1,721,213 research outputs found
Italian survey of neonatal respiratory support strategies
No full textAlthough the management of respiratory distress syndrome (RDS) in preterm infants has been characterized by significant progress in recent years, it is difficult to translate the research results into clinical practice. Previous surveys have demonstrated that in some areas, the current management of RDS does not reflect evidence from randomized trials. Therefore, the Pulmonology Study Group of the Italian Society of Neonatology decided to perform a similar survey in Italy with the aim of identifying possible aspects of respiratory management of preterm infants with RDS that merit improvement, and of suggesting focused interventions for their resolution
Early congenital syphilis in a premature newborn: typical cutaneous manifestations in atypical skin areas
No full textnot availabl
Early dexamethasone therapy in very low birth weight infants
No full textThe study by Durand et al in the April 1995 issue of Pediatrics on the effects of dexamethasone therapy for chronic lung disease (CLD) in very low birth weight (VLBW) infants is no doubt of interest because it is the first to demonstrate that an early 1-week course of dexamethasone decreases the incidence of CLD. nevertheless, in terms of dealing with the side effects of dexamethasone therapy, the authors gave no details about the cardiac evaluation of the infants studied, even if an echocardiogram was performed before enrollment and at weekly intervals thereafter
Effects of early dexamethasone therapy on pulmonary fibrogenic mediators and respiratory mechanism in preterm infants
No full textCorticosteroid administration may prevent chronic lung disease in premature newborns, perhaps by modulating the synthesis of various cytokines, including those involved in fibrogenic processes. This study analyses the levels of three fibrogenic cytokines, namely vascular endothelial growth factor, transforming growth factor-beta 1 and basic fibroblast growth factor in tracheobronchial aspirate fluids collected from 20 premature newborns randomly assigned to the early dexamethasone group or to the control group. Furthermore, pulmonary function tests were performed on days 0 and 2 following the start of therapy. The results show that early corticosteroid administration reduces transforming growth factor-beta 1 and basic fibroblast growth factor levels, and abolishes the spontaneous vascular endothelial growth factor increase observed in untreated patients, concomitantly with significant improvement of dynamic lung compliance and shorter duration of the intubation period in the treated group of patients. Significant correlations were observed between the levels of transforming growth factor-beta 1 and vascular endothelial growth factor, indicating that the production of both these cytokines is coordinated. Finally, transforming growth factor-beta 1 ratios (day 2/day 0), representing early variations of the cytokine levels, were significantly different between treated and untreated subjects and correlated with the dynamic lung compliance ratios and the extubation day, suggesting that the downmodulation of some fibrogenic mediators may be involved in the mode of action of dexamethasone
High-frequency ventilation is/is not the optimal physiological approach to ventilate ARDS patients
No full textCombination of ketamine and fentanyl (KetaFent) for safe insertion of ultrasound-guided central venous catheters in infants
Full text linkCentrally inserted central catheters (CICCs) are placed by ultrasound guided puncture of the internal jugular or brachio-cephalic vein. It is crucial to achieve a good level of sedation and analgesia in order to keep the babies still thus reducing the risk of procedural failure. The aim of this study is to evaluate the efficacy of the combination of ketamine and fentanyl during the CICC placement procedure. We retrospectively collected data from 72 infants who underwent CICC insertion after sedation with KetaFent protocol. The primary outcome was to assess the success of the procedure defined as CICC placement. Secondary outcome was intubation during the procedure in non-ventilated infants (noninvasive ventilation or spontaneous respiration), need for repeat doses of study medications to complete the procedure, time to complete the procedure, the level of analgesia assessed using vital parameters. The procedure was completed in 100% of cases. There were no cases of hypotension during and at the end of the procedure. No intubation was performed on non-ventilated infants. The combination of ketamine and fentanyl for sedation and analgesia in infants requiring insertion of a CICC is 100% successful. It is associated with a low risk of side effect like apnea and intubation. Insertion of a central venous catheter is a painful procedure for infants. Adequate sedation is mandatory to keep the baby still thus reducing the risk of procedural failure
Umbilical cord blood as a source for red-blood-cell transfusion in neonatology: a systematic review
No full textThe prevention and treatment of anaemia in newborn patients made tremendous progress in the last decades. However, red-blood-cell (RBC) transfusions remain unavoidable in many neonates candidate to surgery and especially in preterm infants. In particular, anaemia occurring in neonates born at extremely low gestational age is actually severe and frequently requires transfusions. Several approaches have been explored to prevent or even to reduce the threshold and the frequency of RBC transfusions. Among these, umbilical cord blood (UCB) collection and processing to obtain RBC components for autologous or allogeneic transfusion have been extensively investigated. In this systematic review, we revised the literature concerning the use of UCB for either autologous or allogeneic transfusion purposes and we illustrated the rationale for a transfusion therapy tailored to extremely preterm neonates, based on RBC concentrates from allogeneic UCB donations
Antifungal prophylaxis: identification of preterm neonates at high risk for invasive fungal infection.
