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Galloway I, Roehr CC, Tan K. Withdrawal and withholding of life sustaining treatment (WWLST): an under recognised factor in the morbidity or mortality of periviable infants?-a narrative review. Transl Pediatr 2024; 13:459-473. [PMID: 38590374 PMCID: PMC10998991 DOI: 10.21037/tp-23-468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
Background and Objective The morbidity and mortality of infants born extremely preterm varies substantially across networks, within countries and throughout the globe. Most of the literature tends to focus on the management at birth and choices around active resuscitation of extremely preterm infants. Withdrawal and withholding of life sustaining treatment (WWLST) is an important and central process in the neonatal intensive care unit (NICU) and practices vary substantially. As such, our objective in this review was to explore whether end of life decisions also contribute to variations in the morbidity and mortality of periviable infants. Methods This narrative literature review is based on studies from the last 15 years found using several searches of medical databases (OVID Medline, Scopus and Cochrane Systematic Reviews) performed between March 2021 and December 2023. Key Content and Findings Just as outcomes in periviable infants vary, the rates of and processes behind WWLST differ in the periviable population. Variation increases as gestational age decreases. Parental involvement is crucial to share decision making but the circumstances and rates of parental involvement differ. Strict guidelines in end-of-life care may not be appropriate, however there is a need for more targeted guidance for periviable infants as a specific population. The current literature available relating to periviable infants or WWLST is minimal, with many datasets rapidly becoming outdated. Conclusions Further research is needed to establish the role of WWLST in variation of periviable infants' outcomes. The unification of data, acquisition of more recent datasets and inclusion of variables relating to end-of-life decisions in data collection will aid in this process.
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Affiliation(s)
- Isobel Galloway
- Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Charles Christoph Roehr
- Women’s and Children’s, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kenneth Tan
- Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria, Australia
- Monash Newborn, Monash Children’s Hospital, Victoria, Australia
- School of Medicine, Taylor’s University, Selangor, Malaysia
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Roehr CC, Szczapa T, Stiris T, Hadjipanayis A, Koletzko B, Ross-Russell R, Hüppi P, Wellmann S, Vento M. European Training Requirements in Neonatology 2021: The ESPR, EAP, and UEMS Accredited European Syllabus for Neonatal Training. Neonatology 2024:1-8. [PMID: 38522419 DOI: 10.1159/000536247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION The European Union stipulates transnational recognition of professional qualifications for several sectoral professions, including medical doctors. The Union of European Medical Specialists (UEMS), in its "Charter on Training of Medical Specialists," defines the principles for high-level medical training. These principles are manifested in the framework for European Training Requirements (ETR), ensuring medical training reflects modern medical practice and current scientific findings. In 1998, the European Society for Paediatric Research developed the first ETR for Neonatology. We present the ETR Neonatology in its third iteration (ETR III), ratified by the European Academy of Paediatrics (EAP), and approved by UEMS in 2021. METHODS In generating the ETR III, existing European policy documents on training requirements, including national syllabi and the European Standards of Care for Newborn Health were considered. To ensure the ETR III meets a pan-European standard of expertise in Neonatology, input from representatives from 27 European national paediatric/neonatal societies, and a European parent organisation, was sought. RESULTS The ETR III summarises the requirements of contemporary training programs in Neonatology and offers a system for accrediting trainers and training centres. We describe the content of the ETR III training syllabus and means of gaining and assessing competency as a medical care provider in Neonatology. CONCLUSION Graduates of courses following the ETR III Neonatology will obtain a certificate of satisfactory training completion which should be accepted by all European member states as a baseline qualification to practice as a specialist in neonatal medicine, enabling mutual recognition of status throughout Europe.
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Affiliation(s)
- Charles Christoph Roehr
- European Society for Paediatric Research, Satigny, Switzerland
- European Board of Neonatal & Child Health Research, Satigny, Switzerland
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Tomasz Szczapa
- European Board of Neonatal & Child Health Research, Satigny, Switzerland
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium
- Department of Neonatology, Oslo University Hospital, Norway and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, Brussels, Belgium
- Medical School, European University Cyprus, Nicosia, Cyprus
| | - Berthold Koletzko
- European Academy of Paediatrics, Brussels, Belgium
- Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rob Ross-Russell
- European Academy of Paediatrics, Brussels, Belgium
- European Board of Paediatrics/Union of European Medical Specialists, Brussels, Belgium
- Department of Paediatric Respiratory Medicine, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Petra Hüppi
- European Society for Paediatric Research, Satigny, Switzerland
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Sven Wellmann
- European Society for Paediatric Research, Satigny, Switzerland
- Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Maximo Vento
- European Board of Neonatal & Child Health Research, Satigny, Switzerland
- Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
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Ramaswamy VV, Bandyopadhyay T, Abiramalatha T, Pullattayil S AK, Szczapa T, Wright CJ, Roehr CC. Clinical decision thresholds for surfactant administration in preterm infants: a systematic review and network meta-analysis. EClinicalMedicine 2023; 62:102097. [PMID: 37538537 PMCID: PMC10393620 DOI: 10.1016/j.eclinm.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Background The ideal threshold at which surfactant administration in preterm neonates with respiratory distress syndrome (RDS) is most beneficial is contentious. The aim of this systematic review was to determine the optimal clinical criteria to guide surfactant administration in preterm neonates with RDS. Methods The systematic review was registered in PROSPERO (CRD42022309433). Medline, Embase, CENTRAL and CINAHL were searched from inception till 16th May 2023. Only randomized controlled trials (RCTs) were included. A Bayesian random effects network meta-analysis (NMA) evaluating 33 interventions was performed. The primary outcome was requirement of invasive mechanical ventilation (IMV) within 7 days of life. Findings 58 RCTs were included. In preterm neonates ≤30 weeks after adjusting for the confounding factor of modality of surfactant administration, an arterial alveolar oxygen tension ratio (aAO2) <0.36 (FiO2: 37-55%) was ranked the best threshold for decreasing the risk of IMV, very low certainty. Further, surfactant administration at an FiO2 40-45% possibly decreased mortality compared to rescue treatment when respiratory failure was diagnosed, certainty very low. The reasonable inference that could be drawn from these findings is that surfactant administration may be considered in preterm neonates of ≤30 weeks' with RDS requiring an FiO2 ≥ 40%. There was insufficient evidence for the comparison of FiO2 thresholds: 30% vs. 40%. The evidence was sparse for surfactant administration guided by lung ultrasound. For the sub-group >30 weeks, nebulized surfactant administration at an FiO2 < 30% possibly increased the risk of IMV compared to Intubate-Surfactant-Extubate at FiO2 < 30% and 40%, and less invasive surfactant administration at FiO2 40%, certainty very low. Interpretation Surfactant administration may be considered in preterm neonates of ≤30 weeks' with RDS if the FiO2 requirement is ≥40%. Future trials are required comparing lower FiO2 thresholds of 30% vs. 40% and that guided by lung ultrasound. Funding None.
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Affiliation(s)
| | | | - Thangaraj Abiramalatha
- Department of Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
| | | | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Clyde J. Wright
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Newborn Services, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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Moschino L, Ramaswamy VV, Reiss IKM, Baraldi E, Roehr CC, Simons SHP. Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis. Pediatr Res 2023; 93:471-491. [PMID: 35654833 DOI: 10.1038/s41390-022-02121-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/23/2022] [Accepted: 05/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sedation to preterm neonates receiving less invasive surfactant administration (LISA) for respiratory distress syndrome is controversial. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) to evaluate the effect of sedative drugs for LISA on respiratory outcomes and adverse effects. RESULTS One RCT (78 neonates) and two OS (519 neonates) were analyzed in pairwise meta-analysis and 30 studies (2164 neonates) in proportion-based meta-analysis. Sedative drugs might not affect the duration of the procedure [RCT: mean difference (MD) (95% CI); -11 (-90; 67) s; OS: MD 95% CI: -60 (-178; 58) s; low certainty of evidence (CoE)]. Evidence for success at the first attempt and rescue intubation was uncertain (very low CoE). The risk of nasal intermittent positive pressure ventilation [RCT: 1.97 (1.38-2.81); OS: RR, 95% CI: 2.96 (1.46; 6.00), low CoE], desaturation [RCT: RR, 95% CI: 1.30 (1.03; 1.65), low CoE], and apnea [OS: RR, 95% CI: 3.13 (1.35; 7.24), very low CoE] might be increased with sedation. Bradycardia, hypotension, and mechanical ventilation were comparable between groups (low CoE). CONCLUSIONS Use of sedative drugs for LISA temporarily affects the newborn's breathing. Further trials are warranted to explore the use of sedation for LISA. IMPACT The effect of sedative drugs (analgesics, sedatives, anesthetics) compared to the effect of no-sedation for LISA in preterm infants with RDS is underexplored. This systematic review and meta-analysis assesses the impact of sedative drugs compared to no-sedation for LISA on short-term pulmonary outcomes and potential adverse events. Sedative drugs for LISA temporarily affect the newborn's breathing (desaturation, apnea) and increase the need for nasal intermittent positive pressure ventilation. For most outcomes, certainty of evidence is low/very low.
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Affiliation(s)
- Laura Moschino
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | | | - Irwin Karl Marcel Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Charles Christoph Roehr
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK. .,Faculty of Health Sciences, University of Bristol, Bristol, UK. .,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Sinno Henricus Paulus Simons
- Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Scrivens A, Reibel NJ, Heeger L, Stanworth S, Lopriore E, New HV, Dame C, Fijnvandraat K, Deschmann E, Aguar M, Brække K, Cardona FS, Cools F, Farrugia R, Ghirardello S, Lozar J, Matasova K, Muehlbacher T, Sankilampi U, Soares H, Szabo M, Szczapa T, Zaharie G, Roehr CC, Fustolo-Gunnink S. Survey of transfusion practices in preterm infants in Europe. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324619. [PMID: 36653173 DOI: 10.1136/archdischild-2022-324619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/10/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Preterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data. METHODS From October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries. RESULTS Responses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs. CONCLUSIONS Transfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.
