seconds. Respiratory rate was predominantly modulated by expiratory time. The severity of RDS was the main influence on expiratory time.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2008
Publisher: BMJ
Date: 11-1982
Abstract: Oesophageal pressure measured with an air-filled, thin latex balloon on a 6 French gauge catheter can accurately measure intraoesophageal pressures in ventilated preterm babies. Intraoesophageal pressures and intrapleural pressures are equivalent. Less than 10% of the applied positive ventilator pressure is transmitted to the oesophageal balloon and the intrapleural catheter (intercostal drain). The oesophageal traces show that ventilated babies breath independently of the ventilator. The largest deflections recorded from the oesophageal trace are from spontaneous inspiratory activity. During paralysis with pancuronium spontaneous respiration is inhibited, peristaltic waves are still recorded, and there is little transmitted pressure from the ventilator to the oesophagus or intercostal drain.
Publisher: BMJ
Date: 12-1986
Abstract: We describe a simple technique of neonatal ventilation that induces the neonate to breathe in synchrony with the ventilator. This preserves the beneficial effects of spontaneous respiration (unlike therapeutic paralysis) and reduces potentially harmful interactions between baby and ventilator. The technique uses measurements of the neonate's own respiratory timing.
Publisher: Elsevier BV
Date: 06-1985
DOI: 10.1016/S0140-6736(85)92816-8
Abstract: The spread of dengue (DEN) worldwide combined with an increased severity of the DEN-associated clinical outcomes have made this mosquito-borne virus of great global public health importance. Progress in understanding DEN pathogenesis and in developing effective treatments has been h ered by the lack of a suitable small animal model. Most of the DEN clinical isolates and cell culture-passaged DEN virus strains reported so far require either host adaptation, inoculation with a high dose and/or intravenous administration to elicit a virulent phenotype in mice which results, at best, in a productive infection with no, few, or irrelevant disease manifestations, and with mice dying within few days at the peak of viremia. Here we describe a non-mouse-adapted DEN2 virus strain (D2Y98P) that is highly infectious in AG129 mice (lacking interferon-alpha/beta and -gamma receptors) upon intraperitoneal administration. Infection with a high dose of D2Y98P induced cytokine storm, massive organ damage, and severe vascular leakage, leading to haemorrhage and rapid death of the animals at the peak of viremia. In contrast, very interestingly and uniquely, infection with a low dose of D2Y98P led to asymptomatic viral dissemination and replication in relevant organs, followed by non-paralytic death of the animals few days after virus clearance, similar to the disease kinetic in humans. Spleen damage, liver dysfunction and increased vascular permeability, but no haemorrhage, were observed in moribund animals, suggesting intact vascular integrity, a cardinal feature in DEN shock syndrome. Infection with D2Y98P thus offers the opportunity to further decipher some of the aspects of dengue pathogenesis and provides a new platform for drug and vaccine testing.
Publisher: BMJ
Date: 12-1987
Abstract: Cerebral blood flow velocity was measured using Doppler ultrasonography in 20 babies who weighed less than 2500 g at birth and who were receiving assisted ventilation their patterns of spontaneous respiration were recorded simultaneously. The babies were induced to breathe synchronously or asynchronously with the ventilator by manipulating the inspiratory and expiratory time settings. The variability of cerebral blood flow velocity (coefficient of variation) was calculated from the area of the maximum Doppler frequency shift envelope for 10 cardiac cycles from 211 recordings made on 42 occasions, and was greatest within 12 hours of birth after which it fell progressively over the next 48 hours. Variability of cerebral blood flow velocity was significantly greater when the infants were breathing out of synchrony with the ventilator (median 11%, interquartile range 8-14%) than when they were either apnoeic (median 5%, 3-7%), or breathing synchronously with the ventilator (median 5%, 3-6%).
Publisher: Springer Berlin Heidelberg
Date: 2010
Publisher: Wiley
Date: 19-03-2013
Publisher: Elsevier BV
Date: 09-2006
Publisher: Springer Science and Business Media LLC
Date: 05-2009
Publisher: Wiley
Date: 03-2014
DOI: 10.1111/JPC.12543
Publisher: Springer Science and Business Media LLC
Date: 07-2007
Publisher: BMJ
Date: 07-2005
Publisher: BMJ
Date: 05-2008
Abstract: Techniques of positioning and holding neonatal face masks vary. Studies have shown that leak at the face mask is common and often substantial irrespective of operator experience. (1) To identify a technique for face mask placement and hold which will minimise mask leak. (2) To investigate the effect of written instruction and demonstration of the identified technique on mask leak for two round face masks. Three experienced neonatologists compared methods of placing and holding face masks to minimise the leak for Fisher & Paykel 60 mm and Laerdal size 0/1 masks. 50 clinical staff gave positive pressure ventilation to a modified manikin designed to measure leak at the face mask. They were provided with written instructions on how to position and hold each mask and then received a demonstration. Face mask leak was measured after each teaching intervention. A technique of positioning and holding the face masks was identified which minimised leak. The mean (SD) mask leaks before instruction, after instruction and after demonstration were 55% (31), 49% (30), 33% (26) for the Laerdal mask and 57% (25), 47% (28), 32% (30) for the Fisher & Paykel mask. There was no significant difference in mask leak between the two masks. Written instruction alone reduced leak by 8.8% (CI 1.4% to 16.2%) for either mask when combined with a demonstration mask leak was reduced by 24.1% (CI 16.4% to 31.8%). Written instruction and demonstration of the identified optimal technique resulted in significantly reduced face mask leak.
Publisher: Springer Science and Business Media LLC
Date: 10-2008
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2010
Abstract: The goal was to define reference ranges for pulse oxygen saturation (Spo2) values in the first 10 minutes after birth for infants who received no medical intervention in the delivery room. Infants were eligible if a member of the research team was available to record Spo2 immediately after birth. Infants were excluded if they received supplemental oxygen or any type of assisted ventilation. Spo2 was measured with a sensor applied to the right hand or wrist as soon as possible after birth data were collected every 2 seconds. We studied 468 infants and recorded 61650 Spo2 data points. The infants had a mean ± SD gestational age of 38 ± 4 weeks and birth weight of 2970 ± 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 Spo2 value of & %. Spo2 values for preterm infants increased more slowly than those for term infants. We present percentile charts for all infants, term infants of ≥37 weeks, preterm infants of 32 to 36 weeks, and extremely preterm infants of & weeks. These data represent reference ranges for Spo2 in the first 10 minutes after birth for preterm and term infants.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.RESP.2015.09.009
Abstract: We hypothesized that radiographically-assessed hyperinflation in bronchopulmonary dysplasia (BPD) is related to the degree of oxygenation impairment. Our objective was to explore the relation of chest radiographic thoracic area (CRTA) with right-to-left shunt, right shift of the oxyhemoglobin dissociation curve and ventilation erfusion ratio (VA/Q) in infants with BPD. Twenty-two infants born at median (IQR) gestation of 26 (24-28) weeks with BPD were prospectively studied at 39 (30-69) days. Inspired oxygen (FiO2) was varied to obtain transcutaneous oxygen saturation (SpO2) values between 85 and 96%. Shunt, shift and VA/Q were derived by plotting and analysing pairs of SpO2 and FiO2. CRTA was measured by free hand-tracing the perimeter of the thoracic area in anterio-posterior chest radiographs. Median (IQR) shunt was 8 (1-14)%, shift was 13 (11-19)kPa and VA/Q 0.42 (0.30-0.48). Median (IQR) CRTA/kg was 2495 (1962-2838)mm(2) and was significantly related to shift (r=0.674, p<0.001), VA/Q (r=-0.633, p<0.001), weight at study (r=-0.457, p=0.003) and day of life (r=-0.406, p=0.009), but not to shunt. CRTA in BPD is significantly related to oxygenation impairment as quantified by shift and VA/Q. CRTA can be used as a simple radiographic test to quantify BPD severity.
