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Byrne BJ, Kapadia V. Improving Accuracy for Initial Endotracheal Tube Size Selection for Newborns. Pediatrics 2024; 153:e2023064843. [PMID: 38469641 DOI: 10.1542/peds.2023-064843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Bobbi J Byrne
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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2
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Foglia EE, Shah BA, DeShea L, Lander K, Kamath-Rayne BD, Herrick HM, Zaichkin J, Lee S, Bonafide C, Song C, Hallford G, Lee HC, Kapadia V, Leone T, Josephsen J, Gupta A, Strand ML, Beasley WH, Szyld E. Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors. Resusc Plus 2024; 17:100515. [PMID: 38094660 PMCID: PMC10716019 DOI: 10.1016/j.resplu.2023.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 04/11/2024] Open
Abstract
Aim Neonatal resuscitation guidelines promote the laryngeal mask (LM) interface for positive pressure ventilation (PPV), but little is known about how the LM is used among Neonatal Resuscitation Program (NRP) Providers and Instructors. The study aim was to characterize the training, experience, confidence, and perspectives of NRP Providers and Instructors regarding LM use during neonatal resuscitation at birth. Methods A voluntary anonymous survey was emailed to all NRP Providers and Instructors. Survey items addressed training, experience, confidence, and barriers for LM use during resuscitation. Associations between respondent characteristics and outcomes of both LM experience and confidence were assessed using logistic regression. Results Between 11/7/22-12/12/22, there were 5,809 survey respondents: 68% were NRP Providers, 55% were nurses, and 87% worked in a hospital setting. Of these, 12% had ever placed a LM during newborn resuscitation, and 25% felt very or completely confident using a LM. In logistic regression, clinical or simulated hands-on training, NRP Instructor role, professional role, and practice setting were all associated with both LM experience and confidence.The three most frequently identified barriers to LM use were insufficient experience (46%), preference for other interfaces (25%), and failure to consider the LM during resuscitation (21%). One-third (33%) reported that LMs are not available where they resuscitate newborns. Conclusion Few NRP providers and instructors use the LM during neonatal resuscitation. Strategies to increase LM use include hands-on clinical training, outreach promoting the advantages of the LM compared to other interfaces, and improving availability of the LM in delivery settings.
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Affiliation(s)
- Elizabeth E. Foglia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Birju A. Shah
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lise DeShea
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kathryn Lander
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Beena D. Kamath-Rayne
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Heidi M. Herrick
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Sura Lee
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Christopher Bonafide
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Clara Song
- Southern California Permanente Medical Group, Anaheim, CA, United States
| | - Gene Hallford
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Henry C. Lee
- Division of Neonatology, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Vishal Kapadia
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
| | - Tina Leone
- Division of Neonatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Justin Josephsen
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Arun Gupta
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marya L. Strand
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - William H. Beasley
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Edgardo Szyld
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - for the American Academy of Pediatrics Delivery Room Intervention, Evaluation DRIVE Network
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
- Positive Pressure, PLLC, Shelton, WA, United States
- Southern California Permanente Medical Group, Anaheim, CA, United States
- Division of Neonatology, University of California San Diego School of Medicine, La Jolla, CA, United States
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
- Division of Neonatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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3
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Jagarapu J, Kapadia V, Mir I, Kakkilaya V, Carlton K, Fokken M, Brown S, Hall-Barrow J, Savani RC. TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers. J Telemed Telecare 2024; 30:165-172. [PMID: 34524916 DOI: 10.1177/1357633x211038153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/17/2022]
Abstract
BACKGROUND The use of telemedicine to provide care for critically ill newborn infants has significantly evolved over the last two decades. Children's Health System of Texas and University of Texas Southwestern Medical Center established TeleNICU, the first teleneonatology program in Texas. OBJECTIVE To evaluate the effectiveness of Tele Neonatal Intensive Care Unit (TeleNICU) in extending quaternary neonatal care to more rural areas of Texas. MATERIALS AND METHODS We conducted a retrospective review of TeleNICU consultations from September 2013 to October 2018. Charts were reviewed for demographic data, reasons for consultation, and consultation outcomes. Diagnoses were classified as medical, surgical, or combined. Consultation outcomes were categorized into transferred or retained. Transport cost savings were estimated based on the distance from the hub site and the costs for ground transportation. RESULTS TeleNICU had one hub (Level IV) and nine spokes (Levels I-III) during the study period. A total of 132 direct consultations were completed during the study period. Most consultations were conducted with Level III units (81%) followed by level I (13%) and level II (6%) units. Some common diagnoses included prematurity (57%), respiratory distress (36%), congenital anomalies (25%), and neonatal surgical emergencies (13%). For all encounters, 54% of the patients were retained at the spoke sites, resulting in an estimated cost savings of USD0.9 million in transport costs alone. The likelihood of retention at spoke sites was significantly higher for medical diagnoses compared to surgical diagnoses (89% vs. 11%). CONCLUSION Telemedicine effectively expands access to quaternary neonatal care for more rural communities, helps in the triage of neonatal transfers, promotes family centered care, and significantly reduces health care costs.