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Affiliation(s)
- Alexandra Scrivens
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Lisanne Heeger
- Neonatology, Leiden University Medical Centre, Leiden, The Netherlands.,Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Simon Stanworth
- Department of Haematology, National Health Service, Blood and Transplant, Oxford University Hopsitals NHS Foundation Trust, Oxford, UK
| | - Enrico Lopriore
- Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Helen V New
- Paediatric Transfusion Medicine, National Health Service, Blood and Transplant, London, UK
| | - Christof Dame
- Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Fijnvandraat
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Pediatrics, Emma Children's Hospital, Pediatric Hematology, University of Amsterdam, Amsterdam, The Netherlands
| | - Emöke Deschmann
- University Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
| | - Marta Aguar
- Servicio de Neonatologia, University & Polytechnic Hospital La Fe, Valencia, Spain
| | - Kristin Brække
- Women and Children's division, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Francesco Stefano Cardona
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Pediatric Neurology, Medical University of Vienna, Wien, Austria
| | - Filip Cools
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Stefano Ghirardello
- Neonatal Intensive Care and Neonatology Unit, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jana Lozar
- Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Matasova
- Jessenius Faculty of Medicine in Martin, University Hospital Martin, Martin, Slovakia
| | | | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Henrique Soares
- Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Miklos Szabo
- Division of Neonatology 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriela Zaharie
- Neonatology, University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Cluj Napoca, Romania
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK .,Women and Children's, Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Suzanne Fustolo-Gunnink
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Pediatric Hematology, Amsterdam University Medical Center, Amsterdam, Netherlands
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Ramaswamy VV, Bandyopadhyay T, Nangia S, Kumar G, Pullattayil AK, Trevisanuto D, Roehr CC, Lakshminrusimha S. Assessment of Change in Practice of Routine Tracheal Suctioning Approach of Non-Vigorous Infants Born through Meconium-Stained Amniotic Fluid: A Pragmatic Systematic Review and Meta-Analysis of Evidence outside Randomized Trials. Neonatology 2023; 120:161-175. [PMID: 36754038 DOI: 10.1159/000528715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/11/2022] [Indexed: 02/10/2023]
Abstract
AIM The 2015 recommendation of the International Liaison Committee on Resuscitation of no routine tracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) was based on very low certainty of evidence (CoE) necessitating ongoing monitoring. The aim of this systematic review was to perform a meta-analysis of observational studies comparing the effect of implementing immediate resuscitation without routine tracheal suctioning versus with routine suctioning in neonates born through MSAF. METHODS MEDLINE, Embase, CENTRAL, and Web of Science were searched. Observational studies with a before-and-after design were included. Two authors extracted data independently. CoE based on GRADE recommendations was performed. RESULTS 13 studies were included. Clinical benefit or harm could not be excluded for the composite primary outcome of mortality or requirement of extracorporeal membranous oxygenation (ECMO) (relative risk, 95% confidence interval: 0.74 [0.47-1.17]), and mortality (0.68 [0.42-1.11]). "Routine tracheal suctioning" epoch had possibly lesser risk of meconium aspiration syndrome (MAS) when compared to "no routine tracheal suctioning" epoch (0.68 [0.47-0.99]). "Routine tracheal suctioning" epoch also possibly had a lower risk of hospital admission for respiratory symptoms, requirement of non-invasive respiratory support, invasive mechanical ventilation, surfactant treatment, air leak, and low-flow oxygen therapy. Clinical benefit or harm could not be excluded for the outcome of mortality or ECMO among those diagnosed with MAS (1.09 [0.86-1.39]), but "routine tracheal suctioning" was possibly associated with lower risk of respiratory morbidities among those diagnosed with MAS. The CoE was very low for most of the outcomes evaluated. CONCLUSIONS Due to the very low CoE for the outcomes evaluated, no definitive conclusions can be drawn warranting the need for additional studies.
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Affiliation(s)
| | - Tapas Bandyopadhyay
- Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Sushma Nangia
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Gunjana Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Abdul Kareem Pullattayil
- Associate Librarian, Bracken Health Sciences Library, Queen's University, Kingston, Ontario, Canada
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University of Padua, University Hospital of Padua, Padua, Italy
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Division, Nuffield Department of Population Health, Medical Sciences, University of Oxford, Oxford, UK
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK
- University of Bristol, Faculty of Health Sciences, Bristol, UK
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
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Mahmoud RA, Schmalisch G, Oswal A, Christoph Roehr C. Non-invasive ventilatory support in neonates: An evidence-based update. Paediatr Respir Rev 2022; 44:11-18. [PMID: 36428196 DOI: 10.1016/j.prrv.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
Non-invasive ventilatory support (NIV) is considered the gold standard in the care of preterm infants with respiratory distress syndrome (RDS). NIV from birth is superior to mechanical ventilation (MV) for the prevention of death or bronchopulmonary dysplasia (BPD), with a number needed to treat between 25 and 35. Various methods of NIV are available, some of them extensively researched and with well proven efficacy, whilst others are needing further research. Nasal continuous positive airway pressure (nCPAP) has replaced routine invasive mechanical ventilation (MV) for the initial stabilization and the treatment of RDS. Choosing the most suitable form of NIV and the most appropriate patient interface depends on several factors, including gestational age, underlying lung pathophysiology and the local facilities. In this review, we present the currently available evidence on NIV as primary ventilatory support to preventing intubation and for secondary ventilatory support, following extubation. We review nCPAP, nasal high-flow cannula, nasal intermittent positive airway pressure ventilation, bi-level positive airway pressure, nasal high-frequency oscillatory ventilation and nasal neurally adjusted ventilatory assist modes. We also discuss most suitable NIV devices and patient interfaces during resuscitation of the newborn in the delivery room.
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Affiliation(s)
- Ramadan A Mahmoud
- Department of Pediatrics, Sohag Faculty of Medicine, Sohag University, Egypt; Department of Neonatology, Maternity and Child Hospital, Al-kharj, Saudi Arabia
| | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Abhishek Oswal
- Newborn Care, Southmead Hospital, North Bristol Trust, Bristol, UK
| | - Charles Christoph Roehr
- Newborn Care, Southmead Hospital, North Bristol Trust, Bristol, UK; University of Bristol, Faculty of Medicine, Bristol, UK.
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8
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Boyle E, Roehr CC. Surfactant therapy in late preterm and term neonates with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:393-397. [PMID: 34686533 DOI: 10.1136/archdischild-2021-322890] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are no evidence-based recommendations for surfactant use in late preterm (LPT) and term infants with respiratory distress syndrome (RDS). OBJECTIVE To investigate the safety and efficacy of surfactant in LPT and term infants with RDS. METHODS Systematic review, meta-analysis and evidence grading. INTERVENTIONS Surfactant therapy versus standard of care. MAIN OUTCOME MEASURES Mortality and requirement for invasive mechanical ventilation (IMV). RESULTS Of the 7970 titles and abstracts screened, 17 studies (16 observational studies and 1 randomised controlled trial (RCT)) were included. Of the LPT and term neonates with RDS, 46% (95% CI 40% to 51%) were treated with surfactant. We found moderate certainty of evidence (CoE) from observational studies evaluating infants supported with non-invasive respiratory support (NRS) or IMV that surfactant use may be associated with a decreased risk of mortality (OR 0.45, 95% CI 0.32 to 0.64). Very low CoE from observational trials in which surfactant was administered at FiO2 >0.30-0.40 to infants on Continuous Positive Airway Pressure (CPAP) indicated that surfactant did not decrease the risk of IMV (OR 1.20, 95% CI 0.40 to 3.56). Very low to low CoE from the RCT and observational trials showed that surfactant use was associated with a significant decrease in risk of air leak, persistent pulmonary hypertension of the newborn (PPHN), duration of IMV, NRS and hospital stay. CONCLUSIONS Current evidence base on surfactant therapy in LPT and term infants with RDS indicates a potentially decreased risk of mortality, air leak, PPHN and duration of respiratory support. In view of the low to very low CoE and widely varying thresholds for deciding on surfactant replacement in the included studies, further trials are needed.
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, Delhi, India
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charles Christoph Roehr
- Nuffield Department of Population Health, Medical Sciences Division, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK .,Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK.,Faculty of Health Sciences, University of Bristol, Bristol, UK
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9
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Roberts CT, Klink S, Schmölzer GM, Blank DA, Badurdeen S, Crossley KJ, Rodgers K, Zahra V, Moxham A, Roehr CC, Kluckow M, Gill AW, Hooper SB, Polglase GR. Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs. Arch Dis Child Fetal Neonatal Ed 2022; 107:311-316. [PMID: 34462318 DOI: 10.1136/archdischild-2021-322638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Intraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous epinephrine administration during resuscitation of severely asphyxiated lambs at birth. METHODS Near-term lambs (139 days' gestation) were instrumented antenatally for measurement of carotid and pulmonary blood flow and systemic blood pressure. Intrapartum asphyxia was induced by umbilical cord clamping until asystole. Resuscitation commenced with positive pressure ventilation followed by chest compressions and the lambs received either intraosseous or central intravenous epinephrine (10 μg/kg); epinephrine administration was repeated every 3 min until return of spontaneous circulation (ROSC). The lambs were maintained for 30 min after ROSC. Plasma epinephrine levels were measured before cord clamping, at end asphyxia, and at 3 and 15 min post-ROSC. RESULTS ROSC was successful in 7 of 9 intraosseous epinephrine lambs and in 10 of 12 intravenous epinephrine lambs. The time and number of epinephrine doses required to achieve ROSC were similar between the groups, as were the achieved plasma epinephrine levels. Lambs in both groups displayed a similar marked overshoot in systemic blood pressure and carotid blood flow after ROSC. Blood gas parameters improved more quickly in the intraosseous lambs in the first 3 min, but were otherwise similar over the 30 min after ROSC. CONCLUSIONS Intraosseous epinephrine administration results in similar outcomes to intravenous epinephrine during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for epinephrine administration in current guidelines.