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.VIROL.2008.11.028
Abstract: HIV-1 genomic RNA (gRNA) dimerization is important for viral infectivity and is regulated by proteolytic processing of the Gag precursor protein (Pr55gag) under the direction of the viral protease. The processing occurs in successive steps and, to date, the step associated with formation of a wild-type (WT) level of gRNA dimers has not been identified. The primary cleavage ides Pr55gag into two proteins. The C-terminal polypeptide is termed NCp15 (NCp7-p1-p6) because it contains the nucleocapsid protein (NC), a key determinant of gRNA dimerization and packaging. To examine the importance of precursor polypeptides NCp15 and NCp9 (NCp7-p1), we introduced mutations that prevented the proteolytic cleavages responsible for the appearance of NCp9 or NCp7. Using native Northern blot analysis, we show that gRNA dimerization was impaired when both the secondary (p1-p6) and tertiary (p7-p1) cleavage sites of NCp15 were abolished, but unaffected when only one or the other site was abolished. Though processing to NCp9 therefore suffices for a WT level of gRNA dimerization, we also show that preventing cleavage at the p7-p1 site abolished HIV-1 replication. To identify the minimum level of protease activity compatible with a WT level of gRNA dimers, we introduced mutations Thr26Ser and Ala28Ser in the viral protease to partially inactivate it, and we prepared composite HIV-1 resulting from the cotransfection of various ratios of WT and protease-inactive proviral DNAs. The results reveal that a 30% processing of Pr55gag into mature capsid proteins (CA/CA-p2) yielded a WT level of gRNA dimers, while a 10% Pr55gag processing hardly increased gRNA dimerization above the level seen in protease-inactive virions. We found that full gRNA dimerization required less than 50% WT NC in complementation asssays. Finally, we show that if we destroy alpha helix 1 of the capsid protein (CA), gRNA dimerization is impaired to the same extent as when the viral protease is inactivated. Cotransfection studies show that this CA mutation, in contrast to the NC-disabling mutations, has a dominant negative effect on HIV-1 RNA dimerization, viral core formation, and viral replication. This represents the first evidence that a capsid mutation can affect HIV-1 RNA dimerization.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.JPEDS.2010.08.044
Abstract: To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS). We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO). Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization. Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.
Publisher: Elsevier BV
Date: 08-1986
DOI: 10.1016/S0140-6736(86)90100-5
Abstract: Neuroinflammatory changes, characterized by an increase in microglial activation and often accompanied by upregulation of inflammatory cytokines like interleukin-1beta (IL-1beta), are common to many, if not all, neurodegenerative diseases. Similar, though less dramatic neuroinflammatory changes, are also known to occur with age. Among the consequences of these changes is an impairment in synaptic function and the evidence suggests that inflammatory cytokines may be the primary contributory factor responsible for the deficits in synaptic plasticity which have been identified in aged rodents. Specifically a decrease in the ability of aged rats to sustain long-term potentiation (LTP) in perforant path-granule cells of the hippoc us is associated with increased microglial activation. This review considers the evidence which suggests a causal relationship between these changes and the factors which contribute to the age-related microglial activation, and reflects on data which demonstrate that agents which inhibit microglial activation also improve ability of rats to sustain LTP.
Publisher: Elsevier BV
Date: 05-2001
Publisher: Elsevier BV
Date: 10-2010
Publisher: BMJ
Date: 18-07-2007
Publisher: BMJ
Date: 03-2010
Abstract: Non-invasive respiratory support is increasingly popular but is associated with complications including nasal trauma. The present report describes a novel method of oral continuous positive airway pressure (CPAP) delivery in an extremely premature infant with severe nasal septum erosion. The distal end of a cut down endotracheal tube was passed through a small hole made in the teat of a dummy (infant pacifier) and sutured in place. The dummy was secured in the infant's mouth and CPAP was delivered to the pharynx. The device was well tolerated and the infant was successfully managed using this technique for 48 days, avoiding endotracheal intubation and ventilation.
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.JPEDS.2011.09.017
Abstract: 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)). Infants receiving mask resuscitation were randomized to have the display of an RFM (airway pressure, flow, and V(T) waves) either visible or masked. 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). Using an RFM was associated with significantly less mask leak, more mask adjustments, and a lower rate of excessive V(T).
Publisher: Wiley
Date: 06-09-2011
DOI: 10.1111/J.1651-2227.2010.01981.X
Abstract: Ventilator frequency is one of the determinants of tidal volume delivery during high-frequency ventilation. Clinicians increasingly use data on ventilator displays to inform their decisions. To measure the frequencies delivered by the Dräger Babylog 8000plus ventilator when used in high-frequency mode. Ventilator waveforms using a test lung were recorded at the full range of settings 5-20 Hz using Spectra software at 1000 Hz. The changes in frequency produced by a 1-Hz change in set frequency were calculated. Actual and displayed frequencies were compared. For settings up to 12 Hz, median (range) difference between set and delivered frequencies was 0 (-0.4 to +0.1) Hz. Above 12 Hz, delivered frequency varied by -0.3 (-1.9 to +0.3) Hz. For 1-Hz changes in frequency settings, in the range 5-12 Hz, 1-Hz changes produced a change in delivered frequency of 1.0 (0.6-1.4) Hz. Above 12 Hz, the corresponding changes were 0.7 (0-2.9) Hz. The ventilator displays the set frequency during operation rather than the delivered frequency. At 12 Hz and below, the differences between set and delivered frequencies were relatively small compared with those at 13 Hz and higher. Above 13 Hz, the difference between set and delivered frequencies was up to 2.9 Hz. Some frequency setting changes did not result in a change in delivered frequency.
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2010
Abstract: Major changes in cardiovascular and respiratory physiology underpin the successful transition from fetal to neonatal life, and it is now apparent that lung aeration and the onset of pulmonary ventilation trigger such changes. Because preterm infants commonly have difficulty in making the transition to neonatal life, it is important to understand the mechanisms of lung aeration and how this action can be facilitated to improve the transition in these very immature infants. Recent imaging studies have demonstrated that after birth, airway liquid clearance and lung aeration are intrinsically linked and regulated primarily by transpulmonary pressures generated during inspiration. This indicates that airway liquid clearance is not solely dependent on sodium reabsorption and that a variety of mechanisms that may act before, during, and after birth are involved. The level of contribution of each mechanism likely depends on the timing and mode of delivery. Based on the knowledge that transpulmonary pressures primarily regulate airway liquid clearance after birth, it is possible to devise ventilation strategies that facilitate this process in very preterm infants. In particular, such strategies should initially focus on moving liquid rather than air through the airways because liquid has a much higher resistance and should assist in establishing and maintaining functional residual capacity. Two potential strategies are an initial sustained inflation and ventilation with a positive end-expiratory pressure.
Publisher: Elsevier BV
Date: 05-1991
DOI: 10.1016/0378-3782(91)90187-8
Abstract: All low birthweight babies ventilated for the respiratory distress syndrome during a period of fourteen months were randomised to receive endotracheal suction 12-hourly or 6-hourly. There were no significant differences in respiratory outcome between the groups. These observations suggest that it is safe to aspirate endotracheal tubes infrequently during the first few days in uncomplicated respiratory distress syndrome.
Publisher: BMJ
Date: 03-2009
Abstract: Two unexpected observations were made during ventilation with the Dräger Babylog 8000+ in volume-guarantee mode: (a) during complete obstruction to gas flow down the endotracheal tube (ETT), positive inspiratory pressure (PIP) was reduced to half way between the maximum inflating pressure and the positive end expiratory pressure (PEEP) even though the set expired tidal volume had not been achieved (b) an external Dräger waveform monitor may stop displaying real-time waveforms when a tube-obstructed alarm is activated. To investigate these phenomena using a test lung. A 50 ml Dräger test lung was attached to the ventilation circuit of a Dräger Babylog 8000+. Partial obstruction to ETT flow was induced by compressing the tubing leading to the test lung, and complete obstruction was achieved by cl ing. Recordings were made from the digital output of the ventilator at 125 Hz. When the ETT flow was completely obstructed during VG ventilation, a constant PIP was set midway between the set maximum and PEEP. This did not happen during partial obstruction. The external waveform monitor display froze when ETT flow was completely obstructed. During complete ETT obstruction, the PIP is set to a pressure midway between maximum PIP and PEEP even if this is less than the PIP used before the obstruction. Further research is needed to evaluate whether this reduction in PIP is associated with prolongation of precipitating events.
Publisher: Wiley
Date: 04-2004
DOI: 10.1111/J.1440-1754.2004.00339.X
Abstract: The equipment used to provide positive pressure ventilation at neonatal resuscitation varies between institutions. Available devices were reviewed and their use surveyed in a geographically defined region. The aim of this study was to establish which resuscitation equipment is used at neonatal intensive care units in Australia and New Zealand. A questionnaire was sent to a neonatologist at each of the 29 neonatal intensive care units in Australia and New Zealand, asking which resuscitation equipment they used. If it was not returned, follow up was by email and telephone. Data was obtained from all units. Round face masks are used at all centres. Anatomically shaped masks are infrequently used at two of the three centres (10%) that have them. Straight endotracheal tubes are used exclusively at 23 (79%) centres. Shouldered tubes are used infrequently at three of the six centres that have them. The Laerdal Infant Resuscitator self-inflating bag is used at 22 (76%) centres. Flow-inflating bags are used at 12 (41%) centres. The Neopuff Infant Resuscitator is used at 14 (48%) centres. Varying oxygen concentrations are provided at delivery at 6/25 (24%) centres. There is a paucity of evidence for the efficacy of the equipment used currently to resuscitate newborn infants. This complete survey of the tertiary centres in a geographical region shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Further research is necessary to determine which devices are preferable for this most important and common intervention.
