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Dini G, Ceccarelli S, Celi F, Semeraro CM, Gorello P, Verrotti A. Meconium aspiration syndrome: from pathophysiology to treatment. Ann Med Surg (Lond) 2024; 86:2023-2031. [PMID: 38576961 PMCID: PMC10990371 DOI: 10.1097/ms9.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Meconium aspiration syndrome (MAS) is a clinical condition characterized by respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF). Despite advances in obstetric practices and perinatal care, MAS remains an important cause of morbidity and mortality in term and post-term newborns. Since the 1960s, there have been significant changes in the perinatal and postnatal management of infants born through MSAF. Routine endotracheal suctioning is no longer recommended in both vigorous and non-vigorous neonates with MSAF. Supportive care along with new treatments such as surfactant, inhaled nitric oxide, and high-frequency ventilation has significantly improved the outcome of MAS patients. However, determining the most appropriate approach for this condition continues to be a topic of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management, and prognosis of infants with MAS.
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Affiliation(s)
- Gianluca Dini
- Neonatal Intensive Care Unit, “Santa Maria” Hospital, Terni
| | | | - Federica Celi
- Neonatal Intensive Care Unit, “Santa Maria” Hospital, Terni
| | | | - Paolo Gorello
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia
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Berazategui JP, Larcade RP, Fernández AL, Soria RM, Castro AA, Ávila AS, Vain NE. Can Intubation Be Improved with Endotracheal Tubes Marked with a Color Scale? Randomized Controlled Study. Am J Perinatol 2023; 40:1543-1550. [PMID: 34592768 DOI: 10.1055/a-1659-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to assess if a color scale in the endotracheal tube (ETT) can help operators to correctly select the size and depth of placement of the ETT and decrease the time required to complete the procedure and compared with the usual numeric ETT scale in a mannequin model. STUDY DESIGN The study was conducted in eight centers. Each size of the ETT was identified with a different color. The experimental ETTs had two different colored areas, one for the mouthpiece and another to identify where the ETT should be taped above the lip (an area of 1 cm. The operators were trained as part of the protocol using an instructional video. Four clinical scenarios requiring endotracheal intubation were designed and randomly assigned. Each operator had to select the size and depth of ETT based on the birth weight (BW), and then had to perform four intubations. RESULTS A total of 108 operators performed 432 intubations. No differences were found in the correct placement and selection of the ETT. Median time (in seconds) required for intubation using numeric versus experimental tube was: for ETT Ø NRP (Neonatal Resuscitation Program) 2.5, 11.5 versus 8 (p < 0.001), ETT Ø 3, 12 versus 10 (p < 0.001), ETT Ø 3.5, 15.5 versus12 (p = 0.003), ETT Ø 4, 12 versus11 (p = 0.019). CONCLUSION No significant difference was observed in the selection and correct placement of the ETT. However, the intubation time was significantly shorter using the experimental ETT. This device could improve the effectiveness of intubation by reducing the time needed to properly place the ETT at mid trachea. KEY POINTS · It is an innovative intervention to try to solve a great inconvenience of daily practice.. · The study also raises the difficulty in maintaining the ability of endotracheal intubation.. · It proposes a scale that ensures the correct location with a safe fixation zone..
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Affiliation(s)
- Juan P Berazategui
- Neonatology Unit, Sanatorio Anchorena San Martin, Buenos Aires, Argentina
- Neonatology Unit, Austral University Hospital, Pilar, Buenos Aires, Argentina
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
| | - Ramon P Larcade
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
- Neonatology Unit - Sanatorio de la Trinidad Palermo and Ramos Mejía, Buenos Aires, Argentina
| | - Ariel L Fernández
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
| | - Rose M Soria
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
| | - Adriana A Castro
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
- Neonatology Unit, Hospital Evita Lanús, Buenos Aires, Argentina
| | - Aldana S Ávila
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
- Neonatology Unit - Sanatorio de la Trinidad Palermo and Ramos Mejía, Buenos Aires, Argentina
| | - Nestor E Vain
- Department of Clinical Research - Foundation for Maternal and Child Health, Buenos Aires, Argentina
- Neonatology Unit - Sanatorio de la Trinidad Palermo and Ramos Mejía, Buenos Aires, Argentina
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Zubi ZBH, Abdullah AFB, Helmi MABM, Hasan TH, Ramli N, Ali AAABM, Mohamed MAS. Indications, Measurements, and Complications of Ten Essential Neonatal Procedures. Int J Pediatr 2023; 2023:3241607. [PMID: 37705709 PMCID: PMC10497369 DOI: 10.1155/2023/3241607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.
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Affiliation(s)
- Zainab Bubakr Hamad Zubi
- Department of Paediatrics, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Ahmad Fadzil Bin Abdullah
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Muhd Alwi Bin Muhd Helmi
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Taufiq Hidayat Hasan
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Noraida Ramli
- Department of Paediatrics, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Mossad Abdelhak Shaban Mohamed
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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Al-Shehri H, Alqahtani R, Alromih AM, Altamimi A, Alshehri K, Almehaideb L, Jabari M, Alzayed A. The practices of intravenous sodium bicarbonate therapy in neonatal intensive care units: A multi-country survey. Medicine (Baltimore) 2023; 102:e34337. [PMID: 37478246 PMCID: PMC10662854 DOI: 10.1097/md.0000000000034337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023] Open
Abstract
A common occurrence in the neonatal intensive care unit (NICU) is metabolic acidosis. Sodium bicarbonate (SB) has been widely used, but there is insufficient evidence on how SB affects neonates in NICUs with metabolic acidosis. The worsening of intracellular acidosis, the impairment of myocardial function, fluctuations in cerebral blood flow, and intracranial hemorrhage are some of the unfavorable effects of SB treatment in neonates that have been documented in the literature. This study aimed to explore neonatologists' practices for using intravenous SB (ISB) in NICUs. A multi-country survey was carried out in 2022 using an online questionnaire sent to neonatologists in various countries in order to gather information about the use of ISB in NICUs. A previously validated questionnaire was adapted and used in this study. The response rate was 67%. The findings show that 91.2% of neonatologists were using SB to correct metabolic acidosis in the NICU; 71.4% did not have written guidelines for using sodium bicarbonate. The majority of them (78.9%) reported that dosage is included in their guidelines for the use of ISB. The findings of this study emphasize the critical importance of providing guidelines in using ISB for managing metabolic acidosis in NICU to standardize procedures and reduce the use of potentially unsuitable and unsafe treatments, as it has been shown that 71.4% of neonatologists worldwide use sodium bicarbonate without guidelines.
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Affiliation(s)
- Hassan Al-Shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Renad Alqahtani
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Aroob M. Alromih
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Amal Altamimi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Khloud Alshehri
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Latifah Almehaideb
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mosleh Jabari
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah Alzayed
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Robin B, Soghier LM, Vachharajani A, Moussa A. Laryngeal Mask Airway Clinical Use and Training: A Survey of North American Neonatal Health Care Professionals. Am J Perinatol 2023. [PMID: 37429322 DOI: 10.1055/s-0043-1771017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The aim of this study was to explore North American neonatal health care professionals' (HCPs) experience, confidence, skill, and training with the laryngeal mask airway (LMA). STUDY DESIGN This was a cross-sectional survey. RESULTS The survey was completed by 2,159 HCPs from Canada and the United States. Seventy nine percent had no clinical experience with the LMA, and less than 20% considered the LMA an alternative to endotracheal intubation (EI). The majority had received LMA training; however, 28% of registered nurses, 18% of respiratory therapists, 17% of physicians, and 12% of midwives had never inserted an LMA in a mannequin. Less than a quarter of respondents agreed that the current biennial Neonatal Resuscitation Program instruction paradigm is sufficient for LMA training. All groups reported low confidence and skill with LMA insertion, and compared with all other groups, the respiratory therapists had the highest reported confidence and skill. CONCLUSION This survey study, which is the first of its kind to include midwives, demonstrates that neonatal HCPs lack experience, confidence, skill, and training with the LMA, rarely use the device, and in general, do not consider the LMA as an alternative to EI. These findings contribute to, and support the findings of previous smaller studies, and in conjunction with the diminishing opportunities for EI, highlight the need for programs to emphasize the importance of the LMA for neonatal airway management and prioritize regular LMA training, with focus that parallels the importance placed on the skills of EI and mask ventilation. KEY POINTS · Lack of training for laryngeal mask airway use in neonatal resuscitation.. · Neonatal health care professionals rarely use the laryngeal mask airway as an alternate airway device.. · Neonatal health care professionals lack confidence and skill with the laryngeal mask airway..
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Affiliation(s)
- Beverley Robin
- Department of Pediatrics, Rush University Medical Center; Chicago, Illinois
| | - Lamia M Soghier
- Department of Neonatology, Children's National Hospital, The George Washington University School of Medicine and Health Sciences; Washington, District of Columbia
| | | | - Ahmed Moussa
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
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Washington M, Macaden L, Smith A, Selvam S, Mony PK. Determinants of Kangaroo Mother Care Uptake for Small Babies Along the Health Facility to Community Continuum in Karnataka, India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200457. [PMID: 37348942 DOI: 10.9745/ghsp-d-22-00457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/25/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Kangaroo mother care (KMC) scale-up is a proposed strategy to accelerate reduction in neonatal mortality rates. We aimed to identify determinants of KMC uptake for small babies (less than 2,000 g birth weight) along the health facility to community continuum in Karnataka, India. METHODS From June 2017 to March 2020, data on characteristics of health facilities and health care workers (HCWs) from 8 purposively selected health facilities were assessed. Knowledge, attitude, and support the mothers received for KMC uptake were assessed once between 4 weeks and 8 weeks unadjusted age of the cohort of babies. Secondary data on KMC were obtained from the district-wide implementation research project database. Bivariate analysis was used to assess the association of characteristics of health facilities, HCWs, mothers, and small babies with the day of KMC initiation and its duration. Log-binomial regression analysis was then computed to identify determinants of KMC. RESULTS We recruited 227 (91.5%) of 248 babies eligible to participate with a mean unadjusted age of 35.6 days (±7.5) and 1,693.9 g (±263.1 g) birth weight. KMC was initiated for 95.2% of 227 babies at the health facility; initiated at 3 days or earlier of life for 59.6% of 226 babies; and babies continued to receive KMC for more than 4 weeks (30.2 days [±8.4]) at home. Determinants of KMC initiation were HCWs' attitudes, initiation support at the health facility, and place of hospitalization. Determinants of KMC maintenance at the health facility were HCWs' skills and support the mother received at the facility after initiating KMC. Place of hospitalization and HCWs' knowledge determined KMC duration at home 1 week after discharge. CONCLUSION These findings emphasize the importance of competent HCWs and support for mothers at the health facility for initiation and maintenance of KMC within the health facility and 1 week after discharge.