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Affiliation(s)
- Calum T Roberts
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia .,Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Monash Newborn, Monash Health, Clayton, Victoria, Australia
| | - Sarah Klink
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Douglas A Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Monash Newborn, Monash Health, Clayton, Victoria, Australia
| | - Shiraz Badurdeen
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Kelly J Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Karyn Rodgers
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Valerie Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Alison Moxham
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.,Newborn Care, Division of Women and Children, University of Bristol, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Newborn Care, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Martin Kluckow
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrew William Gill
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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10
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O'Shea JE, Scrivens A, Edwards G, Roehr CC. Safe emergency neonatal airway management: current challenges and potential approaches. Arch Dis Child Fetal Neonatal Ed 2022; 107:236-241. [PMID: 33883207 DOI: 10.1136/archdischild-2020-319398] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/21/2021] [Accepted: 03/30/2021] [Indexed: 11/03/2022]
Abstract
This review examines the airway adjuncts currently used to acutely manage the neonatal airway. It describes the challenges encountered with facemask ventilation and intubation. Evidence is presented on how to optimise intubation safety and success rates with the use of videolaryngoscopy and attention to the intubation environment. The supraglottic airway (laryngeal mask airway) is emerging as a promising neonatal airway adjunct. It can be used effectively with little training to provide a viable alternative to facemask ventilation and intubation in neonatal resuscitation and be used as an alternative conduit for the administration of surfactant.
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Affiliation(s)
- Joyce E O'Shea
- Neonatology, Royal Hospital for Children, Glasgow, UK joyce.o'.,Neonatal Transport, Scotstar, Glasgow, UK
| | - Alexandra Scrivens
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gemma Edwards
- Neonatology, Royal Hospital for Children, Glasgow, UK
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford, UK.,Department of Population Health, National Perinatal Epidemiology Unit Clinical Trials Unit, Oxford, UK
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11
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Mildenberger E, Zemlin M, Roehr CC, Orzalesi MM, Lister G. In memory of Prof. Dr. Hans Versmold. Pediatr Res 2022; 92:1195-1196. [PMID: 35177814 DOI: 10.1038/s41390-022-01998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Eva Mildenberger
- Neonatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Zemlin
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Marcello M Orzalesi
- Maruzza Lefebvre D'Ovidio Foundation Onlus, Via del Nuoto 11, 00135, Rome, Italy
| | - George Lister
- Department of Pediatrics, Yale University, PO Box 208064, New Haven, CT, 06520, USA.
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12
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Ramaswamy VV, Abiramalatha T, Roehr CC. Addressing the Lack of Clarity About Administering Surfactant in Preterm Infants With Respiratory Distress Syndrome Treated With Noninvasive Respiratory Support. JAMA Pediatr 2022; 176:121-122. [PMID: 34694350 DOI: 10.1001/jamapediatrics.2021.4098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.,University of Bristol, Women's and Children Division, Bristol, United Kingdom
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13
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Sun S, Zivanovic S, Earnest A, Roehr CC, Tan K. Respiratory management and bronchopulmonary dysplasia in extremely preterm infants: a comparison of practice between centres in Oxford and Melbourne. J Perinatol 2022; 42:53-57. [PMID: 34987168 DOI: 10.1038/s41372-021-01274-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Considerable variation in the care of extremely low gestational age infants (ELGAN) contributes to the variation in incidence of bronchopulmonary dysplasia (BPD). We compared management and outcomes of two neonatal centres with different respiratory support strategies. STUDY DESIGN Retrospective cohort study of infants <28 weeks gestational age treated at two units in Australia and the UK between 2015 and 2017. RESULT Of 492 infants, the overall incidence of BPD for extremely preterm infants was 62.20% and was similar across both sites (64.84% at Monash vs. 60.65% at Oxford). Independent predictors for the development of BPD or mortality included the days on mechanical ventilation (MV, adjusted OR 1.13, 95% Cl 1.07-1.19) and use of inhaled nitric oxide (adjusted OR 13.42, 95% Cl 1.75-103.28). CONCLUSION Primary choice of non-invasive respiratory support had no significant impact on BPD development. Duration of MV and using nitric oxide were independent predictors for death or BPD.
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Affiliation(s)
- Sunjuri Sun
- Department of Paediatrics, School of Clinical Sciences (SCS) at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Sanja Zivanovic
- Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK.,Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK. .,Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Kenneth Tan
- Department of Paediatrics, School of Clinical Sciences (SCS) at Monash Health, Monash University, Melbourne, VIC, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
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14
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Shaik NB, Pullattayil S AK, Cavallin F, Roehr CC, Trevisanuto D. Delivery room CPAP in improving outcomes of preterm neonates in low-and middle-income countries: A systematic review and network meta-analysis. Resuscitation 2021; 170:250-263. [PMID: 34757058 DOI: 10.1016/j.resuscitation.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To study the impact of delivery room continuous positive airway pressure (DRCPAP) on outcomes of preterm neonates in low- and middle- income countries (LMICs) by comparing with interventions: oxygen supplementation, late DRCPAP, DRCPAP with sustained inflation, DRCPAP with surfactant and invasive mechanical ventilation (IMV). METHODS Medline, Embase, CENTRAL, WOS and CINAHL searched. Observational studies and randomized controlled trials (RCTs) were included. Pair-wise meta-analysis and Bayesian network meta-analysis (NMA) were utilized. Primary outcome was receipt of IMV. RESULTS Data from 11 of the 18 included studies (4 observational studies, 7 RCTs) enrolling 4210 preterm infants was synthesized. Moderate certainty of evidence (CoE) from NMA of RCTs comparing DRCPAP with surfactant administration versus DRCPAP alone suggested no decrease in subsequent receipt of IMV [Risk ratio (RR); 95% Credible Interval (CrI): 0.73; (0.34, 1.40)]. Very low CoE from observational studies comparing use of DRCPAP versus oxygen supplementation indicated a trend towards decreased IMV [RR; 95% Confidence Interval (CI): 0.75; (0.56-1.00)]. Although moderate CoE from NMA evaluating DRCPAP versus oxygen supplementation showed a trend towards decreased receipt of surfactant, it did not reach statistical significance [RR; 95% CrI: 0.69; (0.44, 1.06)]. Moderate CoE from NMA indicated that none of the interventions, when compared with use of supplemental oxygen alone or with each other decreased mortality or bronchopulmonary dysplasia. LIMITATIONS CoE was very low for primary outcome. CONCLUSIONS Present evidence is not sufficient for use of DRCPAP, but also did not show harm. Since it seems unlikely that there are marked variations in patient physiology to explain the difference in efficacy between high income countries and LMICs, we suggest future research evaluating other barriers in improving the effectiveness of DRCPAP in LMICs.
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | | | | | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, United Kingdom; Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom; University of Bristol, Women's and Children Division, Bristol, United Kingdom
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
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15
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Ramaswamy VV, Roehr CC. Is a New Era Coming for Bronchopulmonary Dysplasia Prevention With Corticosteroids?-Reply. JAMA Pediatr 2021; 175:1079-1080. [PMID: 34228118 DOI: 10.1001/jamapediatrics.2021.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Medical Sciences Division, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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16
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Shaik NB, Bandiya P, Nanda D, Pullattayil S. AK, Murki S, Roehr CC. ELBW and ELGAN outcomes in developing nations-Systematic review and meta-analysis. PLoS One 2021; 16:e0255352. [PMID: 34352883 PMCID: PMC8342042 DOI: 10.1371/journal.pone.0255352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Context Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied. Objectives Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs. Data sources CENTRAL, EMBASE, MEDLINE and Web of Science. Study selection Prospective and retrospective observational studies were included. Data extraction and synthesis Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE). Results 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE–low) for ELBW and 39% (34% - 44%) (CoE—moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000–2009 and 2010–2020. Except for necrotising enterocolitis [ELBW and ELGANs—8% (7% - 10%)] and periventricular leukomalacia [ELBW—7% (4% - 11%); ELGANs—6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs. Limitations CoE was very low to low for all secondary outcomes. Conclusions Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies. Trial registration PROSPERO (CRD42020222873).
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
- * E-mail:
| | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | - Prathik Bandiya
- Department of Neonatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Debasish Nanda
- Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India
| | | | - Srinivas Murki
- Department of Neonatology, Paramitha Women and Children’s Hospital, Hyderabad, India
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, United Kingdom
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom
- University of Bristol, Women’s and Children Division, Bristol, United Kingdom
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17
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Ramaswamy VV, Bandyopadhyay T, Ahmed J, Bandiya P, Zivanovic S, Roehr CC. Enteral Feeding Strategies in Preterm Neonates ≤32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis. Ann Nutr Metab 2021; 77:204-220. [PMID: 34247152 DOI: 10.1159/000516640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Critical aspects of time of feed initiation, advancement, and volume of feed increment in preterm neonates remain largely unanswered. METHODS Medline , Embase, CENTRAL and CINAHL were searched from inception until 25th September 2020. Network meta-analysis with the Bayesian approach was used. Randomized controlled trials (RCTs) evaluating preterm neonates ≤32 weeks were included. Feeding regimens were divided based on the following categories: initiation day: early (<72 h), moderately early (72 h-7 days), and late (>7 days); advancement day: early (<72 h), moderately early (72 h-7 days), and late (>7 days); increment volume: small volume (SV) (<20 mL/kg/day), moderate volume (MoV) (20-< 30 mL/kg/day), and large volume (≥30 mL/kg/day); and full enteral feeding from the first day. Sixteen regimens were evaluated. Combined outcome of necrotizing enterocolitis (NEC) stage ≥ II or mortality before discharge was the primary outcome. RESULTS A total of 39 studies enrolled around 6,982 neonates. Early initiation (EI) with moderately early or late advancement using MoV increment enteral feeding regimens appeared to be most efficacious in decreasing the risk of NEC or mortality when compared to EI and early advancement with SV increment (risk ratio [95% credible interval]: 0.39 [0.12, 0.95]; 0.34 [0.10, 0.86]) (GRADE-very low). CONCLUSIONS Early initiated, moderately early, or late advanced with MoV increment feeding regimens might be most appropriate in decreasing the risk of NEC stage ≥II or mortality. In view of the certainty of evidence being very low, adequately powered RCTs evaluating these 2 strategies are warranted.
