1,720,970 research outputs found
Pregnancy and neonatal respiratory outcome
No full textPreterm labor is the final common pathway of different complications of pregnancy and despite substantial progress in antenatal care, preterm birth remains a major health issue across the globe. Preterm deliveries in the larger group of spontaneous preterm labor or preterm prelabor rupture of membranes (PPROM) are often associated with intrauterine chorioamnionitis. Current evidence underlines the role of "inflammatory" and "placental dysfunction" disorders in pregnancy on prematurity-associated morbidity, particularly respiratory outcome. (www.actabiomedica.it)
Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data
Full text linkDespite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as a better tolerated form of NIV, allowing better access to the baby’s face, which may improve nursing, feeding and bonding. HFNC may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for care-givers than conventional NCPAP. Limited evidence is available to support the specific role, efficacy and safety of HFNC in newborns and to demonstrate efficacy compared with NCPAP; some studies suggest a potential role for HFNC in respiratory care of the neonate as a distinct non invasive ventilatory support. We present the preliminary data of a randomized clinical trial; the aim of this study was to assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with mild to moderate respiratory distress syndrome (RDS)
High Flow Nasal Cannula Versus Nasal CPAP in the Management of Respiratory Distress Syndrome : Preliminary Data
No full textBACKGROUND: High flow nasal cannula (HFNC) are gaining in popularity as a form of non invasive ventilation (NIV) alternative to nasal continuous positive airway pressure (NCPAP) in preterm infants. Despite of a greater ease of use and reports of improved tolerance, there is a limited evidence to support its efficacy and safety.
OBJECTIVE: To assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with respiratory distress syndrome (RDS).
DESIGN/METHODS: Preterm infants with gestational age (GA) between 29+0 and 36+6 weeks and radiological and clinical signs of moderate RDS were randomized to NCPAP (Infant Flow SIPAP- CareFusion) at 4-6 cmH2O or heated humidified HFNC (Precision Flow - Vapotherm) at 4-6 l/min. The primary outcome was the need of intubation within the first 72 hours of life. Secondary outcomes included: the need of surfactant, total duration of respiratory assistance and NIV, length of hospitalization and O2 supplementation, time to full enteral feeding and the incidence of the most common short and long term complications of prematurity (necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage, bronchopulmonary dysplasia and retinopathy of prematurity). Continuous variables were analyzed by Student t test and categorical variables by Fisher's exact test. Statistical significance was considered for p<0.05.
RESULTS: We enrolled 92 infants [NCPAP (n 52): GA 33±1.89 wks (mean±SD), BW 1895±487 g; HFNC (n 40): GA 33±1.83 wks, BW 1930±513 g]. The baseline characteristics and perinatal risk factors were similar between the two groups (p=NS). Despite the need of intubation within 72 hours was greater in HFNC group (12.5%, 5/40) compared to NCPAP group (5.7%, 3/52), the difference was not statistically significant (p=0.28). Differences in secondary outcomes were not observed; particularly mean duration of NIV was 5.8 days in HFNC group vs 4.3 in NCPAP group, mean total duration of respiratory assistance 6.4 days vs 4.7 and mean length of hospitalization 25.3 days vs 24.4 (p=NS).
CONCLUSIONS: According to our preliminary data, HFNC seems as effective and safe as NCPAP in the management of moderate RDS in premature infants. Further trials are needed to validate the use of HFNC as a non invasive respiratory support in situations when NCPAP has traditionally been use
Therapy with high-flow nasal intubation in preterm infants
No full textDespite of improved survival of premature infants, the incidence of long-term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as an efficient, better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. The aim of this review is to discuss the available evidence of effectiveness and safety of HFNC in preterm newborns with respiratory distress syndrome (RDS). It is known that distending pressure generated by HFNC increases with increasing flow rate and decreasing infant size and varies according to the amount of leaks by nose and mouth. The effects of HFNC on lung mechanics, its clinical efficacy and safety are still insufficiently investigated. In conclusion, there is a growing evidence of the feasibility of HFNC as an alternative mode of NIV. However, further larger randomized trials are required, before being able to recommend HFNC in the treatment of moderate respiratory distress of preterm infant
Assessment of pulmonary function in a follow-up of premature infants: our experience
No full textRespiratory diseases are a major cause of morbidity in neonates, especially preterm infants; a long term complication of prematurity such as bronchopulmonary dysplasia (BPD) is particularly relevant today. The exact role of the Pulmonary Function Test (PFT) in this area is not yet well defined; the PFT in newborns and infants - in contrast to what happens in uncooperative children and adults - are routinely used only in a few centers. The assessment of pulmonary function in newborns and infants, however, is nowadays possible with the same reliability that in cooperative patients with the possibility to extend the assessment of polmonary function from bench to bed. The assessment of pulmonary function must be carried out with non invasive and safe methods, at the bedside, with the possibility of continuous monitoring and providing adequate calculation and management of data. The ability to assess lung function helps to define the mechanisms of respiratory failure, improving the treatment and its effects and is therefore a useful tool in the follow-up of newborn and infant with pulmonary disease
Notice of Duplicate Publication: Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity: A Randomized Clinical Noninferiority Trial (JAMA Pediatr. doi:10.1001/jamapediatrics.2016.1243)
Full text linkGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Pulmonary Function in Neonatal Respiratory Distress Syndrome : Effects of Two Modes of Non Invasive Ventilation
No full textBACKGROUND: Despite of improved survival of premature infants, the incidence of long-term complications associated with ventilation-induced lung injury remains high. Non-invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. High flow nasal cannula (HFNC) is emerging as an efficient form of NIV.
OBJECTIVE: To compare the effects of nasal continuous positive airway pressure (NCPAP) and heated humidified HFNC on lung function in preterm newborns with respiratory distress syndrome (RDS).
DESIGN/METHODS: A randomized crossover trial was performed on newborns with mild/moderate RDS, gestational age (GA) <34 weeks and postnatal age (PNA) <96 hours. Each neonate underwent both NCPAP (Infant Flow Driver System - EME) delivering 2, 4, 6 cmH2O and heated humidified HFNC (Precision Flow - Vapotherm) at 2, 4, 6 lpm. Sequences of these six, 15 minutes lasting ventilatory conditions were randomized. Lung volumes were measured using respiratory inductance plethysmography (Bioradio 150-CleveMed) calibrated with face-mask pneumotachography. An esophageal balloon estimated pleural pressure and a catheter-transducer system measured retropharyngeal pressure (Prp). Breathing pattern, lung mechanics, work of breathing (WOB), labored breathing index (LBI) and pressure time product (PTP) were calculated. ANOVA on Ranks for repeated measurements and Tukey test for multiple comparisons were performed. Differences were considered statistically significant for p<0.05.
RESULTS: 20 newborns (mean GA 31±1 weeks, mean birth weight 1510±302g, mean PNA 53.5±27.5 hours) were enrolled. NCPAP was compared to HFNC selecting the conditions providing a Prp at end-expiration as close as possible to 2 and 4 cmH2O. At the same Prp, no significant difference was noticed in breathing pattern (Respiratory Rate, Tidal Volume, Minute Ventilation, Inspiratory and Expiratory Asynchrony Index), lung mechanics (Dynamic Resistance and Compliance), WOB (inspiratory, expiratory, elastic and resistive), LBI and PTP. A trend in higher values of WOB, LBI and PTP in HFNC was noticed.
CONCLUSIONS: Our results show that NCPAP and HFNC have similar effect on breathing pattern, lung mechanics and WOB, providing comparable ventilatory support in preterm infants with RDS. Further studies are needed to identify possible differences between the two approaches on clinical long-term outcome
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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