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de Mendonça KT, Lanza FC, de Sousa Morais RL, Camargos ACR. Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit. Early Hum Dev 2022; 174:105682. [PMID: 36206619 DOI: 10.1016/j.earlhumdev.2022.105682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is no clarity about which clinical variables during hospitalization in the Neonatal Intensive Care Unit (NICU) are associated with abnormal General Movements (GMs). OBJECTIVE To describe the trajectory of GMs of preterm newborns and explore the association between clinical variables and the presence of abnormal GMs during the NICU stay. METHODS Fifty-eight preterm newborns (33 males), with a mean gestational age at birth of 31,93 week's postmenstrual age, were evaluated using the GMs assessment by Hadders-Algra method. Clinical variables recorded weekly throughout the hospitalization period. The weekly association between clinical variables and the presence of abnormal GMs was tested using the Generalized Estimating Equations (GEE) model. RESULTS Preterm infants were recorded for up to sixteen weeks and more than half of the infants (56.9 %) had abnormal movements in at least one week during hospitalization. The absence of peri-intraventricular hemorrhage (PIVH) grades I-II and non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced, respectively, by 77.3 % (OR = 0.23; p > 0.0001) and 64.3 % (OR = 0.36; p > 0.0001) the chance of having an abnormal classification. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR = 0.025; p > 0.0001). CONCLUSION PIVH grades I-II, longer durations of mechanical ventilation and the presence of non-invasive ventilatory support and/or oxygen therapy are associated with abnormal movements during stay in the neonatal period. The data suggest that development outcome of infants having these conditions should be closely monitored.
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Affiliation(s)
- Karoline Tury de Mendonça
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Córdoba Lanza
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosane Luzia de Sousa Morais
- Graduate Program in Health, Society and Environment and Department of Physiotherapy, Universidade Federal do Vale do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ana Cristina Resende Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Inocencio IM, Tran NT, Nakamura S, Khor SJ, Wiersma M, Stoecker K, Polglase GR, Pearson JT, Wong FY. Increased peak end-expiratory pressure in ventilated preterm lambs changes cerebral microvascular perfusion: direct synchrotron microangiography assessment. J Appl Physiol (1985) 2020; 129:1075-1084. [PMID: 32909920 DOI: 10.1152/japplphysiol.00652.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Positive end-expiratory pressure (PEEP) improves oxygenation in mechanically ventilated preterm neonates by preventing lung collapse. However, high PEEP may alter cerebral blood flow secondarily to the increased intrathoracic pressure, predisposing to brain injury. The precise effects of high PEEP on cerebral hemodynamics in the preterm brain are unknown. We aimed to assess the effect of PEEP on microvessels in the preterm brain by using synchrotron radiation (SR) microangiography, which enables in vivo real-time high-resolution imaging of the cerebral vasculature. Preterm lambs (0.8 gestation, n = 4) were delivered via caesarean section, anesthetized, and ventilated. SR microangiography of the right cerebral hemisphere was performed with iodine contrast administered into the right carotid artery during PEEP ventilation of 5 and 10 cmH2O. Carotid blood flow was measured using an ultrasonic flow probe placed around the left carotid artery. An increase of PEEP from 5 to 10 cmH2O increased the diameter of small cerebral vessels (<150 µm) but decreased the diameter of larger cerebral vessels (>500 µm) in all four lambs. Additionally, the higher PEEP increased the cerebral contrast transit time in three of the four lambs. Carotid blood flow increased in two lambs, which also had increased carbon dioxide levels during PEEP 10. Our results suggest that PEEP of 10 cmH2O alters the preterm cerebral hemodynamics, with prolonged cerebral blood flow transit and engorgement of small cerebral microvessels likely due to the increased intrathoracic pressure. These microvascular changes are generally not reflected in global assessment of cerebral blood flow or oxygenation.NEW & NOTEWORTHY An increase of positive end-expiratory pressure (PEEP) from 5 to 10 cmH2O increased the diameter of small cerebral vessels (<150 µm) but decreased the diameter of larger cerebral vessels (>500 µm). This suggests increased intrathoracic pressure due to high PEEP can drive microvessel engorgement in the preterm brain, which may play a role in cerebrovascular injury.