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Affiliation(s)
- Maryann Washington
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India.
| | - Leah Macaden
- Nursing Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Annetta Smith
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Sumithra Selvam
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India
| | - Prem K Mony
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India
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Perrone S, Manti S, Petrolini C, Dell'Orto VG, Boscarino G, Ceccotti C, Bertini M, Buonocore G, Esposito SMR, Gitto E. Oxygen for the Newborn: Friend or Foe? CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030579. [PMID: 36980137 PMCID: PMC10047080 DOI: 10.3390/children10030579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Oxygen supplementation is widely used in neonatal care, however, it can also cause toxic effects if not used properly. Therefore, it appears crucial to find a balance in oxygen administration to avoid damage as a consequence of its insufficient or excessive use. Oxygen toxicity is mainly due to the production of oxygen radicals, molecules normally produced in humans and involved in a myriad of physiological reactions. In the neonatal period, an imbalance between oxidants and antioxidant defenses, the so-called oxidative stress, might occur, causing severe pathological consequences. In this review, we focus on the mechanisms of the production of oxygen radicals and their physiological functions in determining a set of diseases grouped together as "free radical diseases in the neonate". In addition, we describe the evolution of the oxygenation target recommendations during neonatal resuscitation and post-stabilization phases with the aim to define the best oxygen administration according to the newest evidence.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Sara Manti
- Pediatric Unit, Department of Human Pathology "Gaetano Barresi", University of Messina, 98122 Messina, Italy
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Giovanna Dell'Orto
- Neonatology Unit, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Giovanni Boscarino
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Ceccotti
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Mattia Bertini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | | | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Human Pathology "Gaetano Barresi", University of Messina, 98122 Messina, Italy
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Ibrahim J, Vats K. History of Neonatal Resuscitation: From Uncivilized to Evidence-based Practices. Neoreviews 2023; 24:e57-e66. [PMID: 36720687 DOI: 10.1542/neo.24-2-e57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Neonatal resuscitation, an early and critical intervention in human life, has dramatically evolved. This procedure has gone through phases from uncivilized practices that were sometimes based on myths to the current evidence-based approaches. In this review, we will shed light on the evolution of neonatal resuscitation from early centuries to the current day. Our goal is to highlight the value of clinical research and its role in invalidating hazardous practices and establishing evidence-based guidelines.
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Affiliation(s)
- John Ibrahim
- Newborn Division, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kalyani Vats
- Newborn Division, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
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Berisha G, Boldingh AM, Nakstad B, Blakstad EW, Rønnestad AE, Lee Solevåg A. Retrospectively Assessed Muscle Tone and Skin Colour following Airway Suctioning in Video-Recorded Infants Receiving Delivery Room Positive Pressure Ventilation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010166. [PMID: 36670716 PMCID: PMC9856869 DOI: 10.3390/children10010166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
Background: Recently, the International Liaison Committee on Resuscitation published a systematic review that concluded that routine suctioning of clear amniotic fluid in the delivery room might be associated with lower oxygen saturation (SpO2) and 10 min Apgar score. The aim of this study was to examine the effect of delivery room airway suctioning on the clinical appearance, including muscle tone and skin colour, of video-recorded term and preterm infants born through mainly clear amniotic fluid. Methods: This was a single-centre observational study using transcribed video recordings of neonatal stabilizations. All infants who received delivery room positive pressure ventilation (PPV) from August 2014 to November 2016 were included. The primary outcome was the effect of airway suctioning on muscle tone and skin colour (rated 0−2 according to the Apgar score), while the secondary outcome was the fraction of infants for whom airway suction preceded the initiation of PPV as a surrogate for “routine” airway suctioning. Results: Airway suctioning was performed in 159 out of 302 video recordings and stimulated a vigorous cry in 47 (29.6%) infants, resulting in improvements in muscle tone (p = 0.09) and skin colour (p < 0.001). In 43 (27.0%) infants, airway suctioning preceded the initiation of PPV. Conclusions: In this single-centre observational study, airway suctioning stimulated a vigorous cry with resulting improvements in muscle tone and skin colour. Airway suctioning was often performed prior to the initiation of PPV, indicating a practice of routine suctioning and guideline non-compliance.
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Affiliation(s)
- Gazmend Berisha
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
- The Department of Anaesthesia and Intensive Care Unit, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway
- Correspondence: ; Tel.: +47-99022121
| | - Anne Marthe Boldingh
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway
| | - Britt Nakstad
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
- Department of Paediatrics and Adolescent Health, University of Botswana, Private Bag, Gaborone 0022, Botswana
| | - Elin Wahl Blakstad
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway
| | - Arild Erland Rønnestad
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway
| | - Anne Lee Solevåg
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway
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Chilakala SK, Parfenova H, Pourcyrous M. The effects of sodium bicarbonate infusion on cerebrovascular function in newborn pigs. Pediatr Res 2022; 92:729-736. [PMID: 34862458 PMCID: PMC9163205 DOI: 10.1038/s41390-021-01876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sodium bicarbonate (NaHCO3) is no longer recommended by the Neonatal Resuscitation Program (NRP), but is still being used by some neonatologists. The effects of NaHCO3 on cerebral hemodynamics are unclear. Therefore, we investigated the effects of NaHCO3 on cerebral blood flow (CBF) and cerebrovascular function using a newborn piglet model. METHODS Newborn pigs were anesthetized, intubated, and ventilated. Cranial windows were implanted to evaluate changes in pial arteriolar diameters (PADs) as a surrogate for CBF during a 4-h intravenous infusion of 3% NaHCO3. Cerebrovascular reactivity to vasodilators and vasoconstrictors was investigated during vehicle control and during NaHCO3 infusion. RESULTS NaHCO3 infusion caused significant and progressive pial arteriolar vasoconstrictions. During NaHCO3 infusion, cerebrovascular reactivity was preserved. Adding vasodilators decreased cerebral vasoconstriction, while adding vasoconstrictors exaggerated cerebral vasoconstriction. CONCLUSIONS Intravenous infusion of NaHCO3 over 4 h caused progressive vasoconstriction of pial arterioles. Cerebrovascular function evaluated by the responses of pial arterioles to physiologically relevant vasoconstrictors and vasodilators was preserved during NaHCO3 infusion. A notable additional reduction of PADs was observed during NaHCO3 infusion in the presence of vasoconstrictors. Extrapolating our findings to human neonates should alarm the clinicians that using NaHCO3 in neonates may cause cerebral hypoperfusion. IMPACT Cerebral vasoconstriction occurs during slow infusion of 3% diluted NaHCO3. Cerebral vasoconstriction is exaggerated when another vasoconstrictor is added during NaHCO3 infusion. Cerebrovascular function is preserved during NaHCO3 infusion. Clinicians should be aware of the risk of cerebral hypoperfusion with NaHCO3 infusion in vulnerable neonates.
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Affiliation(s)
- Sandeep K Chilakala
- Department of Pediatrics, University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee
| | - Helena Parfenova
- Department of Physiology, University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee
| | - Massroor Pourcyrous
- Department of Pediatrics, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA. .,Department of Physiology, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA. .,Department of Obstetrics/Gynecology, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA.
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Matthews LJ, Mpody C, Nafiu OO, Tobias JD. Morbidity and mortality following noncardiac surgical procedures among children with autosomal trisomy. Paediatr Anaesth 2022; 32:631-636. [PMID: 35156266 DOI: 10.1111/pan.14415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trisomy 13 (T13), trisomy 18 (T18), and trisomy 21 (T21) are the most common autosomal trisomies. One unifying feature of all trisomies is their association with major congenital malformations, which often require life-prolonging surgical procedures. Few studies, mostly among cardiac surgery patients, have examined the outcome of those who undergo surgical procedures. We examined the differences in postsurgical outcomes between the trisomy groups. METHOD Using the National Surgical Quality Improvement Program dataset, we identified children (<18 years of age) with T13, T18, or T21 who underwent noncardiac surgery (2012-2018). We estimated the incidence of mortality and indicator of resource utilization (unplanned reoperation, unplanned tracheal reintubation, and extended length of hospital stay). RESULTS Of the 349 158 inpatient surgical cases during the study period, we identified 4202 children with one of the autosomal trisomies of interest (T13: 152; T18: 335; and T21: 3715). The rates of postoperative mortality were substantially higher for T18 and T13 than T21 and nontrisomy children (T18 vs. T21: 11.1% vs. 1.6%, adjusted odds ratio: 5.01, 95%CI: 2.89,8.70, p < .01), (T13 vs. T21: 8.1% vs. 1.6%, adjusted odds ratio: 2.86, 95%CI: 1.25,6.54, p = .01). Children with T18 had the highest rates of extended length of stay (62.7%) and prolonged mechanical ventilation (32.5%). T18 and T13 neonates had the highest surgical mortality burden (T13: 26.5%, T18: 31.8%, and T21: 2.8%). CONCLUSION Approximately, one-third of T18 and T13 neonates, who had surgery, died, underscoring the lethality of these trisomies and the need for a comprehensive preoperative ethical discussion with families of these children.