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.RESUSCITATION.2011.02.029
Abstract: When using a T-piece device, resuscitators may try to improve airway pressures by increasing gas flow instead of correcting face mask position. To measure the effects of changing gas flow during positive pressure ventilation (PPV) on peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), expiratory tidal volume (V(Te)) and mask leak. Using a Neopuff T-piece device, 20 neonatal staff members delivered PPV to a modified, leak-free manikin. Resuscitation parameters were recorded. Study A: PPV for 4 min at PIP 30 cm H(2)O and PEEP 5 cm H(2)O. Each minute gas flow was increased (5, 8, 10, and 15 L/min). PIP and PEEP settings were unchanged. Study B: same pressure settings PPV for 1 min with 5, 8, 10, and 15 L/min in a random order, at a rate of ∼ 60/min. The pressures were adjusted to maintain the same PIP and PEEP after each flow change. Study A: As gas flow increased (5, 8, 10 and 15 L/min) the median PEEP increased from 4.7 to 26.4 cm H(2)O (p<0.002). Median V(Te) decreased from 10.0 to 0.8 mL (p<0.001). PIP increased slightly from 30 cm H(2)O to 36 cm H(2)O at 15 L/min (p<0.005). Mask leak increased from 14% to 98% (p<0.001) because mask pressure increased. Study B: when PIP and PEEP were maintained there were no significant differences in V(Te) (p=0.42) or mask leak (p=0.51) with changing gas flow. During PPV increasing gas flow dramatically increased PEEP and mask leak and in consequence reduced V(Te). Gas flow should rarely be changed during T-piece resuscitation.
Publisher: Elsevier BV
Date: 1981
DOI: 10.1016/S0140-6736(81)90002-7
Abstract: Artificial lung surfactant prepared with pure dipalmitoylphosphatidylcholine and phosphatidylglycerol in a ratio of 7:3 was made as a dry powder and then blown down an endotracheal tube into the lungs of 22 very premature babies at birth. Only one dose was given. The treated babies did better than their 33 controls. Fewer needed ventilation, and those who did required lower pressures in the first six hours of life. None of the treated babies died, compared with 8 of the controls.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.JPEDS.2010.12.016
Abstract: To compare respiratory and other morbidities between very preterm infants with and without a pneumothorax and to determine whether infants at higher risk of pneumothorax can be identified early in their course. Preterm infants at 23 to 28 weeks' gestation with pneumothorax were compared with matched control subjects. Demographic and clinical data from birth through the first 72 hours were compared. Sixty-two (9.2%) of 675 infants had pneumothorax. There were no significant differences in the baseline maternal and infant characteristics. Mortality was significantly higher in the pneumothorax group (43%) versus control subjects (13%). There was no significant difference in continuous positive airway pressure or surfactant treatment or rates of intraventricular hemorrhage or bronchopulmonary dysplasia. Infants treated with early continuous positive airway pressure in the delivery room typically had pneumothorax on day 2 of life. Those who had pneumothorax had higher inspired fraction of oxygen before its diagnosis and over the first 12 hours of life than did control subjects. Pneumothorax is associated with increased mortality and with severity of lung disease in the first day of life. It may be possible to identify babies at highest risk of pneumothorax on the basis of inspired fraction of oxygen in the first 12 hours of life.
Publisher: Elsevier BV
Date: 03-1988
DOI: 10.1016/0378-3782(88)90094-1
Abstract: Lung surfactant was obtained by postmortem lavage from: (A) premature babies: 34 dying acutely within 2 days of birth from Hyaline Membrane Disease (HMD), 20 dying several days after birth with HMD and its consequences, 8 dying from causes other than HMD (B) mature babies: 24 dying stillborn, 15 dying soon after birth and 16 dying between 2 weeks and 1 year of age with minimal lung pathology. The phospholipid composition of the surfactant was analysed. Compared to the surfactant of babies dying acutely from HMD, that of the babies dying later from HMD contained significantly higher proportions of phosphatidylcholine (PC) and significantly lower proportions of sphingomyelin while that of the mature babies contained significantly higher proportions of PC and phosphatidylglycerol but significantly lower proportions of sphingomyelin and combined phosphatidylinositol and phosphatidylserine. The surfactant of premature babies dying of causes other than HMD was similar and intermediate to that of both groups of babies dying from HMD. The PC fraction composition of the surfactant of the babies dying acutely from HMD contained significantly lower proportions of the disaturated fraction than those of the babies dying later from HMD, stillborn babies or mature babies.
Publisher: Elsevier BV
Date: 05-1987
Publisher: Springer Science and Business Media LLC
Date: 03-1992
DOI: 10.1007/BF01954385
Publisher: BMJ
Date: 11-11-2015
DOI: 10.1136/ARCHDISCHILD-2014-307144
Abstract: Delayed umbilical cord cl ing (DCC) affects the cardiopulmonary transition and blood volume in neonates immediately after birth. However, little is known of blood flow in the umbilical vessels immediately after birth during DCC. The objective is to describe the duration and patterns of blood flow through the umbilical vessels during DCC. Arterial and venous umbilical blood flow was measured during DCC using Doppler ultrasound in uncomplicated term vaginal deliveries. Immediately after birth, the probe was placed in the middle of the umbilical cord, pattern and duration of flow in vein and arteries were evaluated until cord cl ing. Thirty infants were studied. Venous flow: In 10% no flow was present, in 57% flow stopped at 4:34 (3:03-7:31) (median (IQR) min:sec) after birth, before the cord was cl ed. In 33%, flow continued until cord cl ing at 5:13 (2:56-9:15) min:sec. Initially, venous flow was intermittent, increasing markedly during large breaths or stopping and reversing during crying, but then became continuous. Arterial flow: In 17% no flow was present, in 40% flow stopped at 4:22 (2:29-7:17) min:sec, while cord pulsations were still palpable. In 43% flow continued until the cord was cl ed at 5:16 (3:32-10:10) min:sec. Arterial flow was pulsatile, unidirectional towards placenta or bidirectional to/from placenta. In 40% flow became continuous towards placenta later on. During delayed umbilical cord cl ing, venous and arterial umbilical flow occurs for longer than previously described. Net placental transfusion is probably the result of several factors of which breathing could play a major role. Umbilical flow is unrelated to cessation of pulsations.
Publisher: Informa UK Limited
Date: 1990
DOI: 10.3109/14639239009025273
Abstract: Baby Check, a scoring system for quantifying illness in young babies, was developed from a study of 1007 well and ill babies in Cambridge and Melbourne. This paper describes the setting up of field trials to test the performance of the scoring system when used by mothers, GPs and hospital doctors. Preliminary results suggest that the scoring system is attractive, easy to use, useful and of high specificity. Its sensitivity to serious illness is also thought to be high but this will become clearer when the main hospital field trial has been completed.
Publisher: American Physiological Society
Date: 05-2009
DOI: 10.1152/JAPPLPHYSIOL.91591.2008
Abstract: The factors regulating lung aeration and the initiation of pulmonary gas exchange at birth are largely unknown, particularly in infants born very preterm. As hydrostatic pressure gradients may play a role, we have examined the effect of a positive end-expiratory pressure (PEEP) on the spatial and temporal pattern of lung aeration in preterm rabbit pups mechanically ventilated from birth using simultaneous phase-contrast X-ray imaging and plethysmography. Preterm rabbit pups were delivered by caesarean section at 28 days of gestational age, anesthetized, intubated, and placed within a water-filled plethysmograph (head out). Pups were imaged as they were mechanically ventilated from birth with a PEEP of either 0 cmH 2 O or 5 cmH 2 O. The peak inflation pressure was held constant at 35 cmH 2 O. Without PEEP, gas only entered into the distal airways during inflation. The distal airways collapsed during expiration, and, as a result, the functional residual capacity (FRC) did not increase above the lung's anatomic dead space volume (2.5 ± 0.8 ml/kg). In contrast, ventilation with 5-cmH 2 O PEEP gradually increased aeration of the distal airways, which did not collapse at end expiration. The FRC achieved in pups ventilated with PEEP (19.9 ± 3.2 ml/kg) was significantly greater than in pups ventilated without PEEP (−2.3 ± 3.5 ml/kg). PEEP greatly facilitates aeration of the distal airways and the accumulation of FRC and prevents distal airway collapse at end expiration in very preterm rabbit pups mechanically ventilated from birth.
