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Pichler G, Goeral K, Hammerl M, Perme T, Dempsey EM, Springer L, Lista G, Szczapa T, Fuchs H, Karpinski L, Bua J, Avian A, Law B, Urlesberger B, Buchmayer J, Kiechl-Kohlendorfer U, Kornhauser-Cerar L, Schwarz CE, Gründler K, Stucchi I, Schwaberger B, Klebermass-Schrehof K, Schmölzer GM. Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth (COSGOD III): multicentre randomised phase 3 clinical trial. BMJ 2023; 380:e072313. [PMID: 36693654 PMCID: PMC9871806 DOI: 10.1136/bmj-2022-072313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate whether monitoring of cerebral tissue oxygen saturation using near infrared spectroscopy in addition to routine monitoring combined with defined treatment guidelines during immediate transition and resuscitation increases survival without cerebral injury of premature infants compared with standard care alone. DESIGN Multicentre, multinational, randomised controlled phase 3 trial. SETTING 11 tertiary neonatal intensive care units in six countries in Europe and in Canada. PARTICIPANTS 1121 pregnant women (<32 weeks' gestation) were screened prenatally. The primary outcome was analysed in 607 of 655 randomised preterm neonates: 304 neonates in the near infrared spectroscopy group and 303 in the control group. INTERVENTION Preterm neonates were randomly assigned to either standard care (control group) or standard care plus monitoring of cerebral oxygen saturation with a dedicated treatment guideline (near infrared spectroscopy group) during immediate transition (first 15 minutes after birth) and resuscitation. MAIN OUTCOME MEASURE The primary outcome, assessed using all cause mortality and serial cerebral ultrasonography, was a composite of survival without cerebral injury. Cerebral injury was defined as any intraventricular haemorrhage or cystic periventricular leukomalacia, or both, at term equivalent age or before discharge. RESULTS Cerebral tissue oxygen saturation was similar in both groups. 252 (82.9%) out of 304 neonates (median gestational age 28.9 (interquartile range 26.9-30.6) weeks) in the near infrared spectroscopy group survived without cerebral injury compared with 238 (78.5%) out of 303 neonates (28.6 (26.6-30.6) weeks) in the control group (relative risk 1.06, 95% confidence interval 0.98 to 1.14). 28 neonates died (near infrared spectroscopy group 12 (4.0%) v control group 16 (5.3%): relative risk 0.75 (0.33 to 1.70). CONCLUSION Monitoring of cerebral tissue oxygen saturation in combination with dedicated interventions in preterm neonates (<32 weeks' gestation) during immediate transition and resuscitation after birth did not result in substantially higher survival without cerebral injury compared with standard care alone. Survival without cerebral injury increased by 4.3% but was not statistically significant. TRIAL REGISTRATION ClinicalTrials.gov NCT03166722.
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Affiliation(s)
- Gerhard Pichler
- Research Unit for Microcirculation and Macrocirculation of the Newborn, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
- Division of Neonatology, Medical University of Graz, 8036 Graz, Austria
| | - Katharina Goeral
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Marlene Hammerl
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tina Perme
- NICU, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Laila Springer
- Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Gianluca Lista
- Neonatologia e Terapia Intensiva Neonatale (TIN) Ospedale dei Bambini "V Buzzi," Milano, Italia
| | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Chair of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Hans Fuchs
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukasz Karpinski
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Chair of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, "IRCCS Burlo Garofolo," Trieste, Italy
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Brenda Law
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Berndt Urlesberger
- Research Unit for Microcirculation and Macrocirculation of the Newborn, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
- Division of Neonatology, Medical University of Graz, 8036 Graz, Austria
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Lilijana Kornhauser-Cerar
- NICU, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Christoph E Schwarz
- INFANT Research Centre, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Kerstin Gründler
- Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Ilaria Stucchi
- Neonatologia e Terapia Intensiva Neonatale (TIN) Ospedale dei Bambini "V Buzzi," Milano, Italia
| | - Bernhard Schwaberger
- Research Unit for Microcirculation and Macrocirculation of the Newborn, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
- Division of Neonatology, Medical University of Graz, 8036 Graz, Austria
| | - Katrin Klebermass-Schrehof
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Pichler G, Baumgartner S, Biermayr M, Dempsey E, Fuchs H, Goos TG, Lista G, Lorenz L, Karpinski L, Mitra S, Kornhauser-Cerar L, Avian A, Urlesberger B, Schmölzer GM. Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth (COSGOD III): an investigator-initiated, randomized, multi-center, multi-national, clinical trial on additional cerebral tissue oxygen saturation monitoring combined with defined treatment guidelines versus standard monitoring and treatment as usual in premature infants during immediate transition: study protocol for a randomized controlled trial. Trials 2019; 20:178. [PMID: 30894226 PMCID: PMC6427901 DOI: 10.1186/s13063-019-3258-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transition immediately after birth is a complex physiological process. The neonate has to establish sufficient ventilation to ensure significant changes from intra-uterine to extra-uterine circulation. If hypoxia or bradycardia or both occur, as commonly happens during immediate transition in preterm neonates, cerebral hypoxia-ischemia may cause perinatal brain injury. The primary objective of the COSGOD phase III trial is to investigate whether it is possible to increase survival without cerebral injury in preterm neonates of less than 32 weeks of gestation by targeting cerebral tissue oxygen saturation (crSO2) using specified clinical treatment guidelines during the immediate transition period after birth (the first 15 min) in addition to the routine monitoring of arterial oxygen saturation (SpO2) and heart rate (HR). METHODS/DESIGN COSGOD III is an investigator-initiated, randomized, multi-center, multi-national, phase III clinical trial. Inclusion criteria are neonates of less than 32 weeks of gestation, decision to provide full life support, and parental informed consent. Exclusion criteria are severe congenital malformations of brain, heart, lung, or prenatal cerebral injury or a combination of these. The premature infants will be randomly assigned to study or control groups. Both groups will have a near-infrared spectroscopy (NIRS) device (left frontal), pulse oximeter (right palm/wrist), and electrocardiogram placed immediately after birth. In the study group, the crSO2, SpO2, and HR readings are visible, and the infant will receive treatment in accordance with defined treatment guidelines. In the control group, only SpO2 and HR will be visible, and the infant will receive routine treatment. The intervention period will last for the first 15 min after birth during the immediate transition period and resuscitation. Thereafter, each neonate will be followed up for primary outcome to term date or discharge. The primary outcome is mortality or cerebral injury (or both) defined as any intra-ventricular bleeding or cystic periventricular leukomalacia (or both). Secondary outcomes are neonatal morbidities. DISCUSSION crSO2 monitoring during immediate transition has been proven to be feasible and improve cerebral oxygenation during immediate transition. The additional monitoring of crSO2 with dedicated interventions may improve outcome of preterm neonates as evidenced by increased survival without cerebral injury. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03166722 . Registered March 5, 2017.
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Affiliation(s)
- Gerhard Pichler
- Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Paediatrics, Medical University of Graz, Auenbruggerplatz 30, 8036 Graz, Austria
| | - Sigrid Baumgartner
- Universitätsklinik für Kinder- und Jugendheilkunde Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Medizinische Universität Wien, Währingergürtel 18-20, Wien, 1090 Austria
| | - Marlene Biermayr
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innsbruck, 6020 Austria
| | - Eugene Dempsey
- Infant Centre, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Hans Fuchs
- Center for Pediatrics, Department of Neonatology, Faculty of Medicine, Medical Center-University of Freiburg, Mathildenstrasse 1, Freiburg, 79106 Germany
| | - Tom G. Goos
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Wytemaweg 80, Rotterdam, 3015 the Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 5, Delft, 2628 The Netherlands
| | - Gianluca Lista
- Neonatologia e Terapia Intensiva Neonatale (TIN) Ospedale dei Bambini “V.Buzzi”, Via Castelvetro 32, Milano, 20154 Italy
| | - Laila Lorenz
- Department of Neonatology, University Children’s Hospital of Tübingen, Calwerstrasse 7, Tübingen, 72076 Germany
| | - Lukasz Karpinski
- Poznan University of Medical Sciences, Fredry 10, Poznan, 61-701 Poland
| | - Souvik Mitra
- Division of Neonatal-Perinatal Medicine, IWK Health Centre, University Avenue 5980, Halifax, B3K 6R8 Nova Scotia Canada
| | - Lilijana Kornhauser-Cerar
- NICU, Division for Perinatology, University Medical Centre Ljubljana, Zaloska cesta 7, Ljubljana, 1000 Slovenia
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, Graz, 8036 Austria
| | - Berndt Urlesberger
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Paediatrics, Medical University of Graz, Auenbruggerplatz 30, Graz, 8036 Austria
| | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Kingsway Avenue 10240, Edmonton, T5H 3V9 Alberta Canada
- Department of Pediatrics, University of Alberta, Kingsway Avenue 10240, Edmonton, T5H 3V9 Alberta Canada
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Feng X, Ray P, Jarrett J, Karpinski L, Jones B, Knowlton K. Short communication: Effect of abomasal inorganic phosphorus infusion on phosphorus absorption in large intestine, milk production, and phosphorus excretion of dairy cattle. J Dairy Sci 2018; 101:7208-7211. [DOI: 10.3168/jds.2018-14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
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Kalka D, Domagala Z, Gebala J, Karpinski L, Borecki M, Grzeszczyk S, Dulanowski J, Rusiecki L, Krauz E, Pilecki W. P-01-012 The importance of sexual functionality for patients undergoing cardiac rehabilitation due to ischaemic heart disease. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shumack AE, Rzadkiewicz J, Chernyshova M, Jakubowska K, Scholz M, Byszuk A, Cieszewski R, Czarski T, Dominik W, Karpinski L, Kasprowicz G, Pozniak K, Wojenski A, Zabolotny W, Conway NJ, Dalley S, Figueiredo J, Nakano T, Tyrrell S, Zastrow KD, Zoita V. X-ray crystal spectrometer upgrade for ITER-like wall experiments at JET. Rev Sci Instrum 2014; 85:11E425. [PMID: 25430332 DOI: 10.1063/1.4891182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The high resolution X-Ray crystal spectrometer at the JET tokamak has been upgraded with the main goal of measuring the tungsten impurity concentration. This is important for understanding impurity accumulation in the plasma after installation of the JET ITER-like wall (main chamber: Be, divertor: W). This contribution provides details of the upgraded spectrometer with a focus on the aspects important for spectral analysis and plasma parameter calculation. In particular, we describe the determination of the spectrometer sensitivity: important for impurity concentration determination.