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Affiliation(s)
- Leslie J Matthews
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Chiruvolu A, Wiswell TE. Appropriate Management of the Nonvigorous Meconium-Stained Newborn Meconium. Neoreviews 2022; 23:e250-e261. [PMID: 35362037 DOI: 10.1542/neo.23-4-e250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Before 2015, major changes in Neonatal Resuscitation Program (NRP) recommendations not supporting previously endorsed antepartum, intrapartum and postpartum interventions to prevent meconium aspiration syndrome were based on adequately powered multicenter randomized controlled trials. The 2015 and 2020 American Heart Association guidelines and 7th and 8th edition of NRP suggest not performing routine intubation and tracheal suctioning of nonvigorous meconium-stained newborns. However, this was given as a weak recommendation with low-certainty evidence. The purpose of this review is to summarize the evidence and explore the question of appropriate delivery room management for nonvigorous meconium-stained newborns.
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Affiliation(s)
- Arpitha Chiruvolu
- Division of Neonatology, Baylor University Medical Center, and Pediatrix Medical Group of Dallas, Dallas, TX
| | - Thomas E Wiswell
- Division of Neonatology, Kaiser Permanente Moanalua Medical Center, Honolulu, HI
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13
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Soraisham AS, Srivastava A. Recent Update on Neonatal Resuscitation. Indian J Pediatr 2022; 89:279-287. [PMID: 34021866 DOI: 10.1007/s12098-021-03796-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022]
Abstract
Every 5 y, the International Liaison Committee on Resuscitation publishes consensus on cardiopulmonary resuscitation, and emergency cardiovascular science and treatment recommendations. The latest update on neonatal resuscitation guidelines was published in 2020. Here, the authors review the important changes in the recent recommendations, including initial steps of resuscitation, umbilical cord management, management of nonvigorous infants born through meconium-stained amniotic fluid, sustained inflation in preterm infants, epinephrine, vascular access, timing of discontinuation of resuscitative effort, and team briefing and debriefing.
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Affiliation(s)
- Amuchou S Soraisham
- Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,NICU Foothills Medical Centre, University of Calgary, Calgary, Alberta, T2N 2T9, Canada.
| | - Ankur Srivastava
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Abstract
BACKGROUND Endotracheal intubation is a commonly performed procedure in neonates, the risks of which are well-described. Some endotracheal tubes (ETT) are equipped with a cuff that can be inflated after insertion of the ETT in the airway to limit leak or aspiration. Cuffed ETTs have been shown in larger children and adults to reduce gas leak around the ETT, ETT exchange, accidental extubation, and exposure of healthcare workers to anesthetic gas during surgery. With improved understanding of neonatal airway anatomy and the widespread use of cuffed ETTs by anesthesiologists, the use of cuffed tubes is increasing in neonates. OBJECTIVES To assess the benefits and harms of cuffed ETTs (inflated or non-inflated) compared to uncuffed ETTs for respiratory support in neonates. SEARCH METHODS We searched CENTRAL, PubMed, and CINAHL on 20 August 2021; we also searched trial registers and checked reference lists to identify additional studies. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, and cluster-randomized trials comparing cuffed (inflated and non-inflated) versus uncuffed ETTs in newborns. We sought to compare 1. inflated, cuffed versus uncuffed ETT; 2. non-inflated, cuffed versus uncuffed ETT; and 3. inflated, cuffed versus non-inflated, cuffed ETT. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion, extracted data, and assessed risk of bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We identified one eligible RCT for inclusion that compared the use of cuffed (inflated if ETT leak greater than 20% with cuff pressure 20 cm H2O or less) versus uncuffed ETT. The author provided a spreadsheet with individual data. Among 76 infants in the original manuscript, 69 met the inclusion and exclusion criteria for this Cochrane Review. We found possible bias due to lack of blinding and other bias. We are very uncertain about frequency of postextubation stridor, because the confidence intervals (CI) of the risk ratio (RR) were very wide (RR 1.36, 95% CI 0.35 to 5.25; risk difference (RD) 0.03, -0.11 to 0.18; 1 study, 69 participants; very low-certainty evidence). No neonate was diagnosed with postextubation subglottic stenosis; however, endoscopy was not available to confirm the clinical diagnosis. We are very uncertain about reintubation for stridor or subglottic stenosis because the CIs of the RR were very wide (RR 0.27, 95% CI 0.01 to 6.49; RD -0.03, 95% CI -0.11 to 0.05; 1 study, 69 participants; very low-certainty evidence). No neonate had surgical intervention (e.g. endoscopic balloon dilation, cricoid split, tracheostomy) for stridor or subglottic stenosis (1 study, 69 participants). Neonates randomized to cuffed ETT may be less likely to have a reintubation for any reason (RR 0.06, 95% CI 0.01 to 0.45; RD -0.39, 95% CI -0.57 to -0.21; number needed to treat for an additional beneficial outcome 3, 95% CI 2 to 5; 1 study, 69 participants; very low-certainty evidence). We are very uncertain about accidental extubation because the CIs of the RR were wide (RR 0.82, 95% CI 0.12 to 5.46; RD -0.01, 95% CI -0.12 to 0.10; 1 study, 69 participants; very low-certainty evidence). We are very uncertain about all-cause mortality during initial hospitalization because the CIs of the RR were extremely wide (RR 2.46, 95% CI 0.10 to 58.39; RD 0.03, 95% CI -0.05 to 0.10; 1 study, 69 participants; very low-certainty evidence). There is one ongoing trial. We classified two studies as awaiting classification because outcome data were not reported separately for newborns and older infants. AUTHORS' CONCLUSIONS Evidence for comparing cuffed versus uncuffed ETTs in neonates is limited by a small number of babies in a single RCT with possible bias. There is very low certainty evidence for all outcomes of this review. CIs of the estimate for postextubation stridor were wide. No neonate had clinical evidence for subglottic stenosis; however, endoscopy results were not available to assess the anatomy. Additional RCTs are necessary to evaluate the benefits and harms of cuffed ETTs (inflated and non-inflated) in the neonatal population. These studies must include neonates and be conducted both for short-term use (in the setting of the operating room) and chronic use (in the setting of chronic lung disease) of cuffed ETTs.
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Affiliation(s)
- Vedanta Dariya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luca Moresco
- Pediatric and Neonatology Unit, Ospedale San Paolo, Savona, Italy
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern at Dallas, Dallas, Texas, USA
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Fick TA, Sexson Tejtel SK. Trisomy 18 Trends over the Last 20 Years. J Pediatr 2021; 239:206-211.e1. [PMID: 34363815 DOI: 10.1016/j.jpeds.2021.07.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the trends in hospitalizations for children with trisomy 18 over time and to determine the rate of invasive procedures on these children, using a large inpatient database. STUDY DESIGN A retrospective analysis using the Kids' Inpatient Database from 1997 to 2016 was performed for trisomy 18. We evaluated survival to discharge as well as the presence of pulmonary, skeletal, neurologic, gastrointestinal, renal, and hematologic/bleeding problems. We also searched for the following interventions, if performed: gastrostomy tube placement, tracheostomy, or cardiac procedure. RESULTS Over this period 10 151 admissions occurred in children with a diagnosis of trisomy 18. Between 1997 and 2016, the number of children admitted annually with trisomy 18 increased 74% from 1036 to 1798. The proportion of patients born prematurely remained stable at 14%-16% throughout the study. Gastrostomy tube placement increased 12-fold during the study period, tracheostomy increased 11-fold, and cardiac intervention increased 5-fold. The overall mortality rate decreased in those with trisomy 18 from 32% in 1997 to 21% in 2016. CONCLUSIONS We highlight a decreased inpatient mortality rate during the study period. The number of children undergoing interventions such as gastrostomy tube and tracheostomy increased, as did the number of children undergoing cardiac intervention. Although the number of procedures has increased with the mortality rate decreasing, it is unclear at present whether the 2 are related.
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Cannavò L, Perrone S, Viola V, Marseglia L, Di Rosa G, Gitto E. Oxidative Stress and Respiratory Diseases in Preterm Newborns. Int J Mol Sci 2021; 22:ijms222212504. [PMID: 34830385 PMCID: PMC8625766 DOI: 10.3390/ijms222212504] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 01/01/2023] Open
Abstract
Premature infants are exposed to increased generation of reactive oxygen species, and on the other hand, they have a deficient antioxidant defense system. Oxidative insult is a salient part of lung injury that begins as acute inflammatory injury in respiratory distress disease and then evolves into chronic and structural scarring leading to bronchopulmonary dysplasia. Oxidative stress is also involved in the pathogenesis of pulmonary hypertension in newborns through the modulation of the vascular tone and the response to pulmonary vasodilators, with consequent decrease in the density of the pulmonary vessels and thickening of the pulmonary arteriolar walls. Oxidative stress has been recognized as both a trigger and an endpoint for several events, including inflammation, hypoxia, hyperoxia, drugs, transfusions, and mechanical ventilation, with impairment of pulmonary function and prolonged lung damage. Redoxomics is the most fascinating new measure to address lung damage due to oxidative stress. The new challenge is to use omics data to discover a set of biomarkers useful in diagnosis, prognosis, and formulating optimal and individualized neonatal care. The aim of this review was to examine the most recent evidence on the relationship between oxidative stress and lung diseases in preterm newborns. What is currently known regarding oxidative stress-related lung injury pathogenesis and the available preventive and therapeutic strategies are also discussed.