Publisher: BMJ
Date: 08-2005
Publisher: BMJ
Date: 20-05-2010
Abstract: Nasal intermittent positive pressure ventilation (NIPPV) is a mode of non-invasive respiratory support. Its mechanisms of action and optimal delivery techniques are unknown. This observational study aimed to investigate and quantify delivered peak pressures during non-synchronised ventilator-generated NIPPV. Infants born below 30 weeks gestation receiving ventilator-generated NIPPV delivered via Hudson prongs were recruited. Intraprong pressure, change in tidal volume, respiratory rate, oxygen saturations, inspired oxygen and video images were recorded. Eleven infants (four infants were female) of median (interquartile range IQR) gestational age 25(+/-3) (25(+/-2) 26(+/-0)) weeks and birth weight 732 (699-895) g, were studied at 24 (19-41) days of age. Six infants, with set peak pressure (peak inflation pressure PIP) of 20 cm H(2)O, received a median pressure of 15.9 (IQR 13.6-17.9) cm H(2)O. 37% of inflations were delivered at least 5 cm H(2)O below set PIP. 12.7% of inflations were delivered above set PIP. Five infants with set PIP of 25 cm H(2)O received a median PIP of 17.2 (IQR 15.0-18.3) cm H(2)O. 83% of inflations were delivered at least 5 cm H(2)O below set PIP, with 6.1% delivered higher than set PIP. The difference in delivered PIP between the groups was 1.3 cm H(2)O. PIP was highest and most variable when the infant was moving. Delivered PIP did not vary whether it coincided with spontaneous inspiration or expiration. During ventilator-generated non-synchronised NIPPV delivered PIP was variable and frequently lower than set PIP. Delivered PIP was occasionally greater than set PIP.
Publisher: American Physical Society (APS)
Date: 06-04-2005
Publisher: BMJ
Date: 06-1988
DOI: 10.1136/ADC.63.6.678
Abstract: Breast cancer is the most common malignant neoplasm and the most common cause of death among women. The core needle biopsy is becoming a universal practice in diagnosing breast lesions suspected of malignancy. Unfortunately, breast core needle biopsies also bear the risk of having false-negative results. 988 core needle breast biopsies were performed at the Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, between 01 March 2006 and 29 February 2008. Malignant lesions were diagnosed in 426/988 (43.12%) cases, atypical hyperplasia in 69/988 (6.98%), and benign lesions in 493/988 (49.90%) cases. Twenty-two out of 988 biopsies (2.23%) were found to be false negative. Histopathological assessment of tissue specimens was repeated in these cases. In 14/22 (64%) cases, the previous diagnosis of a benign lesion was changed. In 8/22 (36%) cases, the diagnosis of a benign lesion was confirmed. False-negative rate was calculated at 2.2%. The rate of false-negative diagnoses resulting from a radiological mistake was estimated at 36%. The rate of false-negative diagnoses, resulting from histopathological assessment, was 64%. False-negative results caused by a radiological error comprised 1.5% of all histopathologically diagnosed cancers and atypias (sensitivity of 98.5%). There were no false-positive results in our material - the specificity of the method was 100%. Histopathological interpretation is a substantial cause of false-negative results of breast core needle biopsy. Thus, in case of a radiological-histopathological ergence, histopathological analysis of biopsy specimens should be repeated. The main radiological causes of false-negative results of breast core needle biopsy are as follows: s ling from an inappropriate site and histopathological non-homogeneity of cancer infiltration.
Publisher: Elsevier BV
Date: 11-2006
Publisher: Elsevier BV
Date: 06-1979
DOI: 10.1016/0005-2760(79)90229-7
Abstract: It is suggested that the phospholipids at the alveolar/air interface exhibit both thermodynamic (equilibrium) and kinetic forces during the course of a respiratory cycle. The alveolae are kept open at full expiration by a residue of nearly pure dipalmitoyl phosphatidylcholine which is condensed and therefore, incompressible at 37 degrees C.
Publisher: American Physical Society (APS)
Date: 20-04-2009
Publisher: BMJ
Date: 03-04-2007
Abstract: Extubation failure in premature infants is common. A spontaneous breathing trial (SBT) was prospectively evaluated to determine timing of extubation. Compared with historical controls, infants were extubated at significantly higher ventilator rates and airway pressures using the SBT. No differences in rates of bronchopulmonary dysplasia or duration of ventilation were seen.
Publisher: Elsevier BV
Date: 04-1984
Publisher: BMJ
Date: 22-09-2010
Abstract: Video observations and recordings of respiratory signals from mannequin studies and delivery room (DR) resuscitations are described. This article discusses the uses of a respiratory function monitor (RFM) during training and resuscitations along with potential pitfalls and limitations. It adds objectivity to the clinical assessment. A respiratory function monitor provides real-time quantitative information including tidal volume and leak. It may be used to teach correct mask hold and positioning techniques during simulation-based mannequin. Ex les demonstrating its potential usefulness during resuscitations are provided. However, further studies are needed to investigate whether it can help improve short-term and long-term outcomes.
Publisher: Wiley
Date: 30-11-2013
DOI: 10.1111/APA.12070
Abstract: Lung lavage using two aliquots of 15 mL/kg of dilute surfactant was performed in 30 ventilated infants with severe meconium aspiration syndrome (MAS). Mean recovery of instilled lavage fluid was 46%, with greater fluid return associated with lower mean airway pressure at 24 h and a shorter duration of respiratory support. Recovery of instilled lavage fluid is paramount in effective lung lavage in MAS and must be afforded priority in the lavage technique.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2010
Publisher: Wiley
Date: 29-09-2009
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.JPEDS.2008.01.002
Abstract: To determine the accuracy of heart rate obtained by pulse oximetry (HR(PO)) relative to HR obtained by 3-lead electrocardiography (HR(ECG)) in newborn infants in the delivery room. Immediately after birth, a preductal PO sensor and ECG leads were applied. PO and ECG monitor displays were recorded by a video camera. Two investigators reviewed the videos. Every two seconds, 1 of the investigators recorded HR(PO) and indicators of signal quality from the oximeter while masked to ECG, whereas the other recorded HR(ECG) and ECG signal quality while masked to PO. HR(PO) and HR(ECG) measurements were compared using Bland-Altman analysis. We attended 92 deliveries 37 infants were excluded due to equipment malfunction. The 55 infants studied had a mean (+/-standard deviation [SD]) gestational age of 35 (+/-3.7) weeks, and birth weight 2399 (+/-869) g. In total, we analyzed 5877 data pairs. The mean difference (+/-2 SD) between HR(ECG) and HR(PO) was -2 (+/-26) beats per minute (bpm) overall and -0.5 (+/-16) bpm in those infants who received positive-pressure ventilation and/or cardiac massage. The sensitivity and specificity of PO for detecting HR(ECG) <100 bpm was 89% and 99%, respectively. PO provided an accurate display of newborn infants' HR in the delivery room, including those infants receiving advanced resuscitation.
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.JPEDS.2005.12.050
Abstract: Because the optimal concentration of oxygen (FiO2) required for stabilization of the newly born infant has not been established, the FiO2 is commonly adjusted according to the infant's oxygen saturation (SpO2). We aimed to determine the range of pre-ductal SpO2 in the first minutes of life in healthy newborn infants. We applied an oximetry sensor to the infant's right palm or wrist of term and preterm deliveries immediately after birth. Infants who received any resuscitation or supplemental oxygen were excluded. SpO2 was recorded at 60 second intervals for at least 5 minutes and until the SpO2 was >90%. A total of 205 deliveries were monitored 30 infants were excluded from the study. SpO2 readings were obtained within 60 seconds of age from 92 of 175 infants (53%). The median (interquartile range) SpO2 at 1 minute was 63% (53%-68%). There was a gradual rise in SpO2 with time, with a median SpO2 at 5 minutes of 90% (79%-91%). Many newborns have an SpO2 <90% during the first 5 minutes of life. This should be considered when choosing SpO2 targets for infants treated with supplemental oxygen in the delivery room.
Publisher: Elsevier BV
Date: 2012
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.CLP.2012.06.016
Abstract: This article shows that volume-targeted ventilation is physiologically more logical than pressure-limited ventilation, and is associated with a reduced risk of pneumothorax, hypocarbia, duration of ventilation, death or bronchopulmonary dysplasia, and severe intraventricular hemorrhage. Therefore, it should now be adopted as the main mode for mechanical ventilation of preterm neonates.
Publisher: BMJ
Date: 09-2007
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2010
Abstract: Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need respiratory support in the NICU, but international resuscitation guidelines do not stipulate use of this therapy during stabilization at birth. We aimed to investigate the effect of humidified and heated gas on admission temperature in preterm infants who require respiratory support at birth. Two cohorts of very preterm infants born at ≤32 weeks' gestational age in the Leiden University Medical Center were compared prospectively before (the “cold” cohort) and after (the “heated” cohort) introduction of the use of heated and humidified gas during respiratory support at birth (continuous positive airway pressure or intubation). The primary outcome was the infant's rectal temperature at admission in the NICU. There was a difference in the mean (SD) rectal temperature between the cold and heated cohorts (35.9 [0.6] vs 36.4 [0.6], respectively P & .0001). Normothermia (36.5°C–37.5°C) occurred less often in the cold cohort than in the heated cohort (12% vs 43% P & .0001). There was no difference in occurrence of mild hypothermia (36.0°C–36.4°C) between groups (33% vs 35% not significant). Moderate hypothermia (& .0°C) occurred more often in the cold cohort (53% vs 19% P & .001). The use of heated and humidified air during respiratory support in very preterm infants just after birth reduced the postnatal decrease in temperature. Heating and humidifying the gas during stabilization merits additional investigation.