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Affiliation(s)
| | - Vishal Kapadia
- The University of Texas Southwestern Medical Center, USA
| | - Imran Mir
- The University of Texas Southwestern Medical Center, USA
| | | | - Kristin Carlton
- Children's Medical Center of The Children's Health System of Texas, USA
| | - Micky Fokken
- Children's Medical Center of The Children's Health System of Texas, USA
| | | | - Julie Hall-Barrow
- Children's Medical Center of The Children's Health System of Texas, USA
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4
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Morgan B, Kapadia V, Crawford L, Martin S, McCollom J. Bridging the gap: Palliative care integration into survivorship care. Curr Probl Cancer 2023; 47:101019. [PMID: 37866988 DOI: 10.1016/j.currproblcancer.2023.101019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023]
Abstract
As the number of cancer survivors grows, there is an increasing need for comprehensive care to address the unique physical, psychological, and social needs of this population. Palliative care (PC) integration within survivorship care offers a promising model of care, however, there is no comprehensive review of literature to guide clinical practice. This manuscript presents a scoping review of the research literature on models of care that integrate PC with survivorship care, as well as a detailed description of an exemplar clinical model. We identified 20 articles that described various models of survivorship care with integrated PC, highlighting the diversity of approaches and the multidisciplinary nature of interventions. Few studies reported outcomes but those that did demonstrated improvements in pain, self-efficacy, depression, function, and documentation of advance care planning. The evidence base remains limited, indicating the need for further research in this area with a focus on exploring outcomes using prospective experimental designs. Future clinical practice and research should explore sustainable payment models and the implementation of integrated survivorship care in value-based payment systems.
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Affiliation(s)
- Brianna Morgan
- Department of Medicine, Division of Geriatrics and Palliative Care, New York University Grossman School of Medicine, New York City, NY
| | - Vishal Kapadia
- Landmark Health, Part of Optum Home and Community, Irving, TX
| | - Lesa Crawford
- Parkview Health, Parkview Packnett Family Cancer Institute, Fort Wayne, IN
| | - Samina Martin
- Department of Internal Medicine, Parkview Health, Fort Wayne, IN
| | - Joseph McCollom
- Parkview Health, Parkview Packnett Family Cancer Institute, Fort Wayne, IN.
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5
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Katheria A, Schmölzer GM, Janvier A, Kapadia V, Saugstad OD, Vento M, Kushnir A, Tracy M, Rich W, Oei JL. A Narrative Review of the Rationale for Conducting Neonatal Emergency Studies with a Waived or Deferred Consent Approach. Neonatology 2023; 120:344-352. [PMID: 37231967 DOI: 10.1159/000530257] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/27/2022] [Accepted: 03/14/2023] [Indexed: 05/27/2023]
Abstract
Emergency research studies are high-stakes studies that are usually performed on the sickest patients, where many patients or guardians have no opportunity to provide full informed consent prior to participation. Many emergency studies self-select healthier patients who can be informed ahead of time about the study process. Unfortunately, results from such participants may not be informative for the future care of sicker patients. This inevitably creates waste and perpetuates uninformed care and continued harm to future patients. The waiver or deferred consent process is an alternative model that may be used to enroll sick patients who are unable to give prospective consent to participate in a study. However, this process generates vastly different stakeholder views which have the potential to create irreversible impediments to research and knowledge. In studies involving newborn infants, consent must be sought from a parent or guardian, and this adds another layer of complexity to already fraught situations if the infant is very sick. In this manuscript, we discuss reasons why consent waiver or deferred consent processes are vital for some types of neonatal research, especially those occurring at and around the time of birth. We provide a framework for conducting neonatal emergency research under consent waiver that will ensure the patient's best interests without compromising ethical, beneficial, and informative knowledge acquisition to improve the future care of sick newborn infants.