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Affiliation(s)
- Laura Cannavò
- Neonatal and Pediatric Intensive Care Unit, Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (L.C.); (V.V.); (L.M.); (E.G.)
| | - Serafina Perrone
- Neonatology Unity, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-703518
| | - Valeria Viola
- Neonatal and Pediatric Intensive Care Unit, Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (L.C.); (V.V.); (L.M.); (E.G.)
| | - Lucia Marseglia
- Neonatal and Pediatric Intensive Care Unit, Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (L.C.); (V.V.); (L.M.); (E.G.)
| | - Gabriella Di Rosa
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Eloisa Gitto
- Neonatal and Pediatric Intensive Care Unit, Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (L.C.); (V.V.); (L.M.); (E.G.)
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Saugstad OD, Robertson NJ, Vento M. A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant. Acta Paediatr 2021; 110:1107-1112. [PMID: 33417251 DOI: 10.1111/apa.15754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
The 2020 recommendations from the International Liaison Committee on Resuscitation are an improved version of the 2015 version. The algorithm and 15 procedures are unchanged from 2015, but there are six procedures with new or changed recommendations. One new recommendation is briefing/debriefing following neonatal resuscitation. Procedures with changed suggestions/recommendations are as follows: suctioning of non-vigorous infants delivered through meconium-stained amniotic fluid, sustained inflation of preterm infants, optimising epinephrine (adrenaline), vascular access and discontinuing resuscitative efforts. CONCLUSION: In this review, we summarise the present recommendations and offer additional comments and views regarding heart rate detection, cord clamping, oxygenation and thermal control.
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Affiliation(s)
- Ola D. Saugstad
- Department of Pediatric Research University of Oslo Oslo Norway
- Ann and Robert H. Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Nicola J. Robertson
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
- Institute for Women’s Health University College London London UK
| | - Maximo Vento
- Division of Neonatology University and Polytechnic Hospital La Fe Valencia Spain
- Health Research Institute La Fe Valencia Spain
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Monfredini C, Cavallin F, Villani PE, Paterlini G, Allais B, Trevisanuto D. Meconium Aspiration Syndrome: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:230. [PMID: 33802887 PMCID: PMC8002729 DOI: 10.3390/children8030230] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023]
Abstract
Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome.
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Affiliation(s)
- Chiara Monfredini
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | | | - Paolo Ernesto Villani
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | - Benedetta Allais
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; (C.M.); (P.E.V.); (G.P.); (B.A.)
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University of Padova, 35128 Padova, Italy
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Massenzi L, Aufieri R, Donno S, Agostino R, Dotta A. Use of intravenous sodium bicarbonate in neonatal intensive care units in Italy: a nationwide survey. Ital J Pediatr 2021; 47:63. [PMID: 33706798 PMCID: PMC7953611 DOI: 10.1186/s13052-021-00955-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8 and 32.5% of the NICUs). Conclusion This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-00955-3.
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Affiliation(s)
- Luca Massenzi
- Department of Pediatrics and Neonatology, "S. Giovanni Calibita" Fatebenefratelli Hospital, Via di Ponte Quattro Capi 39, 00186, Rome, Italy.
| | - Roberto Aufieri
- Division of Neonatology and Neonatal Intensive Care Unit, ASL Roma 2 - Ospedale Sant'Eugenio, Rome, Italy
| | - Silvia Donno
- INVALSI - Istituto nazionale per la valutazione del sistema educativo di istruzione e formazione, Rome, Italy
| | - Rocco Agostino
- Division of Neonatology, Villa Margherita Private Nursing Home, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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Phattraprayoon N, Tangamornsuksan W, Ungtrakul T. Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:31-38. [PMID: 32561566 PMCID: PMC7788200 DOI: 10.1136/archdischild-2020-318941] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates. DESIGN We conducted a systematic review of non-ETS and ETS in non-vigorous infants born through meconium-stained amniotic fluid (MSAF). We searched PubMed/Medline, Scopus, Clinical Trials.gov, Cumulative Index to Nursing and Allied Health, and Cochrane Library databases from inception to November 2019, using keywords and related terms. Only non-vigorous infants born through MSAF included in randomised controlled trials, were included. We calculated overall relative risks (RRs) and mean differences with 95% CIs using a random-effects model, to determine the impact of ETS in non-vigorous infants born through MSAF. MAIN OUTCOME MEASURES The primary outcome was the incidence of meconium aspiration syndrome (MAS). Secondary outcomes were respiratory outcome measures (pneumothorax, persistent pulmonary hypertension of the newborn, secondary pneumonia, need for respiratory support, duration of mechanical ventilation), initial resuscitation and others including shock, perinatal asphyxia, convulsions, neonatal mortality, blood culture-positive sepsis and duration of hospital stay. RESULTS A total of 2085 articles were identified in the initial database search. Four studies, including 581 non-vigorous meconium-stained infants, fulfilled the inclusion criteria, comprising 292 infants in the non-ETS group and 289 in the ETS group. No statistically significant difference was found for MAS (RR 0.98; 95% CI 0.71 to 1.35). CONCLUSIONS Initiating ETS soon after birth in non-vigorous meconium-stained infants may not alter their neonatal outcomes.
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Affiliation(s)
- Nanthida Phattraprayoon
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wimonchat Tangamornsuksan
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, Zaichkin J. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S524-S550. [DOI: 10.1161/cir.0000000000000902] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Dariya V, Moresco L, Bruschettini M, Brion LP. Cuffed versus uncuffed endotracheal tubes for neonates. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd013736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Vedanta Dariya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine; University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Luca Moresco
- Pediatric and Neonatology Unit; Ospedale San Paolo; Savona Italy
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine; University of Texas Southwestern at Dallas; Dallas Texas USA
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Abstract
Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth. Excess oxygen can cause oxidative stress and tissue injury. Preterm infants due to lung immaturity may need oxygen for successful transition at birth. Although, considerable progress has been made in the last 3 decades, optimum oxygen therapy for preterm delivery room resuscitation remains unknown. In this review, we discuss the history and physiology behind oxygen therapy in the delivery room, evaluate current literature, provide practice points and point out knowledge gaps of oxygen therapy in preterm infant at birth.
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Musharaf I, Daspal S, Shatzer J. Is Video Laryngoscopy the Optimal Tool for Successful Intubation in a Neonatal Simulation Setting? A Single-Center Experience. AJP Rep 2020; 10:e5-e10. [PMID: 31993245 PMCID: PMC6984956 DOI: 10.1055/s-0039-3400970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/13/2019] [Indexed: 10/29/2022] Open
Abstract
Background Endotracheal intubation is a skill required for resuscitation. Due to various reasons, intubation opportunities are decreasing for health care providers. Objective To compare the success rate of video laryngoscopy (VL) and direct laryngoscopy (DL) for interprofessional neonatal intubation skills in a simulated setting. Methods This was a prospective nonrandomized simulation crossover trial. Twenty-six participants were divided into three groups based on their frequency of intubation. Group 1 included pediatric residents; group 2 respiratory therapists and transport nurses; and group 3 neonatal nurse practitioners and physicians working in neonatology. We compared intubation success rate, intubation time, and laryngoscope preference. Results Success rates were 100% for both DL and VL in groups 1 and 2, and 88.9% for DL and 100% for VL in group 3. Median intubation times for DL and VL were 22 seconds (interquartile range [IQR] 14.3-22.8 seconds) and 12.5 seconds (IQR 10.3-38.8 seconds) in group 1 ( p = 0.779); 17 seconds (IQR 8-21 seconds) and 12 seconds (IQR 9-16.5 seconds) in group 2 ( p = 0.476); and 11 seconds (IQR 7.5-15.5 seconds) and 15 seconds (IQR 11.5-36 seconds) in group 3 ( p = 0.024). Conclusion We conclude that novice providers tend to perform better with VL, while more experienced providers perform better with DL. In this era of decreased clinical training opportunities, VL may serve as a useful tool to teach residents and other novice health care providers.
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Affiliation(s)
- Iram Musharaf
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sibasis Daspal
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Shatzer
- Johns Hopkins University School of Education, Baltimore, Maryland
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25
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O’Donnell CP. Face mask respiratory support for preterm infants: Takes their breath away? Resuscitation 2019; 144:189-190. [DOI: 10.1016/j.resuscitation.2019.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 11/28/2022]
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Long B, April MD. Does Room Air Reduce Mortality Among Term Neonates Requiring Respiratory Support at Birth? Ann Emerg Med 2019; 74:509-511. [DOI: 10.1016/j.annemergmed.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Indexed: 10/26/2022]
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Agrawal G, Kumar A, Wazir S, Kumar NC, Shah P, Nigade A, Nagar N, Kumar S, Kumar K. A comparative evaluation of portable Doppler ultrasound versus electrocardiogram in heart-rate accuracy and acquisition time immediately after delivery: a multicenter observational study. J Matern Fetal Neonatal Med 2019; 34:2053-2060. [PMID: 31409165 DOI: 10.1080/14767058.2019.1656193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The assessment of newborns' heart rate (HR) in the delivery room is one of the important steps to ascertain the need for initiation and continuation of resuscitation. At present, ECG is the "gold standard" to monitor neonatal HR in the delivery room. However, various limitations with the use of ECG exist. Furthermore, in developing countries, ECG may not be universally available in delivery rooms. OBJECTIVE To compare the accuracy and HR acquisition time of portable Doppler ultrasound (PDU) versus electrocardiogram (ECG) in newborns. METHODS This multicenter, prospective, observational study across five centers in India between January and September 2017 included neonates more than 34 weeks of gestation (n = 131) delivered by cesarean section. The accuracy of HR recorded by PDU (HRPDU) versus that by ECG (HRECG) was the primary outcome. Secondary outcomes included time to acquisition of an audible and/or visible signal and device application. RESULTS Mean (±SD) gestational age and birthweight were 37.7 (±1.2) weeks and 2954 (±457) g, respectively. The mean (±SD) visible HRPDU was 158 (±21) bpm versus HRECG of 161.3 (±20) bpm (p = .07) which were comparable. The median (1st, third quartile) time to acquisition of audible HRPDU (76 [51, 91] s), was significantly shorter than that of HRECG (96.5 [74.2, 118] s; p < .001). CONCLUSION Portable Doppler has similar accuracy to ECG and is faster in acquiring the signal.