Publisher: BMJ
Date: 12-1992
Abstract: It is well established that integrin alpha 4 beta 1 binds to the vascular cell adhesion molecule (VCAM) and fibronectin and plays an important role in signal transduction. Blocking the binding of VCAM to alpha 4 beta 1 is thought to be a way of controlling a number of disease processes. To better understand how various inhibitors might block the interaction of VCAM and fibronectin with alpha 4 beta 1, we began constructing a structure model for the integrin alpha 4 beta 1 complex. As the first step, we have built a homology model of the beta 1 subunit based on the I domain of the integrin CD11B subunit. The model, including a bound Mg(2+) ion, was optimized through a specially designed relaxation scheme involving restrained minimization and dynamics steps. The native ligand VCAM and two highly active small molecules (TBC772 and TBC3486) shown to inhibit binding of CS-1 and VCAM to alpha 4 beta 1 were docked into the active site of the refined model. Results from the binding analysis fit well with a pharmacophore model that was independently derived from active analog studies. A critical examination of residues in the binding site and analysis of docked ligands that are both potent and selective led to the proposal of a mechanism for beta 1/beta 7 ligand binding selectivity.
Publisher: BMJ
Date: 07-06-2005
Publisher: BMJ
Date: 04-1991
Publisher: American Physical Society (APS)
Date: 14-09-2011
Publisher: BMJ
Date: 03-1984
DOI: 10.1136/ADC.59.3.289
Abstract: Operative hysteroscopy intravascular absorption (OHIA) syndrome is caused by intravascular absorption of fluid distension/irrigation medium during hysteroscopy. There are very few reported cases of this syndrome using saline as irrigation fluid. The current report was on a case of severe OHIA syndrome that necessitated resuscitation in an intensive care unit (ICU). A 41-year-old, 65-kg, smoker female patient was admitted for an endoscopic resection of submucous uterine myoma under general anesthesia using a laryngeal mask airway. In the 50th minute of the procedure, end-tidal CO Absorption of the irrigation fluid can result in life-threatening fluid overload. Accurate fluid balancing and limiting the operation time may prevent such complications. Therefore, early diagnosis and treatment of this syndrome is emphasized.
Publisher: Springer Science and Business Media LLC
Date: 07-2011
Publisher: American Thoracic Society
Date: 15-08-2003
Publisher: Springer Milan
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 14-07-2011
DOI: 10.1038/JP.2011.98
Abstract: A recent systematic review and meta-analysis shows that volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) reduce death and bronchopulmonary dysplasia, pneumothorax, hypocarbia and severe cranial ultrasound abnormalities. In this paper, we present published research and our experience with volume guarantee (VG) ventilation, a VTV mode available on the Dräger Babylog 8000plus and VN500 ventilators. The VG algorithm measures the expired tidal volume (V(T)) for each inflation and adjusts the peak inflating pressure for the next inflation to deliver a V(T) set by the clinician. The advantage of controlling expired V(T) is that this is less influenced by endotracheal tube leak than inspired V(T). VG ventilation can be used with an endotracheal tube leak up to ∼50%. Initial set V(T) for infants with respiratory distress syndrome should be 4.0 to 5.0 ml kg(-1). The set V(T) should be adjusted to maintain normocapnoea. Setting the peak inflating pressure limit well above the working pressure is important to enable the ventilator to deliver the set V(T), and to avoid frequent alarms. This paper provides a practical guide on how to use VG ventilation.
Publisher: Elsevier BV
Date: 09-1986
DOI: 10.1016/0005-2760(86)90139-6
Abstract: Surface and electrokinetic properties of purified calf lung surfactant in various electrolyte solutions were determined. Surface properties were pH dependent in distilled water and the surfactant performed as a good lung surfactant only below pH 4. In more physiological media it was pH insensitive over the range 2-8.5. In distilled water at pH 6 its surface properties improved when NaCl was added up to 20 mM above this concentration it had the surface properties required to stabilise alveoli. The surface properties of surfactant in distilled water were also restored by certain cations (Ca2+, Mg2+, Mn2+, Cd2+ and Ni2+) but not others (Na+, K+, La3+ and Fe3+) when added to an ionic strength of 5.6 mM. Cations that restored its surface activity also reduced the surface charge density on the surfactant particles. Aggregation of surfactant by various metal chlorides was studied by light scattering measurements and bore no relation to surface activity or the charge on the particles. Aggregation of surfactant particles by Ca2+, Cd2+ and Mn2+ was instantly reversed by addition of excess EGTA. The influence of electrolytes on the surface properties of lung surfactant is explained in terms of the electrostatic forces operating in the system.
Publisher: Public Library of Science (PLoS)
Date: 13-11-2014
Publisher: BMJ
Date: 2007
Publisher: Elsevier BV
Date: 10-1985
DOI: 10.1016/0378-3782(85)90132-X
Abstract: 40 preterm, ventilated infants (gestational ages 24-33 weeks) were entered into a double-blind randomised trial to assess the effect of oral theophylline on lung function and ventilator dependence. Theophylline administration was associated with a significant improvement in compliance (P less than 0.05) and hastened weaning from ventilation (P less than 0.01).
Publisher: American Academy of Pediatrics (AAP)
Date: 2006
Abstract: OBJECTIVE. Postnatal corticosteroid therapy is controversial. The aim of this study was to determine the short-term effects of low-dose dexamethasone treatment among chronically ventilator-dependent neonates. METHODS. Very preterm (gestational age: & weeks) or extremely low birth weight (birth weight: & g) infants who were ventilator dependent after the first 1 week of life were eligible and were assigned randomly to receive masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Data on ventilator and oxygen requirements and deaths were recorded. RESULTS. Seventy infants were recruited from 11 centers, at a median age of 23 days. More infants were extubated successfully by 10 days of treatment in the dexamethasone group (60%, 21 of 35 patients) than in the control group (12%, 4 of 34 patients) (odds ratio [OR]: 11.2 95% confidence interval [CI]: 3.2–39.0). Ventilator and oxygen requirements improved substantially, and the duration of intubation was shorter. There was little evidence for a reduction in either the mortality rate (dexamethasone group: 11% control group: 20% OR: 0.52 95% CI: 0.14–1.95) or the rate of oxygen dependence at 36 weeks (dexamethasone group: 85% control group: 91% OR: 0.58 95% CI: 0.13–2.66). There were no obvious effects of low-dose dexamethasone on blood glucose concentrations, blood pressure, or other complications. No infant experienced intestinal perforation. CONCLUSIONS. Low-dose dexamethasone treatment after the first 1 week of life clearly facilitates extubation and shortens the duration of intubation among ventilator-dependent, very preterm/extremely low birth weight infants, without any obvious short-term complications. Combined with recent evidence that infants at very high risk of bronchopulmonary dysplasia may benefit in the long term, our study reopens debate regarding the role of low-dose, late postnatal, corticosteroid therapy.
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.SINY.2008.08.003
Abstract: Non-invasive techniques of respiratory support were developed in order to reduce the adverse effects associated with ventilation via an endotracheal tube. Short bi-nasal prongs provide the most effective nasal interface for delivery of nasal continuous positive airway pressure (nCPAP). Devices used to generate CPAP include conventional ventilators, the 'bubbly bottle' system and the infant flow driver. NCPAP improves the rate of successful extubation. It is useful for preterm infants with respiratory distress syndrome, reducing time spent on an endotracheal tube and oxygen requirement at 28d. However, nCPAP is associated with an increased rate of pneumothorax. Nasal intermittent positive pressure ventilation (NIPPV) is useful for augmenting the effectiveness of nCPAP. It further improves rates of successful extubation and shows promise as an initial method of respiratory support. Further research is required to determine the optimal settings for both nCPAP and NIPPV.
Publisher: Springer Science and Business Media LLC
Date: 09-2009
Publisher: American Academy of Pediatrics (AAP)
Date: 03-2010
Abstract: Some neonatologists state that at the delivery of extremely premature infants they rely on “how the baby looks” when deciding whether to initiate resuscitation. Previous studies have reported poor correlation between early clinical signs and prognosis. To determine if neonatologists can accurately predict survival to discharge of extremely premature infants on the basis of observations in the first minutes after birth. We showed videos of the resuscitation of 10 extremely premature infants (& weeks' gestation) to attending neonatologists and fellows from the 3 major perinatal centers in Melbourne, Australia. Antenatal information was available to the observers. A monitor visible in each video displayed the heart rate and oxygen saturation of the infant. Observers were asked to estimate the likelihood of survival to discharge for each infant at 3 time points: 20 seconds, 2 minutes, and 5 minutes after birth. The predictive ability of observers was expressed as the area (95% confidence interval [CI]) under the receiver-operating-characteristic curve. Seventeen attending neonatologists and 17 neonatal fellows completed the study. Receiver-operating-characteristic curves were generated for the combined and in idual groups. Observers' ability to predict survival was poor (combined results): 0.61 (95% CI: 0.54–0.67) at 20 seconds, 0.59 (95% CI: 0.52–0.64) at 2 minutes, and 0.61 (95% CI: 0.55–0.67) at 5 minutes. Level of experience did not affect the observers' accuracy of predicting survival. Neonatologists' reliance on initial appearance and early response to resuscitation in predicting survival for extremely premature infants is misplaced.