No full textWe read with great interest the article by Healy et al,1 who evaluated the impact of fluconazole prophylaxis (FP) for extremely low birth weight infants on invasive candidiasis (IC) incidence, IC-related mortality rates, and fluconazole susceptibility of Candida isolated. We wish to make some comments thereon.
Healy et al1 demonstrated a decrease of IC in NICU infants, after the introduction of FP, from 0.6% to 0.3%, and a 3.6 fold decrease in ELBW infants. Recent studies have demonstrated that prophylactic use of fluconazole is effective in reducing the incidence of fungal colonization and fungal systemic infections in preterm neonates.2,3 However, because of the lack of larger multicenter randomized trials and data on long term neurodevelopment outcomes as well as concern about unwanted side effects and development of Candida resistance, FP in high risk infants remains controversial. For these reasons, selecting only those infants at highest risk for IC may delay or prevent the emergence of resistance. In recent studies, the criteria chosen to identify “the high-risk neonate” were <1500 g birth weight (BW) and the presence of a central vascular catheter or endotracheal tube.4 These criteria seem to be too wide, because they could regard almost all the population sheltered in a NICU.
In our NICU, FP as well as antibiotic prophylaxis did not exist, and Candida-related mortality was nearly 20% in extremely low birth weight infants. To prevent IC, we introduced a protocol of Candida surveillance cultures from stool and bronchoalveolar lavage fluid in intubated infants, and every infant who developed IC was identified and IC-related mortality was eliminated.5 All neonates with IC had a BW of 27 weeks
Use of Wireless Ultrasound Probe in Isolated Infants: A Case Report of Two SARS-CoV-2-Positive Mothers’ Newborns
No full textThe COVID-19 pandemic has upset habits in any workplace. In hospitals, several precautions have been taken to maintain health-care workers' safety and to avoid disease spread or the possible creation of new epidemic outbreaks. The use of medical devices makes the contamination and the nosocomial virus spread possible, causing infection in medical operators and hospitalized patients. In the neonatal intensive care unit, ultrasound has been an increasingly used tool because it is a non-invasive, repeatable method and it is side effect-free as the newborn is not exposed to radiation. It makes a fast diagnosis and then therapy possible such as in the lung diseases and other life-threatening conditions. The use of portable devices such as the wireless probe has many advantages in routine clinical practice, and during the COVID-19 pandemic, it has proved to be fundamental for the patient and the physician's safety because it reduced the risk of contamination. We report the use of the wireless ultrasound probe in 2 isolated neonates born to SARS-CoV-2-positive mothers
The intracavitary ECG method for tip location of ultrasound-guided centrally inserted central catheter in neonates
No full textBackground: The correct position of the tip of a central venous access device is important in all patients, and especially in neonates. The traditional method of tip location (approximated intra-procedural length estimation + post procedural chest X-ray) is currently considered inaccurate and not cost-effective by most recent guidelines, which recommend the adoption of tip location by intracavitary electrocardiography (IC-ECG) whenever possible. Methods: This study prospectively investigated the applicability, the feasibility, the accuracy, and the safety IC-ECG for tip location in neonates requiring insertion of ultrasound-guided centrally inserted central venous catheters (CICCs) with caliber 3Fr or more. All catheter tip locations were verified using simultaneously both IC-ECG and ultrasound-based tip location, using the Neo-ECHOTIP protocol. Results: A total of 105 neonates were enrolled. The applicability of IC-ECG was 100% since a P wave was evident on the surface ECG of all neonates recruited for the study. The feasibility was also 100% since an increase of the P-wave was detected in all cases. The accuracy was also 100%, since a perfect match between IC-ECG based tip location and ultrasound-based tip location was found. There were no adverse events directly or indirectly related to the IC-ECG technique; no arrhythmias occurred. Conclusions: When applied to ultrasound guided CICCs, tip location by IC-ECG is applicable and feasible in neonates, and it is safe and accurate
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