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Affiliation(s)
- Gopal Agrawal
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurugram, India
| | - Anil Kumar
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurugram, India
| | - Sanjay Wazir
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurugram, India
| | - N Chandra Kumar
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Chennai, India
| | - Piyush Shah
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Mumbai, India
| | - Amit Nigade
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Pune, India
| | - Nandini Nagar
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Bengaluru, India
| | - Surender Kumar
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurugram, India
| | - Kishore Kumar
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Bengaluru, India
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Mistry SC, Lin R, Mumphansha H, Kettley LC, Pearson JA, Akrimi S, Mayne DJ, Hangoma W, Bould MD. Newborn Resuscitation Skills in Health Care Providers at a Zambian Tertiary Center, and Comparison to World Health Organization Standards. Anesth Analg 2019; 127:217-223. [PMID: 29677057 DOI: 10.1213/ane.0000000000003337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Birth asphyxia is a leading cause of early neonatal death. In 2013, 32% of neonatal deaths in Zambia were attributable to birth asphyxia and trauma. Basic, timely interventions are key to improving outcomes. However, data from the World Health Organization suggest that resuscitation is often not initiated, or is conducted suboptimally. Currently, there are little data on the quality of newborn resuscitation in the context of a tertiary center in a lower-middle income country. We aimed to measure the competencies of clinical practitioners responsible for newborn resuscitation. METHODS This observational study was conducted over 5 months in Zambia. Health care professionals were recruited from anesthesia, pediatrics, and midwifery. Newborn skills and knowledge were examined using the following: (1) multiple-choice questions; (2) a ventilation skills test; and (3) 2 low-medium fidelity simulation scenarios. Participant demographics including previous resuscitation training and a self-efficacy rating score were noted. The primary outcome examined performance scores in a simulated scenario, which assessed the care of a newborn that failed to respond to basic interventions. Secondary outcome measures included apnea times after delivery and performance in the other assessments. RESULTS Seventy-eight participants were enrolled into the study (13 physician anesthesiology residents, 13 pediatric residents, and 52 midwives). A significant difference in interprofessional performance was observed when examining checklist scores for the unresponsive newborn simulated scenario (P = .006). The median (quartiles) checklist score (out of 18) was 14.0 (13.0-14.75) for the anesthesiologists, 11.0 (8.5-12.3) for the pediatricians, and 10.8 (8.3-13.9) for the midwives. A score of 14 or more was required to pass the scenario. There was no significant difference in performance between participants with and without previous newborn resuscitation training (P = .246). The median (quartiles) apnea time after delivery was significantly different between all groups (P = .01) with anesthetic and pediatric residents performing similarly, 61 (37-97) and 63 (42.5-97.5) seconds, respectively. The midwifery participants displayed a significantly longer apnea time, 93.5 (66.3-129) seconds. Self-efficacy rating scores displayed no correlation between confidence level and the primary outcome, Spearman coefficient 0.06 (P = .55). CONCLUSIONS Newborn resuscitation skills among health care professionals are varied. Midwives lead the majority of deliveries with anesthesiologists and pediatricians only being present at operative or high-risk births. It is therefore common that midwifery practitioners will initiate resuscitation. Despite this, midwives perform poorly when compared to anesthesia and pediatric residents. To address this discrepancy, a multidisciplinary, simulation-based newborn resuscitation program should be considered with continual clinical reenforcement of best practice.
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Affiliation(s)
- Sara C Mistry
- From the Zambian Anaesthesia Development Program, University Teaching Hospital, Lusaka, Zambia
| | - Richard Lin
- From the Zambian Anaesthesia Development Program, University Teaching Hospital, Lusaka, Zambia
| | | | - Laura C Kettley
- From the Zambian Anaesthesia Development Program, University Teaching Hospital, Lusaka, Zambia
| | - Janaki A Pearson
- From the Zambian Anaesthesia Development Program, University Teaching Hospital, Lusaka, Zambia
| | - Sonia Akrimi
- From the Zambian Anaesthesia Development Program, University Teaching Hospital, Lusaka, Zambia
| | | | | | - M Dylan Bould
- University Teaching Hospital, Lusaka, Zambia.,Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Carter LB, Battaglia A, Cherry A, Manning MA, Ruzhnikov MR, Bird LM, Dowsett L, Graham JM, Alkuraya FS, Hashem M, Dinulos MB, Vallee S, Adam MP, Glass I, Beck AE, Stevens CA, Zackai E, McDougall C, Keena B, Peron A, Vignoli A, Seaver LH, Slavin TP, Hudgins L. Perinatal distress in 1p36 deletion syndrome can mimic hypoxic ischemic encephalopathy. Am J Med Genet A 2019; 179:1543-1546. [PMID: 31207089 DOI: 10.1002/ajmg.a.61266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/16/2019] [Accepted: 06/01/2019] [Indexed: 11/08/2022]
Abstract
1p36 deletion syndrome is a well-described condition with a recognizable phenotype, including cognitive impairment, seizures, and structural brain anomalies such as periventricular leukomalacia (PVL). In a large series of these individuals by Battaglia et al., "birth history was notable in 50% of the cases for varying degrees of perinatal distress." Given the potential for perinatal distress, seizures and PVL, we questioned if this disorder has clinical overlap with hypoxic ischemic encephalopathy (HIE). We reviewed the medical records of 69 individuals with 1p36 deletion to clarify the perinatal phenotype of this disorder and determine if there is evidence of perinatal distress and/or hypoxic injury. Our data provides evidence that these babies have signs of perinatal distress. The majority (59% term; 75% preterm) needed resuscitation and approximately 18% had cardiac arrest. Most had abnormal brain imaging (84% term; 73% preterm) with abnormal white matter findings in over half of patients. PVL or suggestion of "hypoxic insult" was present in 18% of term and 45% of preterm patients. In conclusion, individuals with 1p36 deletion have evidence of perinatal distress, white matter changes, and seizures, which can mimic HIE but are likely related to their underlying chromosome disorder.
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Affiliation(s)
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | | | | | | | - Lynne M Bird
- University of California San Diego and Rady Children's Hospital San Diego, San Diego, California
| | - Leah Dowsett
- Kapi'olani Medical Center and University of Hawai'i, Honolulu, Hawaii
| | - John M Graham
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Fowzan S Alkuraya
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mais Hashem
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | | | - Ian Glass
- University of Washington, Seattle, Washington
| | | | - Cathy A Stevens
- University of Tennessee School of Medicine, Knoxville, Tennessee
| | - Elaine Zackai
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carey McDougall
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Keena
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela Peron
- Child Neuropsychiatry Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Laurie H Seaver
- Spectrum Health Helen DeVos Children's Hospital.,Michigan State University Department of Pediatrics and Human Development, Grand Rapids, Michigan
| | - Thomas P Slavin
- Division of Clinical Cancer Genomics, City of Hope, Duarte, California
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Cavolo A, Dierckx de Casterlé B, Naulaers G, Gastmans C. Physicians' Attitudes on Resuscitation of Extremely Premature Infants: A Systematic Review. Pediatrics 2019; 143:peds.2018-3972. [PMID: 31076541 DOI: 10.1542/peds.2018-3972] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Whether to resuscitate extremely premature infants (EPIs) is a clinically and ethically difficult decision to make. Indications and practices vary greatly across different countries and institutions, which suggests that resuscitation decisions may be influenced more by the attitudes of the individual treating physicians. Hence, gaining in-depth insight into physicians' attitudes improves our understanding of decision-making regarding resuscitation of EPIs. OBJECTIVE To better understand physicians' attitudes toward resuscitation of EPIs and factors that influence their attitudes through a systematic review of the empirical literature. DATA SOURCES Medline, Embase, Web of Science, and Scopus. STUDY SELECTION We selected English-language articles in which researchers report on empirical studies of physicians' attitudes toward resuscitation of EPIs. DATA EXTRACTION The articles were repeatedly read, themes were identified, and data were tabulated, compared, and analyzed descriptively. RESULTS Thirty-four articles were included. In general, physicians were more willing to resuscitate, to accept parents' resuscitation requests, and to refuse parents' nonresuscitation requests as gestational age (GA) increased. However, attitudes vary greatly for infants at GA 23 to 24 weeks, known as the gray zone. Although GA is the primary factor that influences physicians' attitudes, a complex interplay of patient- and non-patient-related factors also influences their attitudes. LIMITATIONS Analysis of English-only articles may limit generalizability of the results. In addition, authors of only 1 study used a qualitative approach, which may have led to a biased reductionist approach to understanding physicians' attitudes. CONCLUSIONS Although correlations between GA and attitudes emerged, the results suggested a more complex interplay of factors influencing such attitudes.
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Affiliation(s)
- Alice Cavolo
- Interfaculty Centre for Biomedical Ethics and Law,
| | | | - Gunnar Naulaers
- Section of Pregnancy, Foetus and Newborn, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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31
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Yuan J, Yang MC, Wu MJ, Gou YS. Sedative depth on neurological outcomes in a juvenile rat model of cardiopulmonary resuscitation. Med Hypotheses 2019; 132:109233. [PMID: 31606702 DOI: 10.1016/j.mehy.2019.109233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/11/2019] [Accepted: 05/18/2019] [Indexed: 01/26/2023]
Abstract
The guidelines for cardiopulmonary resuscitation (CPR) in pediatric advanced life support suggest that midazolam is the preferred agent for sedation in patients with mild hypothermia, whereas children with cardiac arrest (CA) are at a crucial stage regarding their immature nervous system. Studies have shown that midazolam may have a detrimental effect on the developmental of the pediatric nervous system. Our previous study found that midazolam induced neuronal damage after CPR in young rats. It is speculated that: midazolam causes the potential injury of neurons by inhibiting mitochondrial autophagy expression and is an important factor for the poor prognosis in children after successful CPR. This project intends to adopt the modified asphyxiant CPR model in juvenile rats. Survival rate, neurological function and histopathological changes were evaluated to determine the protective effects of appropriate sedation depth on cerebral ischemia-reperfusion injury in juvenile rats after CPR. Combined with cell biology and molecular biology related technologies, the mechanism by which the mitochondrial pinkl-parkin signaling pathway induces autophagy to inhibit neuronal apoptosis may be key factor in the protective effects of sedation depth on the brain. The aim of this study is to provide experimental evidence and elucidate the mechanisms of improvement of cerebral ischemia-reperfusion injury by sedation depth in children after successful CPR and to lay a theoretical and experimental basis for clinical treatment.