Publisher: BMJ
Date: 06-2000
DOI: 10.1136/ADC.82.6.503
Publisher: American Academy of Pediatrics (AAP)
Date: 12-2013
Abstract: Late-onset sepsis frequently complicates prematurity, contributing to morbidity and mortality. Probiotics may reduce mortality and necrotizing enterocolitis (NEC) in preterm infants, with unclear effect on late-onset sepsis. This study aimed to determine the effect of administering a specific combination of probiotics to very preterm infants on culture-proven late-onset sepsis. A prospective multicenter, double-blinded, placebo-controlled, randomized trial compared daily administration of a probiotic combination (Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacterium lactis, containing 1 × 109 total organisms) with placebo (maltodextrin) in infants born before 32 completed weeks’ gestation weighing & g. The primary outcome was at least 1 episode of definite late-onset sepsis. Between October 2007 and November 2011, 1099 very preterm infants from Australia and New Zealand were randomized. Rates of definite late-onset sepsis (16.2%), NEC of Bell stage 2 or more (4.4%), and mortality (5.1%) were low in controls, with high breast milk feeding rates (96.9%). No significant difference in definite late-onset sepsis or all-cause mortality was found, but this probiotic combination reduced NEC of Bell stage 2 or more (2.0% versus 4.4% relative risk 0.46, 95% confidence interval 0.23 to 0.93, P = .03 number needed to treat 43, 95% confidence interval 23 to 333). The probiotics B infantis, S thermophilus, and B lactis significantly reduced NEC of Bell stage 2 or more in very preterm infants, but not definite late-onset sepsis or mortality. Treatment with this combination of probiotics appears to be safe.
Publisher: BMJ
Date: 09-2007
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1440-1754.2009.01551.X
Abstract: To determine the additional financial cost to families of babies admitted to the nurseries of The Royal Women's Hospital, Melbourne, Australia. Prospective case series of consecutive babies admitted to the Special and Intensive Care Nurseries at The Royal Women's Hospital, Melbourne, Australia. Data were collected from diaries completed by parents who recorded expenses related to having their baby in hospital. Fifty nine families of babies born <34 weeks' gestation who were hospitalised for at least 2 weeks. The median expenditure per family per week was Australian (A) $243 and the median length of stay in the nurseries was 7 weeks. The major costs were related to food and transport. Expenses related to the expression/storage of breast milk and accommodation were also considerable consuming 11% and 14%, respectively of the weekly amount spent. Of the 23 families who reported lost or reduced income, the median amount lost per week per family was A$324. The financial burden on families with babies admitted to a tertiary neonatal unit is substantial. The median cost per week was approximately one quarter of the average gross weekly income and included lost income as well as additional expenses. It is important that institutions and health-care systems recognise the magnitude of this additional burden on vulnerable families.
Publisher: Elsevier BV
Date: 10-2005
DOI: 10.1016/J.JPEDS.2005.05.014
Abstract: Clinical assessment and end-tidal carbon dioxide (ETCO2) detectors are used to verify tracheal intubation in newborn infants. A case is presented in which an ETCO2 detector was misleading in determining endotracheal tube (ETT) position but useful in determining the efficacy of ventilation in an extremely preterm infant.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.SINY.2013.08.009
Abstract: Face mask ventilation provides respiratory support to newly born or sick infants. It is a challenging technique and difficult to ensure that an appropriate tidal volume is delivered because large and variable leaks occur between the mask and face airway obstruction may also occur. Technique is more important than the mask shape although the size must appropriately fit the face. The essence of the technique is to roll the mask on to the face from the chin while avoiding the eyes, with a finger and thumb apply a strong even downward pressure to the top of the mask, away from the stem and sloped sides or skirt of the mask, place the other fingers under the jaw and apply a similar upward pressure. Preterm infants require continuous end-expiratory pressure to facilitate lung aeration and maintain lung volume. This is best done with a T-piece device, not a self-inflating or flow-inflating bag.
Publisher: BMJ
Date: 03-05-2013
DOI: 10.1136/FETALNEONATAL-2011-301340
Abstract: A spontaneous breathing trial (SBT) has been used to guide suitability of extubation in VLBW infants. Respiratory variability (RV) has been used to assess extubation readiness in adults but was never investigated in preterms. The combination of a SBT and RV may further improve prediction of successful extubation. Using data previously collected during the SBT, the following respiratory variables were analysed: inspiratory time (T(I)), expiratory time (T(E)), T(I)/total breath time, tidal volume (V(T)) and mean inspiratory flow (V(T)/T(I)). RV was quantified using time-domain analysis for each respiratory variable and expressed as a variability index (VI). The sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the SBT, each VI and combined SBT+VI were calculated. Extubation failure was defined as need of re-intubation within 72 h. A total of 44 infants were included. Successfully (n=36) and unsuccessfully (n=8) extubated infants had similar baseline characteristics and number of breaths analysed. VI for V(T)/T(I)was significantly decreased in the failure group. The combination of the SBT and VI of either T(I)or V(T)were the most accurate predictors of successful extubation with a sensitivity of 100% and specificity of 75% and a PPV and NPV for extubation success of 95% and 100%, respectively. A significant decrease in V(T)/T(I)variability occurred in infants requiring re-intubation. The combination of a SBT failure and decreased variability in T(I)or V(T)was highly predictive of failure. This combination is promising but requires prospective evaluation in a larger population.
Publisher: Springer Science and Business Media LLC
Date: 17-08-2017
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2007
Publisher: BMJ
Date: 03-2009
Abstract: Because of concerns about harmful effects of 100% oxygen on newborn infants, air has started to be used for resuscitation in the delivery room. To describe changes in preductal oxygen saturation (Spo(2)) and heart rate (HR) in the first 10 min after birth in very preterm infants initially resuscitated with 100% oxygen (OX(100)) or air (OX(21)). In July 2006, policy changed from using 100% oxygen to air. Observations of Spo(2) and HR before and after the change were recorded whenever a member of the research team was available to attend the birth. There were 20 infants in the OX(100) group and 106 in the OX(21) group. In the OX(100) group, Spo(2) had risen to a median of 84% after 2 min and 94% by 5 min. In the OX(21) group, median Spo(2) was 31% at 2 min and 54% at 5 min. In the OX(21) group, 92% received supplemental oxygen at a median of 5 min the Spo(2) rose to a median of 81% by 6 min. In the first 10 min after birth, 80% and 55% of infants in the OX(100) and OX(21) groups, respectively, had an Spo(2) > or =95%. Increases in HR over the first 10 min were very similar in the two groups. Most very preterm infants received supplemental oxygen if air was used for the initial resuscitation. In these infants, the use of backup 100% oxygen and titration against Spo(2) resulted in a similar course to "normal" term and preterm infants. Of the infants resuscitated with 100% oxygen, 80% had Spo(2) > or =95% during the first 10 min. The HR changes in the two groups were very similar.
Publisher: Wiley
Date: 03-2007
DOI: 10.1111/J.1440-1754.2007.01036.X
Abstract: To examine the use of high frequency ventilation (HFV) to treat newborn infants in Australia and New Zealand and the associated complications and outcomes. Data for all infants receiving HFV were collected from the 28 neonatal intensive care units contributing to the Australian and New Zealand Neonatal Network database between 1996 and 2003, inclusive. For comparison, the same data were gathered on all infants who received conventional mechanical ventilation (CMV) and nasal continuous positive airway pressure. HFV was used to treat 3270 infants (10.1% of all ventilated infants) between 1996 and 2003 uptake doubled during this period from 5.9% to 12.6% of ventilated infants per year. HFV was most frequently applied in the context of extreme prematurity (29.9% of ventilated infants <26 weeks gestation). HFV is being increasingly used to treat complex diseases such as meconium aspiration syndrome and congenital diaphragmatic hernia (12.2% and 10.6% in 1996 to 25.2% and 48.4% in 2003, respectively, chi2 -test for trend, P<0.001). Infants receiving HFV spent longer on respiratory support than infants treated with CMV (median 21 days compared with 7 days, Mann-Whitney test P<0.001) and required a higher initial FiO2 (median 0.8 compared to 0.5, Mann-Whitney test, P<0.001). The use of HFV was associated with a higher mortality than CMV and nasal continuous positive airway pressure (39.7%, 10.1% and 0.4%, chi2 -test, P<0.001). The incidence of death and intraventricular haemorrhage decreased over time in the HFV group (chi2 -test for trend, P<0.001 and P=0.02 respectively). HFV is an established mode of neonatal ventilation in Australia and New Zealand. HFV is being applied to infants at the greatest risk of serious adverse outcomes, most likely as a rescue therapy.
