1,721,178 research outputs found
Caffeine for preterm infants: current indications and uncertainties
No full textCaffeine is one of the most commonly used therapies in Neonatology, with different indications such as the treatment of apnea and the prevention of extubation failure and bronchopulmonary dysplasia. However, there are still uncertainties regarding effects on central nervous system development, time of discontinuation and dosing of the drug
Refining the definition of BPD: Characterization of intercurrent episodes
No full textBackground: The main definitions of bronchopulmonary dysplasia (BPD), proposed by Jobe-Bancalari, Shennan et al., and Walsh et al., focus on oxygen (O2)-need and ventilatory support for the first weeks of life and at 36 weeks of post-menstrual age (PMA). Oxygen need at 36 weeks of PMA is sometimes due to intercurrent episodes (IEs) other than BPD. The aim of this retrospective study was to characterize IEs and determine their impact on BPD in preterm infants born at 28 days and at 36 weeks of PMA (±10 days) was analyzed. We classified each infant according to the three BPD definitions. Patients requiring O2 or ventilator support at 36 weeks of PMA, with no need for O2 in the first 28 days of life, were qualified for having IEs if their O2/ventilator dependence (at 36 weeks) had a limited duration and/or could be ascribed to a known condition. Then, the contribution of IEs to the BPD rate was evaluated. Results: Out of 1,210 patients, the BPD infants were 431 (35.6%), 169 (14.0%), and 186 (15.4%) according to Jobe-Bancalari, Shennan et al., and Walsh et al., respectively. Twenty-eight patients had IEs (16.6% of those on O2 at 36 weeks of PMA) indicating a mild BPD overestimation (P=0.065). Conclusion: We proposed a definition of IEs and found that IEs could lead to a potential BPD overestimation. Further research is needed to find out if patients with IE, similarly to infants with BPD, are prone to childhood complications and need preventive measures
Correlation between cardiorespiratory events and gastro-esophageal reflux in preterm and term infants: Analysis of predisposing factors
No full textBACKGROUND:
The association between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) among neonates is still controversial.
AIMS:
To test such an association in preterm and term infants.
STUDY DESIGN:
Prospective observational study.
SUBJECTS:
Forty-seven infants with suspected GER and recurrent CRE admitted at a neonatal intensive care unit, who underwent simultaneous and synchronized 24-hour recording of heart rate (HR), peripheral oxygen saturation (SpO2) and pH-impedance monitoring (MII-pH). HR/SpO2 data were filtered to avoid artefactual episodes of hypoxia and hypoperfusion.
OUTCOME MEASURES:
The main outcome measure was the symptom association probability (SAP), with a 2-minute time window. Infants with positive (>95%) and negative (≤95%) SAP index tests were compared by univariate and multivariate statistics.
RESULTS:
Median gestational age at birth was 294/7 weeks, median age at study 36 days. We recorded 3341 GER events and 4936 CRE (4710 desaturations, 226 bradycardias); 609/4936 (12%) CRE were temporally associated with GER episodes: 338 preceded and 271 followed GER events. The SAP index was significant in 5/47 (11%) patients. The SAP index including only CRE following GER events was significant in 3/47 (6%). There was no significant difference in the number of acid, weakly acid, non-acid, pH-only events preceding or following CRE between infants with SAP-positive and SAP-negative tests. Infants with positive SAP-index tests compared to those with SAP-negative tests had lower weight gain in the three days preceding the test and tended to have lower birth weight.