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Affiliation(s)
- Jing Yuan
- The Third People(')s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, China
| | - Meng-Chang Yang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, China
| | - Meng-Jun Wu
- Department of Anesthesiology, Chengdu Women and Children(')s Central Hospital, Chengdu 610041, Sichuan, China.
| | - Yong-Sheng Gou
- Department of Orthopedics, Shuangliu First People's Hospital, Chengdu 610200, Sichuan, China.
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Abstract
The approach to the management of meconium-stained newborns in the delivery room has been changing for over 40 years. The goal is to prevent meconium aspiration syndrome (MAS) and complications related to MAS. For decades, airway obstruction was believed to be a major component of MAS and, consequently, suction maneuvers to remove meconium from the airways were recommended to decrease the frequency and severity of MAS. Initial recommendations were based on observational studies. However, the incidence of MAS and mortality related to MAS has declined since the 1970s, mostly because of a decrease in the number of postterm deliveries. Recently updated guidelines by the American Heart Association and the Neonatal Resuscitation Program have reflected the strength of evidence supporting tracheal intubation and suctioning for nonvigorous, meconium-stained newborns. This article examines practice change since the 1970s in the delivery room management of meconium-stained newborns and evaluates evidence behind the changes.
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Pyle AK, Fleischman AR, Hardart G, Mercurio MR. Management options and parental voice in the treatment of trisomy 13 and 18. J Perinatol 2018; 38:1135-1143. [PMID: 29977011 DOI: 10.1038/s41372-018-0151-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Alaina K Pyle
- Department of Pediatrics and Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, USA.
| | - Alan R Fleischman
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
| | - George Hardart
- Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital, New York City, NY, USA
| | - Mark R Mercurio
- Department of Pediatrics and Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, USA
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34
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Abstract
BACKGROUND The approach to intrapartum and postnatal management of an infant born through meconium-stained amniotic fluid (MSAF) in the delivery room (DR) has changed several times over the last few decades, leading to confusion and anxiety among health care providers (nurses, nurse practitioners, respiratory therapists, midwives, and physicians). This article provides state-of-the-art insight into the evidence or lack thereof for the changes in guidelines. PURPOSE To discuss the evidence for evolution of DR management of vigorous and nonvigorous infants born through any type of MSAF. METHODS Review of guidelines from the Neonatal Resuscitation Program of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, the International Liaison Committee on Resuscitation, Consensus on Science and Treatment Recommendations, and textbooks of neonatal resuscitation and research using MEDLINE via PubMed. FINDINGS In pregnancies complicated by MSAF, intrapartum suctioning of the oro- and nasopharynx and postnatal intubation with tracheal suctioning of infants have been traditionally used to clear the airway and decrease meconium aspiration syndrome. The recommendations for these perinatal practices have changed several times due to some evidence that the procedures are not beneficial and may even be harmful. IMPLICATIONS FOR PRACTICE Intrapartum suctioning and postnatal tracheal suctioning of infants (vigorous or nonvigorous) born through MSAF are not recommended. This is a "high-risk" delivery requiring 2 team members to be present at birth-one with full resuscitation skills including tracheal intubation. IMPLICATIONS FOR RESEARCH Need to evaluate effects of discontinuing the practice of tracheal suctioning in nonvigorous infants on the incidence of meconium aspiration syndrome and neonatal mortality.
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35
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Qureshi MJ, Kumar M. Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Cochrane Database Syst Rev 2018. [PMID: 29542112 PMCID: PMC6494187 DOI: 10.1002/14651858.cd003314.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Providing effective positive pressure ventilation is considered to be the single most important component of successful neonatal resuscitation. Ventilation is frequently initiated manually with bag and face mask (BMV) followed by endotracheal intubation if respiratory depression continues. These techniques may be difficult to perform successfully resulting in prolonged resuscitation or neonatal asphyxia. The laryngeal mask airway (LMA) may achieve initial ventilation and successful resuscitation faster than a bag-mask device or endotracheal intubation. OBJECTIVES Among newborns requiring positive pressure ventilation for cardio-pulmonary resuscitation, is LMA more effective than BMV or endotracheal intubation for successful resuscitation? When BMV is either insufficient or ineffective, is effective positive pressure ventilation and successful resuscitation achieved faster with the LMA compared to endotracheal intubation? SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1), MEDLINE via PubMed (1966 to 15 February 2017), Embase (1980 to 15 February 2017), and CINAHL (1982 to 15 February 2017). We also searched clinical trials registers, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared LMA for neonatal resuscitation with either BMV or endotracheal intubation and reported on any outcomes related to neonatal resuscitation specified in this review. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated studies for risk of bias assessments, and extracted data using Cochrane Neonatal criteria. Categorical treatment effects were described as relative risks and continuous treatment effects were described as the mean difference, with 95% confidence intervals (95% CI) of estimates. MAIN RESULTS We included seven trials that involved a total of 794 infants. Five studies compared LMA with BMV and three studies compared LMA with endotracheal intubation. We added six new studies for this update (754 infants).LMA was associated with less need for endotracheal intubation than BMV (typical risk ratio (RR) 0.24, 95% CI 0.12 to 0.47 and typical risk difference (RD) -0.14, 95% CI -0.14 to -0.06; 5 studies, 661 infants; moderate-quality evidence) and shorter ventilation time (mean difference (MD) -18.90 seconds, 95% CI -24.35 to -13.44; 4 studies, 610 infants). Babies resuscitated with LMA were less likely to require admission to neonatal intensive care unit (NICU) (typical RR 0.60, 95% CI 0.40 to 0.90 and typical RD -0.18, 95% CI -0.31 to -0.04; 2 studies,191 infants; moderate-quality evidence). There was no difference in deaths or hypoxic ischaemic encephalopathy (HIE) events.Compared to endotracheal intubation, there were no clinically significant differences in insertion time or failure to correctly insert the device (typical RR 0.95, 95% CI 0.17 to 5.42; 3 studies, 158 infants; very low-quality evidence). There was no difference in deaths or HIE events. AUTHORS' CONCLUSIONS LMA can achieve effective ventilation during neonatal resuscitation in a time frame consistent with current neonatal resuscitation guidelines. Compared to BMV, LMA is more effective in terms of shorter resuscitation and ventilation times, and less need for endotracheal intubation (low- to moderate-quality evidence). However, in trials comparing LMA with BMV, over 80% of infants in both trial arms responded to the allocated intervention. In studies that allowed LMA rescue of infants failing with BMV, it was possible to avoid intubation in the majority. It is important that the clinical community resorts to the use of LMA more proactively to provide effective ventilation when newborn is not responding to BMV before attempting intubation or initiating chest compressions.LMA was found to offer comparable efficacy to endotracheal intubation (very low- to low-quality evidence). It therefore offers an alternate airway device when attempts at inserting endotracheal intubation are unsuccessful during resuscitation.Most studies enrolled infants with birth weight over 1500 g or 34 or more weeks' gestation. As such, there is lack of evidence to support LMA use in more premature infants.
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Affiliation(s)
- Mosarrat J Qureshi
- Northern Alberta Neonatal Program, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, Canada, T5H 3V9
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Gaertner VD, Flemmer SA, Lorenz L, Davis PG, Kamlin COF. Physical stimulation of newborn infants in the delivery room. Arch Dis Child Fetal Neonatal Ed 2018; 103:F132-F136. [PMID: 28600392 DOI: 10.1136/archdischild-2016-312311] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Neonatal resuscitation guidelines recommend that newborn infants are stimulated to assist with the establishment of regular respirations. The mode, site of application and frequency of stimulations are not stipulated in these guidelines. The effectiveness of stimulation in improving neonatal transition outcomes is poorly described. METHODS We conducted a retrospective review of video recordings of neonatal resuscitation at a tertiary perinatal centre. Four different types of stimulation (drying, chest rub, back rub and foot flick) were defined a priori and the frequency and infant response were documented. RESULTS A total of 120 video recordings were reviewed. Seventy-five (63%) infants received at least one episode of stimulation and 70 (58%) infants were stimulated within the first minute after birth. Stimulation was less commonly provided to infants <30 weeks' gestation (median (IQR) number of stimulations: 0 (0-1)) than infants born ≥30 weeks' gestation (1 (1-3); p<0.001). The most common response to stimulation was limb movement followed by infant cry and facial grimace. Truncal stimulation (drying, chest rub, back rub) was associated with more crying and movement than foot flicks. CONCLUSION Less mature infants are stimulated less frequently compared with more mature infants and many very preterm infants do not receive any stimulation. Most infants were stimulated within the first minute as recommended in resuscitation guidelines. Rubbing the trunk may be most effective but this needs to be confirmed in prospective studies.