Publisher: Cold Spring Harbor Laboratory
Date: 26-01-2021
DOI: 10.1101/2021.01.21.21249496
Abstract: Otitis Media with Effusion (OME) causing hearing impairments affects ∼1 in 10 children starting school in UK/ Europe. 80% have at least one episode with most having conductive hearing loss. Studies showed children with OME hear better with bone conducting headsets. During COVID-19 we investigated whether children with deafness secondary OME, without access to audiology or grommet surgery, could be aided with bone conduction kits and the HearGlueEar app. Starting July 2020, during COVID-19, children aged 3-11 years with OME and on a grommet waiting list were invited to a single arm, prospective study. They received the kit, instructions and HearGlueEar app by post. By 3 weeks parents were asked to charge and pair the devices, attend a remote consultation and complete an OMQ-14 questionnaire. Remote follow-up lasted 3 months. Outcomes: ability to use the equipment, complete the questionnaire about child’s hearing and behaviour before and with the equipment, declining grommet surgery or where deafness resolved, and give opinion about the intervention. 26 children enrolled. Families used the kit at home and school. Most found remote consultations positive and convenient. OMQ-14 responses were 90% positive. Comments were: “Other people have said, wow his speech is clearer.”, “It is making a real difference at home.”, “He said over and over again, “I can hear everybody, wow, wow, wow.”, “It is no exaggeration to say this has made an astronomical improvement to his quality of life”. One child reported “I can hear my best friend again”. “She is getting on really well with the headphones - pairing them with the iPad at home is simply brilliant.” Three families continued with the headset to avoid grommets. Posting a bone conduction kit, HearGlueEar app and remote consultation is effective support for children with deafness secondary to OME. None
Publisher: BMJ
Date: 20-02-2011
Abstract: Nasal intermittent positive pressure ventilation (NIPPV) may be beneficial but the mechanisms of action are undetermined. To investigate the effects of non-synchronised NIPPV on spontaneous breathing in premature infants. 10 infants receiving ventilator generated non-synchronised NIPPV were studied for 30 min. Delivered pressure was measured at the nose respiration was recorded using respiratory inductance plethysmography. Oxygen saturation, carbon dioxide, heart rate, inspired oxygen and video images were recorded. Median gestational age, birth weight, age and study weight were 25(+3) weeks, 797 g, 24 days and 1076 g. When the NIPPV pressure peak commenced during spontaneous inspiration the inspiratory time increased by 21% (p=0.002), relative tidal volume increased by 15% (p=0.01) and expiratory time was unchanged. When the NIPPV pressure peak commenced during spontaneous expiration the expiratory time increased by 13% (p=0.04). NIPPV pressures delivered during apnoea (range 8-28 cm H(2)O) produced chest inflation 5% of the time, resulting in small tidal volumes (26.7% of spontaneous breath size) but reduced oxygen desaturation. NIPPV pressure peaks occurred throughout spontaneous respiration proportional to the inspiratory: expiratory ratio. NIPPV pressure peaks only resulted in a small increase in relative tidal volumes when delivered during spontaneous inspiration. During apnoea pressure peaks occasionally resulted in chest inflation, which ameliorated oxygen desaturations. Infants did not become entrained with the NIPPV pressure changes. Synchronising every rise in applied pressure with spontaneous inspiration may increase the effectiveness of NIPPV and warrants investigation.
Publisher: Elsevier BV
Date: 1984
DOI: 10.1016/S0140-6736(84)90177-6
Abstract: Preterm infants who were making expiratory efforts against ventilator inflation were randomised to be paralysed with pancuronium or to receive no paralysing agent during ventilation. Pneumothoraces developed in all 11 unparalysed babies but in only 1 of 11 (p less than 0.0004) of those managed with pancuronium, which had no serious side-effects. In 34 infants excluded from the trial because they were not breathing against the ventilator, no pneumothoraces developed.
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.EARLHUMDEV.2005.07.002
Abstract: Epidemiological studies show that exposure to factors that restrict fetal growth or lead to low birthweight can alter lung development and have later adverse effects on lung function and respiratory health. The major causal factors include reduced nutrient and oxygen availability, nicotine exposure via maternal tobacco smoking and preterm birth, each of which can affect critical stages of lung development. Experimental studies show that these environmental insults can permanently alter lung structure and hence lung function, increasing the risk of respiratory illness and accelerating the rate of lung aging. Further studies are required that address the molecular and cellular mechanisms by which these factors adversely affect lung development and whether such effects can be blocked or reversed. Ultimately however, a major goal should be to prevent prenatal compromises through clinical monitoring, and in the case of smoking through education, thereby ensuring that each fetus has the best possible environment in which to develop.
Publisher: American Academy of Pediatrics (AAP)
Date: 11-2010
Publisher: BMJ
Date: 16-11-2011
Abstract: Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction. The authors reviewed recordings of infants at 75%. The authors analysed recordings of 56 preterm infants. Obstruction occurred in 14 (26%) recordings and leaks in 27 (51%). Both obstruction and mask leaks were seen in eight (14%) recordings, and neither was seen in 15 (27%). Obstruction occurred at a median (IQR) of 48 (24-60) s after the start of PPV. A median (range) of 22 (3-83) consecutive obstructed inflations were delivered. Face-mask leaks occurred from the first inflation in 19/27 (70%) and in the remaining eight at a median (IQR) of 30 (24-46) s after the start of PPV. A median (range) of 10 (3-117) consecutive inflations with a leak >75% were delivered. Airway obstruction and face-mask leak are common during the first 2 min of PPV. An RFM enables detection of important airway obstruction and mask leak.
Publisher: SPIE
Date: 14-03-2005
DOI: 10.1117/12.591220
Publisher: BMJ
Date: 06-02-2007
Publisher: American Academy of Pediatrics (AAP)
Date: 04-2007
Abstract: OBJECTIVE. Low-dose dexamethasone facilitates extubation in chronically ventilator-dependent infants with no obvious short-term complications. The objective of this study was to determine the long-term effects of low-dose dexamethasone. METHODS. Very preterm (& weeks' gestation) or extremely low birth weight (birth weight & g) infants who were ventilator dependent after the first week of life for whom clinicians considered corticosteroids were indicated were eligible. After informed consent, infants were randomly assigned to masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Survivors were assessed at 2 years' corrected age by staff blinded to treatment group allocation to determine neurosensory outcome, growth, and health. RESULTS. The trial was abandoned well short of its target s le size because of recruitment difficulties. Seventy infants were recruited from 11 centers, 35 in each group: 59 survived to 2 years of age, and 58 (98%) were assessed at follow-up, but data for cerebral palsy were available for only 56 survivors. There was little evidence for a difference in the major end point, the rate of the combined outcome of death, or major disability at 2 years of age (dexamethasone group: 46% controls: 43%). Rates of mortality before follow-up (11% vs 20%), major disability (41% vs 31%), cerebral palsy (14% vs 22%), or of the combined outcomes of death or cerebral palsy (23% vs 37%) were not substantially different between the groups. There were no obvious effects of low-dose dexamethasone on growth or readmissions to hospital after discharge. CONCLUSIONS. Although this trial was not able to provide definitive evidence on the long-term effects of low-dose dexamethasone after the first week of life in chronically ventilator-dependent infants, our data indicate no strong association with long-term morbidity.
Publisher: Springer Science and Business Media LLC
Date: 03-2009
Publisher: Springer Science and Business Media LLC
Date: 15-09-2009
DOI: 10.1007/S00134-009-1628-8
Abstract: To compare four methods of volume recruitment upon initiation of high frequency oscillatory ventilation (HFOV). Anesthetized intubated neonatal piglets (n = 10) underwent repeated saline lavage, followed by conventional mechanical ventilation (CMV). After transition to HFOV at a mean airway pressure 8 cmH2O above CMV (P(basal)), four methods of lung volume recruitment were tested in each animal in random order: Escalating--step-wise pressure increments over 6 min to a peak mean airway pressure 12 cmH2O above P(basal) Sustained dynamic inflation (DI)--a 20 s inflation to the same peak pressure DI repeated six times for 1 s Standard--mean airway pressure set directly at P(basal). After each recruitment method, HFOV continued at P(basal) for 15 min. Thoracic gas volume and distribution of aeration were determined by single slice computed tomography, and oxygenation by arterial blood gas s ling. Escalating recruitment resulted in the greatest thoracic gas volume 15 min post recruitment [77 +/- 3.3% of total lung capacity vs. 70 +/- 4.2% (Sustained DI), 65 +/- 3.5% (Repeated DI),63 +/- 5.1% (Standard) mean +/- SEM P = 0.042, ANOVA]. All methods resulted in a reduction in non-aerated lung, with the greatest redistribution to normally aerated lung being with Escalating recruitment. Oxygenation 15 min post recruitment was better with the Escalating method than with Repeated DI or Standard recruitment (pO2 307 +/- 41 vs. 159 +/- 36 vs. 134 +/- 39 mmHg, respectively P = 0.016, ANOVA). Escalating recruitment produced the greatest increase in lung volume and resolution of atelectasis, and is recommended for lung volume recruitment upon initiation of HFOV.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2004
DOI: 10.1097/00008480-200404000-00004
Abstract: Continuous positive airway pressure is increasingly being used in the care of premature infants. The purpose of this review is to highlight the current controversies in the use of neonatal continuous positive airway pressure. This review explores information about the devices available for delivering continuous positive airway pressure and the pressures that can be used. It also investigates the controversial issues of using continuous positive airway pressure during resuscitation of premature infants and whether infants who are going to be managed on continuous positive airway pressure should be intubated and given surfactant before continuous positive airway pressure is started. It reviews the use of continuous positive airway pressure and the prevention of chronic lung disease and the use of nasal intermittent positive pressure ventilation and the difficult area of weaning from continuous positive airway pressure. Existing evidence suggests that short binasal prongs are most effective, nasal intermittent positive pressure ventilation is a useful way of augmenting neonatal continuous positive airway pressure and that very premature infants can be managed with neonatal continuous positive airway pressure in the delivery room as part of the resuscitation. Further research is required to determine whether important outcomes are improved with the use of nasal continuous positive airway pressure rather than endotracheal intubation and, if so, whether surfactant should be given to infants so managed. Definition of optimal levels of continuous positive airway pressure for infants at varying stages of their disease also requires further research.