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Affiliation(s)
- Viraraghavan Vadakkencherry Ramaswamy
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr. Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Javed Ahmed
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Prathik Bandiya
- Department of Neonatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Sanja Zivanovic
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Medical Sciences Division, Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.,University of Bristol, Women and Children's Health Research Unit, The Children's Southmead Hospital, Bristol, United Kingdom
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18
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Trevisanuto D, Roehr CC, Davis PG, Schmölzer GM, Wyckoff MH, Liley HG, Rabi Y, Weiner GM. Devices for Administering Ventilation at Birth: A Systematic Review. Pediatrics 2021; 148:peds.2021-050174. [PMID: 34135096 DOI: 10.1542/peds.2021-050174] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Positive pressure ventilation (PPV) is the most important intervention during neonatal resuscitation. OBJECTIVE To compare T-piece resuscitators (TPRs), self-inflating bags (SIBs), and flow-inflating bags for newborns receiving PPV during delivery room resuscitation. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and trial registries (inception to December 2020). STUDY SELECTION Randomized, quasi-randomized, interrupted time series, controlled before-and-after, and cohort studies were included without language restrictions. DATA EXTRACTION Two researchers independently extracted data, assessed the risk of bias, and evaluated the certainty of evidence. The primary outcome was in-hospital mortality. When appropriate, data were pooled by using fixed-effect models. RESULTS Meta-analysis of 4 randomized controlled trials (1247 patients) revealed no significant difference between TPR and SIB for in-hospital mortality (risk ratio 0.74; 95% confidence interval [CI] 0.40 to 1.34). Resuscitation with a TPR resulted in a shorter duration of PPV (mean difference -19.8 seconds; 95% CI -27.7 to -12.0 seconds) and lower risk of bronchopulmonary dysplasia (risk ratio 0.64; 95% CI 0.43 to 0.95; number needed to treat 32). No differences in clinically relevant outcomes were found in 2 randomized controlled trials used to compare SIBs with and without positive end-expiratory pressure valves. No studies used to evaluate flow-inflating bags were found. LIMITATIONS Certainty of evidence was very low or low for most outcomes. CONCLUSIONS Resuscitation with a TPR compared with an SIB reduces the duration of PPV and risk of bronchopulmonary dysplasia. A strong recommendation cannot be made because of the low certainty of evidence. There is insufficient evidence to determine the effectiveness of positive end-expiratory pressure valves when used with SIBs.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, National Health Service Foundation Trust, Oxford, United Kingdom.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georg M Schmölzer
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Myra Helen Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Helen G Liley
- Mater Research Institute and Mater Clinical Unit, School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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19
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Ramaswamy VV, Oommen VI, Gupta A, Weerapperuma N, Zivanovic S, Roehr CC. Care practices and outcomes of extremely preterm neonates born at 22-24 weeks -A single centre experience. J Neonatal Perinatal Med 2021; 14:575-582. [PMID: 34120919 DOI: 10.3233/npm-200670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Wide variation in the care practices and survival rates of neonates born at peri-viable gestational ages of 22 +0 -24 +6 weeks exists. This study elucidates the postnatal risk factors for morbidity/mortality, contrasts the care practices and short-term outcomes of this vulnerable group of preterm neonates from a single center with others. METHODS Retrospective study of neonates born at 22 +0 -24 +6 weeks in a level 3 neonatal intensive care unit in UK, over a period of 4 years (2016-2019). RESULTS 94 neonates given active care studied. Survival until discharge was 51.1%(22-23 wks -44%, 24 wks -59.1%) and survival with no major brain injury (MBI) [grade III/IV IVH, cystic periventricular leukomalacia] was 38.3%(22-23 wks -32%, 24 wks -45.4%). Of those who survived until discharge, 75%had no MBI (22-23 wks -72.7%, 24 wks -76.9%). Neonates requiring significant respiratory support within first 72 hours as well as needing rescue high frequency ventilation had significantly high risk of mortality or MBI [aOR -7.17 (2.24-25.79), p = 0.00; 4.76 (1.43-20.00), p = 0.01]. CONCLUSIONS Survival rate differed from other centres. MBI was low amongst survivors. Severe respiratory disease in the initial days was associated with a higher risk of death or MBI.
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Affiliation(s)
- V V Ramaswamy
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - V I Oommen
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - A Gupta
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - N Weerapperuma
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - S Zivanovic
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C C Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Medical Sciences, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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20
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Oommen VI, Ramaswamy VV, Szyld E, Roehr CC. Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:324-326. [PMID: 32963086 DOI: 10.1136/archdischild-2020-319771] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND We investigated the impact of policy change in delivery room resuscitation from routine endotracheal (ET) suctioning of non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) to immediate non-invasive respiratory support. DESIGN Single-centre cohort study. Prospective group (October 2016-September 2017)-non-vigorous neonates born through MSAF managed according to the current (2015) guidance of commencing respiratory support without prior suctioning. Retrospective group (August 2015-July 2016)-non-vigorous neonates born through MSAF who underwent routine ET suctioning. RESULTS 1138 neonates born through MSAF were analysed. No differences in the incidence of meconium aspiration syndrome (MAS), requirement of mechanical ventilation, inhaled nitric oxide or surfactant therapy were found between groups. Less neonatal intensive care unit (NICU) admissions were necessary in the prospective cohort compared with the retrospective group (19.1% vs 55.6%, respectively; p<0.05). CONCLUSION The policy change towards not routinely suctioning non-vigorous neonates born through MSAF at birth was not associated with an increase in the local incidence of MAS and was associated with fewer NICU admissions.
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Affiliation(s)
- Vinod Idicula Oommen
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | | | - Edgardo Szyld
- Division of Newborn Medicine, Department of Paediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK .,National Perinatal Epidemiology Unit, University of Oxford Nuffield Department of Population Health, Oxford, Oxfordshire, UK
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21
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Belkhatir K, Scrivens A, O'Shea JE, Roehr CC. Experience and training in endotracheal intubation and laryngeal mask airway use in neonates: results of a national survey. Arch Dis Child Fetal Neonatal Ed 2021; 106:223-224. [PMID: 32571833 DOI: 10.1136/archdischild-2020-319118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Joyce E O'Shea
- Neonatology, Royal Hospital for Children Glasgow, Glasgow, UK joyce.o'
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford, Oxfordshire, UK.,Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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22
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Roehr CC, Davis PG, Weiner GM, Jonathan Wyllie J, Wyckoff MH, Trevisanuto D. T-piece resuscitator or self-inflating bag during neonatal resuscitation: a scoping review. Pediatr Res 2021; 89:760-766. [PMID: 32526766 DOI: 10.1038/s41390-020-1005-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND To identify the evidence for administering positive pressure ventilation (PPV) to infants at birth by either T-piece resuscitator (TPR) or self-inflating bag (SIB), and to determine whether a full systematic review (SR) is warranted. METHODS Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews, eligible studies included peer-reviewed human studies, prospectively or retrospectively comparing a TPR vs. SIB for administering PPV at birth. Databases searched were OVID Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials. Review Manager software was used for the data analysis. RESULTS Following electronic literature search and review, data from four eligible studies (3 RCT and 1 observational study), enrolling a total of 2889 patients, were included. Studies differed regarding the investigated populations, reported outcomes and came from different geographical areas. In particular for preterm infants, use of TPR for providing PPV may improve survival, result in fewer intubations at birth and decrease the incidence of bronchopulmonary dysplasia. CONCLUSIONS This scoping review identified two new studies with substantive new evidence, pointing towards improved survival, decreased bronchopulmonary dysplasia and fewer intubations at birth, in particular among preterm infants treated with TPR. Full SR of the literature is advised. IMPACT This scoping review identified studies comparing TPR vs. SIB for respiratory support of newborn infants previously not included in the International Liaison Committee on Resuscitation (ILCOR) recommendations. Our review found substantive new evidence highlighting that device choice may impact the outcomes of compromised newborn infants'. This scoping review stipulates the need for full SR and updated meta-analysis of studies investigating supportive equipment for stabilizing infants at birth in order to inform ILCOR treatment recommendations.