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Affiliation(s)
- Vincent D Gaertner
- Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,School of Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Sophie A Flemmer
- Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,School of Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Laila Lorenz
- Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Peter G Davis
- Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Clinical Sciences Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - C Omar Farouk Kamlin
- Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Clinical Sciences Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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O'Donnell CPF, Davis PG, Morley CJ. Endotracheal intubation versus face mask for newborns resuscitated with positive pressure ventilation at birth. Hippokratia 2017. [DOI: 10.1002/14651858.cd004948.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Colm PF O'Donnell
- National Maternity Hospital; Department of Neonatology; Holles Street Dublin 2 Ireland
| | - Peter G Davis
- The University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
- The Royal Women’s Hospital; Parkville VIC Australia 3052
| | - Colin J Morley
- University of Cambridge; Department of Obstetrics and Gynecology; Cambridge UK
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Oei JL. Placing preterm infants on their side at birth does not increase 5 min SpO 2. EVIDENCE-BASED MEDICINE 2017; 22:68-69. [PMID: 28011662 DOI: 10.1136/ebmed-2016-110584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Walker A, Kepron C, Milroy CM. Are There Hallmarks of Child Abuse? I. Osseous Injuries. Acad Forensic Pathol 2016; 6:568-590. [PMID: 31239932 DOI: 10.23907/2016.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/10/2016] [Accepted: 11/09/2016] [Indexed: 11/12/2022]
Abstract
Fractures are commonly found in cases regarded as child abuse. The most commonly encountered fractures are to the ribs and the metaphyses. This paper examines the specificity of the classical metaphyseal lesion (CML) and rib fractures as hallmarks of child abuse. Recently, vitamin D deficiency (rickets) has been proposed as an alternative cause for the appearances typically described in CML. The literature in this area is examined. Rib fractures have also been highly associated with child abuse, particularly posterior rib fractures. As well as metabolic bone disease, resuscitation has been examined as a cause of rib fractures in young children. The current literature remains strongly supportive of rib fractures and metaphyseal fractures being indicators of child abuse.
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Affiliation(s)
| | - Charis Kepron
- Ontario Forensic Pathology Service - Eastern Ontario Regional Forensic Pathology Unit and University of Ottawa - Pathology and Laboratory Medicine
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40
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Wyllie J, Ainsworth S. What is new in the European and UK neonatal resuscitation guidance? Arch Dis Child Fetal Neonatal Ed 2016; 101:F469-73. [PMID: 27127205 DOI: 10.1136/archdischild-2015-309472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/06/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
| | - Sean Ainsworth
- Paediatric and Neonatal Division Planned Care Directorate, Victoria Hospital, Kirkcaldy, UK
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Stenke E, Kieran EA, McCarthy LK, Dawson JA, Van Vonderen JJ, Kamlin COF, Davis PG, Te Pas AB, O'Donnell CPF. A randomised trial of placing preterm infants on their back or left side after birth. Arch Dis Child Fetal Neonatal Ed 2016; 101:F397-400. [PMID: 26847368 DOI: 10.1136/archdischild-2015-309842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/14/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Basic life support guidelines recommend placing spontaneously breathing children and adults on their side. Though the majority of preterm newborns breathe spontaneously, they are routinely placed on their back after birth. We hypothesised that they would breathe more effectively when placed on their side. OBJECTIVE To determine whether preterm newborns placed on their left side at birth, compared with those placed on their back, have higher preductal oxygen saturation (SpO2) at 5 min of life. DESIGN/METHODS We randomised infants <32 weeks to be placed on their back or on their left side immediately after birth. Respiratory support was given with a T-piece and face mask with initial fraction of inspired oxygen (FiO2) of 0.3. The FiO2 was increased if SpO2 was <70% at 5 min. RESULTS We enrolled 87 infants, 41 randomised to back and 46 to left side. The groups were well matched for demographic variables. Fourteen (6 back and 8 left side) infants did not receive respiratory support in the first 5 min. The mean (SD) SpO2 was not different between the groups (back 72 (23) % versus left side 71 (24) %, p=0.956). We observed no adverse effects of placing infants on their side and found no differences in secondary outcomes between the groups. CONCLUSIONS Preterm infants on their left side did not have higher SpO2 at 5 min of life. Placing preterm infants on their side at birth is feasible and appears to be a reasonable alternative to placing them on their back. TRIAL REGISTRATION NUMBER ISRCTN74486341.
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Affiliation(s)
- Emily Stenke
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Emily A Kieran
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland
| | - Lisa K McCarthy
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland
| | - Jennifer A Dawson
- Department of Neonatology, Royal Women's Hospital, Melbourne, Australia
| | | | - C Omar F Kamlin
- Department of Neonatology, Royal Women's Hospital, Melbourne, Australia
| | - Peter G Davis
- Department of Neonatology, Royal Women's Hospital, Melbourne, Australia
| | - Arjan B Te Pas
- Department of Neonatology, Leiden University Medical Centre, Leiden, Netherlands
| | - Colm P F O'Donnell
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland
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Al Hamod DA, Zeidan S, Al Bizri A, Baaklini G, Nassif Y. Ultrasound-guided Central Line Insertion and Standard Peripherally Inserted Catheter Placement in Preterm Infants: Comparing Results from Prospective Study in a Single-center. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:205-9. [PMID: 27298814 PMCID: PMC4899959 DOI: 10.4103/1947-2714.183011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Among preterm infants, the peripherally inserted central catheter (PICC) is the standard line for central venous access; however, its placement exposes them to hypothermia and pain. Ultrasound (US)-guided central line insertion may be less morbid than standard PICC line. Aims: To determine the ease, success rate, and morbidity associated with US-guided central line insertion in the internal jugular vein (IJV) by comparing it to the standard PICC line placement. Materials and Methods: This is a single-center nonrandomized prospective study evaluating preterm infants between October 2013 and June 2014. Patients were allocated into two groups: The standard group (control group) who underwent blind PICC line insertion and the intervention group who underwent a percutaneous US-guided central line insertion in the IJV. The epicutaneo-cava-catheter was used in both groups. Results: Fifty neonates were enrolled on study. A statistically difference in favor of US-IJV insertion was noted concerning the rate of successful first attempt (P < 0.001), insertion (P = 0.001), and procedure duration (P < 0.001) and number of trials (P < 0.001) compared to PICC. No difference in complications (P = 1.000) was noted. Conclusion: US guided catheterization of the IJV technique is faster than PICC line insertion with higher rates of successful first attempt and insertion, less procedure duration and fewer number of trials compared to PICC line insertion. There were no differences in complications.
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Affiliation(s)
- Dany Antanios Al Hamod
- Department of Pediatrics, Division of Neonatalogy, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Smart Zeidan
- Department of Pediatric Surgery, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Ayah Al Bizri
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Baaklini
- Department of Vascular Surgery, Saint George University Hospital, University of Balamand, Beirut, Lebanon
| | - Yolla Nassif
- Department of Pediatrics, Division of Neonatalogy, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
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Graham EM. Infants with Trisomy 18 and Complex Congenital Heart Defects Should Not Undergo Open Heart Surgery. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:286-291. [PMID: 27338604 DOI: 10.1177/1073110516654122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Aggressive medical and surgical interventions have not been clearly demonstrated to improve survival in neonates with trisomy 18; there are no data that demonstrates improved quality of life for these children after these interventions; and these interventions are clearly associated with significant morbidity, resource allocation, and cost.
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Affiliation(s)
- Eric M Graham
- Eric M. Graham, M.D., is a physician in the Division of Pediatric Cardiology at the Medical University of South Carolina
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Marseglia L, D'Angelo G, Manti M, Aversa S, Fiamingo C, Arrigo T, Barberi I, Mamì C, Gitto E. Visfatin: New marker of oxidative stress in preterm newborns. Int J Immunopathol Pharmacol 2016; 29:23-9. [PMID: 26525831 PMCID: PMC5806730 DOI: 10.1177/0394632015607952] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/01/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Oxidative stress is involved in several neonatal conditions characterized by an upregulation in the production of oxidative or nitrative free radicals and a concomitant decrease in the availability of antioxidant species. Oxygen, which is obviously vital to survival, can be highly damaging to neonatal tissue which is known to be poorly equipped to neutralize toxic derivatives. Thus, exposure of the newborn infant to high oxygen concentrations during resuscitation at birth increases oxidative damage. Visfatin is an adipocytokine involved in oxidative stress and an important mediator of inflammation that induces dose-dependent production of both pro-inflammatory and anti-inflammatory cytokines. To our knowledge, the diagnostic value of visfatin as a marker of oxidative stress in preterm newborns has not been investigated. OBJECTIVE The aim of this study was to evaluate visfatin levels in preterm neonates resuscitated with different concentrations of oxygen in the delivery room. PATIENTS Fifty-two preterm newborns with gestational age less than 32 weeks, resuscitated randomly with different oxygen concentrations (40%, 60%, or 100%) were enrolled at the University Hospital of Messina, over a 12-month period to evaluate serum visfatin levels at T0 (within 1 h after birth), T24 h, T72 h, and T168 h of life. RESULTS At T72 h and T168 h, higher serum visfatin values in the high-oxygen group compared to the low- and mild-oxygen subjects (P=0.002 and P<0.001, respectively) were noted. CONCLUSION The results of this study suggest that visfatin could be a new marker of oxidative stress in preterm newborns.