CONCLUSIONS:
GER and CRE were associated in <11% of patients. The evaluation of ponderal growth might be helpful in predicting such an association
Uncertainty Estimation of Biomedical Oximeters: Proposal for an Experimental Test-Bench
No full textParamagnetic oximeters are frequently used in clinical practice to measure and titrate the fraction of inspired oxygen (FiO2) administered to a hypoxic patient. Newborns are prone to several diseases leading to hypoxia but also to oxidative damage, therefore a precise measurement of administered oxygen is of paramount importance. In this study, we evaluated and compared the performance of four commonly used gas analyzers at a Neonatal Unit. A paramagnetic gas analyzer was considered the standard for reference. Gas mixing performed by blenders was also evaluated. We first assessed the stability and composition of O2 and medical air. A settling time study was conducted to estimate a steady-state. Results show how tested blenders underestimated the real measures when FiO2 was <50% and overestimated them when FiO2 ≥50%. In all the tested oximeters the FiO2 was underestimated by 1.18%, but the overall agreement with the gold standard was very good
Which is the preferred substrate for pulmonary surfactant disaturated phosphatidylcholine (DSPC) synthesis in newborn infants?
No full textQuality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries.
No full textOBJECTIVE: The level of adherence to guidelines should be explored particularly in preterm infants for whom poor nutrition has major effects on outcomes in later life. The objective was to evaluate compliance to international guidelines for parenteral nutrition (PN) in preterm infants across neonatal intensive care units (NICUs) of four European countries.
DESIGN: Clinical practice survey by means of a questionnaire addressing routine PN protocols, awareness and implementation of guidelines.
SETTING: NICUs in the UK, Italy, Germany and France.
PARTICIPANTS: One senior physician per unit; 199 units which represent 74% of the NICUs of the four countries.
PRIMARY OUTCOME MEASURE: Adherence of unit protocol to international guidelines.
SECONDARY OUTCOME MEASURE: Factors that influence adherence to guidelines.
RESULTS: 80% of the respondents stated that they were aware of some PN clinical practice guidelines. For amino acid infusion (AA), 63% of the respondents aimed to initiate AA on D0, 38% aimed to administer an initial dose ≥1.5 g/kg/day and 91% aimed for a target dose of 3 or 4 g/kg/day, as recommended. For parenteral lipids, 90% of the respondents aimed to initiate parenteral lipids during the first 3 days of life, 39% aimed to use an initial dose ≥1.0 g/kg/day and 76% defined the target dose as 3-4 g/kg/day, as recommended. Significant variations in PN protocols were observed among countries, but the type of hospital or the number of admissions per year had only a marginal impact on the PN protocols.
CONCLUSIONS: Most respondents indicated that their clinical practice was based on common guidelines. However, the initiation of PN is frequently not compliant with current recommendations, with the main differences being observed during the first days of life. Continuous education focusing on PN practice is needed, and greater efforts are required to disseminate and implement international guidelines
A novel measurement technique for the assessment of best positive end-expiratory pressure in newborn patient
No full textMore than 10 million of infants born prematurely each year in the word. In case of a preterm delivery, there is a dramatic physiological transition from fetal to neonatal life often associated to some infant insufficiencies and/or pathologies. Respiratory diseases, such as distress syndrome and bronchopulmonary dysplasia, are common reasons for admission to a neonatal unit. In order to replace spontaneous breathing and to restore a physiologic gas exchanges, mechanical ventilation (MV) is very often required also in order to evaluate the degree of the insufficiency and/or of the diseases. To control the MV parameters, and the positive end-respiratory pressure, pulse oximetry is the leading instrumentation allowing the measurement of the saturation of the oxygen (SpO2) molecules linked to the hemoglobin in the infant blood. The aim of this paper is to present a novel approach for the assessment of the best positive end-expiratory pressure (PEEP) values using pulse oximetry. Tests have been conducted on a small cohort of 5 infants. Subjects have been monitored using a Computer Aided Work for a period of 4 hours; SpO2, HR (heart rate), FiO2 (fraction of inhale oxygen) and PIP (peak inspiratory pressure) have been simultaneously acquired. Results show that, in average, max SpO2 values are obtained with a PEEP value of 8 mmH2O. Even if the number of subjects used in this study is limited to derive final conclusions, the prospective are extremely interesting in terms of optimal patient treatments
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