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Affiliation(s)
- Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK. .,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Peter Graham Davis
- Department of Newborn Research, The Royal Women's Hospital, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
| | - Gary Marshall Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - J Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
| | - Myra Helen Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, University of Padova, Padova, Italy
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23
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Reynolds P, Bustani P, Darby C, Fernandez Alvarez JR, Fox G, Jones S, Robertson SJ, Vasu V, Roehr CC. Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline. Neonatology 2021; 118:586-592. [PMID: 34515188 DOI: 10.1159/000518396] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Less-invasive surfactant administration (LISA) is a method of surfactant delivery to preterm infants for treating respiratory distress syndrome (RDS), which can reduce the composite risk of death or bronchopulmonary dysplasia and the time on mechanical ventilation. METHODS A systematic literature search of studies published up to April 2021 on minimally invasive catheter surfactant delivery in preterm infants with RDS was conducted. Based on these studies, with parental feedback sought via an online questionnaire, 9 UK-based specialists in neonatal respiratory disease developed their consensus for implementing LISA. Recommendations were developed following a modified, iterative Delphi process using a questionnaire employing a 9-point Likert scale and an a priori level of agreement/disagreement. RESULTS Successful implementation of LISA can be achieved by training the multidisciplinary team and following locally agreed guidance. From the time of the decision to administer surfactant, LISA should take <30 min. The comfort of the baby and requirements to maintain non-invasive respiratory support are important. While many infants can be managed without requiring additional sedation/analgesia, fentanyl along with atropine may be considered. Parents should be provided with sufficient information about medication side effects and involved in treatment discussions. CONCLUSION LISA has the potential to improve outcomes for preterm infants with RDS and can be introduced as a safe and effective part of UK-based neonatal care with appropriate training.
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Affiliation(s)
- Peter Reynolds
- Neonatal Intensive Care Unit, St. Peter's Hospital, Ashford & St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
| | - Porus Bustani
- Children's and Adolescent Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Colm Darby
- Neonatal Unit, Craigavon Area Hospital, Portadown, United Kingdom
| | | | - Grenville Fox
- Evelina London Children's Hospital Neonatal Unit, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steve Jones
- Neonatology, Royal United Hospital, Bath, United Kingdom
| | - Sara Jane Robertson
- Neonatal Intensive Care Unit, St. Peter's Hospital, Ashford & St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
| | - Vimal Vasu
- Neonatal Medicine, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, United Kingdom
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Medical Sciences Division, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
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24
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Peterson J, den Boer MC, Roehr CC. To Sedate or Not to Sedate for Less Invasive Surfactant Administration: An Ethical Approach. Neonatology 2021; 118:639-646. [PMID: 34628413 DOI: 10.1159/000519283] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
Less invasive surfactant administration (LISA) is an effective, minimally invasive technique of administering surfactant to infants with respiratory distress syndrome. While termed less invasive, LISA still requires airway instrumentation with direct laryngoscopy, thus may be considered painful. However, the issue of whether or not to routinely sedate infants for LISA remains contentious, with significant variation in practice between centres. Proponents for giving pharmacological analgesia and/or sedation predominantly focus on patient comfort during the procedure. However, those who favour non-pharmacological measures of pain management focus on the potential for procedural success without the risk of adverse events, such as respiratory depression and potentially the need for escalation to intubation, which may occur with pharmacological agents. The neonatal population who may benefit from LISA is varied. Due to this variety in presentation type, gestational age, and unit experience, there is a need to provide an individualized, tailored approach to sedation and analgesia for these infants. Using a blanket approach to sedation will lead to infants being exposed to sedative medications on the assumption of potential distress, rather than in response to signs of actual distress. This places the infant at risk of the adverse reactions, potentially without them ever having needed the beneficial effect of the medications. This seems an unnecessary risk. This article explores the ethical arguments pertaining to analgesia and sedation during the LISA technique, concluding that a standardized approach to the usage of pharmacological sedation is undesirable. Moreover, we maintain that procedural analgesia and sedation should be based on individualized, infant-centred assessment, rather than on a rigid, standardized approach.
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Affiliation(s)
- Jennifer Peterson
- Neonatal Unit, St Mary's Maternity Hospital, Manchester Foundation Trust, Manchester, United Kingdom,
| | - Maria C den Boer
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Charles Christoph Roehr
- Neonatal Intensive Care Unit, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom.,Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom.,National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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25
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Ramaswamy VV, More K, Roehr CC, Bandiya P, Nangia S. Efficacy of noninvasive respiratory support modes for primary respiratory support in preterm neonates with respiratory distress syndrome: Systematic review and network meta-analysis. Pediatr Pulmonol 2020; 55:2940-2963. [PMID: 32762014 DOI: 10.1002/ppul.25011] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the efficacy of different noninvasive respiratory support (NRS) modes for primary respiratory support of preterm infants with respiratory distress syndrome (RDS). DESIGN Systematic review and network meta-analysis using the Bayesian random-effects approach. MEDLINE, EMBASE, and CENTRAL were searched. INTERVENTIONS High flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), bilevel CPAP (BiPAP), noninvasive positive pressure ventilation (NIPPV). MAIN OUTCOME MEASURES Requirement of invasive mechanical ventilation (MV), any treatment failure. RESULTS A total of 35 studies including 4078 neonates were included. NIPPV was more effective in decreasing the requirement of MV than CPAP (risk ratios [95% credible interval]: 0.60 [0.44, 0.77]) and HFNC [0.66 (0.43, 0.97)]. Surface under the cumulative ranking curve (SUCRA) for NIPPV, BiPAP, HFNC, and CPAP were 0.95, 0.59, 0.32, and 0.13. For the outcome of treatment failure, both NIPPV and BiPAP were more efficacious compared to CPAP and HFNC (0.56 [0.44, 0.71] {NIPPV vs CPAP}, 0.69 [0.51, 0.93] {BiPAP vs CPAP}, 0.42 [0.30, 0.63] {NIPPV vs HFNC}, 0.53 [0.35, 0.81] {BiPAP vs HFNC}). The SUCRA for NIPPV, BiPAP, CPAP, and HFNC were 0.96, 0.70, 0.32, and 0.01. NIPPV was associated with a reduced risk of air leak compared to BiPAP and CPAP (0.36 [0.16, 0.73]; 0.54 [0.30, 0.87], respectively). NIPPV resulted in lesser incidence of bronchopulmonary dysplasia or mortality when compared to CPAP (0.74 [0.52, 0.98]). Nasal injury was lesser with HFNC compared to CPAP (0.15 [0.01, 0.60]). CONCLUSIONS Most effective primary mode of NRS in preterm neonates with RDS was NIPPV.
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Affiliation(s)
| | - Kiran More
- Division of Neonatology, Sidra Medical and Research Center, Doha, Qatar
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,National Perinatal Epidemiology Unit, Medical Sciences Division, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Prathik Bandiya
- Department of Neonatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
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26
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Bugiera M, Szczapa T, Sowińska A, Roehr CC, Szymankiewicz-Bręborowicz M. Cerebral oxygenation and circulatory parameters during pressure-controlled vs volume-targeted mechanical ventilation in extremely preterm infants. ADV CLIN EXP MED 2020; 29:1325-1329. [PMID: 33269819 DOI: 10.17219/acem/128198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is the most common cause of respiratory failure of infants born prematurely with very low birth weight (VLBW). Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant. OBJECTIVES To assess the effect of volume-targeted compared to pressure-controlled mechanical ventilation (MV) on circulatory parameters and cerebral oxygenation StO2 in extremely preterm infants. MATERIAL AND METHODS This prospective, cross-over trial enrolled neonates born before 28 weeks of gestation. The patients were ventilated for 3 h in pressure-controlled assist-control (PC-AC) mode, followed by 3 h of volume-guarantee assist-control ventilation (VG-AC). Pulse oximetry (saturation (SpO2) and heart rate (HR)), near-infrared spectroscopy (NIRS), StO2, and electrical cardiometry (EC) were used in monitoring of the patients. RESULTS Twenty preterm infants with a mean gestational age of 26 weeks were studied. The patients' mean postnatal age was 7.7 days. The SpO2 values and HR were comparable during PC-AC and VG-AC. The mean values of peak inspiratory pressure (PIP), mean airway pressure (MAP) and expiratory tidal volume (VTE) were lower, while the respiratory rate (RR) was higher during PC-VG. There were no significant differences in the mean values of StO2, but based on a comparison of the standard deviations (SD) the StO2 variability was significantly lower during VG-AC. The circulatory parameters were comparable. CONCLUSIONS The StO2 is more stable during VG than PC ventilation. These findings support the use of VG mode in premature infants.
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Affiliation(s)
- Michalina Bugiera
- Department of Neonatology, Poznan University of Medical Sciences, Poland
| | - Tomasz Szczapa
- Department of Neonatology, Poznan University of Medical Sciences, Poland
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poland
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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27
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Hammer H, Weigel H, Proquitté H, Reichert J, Roehr CC, Rüdiger M. Roland R. Wauer (1942–2020): Neonatologe, Wissenschaftler, Lehrer und
Visionär. Z Geburtshilfe Neonatol 2020. [DOI: 10.1055/a-1242-6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Wir trauern um Professor Dr. med. Roland R. Wauer, langjähriger Direktor der
Klinik für Neonatologie, Campus Charité Mitte der
Universitätsmedizin Berlin, unseren Lehrer, Mentor und Freund.
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28
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Nolan JP, Monsieurs KG, Bossaert L, Böttiger BW, Greif R, Lott C, Madar J, Olasveengen TM, Roehr CC, Semeraro F, Soar J, Van de Voorde P, Zideman DA, Perkins GD. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation 2020; 153:45-55. [PMID: 32525022 PMCID: PMC7276132 DOI: 10.1016/j.resuscitation.2020.06.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person’s presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.
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Affiliation(s)
- J P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG UK.