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Affiliation(s)
- A E Shumack
- JET-EFDA, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - J Rzadkiewicz
- National Centre for Nuclear Research, Andrzeja Sołtana 7, 05-400 Otwock, Poland
| | - M Chernyshova
- Institute of Plasma Physics and Laser Microfusion, Hery 23, 01-497 Warsaw, Poland
| | - K Jakubowska
- Institute of Plasma Physics and Laser Microfusion, Hery 23, 01-497 Warsaw, Poland
| | - M Scholz
- Institute of Nuclear Physics PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - A Byszuk
- Institute of Electronic Systems, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - R Cieszewski
- Institute of Electronic Systems, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - T Czarski
- Institute of Plasma Physics and Laser Microfusion, Hery 23, 01-497 Warsaw, Poland
| | - W Dominik
- Faculty of Physics, Institute of Experimental Physics, Warsaw University, 00-681 Warsaw, Poland
| | - L Karpinski
- Institute of Plasma Physics and Laser Microfusion, Hery 23, 01-497 Warsaw, Poland
| | - G Kasprowicz
- Institute of Electronic Systems, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - K Pozniak
- Institute of Electronic Systems, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - A Wojenski
- Institute of Electronic Systems, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - W Zabolotny
- Institute of Electronic Systems, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - N J Conway
- JET-EFDA, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - S Dalley
- JET-EFDA, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - J Figueiredo
- EFDA-CSU, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - T Nakano
- Japan Atomic Energy Agency, Naka, Japan
| | - S Tyrrell
- JET-EFDA, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - K-D Zastrow
- JET-EFDA, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - V Zoita
- The National Institute for Laser, Plasma and Radiation Physics, Association EURATOM-MEdC, Magurele-Bucharest, Romania
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Klir D, Kravarik J, Kubes P, Rezac K, Litseva E, Tomaszewski K, Karpinski L, Paduch M, Scholz M. Fusion neutron detector for time-of-flight measurements in z-pinch and plasma focus experiments. Rev Sci Instrum 2011; 82:033505. [PMID: 21456735 DOI: 10.1063/1.3559548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We have developed and tested sensitive neutron detectors for neutron time-of-flight measurements in z-pinch and plasma focus experiments with neutron emission times in tens of nanoseconds and with neutron yields between 10(6) and 10(12) per one shot. The neutron detectors are composed of a BC-408 fast plastic scintillator and Hamamatsu H1949-51 photomultiplier tube (PMT). During the calibration procedure, a PMT delay was determined for various operating voltages. The temporal resolution of the neutron detector was measured for the most commonly used PMT voltage of 1.4 kV. At the PF-1000 plasma focus, a novel method of the acquisition of a pulse height distribution has been used. This pulse height analysis enabled to determine the single neutron sensitivity for various neutron energies and to calibrate the neutron detector for absolute neutron yields at about 2.45 MeV.
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Affiliation(s)
- D Klir
- Faculty of Electrical Engineering, Czech Technical University in Prague, Technicka 2, 16627 Prague 6, Czech Republic.
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Abstract
An oral mass was observed in a Malayan tapir (Tapirus indicus). Squamous cell carcinoma was diagnosed by histologic examination of a biopsy specimen. A series of intralesional injections using fluorouracil resulted in complete regression of the neoplasm with no recognized adverse effects.
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