Publisher: S. Karger AG
Date: 25-11-2011
DOI: 10.1159/000318663
Abstract: i Background: /i Neonatal resuscitation guidelines do not specify the gas flow rate during mask ventilation. i Aim: /i Investigating the effect of gas flow rates on pressures, volumes delivered and mask leak. i Methods: /i Flow 5 and 10 liters/min were tested. In study part 1, pressure ranges were measured when ventilating an intubated manikin with a Neopuff®. In study part 2, pediatric staff mask-ventilated a manikin (peak inflation pressure (PIP) 30 cm H sub /sub O, positive end expiratory pressure (PEEP) 5 cm H sub /sub O). We measured pressures, expired tidal volume (V sub Te /sub ) and mask leak. i Results: /i Study part 1:an intubated manikin was ventilated with flow 5 versus 10 liters/min: range in PEEP was 0.4–3.6 and 2–14 cm H sub /sub O, respectively, maximum PIP was 73 cm H sub /sub O with both flow rates. Study part 2: when mask ventilation was given with flow 5 versus 10 liters/min: leak decreased (24% (8–85) vs. 80% (34– 94) p 0.0001), V sub Te /sub increased (6.7 (5.1–7.8) vs. 4.7 (2.4–7.0) ml p 0.001), PEEP decreased (3.1 (0.8) vs. 3.7 (0.7) cm H sub /sub O p 0.001), PIP was similar (28.1 (2.7) vs. 28.0 (2.3) cm H sub /sub O NS). Large leaks decreased V sub Te /sub and PEEP during both flow rates, PIP only with flow 5 liters/min. i Conclusion: /i A low flow rate during neonatal mask ventilation may be a good alternative approach in reducing mask leak, provided that inflation time and flow rate warrants set pressures. Only large leaks seem to influence delivered pressures and volumes. Before resuscitation guidelines are advised, more studies on gas flow rates are needed.
Publisher: Springer Science and Business Media LLC
Date: 02-06-2012
DOI: 10.1038/JP.2011.73
Abstract: The objective of this study is to compare the effects of back-up ventilation rates (BURs) on triggered inflations and patient cardiorespiratory stability during assist-control/volume guarantee ventilation (AC/VG). This study is a randomized crossover trial conducted in a neonatal unit in an Australian tertiary NICU. In all, 26 stable preterm infants on AC/VG ventilation were studied at BUR settings of 30, 40 and 50 min(-1). Inflation rate, triggering and cardiorespiratory measures of patient stability were compared during 20 min epochs with 10 min washout periods. The 26 infants studied were median (inter-quartile range) gestational age 27 (26, 30) weeks, birth weight 0.84 (0.75, 1.14) kg and FiO(2) 0.24 (0.21, 0.31) and age 6 (4, 19) days. At BURs of 30, 40 and 50, the proportions of inflations, which were triggered, were mean (s.d.) 85% (11), 75% (19) and 61% (25) P<0.01 for all comparisons. Total delivered inflation rates were 56 (8), 58 (9) and 62 (8) min(-1), respectively. Cardiorespiratory parameters did not vary between the settings. Using a lower BUR allows greater triggering of ventilator inflations. Cardiorespiratory parameters including CO(2) levels were stable at all rates.
Publisher: Wiley
Date: 20-05-2013
DOI: 10.1111/APA.12274
Publisher: Massachusetts Medical Society
Date: 27-05-2010
DOI: 10.1056/NEJME1004342
Publisher: BMJ
Date: 30-06-2010
Abstract: To evaluate mask technique during simulated neonatal resuscitation and test the effectiveness of training in optimal mask handling. Seventy participants(consultants, registrars and nurses) from neonatal units were asked to administer positive pressure ventilation at a flow of 8 l/min and a frequency of 40-60/min to a modified leak free, term newborn manikin (lung compliance 0.5 ml/cm H(2)O) using a Neopuff T-piece device. Recordings were made (1) before training, (2) after training in mask handling and (3) 3 weeks later. Leak was calculated. Obstruction (tidal volume <60% of optimal tidal volume) and severe obstruction (<30% of optimal tidal volume) were calculated when leak was minimal. For the 70 participants, median (IQR) leak was 71% (32-95%) before training, 10% (5-37%) directly after training and 15% (4-33%) 3 weeks later (p<0.001). When leak was minimal, gas flow obstruction was observed before, directly after training and 3 weeks later in 46%, 42% and 37% of inflations, respectively. Severe obstruction did not occur. Mask ventilation during simulated neonatal resuscitation was often h ered by large leaks at the face mask. Moderate airway obstruction occurred frequently when effort was taken to minimise leak. Training in mask ventilation reduced mask leak but should also focus on preventing airway obstruction.
Publisher: American Academy of Pediatrics (AAP)
Date: 2013
Abstract: 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. 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. 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). Using an endotracheal stylet did not significantly improve the success rate of pediatric trainees at neonatal orotracheal intubation.
Publisher: American Academy of Pediatrics (AAP)
Date: 11-2002
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2006
Publisher: Elsevier BV
Date: 06-1982
DOI: 10.1016/S0140-6736(82)92397-2
Abstract: Effective colonization of host cells by some Gram-positive bacteria often involves using lengthy, adhesive macromolecular structures called sortase-dependent pili. Among commensals, the gut-adapted
Publisher: Wiley
Date: 30-03-2011
DOI: 10.1111/J.1440-1754.2011.02036.X
Abstract: The study aims to compare three commonly used neonatal resuscitation devices, the Laerdal self-inflating bag with a positive end expiratory pressure (PEEP) valve, a T-piece resuscitator (T-piece) and a flow-inflating bag to provide peak inflation pressure (PIP) and PEEP. Participants were asked to use each device to give positive pressure ventilation to a modified neonatal mannequin via a face mask to achieve 40-60 inflations per minute, aiming for a PIP/PEEP of 30/5 cm H₂O. A manometer was visible to participants with each device. PIP, PEEP, percentage leak at the face mask and expired tidal volume were measured using a hot-wire anemometer. We analysed 20 inflations from each participant for each device. Fifty participants provided PIP and PEEP with each device. The T-piece was the most accurate and consistent. The flow-inflating bag had the most variation. The leak was lowest with the self-inflating bag and PEEP and highest with the flow-inflating bag, but all had wide variation. Each device was able to provide PIP and PEEP when used appropriately. When compared with other resuscitation devices, the T-piece provided the most accurate and consistent PIP and PEEP.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.RESUSCITATION.2010.10.012
Abstract: Current neonatal resuscitation guidelines recommend using visual assessment of chest wall movements to guide the choice of inflating pressure during positive pressure ventilation (PPV) in the delivery room. The accuracy of this assessment has not been tested. We compared the assessment of chest rise made by observers standing at the infants' head and at the infants' side with measurements of tidal volume. Airway pressures and expiratory tidal volume (V(Te)) were measured during neonatal resuscitation using a respiratory function monitor. After 60s of PPV, resuscitators standing at the infants' head (head view) and at the side of the infant (side view) were asked to assess chest rise and estimate V(Te). These estimates were compared with V(Te) measurements taken during the previous 30s. We studied 20 infants who received a mean (SD) of 23 (4) inflations during the 30s. Some observer felt unable to assess chest rise both from the head view (6/20) and from the side view (3/20). Observers from both head and side tended to underestimate tidal volume by 3.5mL and 3.3mL respectively. Agreement between clinical assessment and measured V(Te) was generally poor. During mask ventilation, resuscitators were unable to accurately assess chest wall movement visually from either head or side view.
Publisher: Elsevier
Date: 2008
Location: United Kingdom of Great Britain and Northern Ireland
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 Colin Morley.