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - L Bossaert
- University of Antwerp, Antwerp, Belgium; European Resuscitation Council (ERC), Niel, Belgium
| | - B W Böttiger
- Anaesthesiology and Intensive Care Medicine, Director of Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - R Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, 3010 Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - C Lott
- Department of Anaesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - J Madar
- University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH UK; Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - T M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - C C Roehr
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), Medical Sciences Division, University of Oxford. Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF UK
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - J Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - P Van de Voorde
- Emergency Medicine - Clinical Head, Ghent University Hospital and University of Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium; Emergency Dispatch Centre, 112 West/East-Flanders, Federal Dept Health, Belgium
| | - D A Zideman
- Anaesthesia and Pre-Hospital Emergency Medicine, Thames Valley Air Ambulance, Stokenchurch House, Stokenchurch, HP14 3SX, UK
| | - G D Perkins
- Critical Care Medicine, University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, CV4 7AL, UK
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29
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Bendor-Samuel OM, Zivanovic S, Odd D, Roehr CC. A Comparison of UK Preterm Anthropometric Charts and INTERGROWTH-21st: Is It Time to Change Growth Charts? Neonatology 2020; 117:300-307. [PMID: 32396901 DOI: 10.1159/000507024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current practice in the UK is to plot premature infant anthropometric measurements on Neonatal and Infant Close Monitoring (NICM) reference charts. These charts have several known limitations. The INTERGROWTH-21st Project has recently produced international ante- and postnatal growth standards. Exact knowledge of growth centiles allows clinicians to accurately assess infant nutritional requirements. OBJECTIVE To compare target centile measurements between INTERGROWTH-21st and UK NICM growth charts for premature infants. METHOD Anthropometric measurements (weight and head circumference) of a convenience sample of neonates born between 24 and 32 weeks of gestation were analysed retrospectively. Measurements were collected across three time points and plotted on both the NICM and INTERGROWTH-21st growth charts. The respective centiles were compared and analysed by paired-sample t test, Wilcoxon rank test analysis, and multilevel mixed-effect linear regression models. RESULTS Centiles for weight and head circumference measurements of 96 infants plotted on INTERGROWTH-21st charts were significantly greater than their corresponding UK charts at all three time points. For weight, the average difference between the two charts varied from 9.1 to 16.4 centiles. The difference between the two charts was greater for female than male infants by up to 6.9 centiles (95% CI 10.1-3.8). CONCLUSION Existing UK NICM reference charts are significantly different to the growth standards of INTERGROWTH-21st. The choice of which growth chart to adopt in the UK could have important consequences on premature infants' future adult health and therefore requires further prospective observational studies with larger data sets including length measurements and more comprehensive population characteristics.
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Affiliation(s)
- Owen Martyn Bendor-Samuel
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK,
| | - Sanja Zivanovic
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - David Odd
- Neonatal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
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30
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Trevisanuto D, Moschino L, Doglioni N, Roehr CC, Gervasi MT, Baraldi E. Neonatal Resuscitation Where the Mother Has a Suspected or Confirmed Novel Coronavirus (SARS-CoV-2) Infection: Suggestion for a Pragmatic Action Plan. Neonatology 2020; 117:133-140. [PMID: 32335559 PMCID: PMC7251577 DOI: 10.1159/000507935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the novel SARS-CoV-2 virus, is rapidly spreading across the world. As the number of infections increases, those of infected pregnant women and children will rise as well. Controversy exists whether COVID-19 can be transmitted in utero and lead to disease in the newborn. As this chance cannot be ruled out, strict instructions for the management of mothers and newborn infants are mandatory. This perspective aims to be a practical support tool for the planning of delivery and neonatal resuscitation of infants born by mothers with suspected or confirmed COVID-19 infection.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy,
| | - Laura Moschino
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
| | - Nicoletta Doglioni
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Teresa Gervasi
- Obstetrics and Gynecology Unit, Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eugenio Baraldi
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
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31
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Moschino L, Zivanovic S, Hartley C, Trevisanuto D, Baraldi E, Roehr CC. Caffeine in preterm infants: where are we in 2020? ERJ Open Res 2020; 6:00330-2019. [PMID: 32154294 PMCID: PMC7049734 DOI: 10.1183/23120541.00330-2019] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/16/2022] Open
Abstract
The incidence of preterm birth is increasing, leading to a growing population with potential long-term pulmonary complications. Apnoea of prematurity (AOP) is one of the major challenges when treating preterm infants; it can lead to respiratory failure and the need for mechanical ventilation. Ventilating preterm infants can be associated with severe negative pulmonary and extrapulmonary outcomes, such as bronchopulmonary dysplasia (BPD), severe neurological impairment and death. Therefore, international guidelines favour non-invasive respiratory support. Strategies to improve the success rate of non-invasive ventilation in preterm infants include pharmacological treatment of AOP. Among the different pharmacological options, caffeine citrate is the current drug of choice. Caffeine is effective in reducing AOP and mechanical ventilation and enhances extubation success; it decreases the risk of BPD; and is associated with improved cognitive outcome at 2 years of age, and pulmonary function up to 11 years of age. The commonly prescribed dose (20 mg·kg−1 loading dose, 5–10 mg·kg−1 per day maintenance dose) is considered safe and effective. However, to date there is no commonly agreed standardised protocol on the optimal dosing and timing of caffeine therapy. Furthermore, despite the wide pharmacological safety profile of caffeine, the role of therapeutic drug monitoring in caffeine-treated preterm infants is still debated. This state-of-the-art review summarises the current knowledge of caffeine therapy in preterm infants and highlights some of the unresolved questions of AOP. We speculate that with increased understanding of caffeine and its metabolism, a more refined respiratory management of preterm infants is feasible, leading to an overall improvement in patient outcome. Caffeine is the current drug of choice to prevent and treat apnoea of prematurity. There is no agreed protocol on the optimal timing and dosage of caffeine therapy for preterm babies. Data on caffeine metabolism may optimise individualised therapy.http://bit.ly/2LMuJPY
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Affiliation(s)
- Laura Moschino
- Dept of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sanja Zivanovic
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Dept of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Eugenio Baraldi
- Dept of Women's and Children's Health, University of Padua, Padua, Italy
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Dept of Paediatrics, University of Oxford, Oxford, UK
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Reynolds PR, Miller TL, Volakis LI, Holland N, Dungan GC, Roehr CC, Ives K. Randomised cross-over study of automated oxygen control for preterm infants receiving nasal high flow. Arch Dis Child Fetal Neonatal Ed 2019; 104:F366-F371. [PMID: 30464005 DOI: 10.1136/archdischild-2018-315342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/27/2018] [Accepted: 10/26/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate a prototype automated controller (IntellO2) of the inspired fraction of oxygen (FiO2) in maintaining a target range of oxygen saturation (SpO2) in preterm babies receiving nasal high flow (HF) via the Vapotherm Precision Flow. DESIGN Prospective two-centre order-randomised cross-over study. SETTING Neonatal intensive care units. PATIENTS Preterm infants receiving HF with FiO2 ≥25%. INTERVENTION Automated versus manual control of FiO2 to maintain a target SpO2 range of 90%-95% (or 90%-100% if FiO2=21%). MAIN OUTCOME MEASURES The primary outcome measure was per cent of time spent within target SpO2 range. Secondary outcomes included the overall proportion and durations of SpO2 within specified hyperoxic and hypoxic ranges and the number of in-range episodes per hour. RESULTS Data were analysed from 30 preterm infants with median (IQR) gestation at birth of 26 (24-27) weeks, study age of 29 (18-53) days and study weight 1080 (959-1443) g. The target SpO2 range was achieved 80% of the time on automated (IntellO2) control (IQR 70%-87%) compared with 49% under manual control (IQR 40%-57%; p<0.0001). There were fewer episodes of SpO2 below 80% lasting at least 60 s under automated control (0 (IQR 0-1.25)) compared with manual control (5 (IQR 2.75-14)). There were no differences in the number of episodes per hour of SpO2 above 98% (4.5 (IQR 1.8-8.5) vs 5.5 (IQR 1.9-14); p=0.572) between the study arms. CONCLUSIONS The IntellO2 automated oxygen controller maintained patients in the target SpO2 range significantly better than manual adjustments in preterm babies receiving HF. TRIAL REGISTRATION NUMBER NCT02074774.
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Affiliation(s)
- Peter R Reynolds
- Neonatal Intensive Care Unit, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK.,School of Biological Sciences, Royal Holloway University of London, Egham, UK
| | - Thomas L Miller
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.,Vixiar Medical, Baltimore, Massachusetts, USA
| | | | - Nicky Holland
- Neonatal Intensive Care Unit, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK
| | - George C Dungan
- Vapotherm, Exeter, New Hampshire, USA.,Canisius College, Buffalo, New York, USA
| | - Charles Christoph Roehr
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Medical Sciences Division, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Kevin Ives
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Affiliation(s)
- Alexandra Scrivens
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Bresesti I, Zivanovic S, Ives KN, Lista G, Roehr CC. National surveys of UK and Italian neonatal units highlighted significant differences in the use of non-invasive respiratory support. Acta Paediatr 2019; 108:865-869. [PMID: 30307647 DOI: 10.1111/apa.14611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/11/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
AIM This study compared how non-invasive respiratory support (NRS) was provided in neonatal units in Italy and the UK. METHODS An NRS questionnaire was sent to tertiary neonatal centres, identified by national societies, from November 2015 to May 2016. RESULTS Responses were received from 49/57 (86%) UK units and 103/115 (90%) Italian units. NRS was started in the delivery room by 61% of UK units and 85% of Italian units. In neonatal intensive care units, 33% of UK units used nasal high-flow therapy (HFT) as primary support, compared to 3% in Italy. Nasal continuous positive airway pressure (CPAP) was used in 57% of UK units and 90% of Italian units. The commonest starting flow rate on nasal HFT for term and preterm infants was 6 L/min in the UK, while Italian units mainly used this flow for term infants. In the UK, 67% of units decreased nasal HFT by 1 L/min per day. In Italy, infants on nasal CPAP were weaned by 1 cm H2 O per day in 39% of units. CONCLUSION The way that NRS was managed for very preterm infants differed between the UK and Italy, reflecting a lack of evidence on optimal NRS and the use of local protocols.