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Affiliation(s)
- Lucia Marseglia
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Gabriella D'Angelo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | | | - Salvatore Aversa
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Chiara Fiamingo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Teresa Arrigo
- Unit of Paediatric Genetics and Immunology, Department of Paediatrics, University of Messina, Italy
| | - Ignazio Barberi
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Carmelo Mamì
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
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Yang C, Zhu X, Lin W, Zhang Q, Su J, Lin B, Ye H, Yu R. Randomized, controlled trial comparing laryngeal mask versus endotracheal intubation during neonatal resuscitation---a secondary publication. BMC Pediatr 2016; 16:17. [PMID: 26811060 PMCID: PMC4727391 DOI: 10.1186/s12887-016-0553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to study the feasibility, efficacy and safety of using laryngeal mask (LM) ventilation compared with endotracheal intubation (ETI) during neonatal resuscitation. Methods Neonates with a heart rate below 60 beats per minute despite 30 s of face mask ventilation were assigned quasi-randomly (odd/even birth date) to LM (n = 36) or ETI (n = 32) ventilation. Differences in first attempt insertion success, insertion time, Apgar score, resuscitation outcome, and adverse effects were compared. Results There were no significant differences in first attempt at successful insertion (LM, 94.4 % vs. ETI, 90.6 %), insertion time (LM, 7.58 ± 1.16 s vs. ETI, 7.89 ± 1.52 s), Apgar score at 1 and 5 min, response time, ventilation time, successful resuscitation (LM, 86.1 % vs. ETI, 96.9 %), and adverse events (LM, n =3 vs. ETI, n =4) between groups. Conclusions Laryngeal mask ventilation is an effective alternative to endotracheal intubation during resuscitation of depressed newborns who do not respond to face-mask ventilation. During an emergency, laryngeal mask ventilation may be a preferred technique for medical staff who are unable to acquire or maintain endotracheal intubation skills. Trial registration: Current Controlled Trials ChiCTR-IOQ-15006488. Registered on 2 June 2015.
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Affiliation(s)
- Chuanzhong Yang
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China.
| | - Xiaoyu Zhu
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Weibin Lin
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Qianshen Zhang
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Jinqiong Su
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Bingchun Lin
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Hongmao Ye
- Neonatal Department, the Third Hospital of Peking University, Beijing, China
| | - Renjie Yu
- Neonatal Department, the First Hospital Affiliated to Tsinghua University, Beijing, China
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Braga MS, Kabbur P, Alur P, Goodstein MH, Roberts KD, Satrom K, Shivananda S, Goswami I, Pappagallo M, Briere CE, Suresh G. Current practice of neonatal resuscitation documentation in North America: a multi-center retrospective chart review. BMC Pediatr 2015; 15:184. [PMID: 26572859 PMCID: PMC4647697 DOI: 10.1186/s12887-015-0503-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Methods Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified. Results Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation. Conclusions Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation.
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Affiliation(s)
- Matthew S Braga
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Children's Hospital at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Prakash Kabbur
- Kapi'olani Medical Center for Women and Children, Neonatology, 1319 Punahou St, Honolulu, HI, 96826, USA.
| | - Pradeep Alur
- Wellspan Health, York Hospital, Neonatology, 1001 S. George St., York, 17403, NY, USA.
| | - Michael H Goodstein
- Wellspan Health, York Hospital, Neonatology, 1001 S. George St., York, 17403, NY, USA.
| | - Kari D Roberts
- University of Minnesota Masonic Children's Hospital, Neonatology, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Katie Satrom
- University of Minnesota Masonic Children's Hospital, Neonatology, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Sandesh Shivananda
- McMaster University, McMaster Children's Hospital, Neonatology, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Ipsita Goswami
- McMaster University, McMaster Children's Hospital, Neonatology, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Mariann Pappagallo
- University of Connecticut Health Center, Connecticut Children's Medical Center, Neonatology, 282 Washington St., Farmington, 06106, CT, USA.
| | - Carrie-Ellen Briere
- University of Connecticut Health Center, Connecticut Children's Medical Center, Neonatology, 282 Washington St., Farmington, 06106, CT, USA.
| | - Gautham Suresh
- Texas Children's Hospital, Baylor College of Medicine, Neonatology, 6621 Fannin St, Houston, TX, 77030, USA.
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Kasdorf E, Laptook A, Azzopardi D, Jacobs S, Perlman JM. Improving infant outcome with a 10 min Apgar of 0. Arch Dis Child Fetal Neonatal Ed 2015; 100:F102-5. [PMID: 25342246 DOI: 10.1136/archdischild-2014-306687] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Asystole at birth and extending through 10 min is rare, with current international recommendations stating it may be appropriate to consider discontinuation of resuscitation in this clinical scenario. These recommendations are based on small case series of both term and preterm infants, where death or abnormal outcome was nearly universal. Study objective was to determine recent outcome of infants with an Apgar score of 0 at 10 min despite cardiopulmonary resuscitation, treated with therapeutic hypothermia or standard treatment, in randomised cooling studies. DESIGN Outcome studies of infants with an Apgar of 0 at 10 min subsequently resuscitated and treated with hypothermia or standard treatment were reviewed and combined with local outcome data of infants treated with hypothermia. RESULTS Four recent studies (n=81) and local data (n=9) yielded a total of 90 infants with an Apgar of 0 at 10 min, with 56 treated with hypothermia and 34 controls. Primary outcome of death or abnormal neurodevelopmental outcome (18-24 months) occurred in 73% cooled and 79.5% normothermic infants (p=0.61). IMPLICATIONS Although poor, the outcome for infants with an Apgar of 0 at 10 min of life has improved substantially in recent years. This may be related to treatment with hypothermia, enhanced resuscitation techniques and/or other supportive management. Current recommendations to consider discontinuation of resuscitation without a detectable heart rate at 10 min should consider these findings.
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Affiliation(s)
- Ericalyn Kasdorf
- Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Abbot Laptook
- Department of Pediatrics, Women & Infants' Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Dennis Azzopardi
- Division of Clinical Sciences and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London, UK
| | - Susan Jacobs
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jeffrey M Perlman
- Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
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Performance-based comparison of neonatal intubation training outcomes: simulator and live animal. Adv Neonatal Care 2015; 15:56-64. [PMID: 25626982 DOI: 10.1097/anc.0000000000000130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this article was to establish psychometric validity evidence for competency assessment instruments and to evaluate the impact of 2 forms of training on the abilities of clinicians to perform neonatal intubation. To inform the development of assessment instruments, we conducted comprehensive task analyses including each performance domain associated with neonatal intubation. Expert review confirmed content validity. Construct validity was established using the instruments to differentiate between the intubation performance abilities of practitioners (N = 294) with variable experience (novice through expert). Training outcomes were evaluated using a quasi-experimental design to evaluate performance differences between 294 subjects randomly assigned to 1 of 2 training groups. The training intervention followed American Heart Association Pediatric Advanced Life Support and Neonatal Resuscitation Program protocols with hands-on practice using either (1) live feline or (2) simulated feline models. Performance assessment data were captured before and directly following the training. All data were analyzed using analysis of variance with repeated measures and statistical significance set at P < .05. Content validity, reliability, and consistency evidence were established for each assessment instrument. Construct validity for each assessment instrument was supported by significantly higher scores for subjects with greater levels of experience, as compared with those with less experience (P = .000). Overall, subjects performed significantly better in each assessment domain, following the training intervention (P = .000). After controlling for experience level, there were no significant differences among the cognitive, performance, and self-efficacy outcomes between clinicians trained with live animal model or simulator model. Analysis of retention scores showed that simulator trained subjects had significantly higher performance scores after 18 weeks (P = .01) and 52 weeks (P = .001) and cognitive scores after 52 weeks (P = .001). The results of this study demonstrate the feasibility of using valid, reliable assessment instruments to assess clinician competency and self-efficacy in the performance of neonatal intubation. We demonstrated the relative equivalency of live animal and simulation-based models as tools to support acquisition of neonatal intubation skills. Retention of performance abilities was greater for subjects trained using the simulator, likely because it afforded greater opportunity for repeated practice. Outcomes in each assessment area were influenced by the previous intubation experience of participants. This suggests that neonatal intubation training programs could be tailored to the level of provider experience to make efficient use of time and educational resources. Future research focusing on the uses of assessment in the applied clinical environment, as well as identification of optimal training cycles for performance retention, is merited.
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Abstract
Delivery room management, especially in the first 'golden' minute, is of the utmost importance. An exact and universal definition of when a baby is born is needed to obtain agreement on what is meant by the first minute of life. Education of young girls is a basic requirement to optimize the health of the mother and baby. Interventions in pregnancy should as far as possible be evidence based. Antenatal care, the selection of birth mode and antenatal steroid therapy when indicated also contribute to obtaining the best outcome. Delayed cord clamping is recommended for both preterm and term infants. However, more data are needed regarding the most immature infants. Routine suctioning of the mouth and airways is not required. Thermal control is important - keep the temperature in the delivery room at 26°C and wrap infants <28 weeks of gestation in plastic. However, this procedure does not reduce mortality. Since delayed cord clamping increases mean birth weight by approximately 30 g/kg, the present birth weight charts based on early clamping need to be corrected. Preterm infants in need of ventilatory support should start with CPAP from the first breath. A T-piece device seems to have some advantages compared to self-inflating bags. Surfactant instillation is often not needed prophylactically provided the mother has received antenatal steroids. Less invasive methods for administering surfactant may be useful. If ventilatory support is needed, start with air in term and near-term infants. For babies of 29-33 weeks of gestation start with 21-30% oxygen and for infants <29 weeks start with 30% oxygen and adjust according to the response obtained.
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Affiliation(s)
- Ola Didrik Saugstad
- Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway
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50
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Abstract
Pulse oximetry has become ubiquitous and is used routinely during neonatal care. Emerging evidence highlights the continued uncertainty regarding definition of the optimal range to target pulse oximetry oxygen saturation levels in very low birth weight infants. Furthermore, maintaining optimal oxygen saturation targets is a demanding and tedious task because of the frequency with which oxygenation changes, especially in these small infants receiving prolonged respiratory support. This article addresses the historical perspective, basic physiologic principles behind pulse oximetry operation, and the use of pulse oximetry in targeting different oxygen ranges at various time-points throughout the neonatal period.
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Affiliation(s)
- Richard A Polin
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway MSCHN 1201, New York, NY 10032-3702, USA.
| | - David A Bateman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway MSCHN 1201, New York, NY 10032-3702, USA
| | - Rakesh Sahni
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway MSCHN 1201, New York, NY 10032-3702, USA
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