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Affiliation(s)
- Ishmael Miguel Inocencio
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Nhi Thao Tran
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Shinji Nakamura
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Song J Khor
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Manon Wiersma
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Katja Stoecker
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Graeme R Polglase
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - James T Pearson
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Centre, Osaka, Japan.,Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
| | - Flora Y Wong
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
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Polglase GR, Miller SL, Barton SK, Kluckow M, Gill AW, Hooper SB, Tolcos M. Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury. Pediatr Res 2014; 75:682-8. [PMID: 24614803 DOI: 10.1038/pr.2014.40] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/16/2013] [Indexed: 02/02/2023]
Abstract
The transition to newborn life in preterm infants is complicated by immature cardiovascular and respiratory systems. Consequently, preterm infants often require respiratory support immediately after birth. Although aeration of the lung underpins the circulatory transition at birth, positive pressure ventilation can adversely affect cardiorespiratory function during this vulnerable period, reducing pulmonary blood flow and left ventricular output. Furthermore, pulmonary volutrauma is known to initiate pulmonary inflammatory responses, resulting in remote systemic involvement. This review focuses on the downstream consequences of positive pressure ventilation, in particular, interactions between cardiovascular output and the initiation of a systemic inflammatory cascade, on the immature brain. Recent studies have highlighted that positive pressure ventilation strategies are precursors of cerebral injury, probably mediated through cerebral blood flow instability. The presence of, or initiation of, an inflammatory cascade accentuates adverse cerebral blood flow, in addition to being a direct source of brain injury. Importantly, the degree of brain injury is dependent on the nature of the initial ventilation strategy used.
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Affiliation(s)
- Graeme R Polglase
- 1] The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia [2] Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Samantha K Barton
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Martin Kluckow
- Department of Neonatalogy, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew W Gill
- Centre for Neonatal Research and Education, The University of Western Australia, Western Australia, Australia
| | - Stuart B Hooper
- 1] The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia [2] Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Mary Tolcos
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
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de Waal KA, Evans N, Osborn DA, Kluckow M. Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. Arch Dis Child Fetal Neonatal Ed 2007; 92:F444-8. [PMID: 17460022 PMCID: PMC2675387 DOI: 10.1136/adc.2006.103929] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Positive pressure ventilation in premature infants can improve oxygenation but may diminish cerebral blood flow and cardiac output. Low superior vena cava (SVC) flow increases risk of intraventricular haemorrhage, and higher mean airway pressure is associated with low SVC flow. Whether this is a direct effect of positive pressure ventilation or a reflection of severity of lung disease is not known. This study aimed to determine if positive end expiratory pressure (PEEP) in ventilated newborns could be increased without clinically relevant cardiorespiratory changes. METHOD Ventilated newborns were studied before and 10 min after increasing PEEP (5 cm H(2)O to 8 cmH(2)O) and again when PEEP returned to baseline. Echocardiographic and respiratory function measurements were collected during the intervention. RESULTS In 50 infants, increased PEEP was associated with a non-significant difference in mean SVC flow of -5 ml/kg/min (95% CI -12 to 3 ml/kg/min) but a significant reduction in right ventricular output of 17 ml/kg/min (95% CI 5 to 28 ml/kg/min). The increase in lung compliance was non-significant (median difference 0.02 ml/cmH(2)O/kg) and the decrease in lung resistance (18 cmH(2)O/l/s; 95% CI 10 to 26 cm H(2)O/l/s) was significant. Changes (%) in lung compliance and SVC flow, when corrected for Paco(2), were positively associated (regression coefficient 0.4%; 95% CI 0.2% to 0.6%). CONCLUSION A short-term increase in PEEP does not lead to significant changes in systemic blood flow, although 36% of infants in the present study had clinically important changes in flow (+/-25%). The intervention can improve dynamic lung function, especially airway resistance. Improvements in compliance tend to be associated with improvements in blood flow.
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Affiliation(s)
- Koert A de Waal
- Academic Medical Centre, Department of Neonatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Abstract
Intracranial pathological changes can occur as a result of impaired craniocervical venous return. Thrombosis of central venous access catheters was demonstrated in two neonates born at 38 and 27 weeks' gestation. Neither infant developed hemorrhage of prematurity as confirmed on cranial ultrasonography. Clinical evidence of vena cava thrombosis and associated spontaneous intraventricular hemorrhage developed on Day 24 and 36, respectively, and these findings were confirmed on imaging studies. In one infant the hemorrhage was accompanied by communicating hydrocephalus.
The cause of the intracranial disease was attributable to the retrograde cerebral venous congestion. This, together with the primitive venous bed developing in the periventricular region, was associated with the spontaneous hemorrhage in the region of the foramen of Monro.
To the authors' knowledge, this is the first report in the English-language literature of spontaneous neonatal intra-cerebral hemorrhage, due to thrombosis of the superior or inferior vena cava.
The natural history of this condition is resolution without sequelae after appropriate therapeutic intervention for the vena cava thrombosis.
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Affiliation(s)
- Sanjay N Misra
- Department of Neurosurgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado 80204, USA.
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