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Affiliation(s)
- Ilia Bresesti
- Division of Neonatology “V. Buzzi” Children's Hospital ASST‐FBF‐Sacco Milan Italy
- Newborn Services John Radcliffe Hospital Oxford UK
| | - Sanja Zivanovic
- Newborn Services John Radcliffe Hospital Oxford UK
- Medical Sciences Division Department of Paediatrics University of Oxford Oxford UK
| | | | - Gianluca Lista
- Division of Neonatology “V. Buzzi” Children's Hospital ASST‐FBF‐Sacco Milan Italy
| | - Charles Christoph Roehr
- Newborn Services John Radcliffe Hospital Oxford UK
- Medical Sciences Division Department of Paediatrics University of Oxford Oxford UK
- Abteilung für Neonatologie Charité Universitätsmedizin Berlin Berlin Germany
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Mactier H, Jackson A, Davis J, Menon G, Morley CJ, Roehr CC, Tinnion RJ. Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey. Anaesthesia 2019; 74:116-117. [PMID: 30511753 DOI: 10.1111/anae.14526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- H Mactier
- Princess Royal Maternity, Glasgow, UK
| | - A Jackson
- Princess Royal Maternity, Glasgow, UK
| | - J Davis
- University of Western Australia, Crawley, WA, Australia
| | - G Menon
- Simpson Centre for Reproductive Health, Edinburgh, UK
| | | | | | - R J Tinnion
- Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle, UK
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Welsford M, Nishiyama C, Shortt C, Weiner G, Roehr CC, Isayama T, Dawson JA, Wyckoff MH, Rabi Y. Initial Oxygen Use for Preterm Newborn Resuscitation: A Systematic Review With Meta-analysis. Pediatrics 2019; 143:peds.2018-1828. [PMID: 30578326 DOI: 10.1542/peds.2018-1828] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5839981895001PEDS-VA_2018-1828Video Abstract CONTEXT: The International Liaison Committee on Resuscitation prioritized to review the initial fraction of inspired oxygen (Fio2) during the resuscitation of preterm newborns. OBJECTIVES This systematic review and meta-analysis provides the scientific summary of initial Fio2 in preterm newborns (<35 weeks' gestation) who receive respiratory support at birth. DATA SOURCES Medline, Embase, Evidence-Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. STUDY SELECTION Studies were selected by pairs of independent reviewers in 2 stages with a Cohen's κ of 0.8 and 1.0. DATA EXTRACTION Pairs of independent reviewers extracted data, appraised the risk of bias (RoB), and assessed Grading of Recommendations Assessment, Development and Evaluation certainty. RESULTS Ten randomized controlled studies and 4 cohort studies included 5697 patients. There are no statistically significant benefits of or harms from starting with lower compared with higher Fio2 in short-term mortality (n = 968; risk ratio = 0.83 [95% confidence interval 0.50 to 1.37]), long-term mortality, neurodevelopmental impairment, or other key preterm morbidities. A sensitivity analysis in which 1 study with a high RoB was excluded failed to reveal a reduction in mortality with initial low Fio2 (n = 681; risk ratio = 0.63 [95% confidence interval 0.38 to 1.03]). LIMITATIONS The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low for all outcomes due to RoB, inconsistency, and imprecision. CONCLUSIONS The ideal initial Fio2 for preterm newborns is still unknown, although the majority of newborns ≤32 weeks' gestation will require oxygen supplementation.
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Affiliation(s)
- Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; .,Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Human Health Science, Kyoto University, Kyoto, Japan
| | - Colleen Shortt
- Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gary Weiner
- Department of Pediatrics and Communicable Diseases, University of Michigan and Charles Stewart Mott Children's Hospital, Ann Arbor, Michigan
| | - Charles Christoph Roehr
- Medical Sciences Division, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, National Health Service Foundation Trust, Oxford, United Kingdom
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Jennifer Anne Dawson
- Neonatal Services, The Royal Women's Hospital and The University of Melbourne, Melbourne, Australia
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Vento M, Bohlin K, Herting E, Roehr CC, Dargaville PA. Surfactant Administration via Thin Catheter: A Practical Guide. Neonatology 2019; 116:211-226. [PMID: 31461712 DOI: 10.1159/000502610] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022]
Abstract
Exogenous surfactant replacement is the most effective evidence-based therapy for respiratory distress syndrome in preterm infants. The mode of administration has evolved in the last decade towards less invasive techniques that aim to effectively provide an adequate dose of surfactant, while allowing spontaneous respiration to continue, and with the support of continuous positive airway pressure. Surfactant delivery via aerosolisation, pharyngeal instillation, and laryngeal mask are being actively pursued in research, but have not yet been adopted to any significant degree in clinical practice. Surfactant administration via thin catheter, on the other hand, is becoming more widely used in neonatal intensive care units worldwide and is now an acknowledged alternative to the standard mode of surfactant delivery. Different devices, including nasogastric tubes, vascular catheters, and purpose-built surfactant instillation catheters are used. We present here a contemporary review of surfactant administration via thin catheter, in a practical guide format that reflects the individual and collective scientific opinions of the clinicians who participated in formulating the guide.
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Affiliation(s)
- Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain, .,Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain,
| | - Kajsa Bohlin
- Department of Neonatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Egbert Herting
- Department of Paediatrics, University of Luebeck, Luebeck, Germany
| | - Charles Christoph Roehr
- Newborn Services, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Medical Sciences Division, University of Oxford, Department of Paediatrics, Oxford, United Kingdom
| | - Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Welsford M, Nishiyama C, Shortt C, Isayama T, Dawson JA, Weiner G, Roehr CC, Wyckoff MH, Rabi Y. Room Air for Initiating Term Newborn Resuscitation: A Systematic Review With Meta-analysis. Pediatrics 2019; 143:peds.2018-1825. [PMID: 30578325 DOI: 10.1542/peds.2018-1825] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5839981898001PEDS-VA_2018-1825Video Abstract CONTEXT: The International Liaison Committee on Resuscitation prioritized to rigorously review the initial fraction of inspired oxygen (Fio2) during resuscitation of newborns. OBJECTIVE This systematic review and meta-analysis provides the scientific summary of initial Fio2 in term and late preterm newborns (≥35 weeks' gestation) who receive respiratory support at birth. DATA SOURCES Medline, Embase, Evidence Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. STUDY SELECTION Studies were selected by pairs of independent reviewers in 2 stages, with a Cohen's κ of 0.8 and 1.0. DATA EXTRACTION Pairs of independent reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. RESULTS Five randomized controlled trials (RCTs) and 5 quasi RCTs included 2164 patients. Room air (Fio2 0.21) was associated with a statistically significant benefit in short-term mortality compared with 100% oxygen (Fio2 1.0) (7 RCTs; n = 1469; risk ratio [RR] = 0.73; 95% confidence interval [CI]: 0.57 to 0.94). No significant differences were observed in neurodevelopmental impairment (2 RCTs; n = 360; RR = 1.41; 95% CI: 0.77 to 2.60) or hypoxic-ischemic encephalopathy (5 RCTs; n = 1315; RR = 0.89; 95% CI: 0.68 to 1.18). LIMITATIONS The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was low for short-term mortality and hypoxic-ischemic encephalopathy and very low for neurodevelopmental impairment. CONCLUSIONS Room air has a 27% relative reduction in short-term mortality compared with Fio2 1.0 for initiating neonatal resuscitation ≥35 weeks' gestation.
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Affiliation(s)
- Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; .,Hamilton Health Sciences, Centre for Paramedic Education and Research, Hamilton, Ontario, Canada
| | - Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Human Health Science, Kyoto University, Kyoto, Japan
| | - Colleen Shortt
- Hamilton Health Sciences, Centre for Paramedic Education and Research, Hamilton, Ontario, Canada
| | - Tetsuya Isayama
- Division of Neonatalogy, National Center for Child Health and Development, Tokyo, Japan
| | - Jennifer Anne Dawson
- Neonatal Services, The Royal Women's Hospital and University of Melbourne, Melbourne, Australia
| | - Gary Weiner
- Pediatrics and Communicable Diseases, University of Michigan and C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Charles Christoph Roehr
- Medical Sciences Division, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, National Health Service Foundation Trust, Oxford, United Kingdom
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Scrivens A, Reynolds PR, Emery FE, Roberts CT, Polglase GR, Hooper SB, Roehr CC. Use of Intraosseous Needles in Neonates: A Systematic Review. Neonatology 2019; 116:305-314. [PMID: 31658465 DOI: 10.1159/000502212] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of intraosseous (IO) access during resuscitation is widely accepted and promoted in paediatric medicine but features less prominently in neonatal training. Whilst umbilical venous catheterization (UVC) is a reliable method of delivering emergency drugs and fluids, it is not always achievable in a timely manner. IO access warrants exploration as an alternative. AIM Conduct a systematic review of existing literature to examine the evidence for efficacy and safety of IO devices in neonatal patients, from birth to discharge. METHOD A search of PubMed, Ovid, Medline, and Embase was carried out. Abstracts were screened for relevance to focus on neonatal-specific literature and studies which carried out separate analyses for neonates (infants <28 days of age or resident on a neonatal unit). RESULTS One case series and 12 case reports describe IO device insertion into 41 neonates, delivering a variety of drugs, including adrenaline (epinephrine) and volume resuscitation. Complications range from none to severe. Cadaveric studies show that despite a small margin for error, IO devices can be correctly sited in neonates. Simulation studies suggest that IO devices may be faster and easier to site than UVC, even in experienced hands. CONCLUSION IO access should be available on neonatal units and considered for early use in neonates where other access routes have failed. Appropriate training should be available to staff in addition to existing life support and UVC training. Further studies are required to assess the optimal device, position, and whether medication can be delivered IO as effectively as by UVC. If IO devices provide a faster method of delivering adrenaline effectively than UVC, this may lead to changes in neonatal resuscitation practice.
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Affiliation(s)
- Alexandra Scrivens
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom,
| | - Peter R Reynolds
- Neonatal Intensive Care Unit, St. Peter's Hospital, Ashford & St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
| | - Faith E Emery
- Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Calum T Roberts
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash University Hospital, Melbourne, Victoria, Australia
| | - Graeme R Polglase
- Hudson Institute, The Ritchie Centre, Melbourne, Victoria, Australia
| | - Stuart B Hooper
- Hudson Institute, The Ritchie Centre, Melbourne, Victoria, Australia
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.,University Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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40
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de Boode WP, Roehr CC, El-Khuffash A. Comprehensive state-of-the-art overview of neonatologist performed echocardiography: Steps towards standardization of the use of echocardiography in neonatal intensive care. Pediatr Res 2018; 84:472-473. [PMID: 30209387 DOI: 10.1038/s41390-018-0118-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/03/2018] [Indexed: 11/09/2022]
Affiliation(s)
- W P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - C C Roehr
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - A El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Department of Pediatrics, The Royal College of Surgeons, Dublin, Ireland
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41
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De Luca D, Tingay DG, van Kaam A, Brunow de Carvalho W, Valverde E, Roehr CC, Mosca F, Matassa PG, Danhaive O, Carnielli VP, Piastra M. Reply to Giesinger and McNamara: The Impact of Therapeutic Hypothermia on Pulmonary Hemodynamics of Meconium Aspiration Syndrome. Am J Respir Crit Care Med 2018; 198:287-288. [DOI: 10.1164/rccm.201803-0411le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniele De Luca
- University of Paris-SaclayParis, France
- Catholic University of the Sacred HeartRome, Italy
| | | | | | | | | | | | - Fabio Mosca
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilan, Italy
| | - Piero G. Matassa
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilan, Italy
| | - Olivier Danhaive
- University of California, San FranciscoSan Francisco, Californiaand
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Umphrey L, Blennow M, Breindahl M, Brown A, Roehr CC, Saugstad OD, Thio M, Trevisanuto D. Navigating a Mid-Level Gap in Neonatal Resuscitation. Neonatology 2018; 114:362-363. [PMID: 30134251 DOI: 10.1159/000491689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/01/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Lisa Umphrey
- Medical Department, Médecins Sans Frontières Operational Centre Paris, Paris,
| | - Mats Blennow
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Morten Breindahl
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Alexandra Brown
- Communications Department, Médecins Sans Frontières, Sydney, New South Wales, Australia
| | - Charles Christoph Roehr
- University of Oxford, Medical Sciences Division, Department of Paediatrics, Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Ola Didrik Saugstad
- Department of Pediatric Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
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Bansal SC, Caoci S, Dempsey E, Trevisanuto D, Roehr CC. The Laryngeal Mask Airway and Its Use in Neonatal Resuscitation: A Critical Review of Where We Are in 2017/2018. Neonatology 2018; 113:152-161. [PMID: 29232665 DOI: 10.1159/000481979] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/05/2017] [Indexed: 11/19/2022]
Abstract
Studies using videotape recordings and respiratory function monitoring have shown that both face mask (FM) application and endotracheal tube (ETT) placement represent a challenge for resuscitators. Hence, there is a strong need for devices that can largely be used independently of individual operator training levels, in order to ensure more reliable support in time-critical situations, such as neonatal resuscitation. The laryngeal mask airway device (LMA) has evolved as a potentially very valuable tool. We conducted a systematic review of studies evaluating the use of the LMA in neonatal resuscitation. An electronic literature search of large medical databases was performed to identify relevant publications on the use of an LMA during neonatal delivery room (DR) resuscitation. Following a rigorous systematic review, we identified a total of 7 randomized controlled trials with results indicating that initial respiratory management of newborn infants with an LMA is feasible for a defined subgroup of infants, but the evidence is still insufficient to recommend the LMA instead of FM ventilation in the DR. There is, in particular, a dearth of evidence of the use of LMA in neonates born before 34 weeks' gestational age or weighing <1,500 g at birth. There were no reports on significant complications following the use of LMA; however, evidence is still limited regarding short- and long-term outcomes. We conclude that the limited currently available evidence suggests that the use of the LMA is a feasible and safe alternative to mask ventilation of late preterm and term infants in the DR. The potential use of LMA resuscitation, in particular for low-gestation and low-birth-weight infants, needs further study.
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Affiliation(s)
- Satvik Chaitanya Bansal
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Headley Way, Oxford, UK
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44
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Umphrey L, Breindahl M, Brown A, Saugstad OD, Thio M, Trevisanuto D, Roehr CC, Blennow M. When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings. Neonatology 2018; 114:112-123. [PMID: 29804116 PMCID: PMC6159832 DOI: 10.1159/000486705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care. OBJECTIVES The aim is to close a significant gap in neonatal care provision in LRS by establishing consensus on a protocol that would guide MSF field teams in their practice of more advanced NR. METHODS An independent committee of international experts was formed and met regularly from June 2016 to agree on the content and design of a new NR algorithm. RESULTS Consensus was reached on a novel, mid-level NR algorithm in April 2017. The algorithm was accepted for use by MSF Operational Center Paris. CONCLUSION This paper contributes to the literature on decision-making in the development of cognitive aids. The authors also highlight how critical gaps in healthcare delivery in LRS can be addressed, even when there is limited evidence to guide the process.
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Affiliation(s)
- Lisa Umphrey
- Medical Department, Médecins Sans Frontières Operational Centre Paris, Paris, France
| | - Morten Breindahl
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Alexandra Brown
- Communications Department, Médecins Sans Frontières, Sydney, New South Wales, Australia
| | - Ola Didrik Saugstad
- Department of Pediatric Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Charles Christoph Roehr
- Department of Paediatrics, Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Mats Blennow
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Zivanovic S, Roehr CC. One Step Further Toward Defining the Optimal Respiratory Care Package for Neonates: Interventions to Successfully Extubate Preterm Infants. JAMA Pediatr 2017; 171:120-121. [PMID: 27918773 DOI: 10.1001/jamapediatrics.2016.3271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sanja Zivanovic
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom2Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom3Department of Neonatology, Charité University Medical Center Berlin, Berlin, Germany
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Sallmon H, Wauer RR, Roehr CC. Ingeborg Syllm-Rapoport (1912-2017): An Exemplary Life for Children and Paediatrics. Neonatology 2017; 112:384-386. [PMID: 28910809 DOI: 10.1159/000479860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/27/2017] [Indexed: 11/19/2022]
Abstract
Ingeborg Syllm-Rapoport, the first Chair in neonatology in Europe, passed away on March 23. Her biography illustrates how medical and scientific work has been influenced by social, ideological, and economic frames and boundaries in the 20th century. Regarded as a "Half-Jew" by the Nazi racist laws, she was denied her medical doctorate. She went to the USA, where she trained in paediatrics and met her husband, the biochemist Samuel Mitja Rapoport. During the "McCarthy Era" both were persecuted as communists. They returned to Europe and became two of the most influential figures at the Charité Hospital in East Berlin. She had to wait until 2015 to finally undergo the doctoral examination at the age of 102 years, making her the oldest person in history to receive a doctorate. We describe Syllm-Rapoport's life and the challenges she had to face living in several countries under different political systems in the 20th century.
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Affiliation(s)
- Hannes Sallmon
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
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Grigg J, Balfour-Lynn IM, Everard M, Hall G, Karadag B, Priftis K, Roehr CC, Rottier BL, Midulla F. Key paediatric messages from the 2016 European Respiratory Society International Congress. ERJ Open Res 2017; 3:00127-2016. [PMID: 28154820 PMCID: PMC5279069 DOI: 10.1183/23120541.00127-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022] Open
Abstract
In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
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Affiliation(s)
- Jonathan Grigg
- Centre for Paediatrics, The Blizard Institute, Queen Mary University of London, London, UK
| | - Ian M. Balfour-Lynn
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Mark Everard
- Princess Margaret Hospital for Children School of Paediatric and Child Health, University of Western Australia, Perth, Australia
| | | | - Bülent Karadag
- Dept of Paediatrics, Athens University Medical School, Attikon General Hospital, Athens, Greece
| | - Kostas Priftis
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Charles Christoph Roehr
- Dept of Paediatrics, Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bart L. Rottier
- Dept of Paediatric Respiratory Medicine, Groningen Research Institute of Asthma and COPD, University Medical Center Groningen, Beatrix Childrens’ Hospital, State University Groningen, Groningen, Netherlands
| | - Fabio Midulla
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
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Abstract
It is rare for newborn infants to require prolonged resuscitation at birth. While there are detailed national and international guidelines on when and how to provide resuscitation to newborns, there is little existing guidance on when newborn resuscitation should be stopped. In this paper we review current guidance surrounding adult, paediatric and neonatal resuscitation as well as recent evidence of outcome for newborn infants requiring prolonged resuscitation. We discuss the ethical principles that can potentially guide decisions surrounding resuscitation and post-resuscitation care. We also propose a structured approach to stopping resuscitation.
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Affiliation(s)
| | - C C Roehr
- John Radcliffe Hospital, Oxford, UK; Dept. Neonatology, Charité University Medical Center Berlin, Germany
| | - D J C Wilkinson
- John Radcliffe Hospital, Oxford, UK; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK.
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Affiliation(s)
- Gauthamen Rajendran
- Newborn Care Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Andrew Pay
- Department of Plastic Surgery, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Charles Christoph Roehr
- Newborn Care Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK Department of Neonatology, Charité University Medical Center Berlin, Berlin, Germany
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