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Affiliation(s)
- Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Georg M Schmölzer
- Division of Neonatal-Perinatal Care (NICU), University of Alberta, Edmonton, Alberta, Canada
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'ethique elinique (BEC), Université de Montréal, Montréal, Québec, Canada
- Division of Neonatology, Research Center, Unité d'éthique clinique, Unité de soins palliatifs, Bureau du Partenariat Patients-Familles-Soignants; CHU Sainte-Justine, Montreal, Québec, Canada
| | - Vishal Kapadia
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ola D Saugstad
- Department of Pediatric Research, Oslo University, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maximo Vento
- Department of Pediatrics, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alla Kushnir
- Department of Neonatology, Children's Regional Hospital at Cooper, Cooper University Health, Camden, New Jersey, USA
| | - Mark Tracy
- Department of Neonatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wade Rich
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
- School of Paediatrics, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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6
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Foglia EE, Davis PG, Guinsburg R, Kapadia V, Liley HG, Rüdiger M, Schmölzer GM, Strand ML, Wyckoff MH, Wyllie J, Weiner GM. Recommended Guideline for Uniform Reporting of Neonatal Resuscitation: The Neonatal Utstein Style. Pediatrics 2023; 151:190463. [PMID: 36632729 DOI: 10.1542/peds.2022-059631] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Clinical research on neonatal resuscitation has accelerated over recent decades. However, an important methodologic limitation is that there are no standardized definitions or reporting guidelines for neonatal resuscitation clinical studies. To address this, the International Liaison Committee on Resuscitation Neonatal Life Support Task Force established a working group to develop the first Utstein-style reporting guideline for neonatal resuscitation. The working group modeled this approach on previous Utstein-style guidelines for other populations. This reporting guideline focuses on resuscitation of newborns immediately after birth for respiratory failure, bradycardia, severe bradycardia, or cardiac arrest. We identified 7 relevant domains: setting, patient, antepartum, birth/preresuscitation, resuscitation process, postresuscitation process, and outcomes. Within each domain, relevant data elements were identified as core versus supplemental. Core data elements should be collected and reported for all neonatal resuscitation studies, while supplemental data elements may be collected and reported using standard definitions when possible. The Neonatal Utstein template includes both core and supplemental elements across the 7 domains, and the associated Data Table provides detailed information and reporting standards for each data element. The Neonatal Utstein reporting guideline is anticipated to assist investigators engaged in neonatal resuscitation research by standardizing data definitions. The guideline will facilitate data pooling in meta-analyses, enhancing the strength of neonatal resuscitation treatment recommendations and subsequent guidelines.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter G Davis
- Newborn Research Center, the Royal Women's Hospital and the University of Melbourne, Victoria, Australia
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Mario Rüdiger
- Saxony Center for Fetal-Neonatal Health.,Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Medizinische Fakultät TU Dresden, Dresden, Germany
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marya L Strand
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Wyllie
- Department of Paediatrics and Neonatology, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Gary M Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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7
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Abousaab C, Kapadia V, Marks S. Multimodal Analgesic Strategies for Cancer-Related Oral Mucositis #450. J Palliat Med 2023; 26:142-144. [PMID: 36607779 DOI: 10.1089/jpm.2022.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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8
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Ramachandran S, Bruckner M, Kapadia V, Schmölzer GM. Chest compressions and medications during neonatal resuscitation. Semin Perinatol 2022; 46:151624. [PMID: 35752466 DOI: 10.1016/j.semperi.2022.151624] [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] [Indexed: 11/24/2022]
Abstract
Prolonged resuscitation in neonates, although quite rare, may occur in response to profound intractable bradycardia as a result of asphyxia. In these instances, chest compressions and medications may be necessary to facilitate return of spontaneous circulation. While performing chest compressions, the two thumb method is preferred over the two finger technique, although several newer approaches are under investigation. While the ideal compression to ventilation ratio is still uncertain, a 3:1 ratio remains the recommendation by the Neonatal Resuscitation Program. Use of feedback mechanisms to optimize neonatal cardiopulmonary resuscitation (CPR) show promise and are currently under investigation. While performing optimal cardiac compressions to pump blood, use of medications to restore spontaneous circulation will likely be necessary. Current recommendations are that epinephrine, an endogenous catecholamine be used preferably intravenously or by intraosseous route, with the dose repeated every 3-5 minutes until return of spontaneous circulation. Finally, while the need for volume replacement is rare, it may be considered in instances of acute blood loss or poor response to resuscitation.
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Affiliation(s)
| | - Marlies Bruckner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Vishal Kapadia
- Division of Neonatology, UT Southwestern Medical Center at Dallas
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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9
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Oei JL, Kapadia V, Rabi Y, Saugstad OD, Rook D, Vermeulen MJ, Boronat N, Thamrin V, Tarnow-Mordi W, Smyth J, Wright IM, Lui K, van Goudoever JB, Gebski V, Vento M. Neurodevelopmental outcomes of preterm infants after randomisation to initial resuscitation with lower (FiO 2 <0.3) or higher (FiO 2 >0.6) initial oxygen levels. An individual patient meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:386-392. [PMID: 34725105 DOI: 10.1136/archdischild-2021-321565] [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: 01/05/2021] [Accepted: 10/04/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the effects of lower (≤0.3) versus higher (≥0.6) initial fractional inspired oxygen (FiO2) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants <32 weeks' gestation. DESIGN Meta-analysis of individual patient data from three randomised controlled trials. SETTING Neonatal intensive care units. PATIENTS 543 children <32 weeks' gestation. INTERVENTION Randomisation at birth to resuscitation with lower (≤0.3) or higher (≥0.6) initial FiO2. OUTCOME MEASURES Primary: death and/or NDI at 2 years of age.Secondary: post-hoc non-randomised observational analysis of death/NDI according to 5-minute oxygen saturation (SpO2) below or at/above 80%. RESULTS By 2 years of age, 46 of 543 (10%) children had died. Of the 497 survivors, 84 (17%) were lost to follow-up. Bayley Scale of Infant Development (third edition) assessments were conducted on 377 children. Initial FiO2 was not associated with difference in death and/or disability (difference (95% CI) -0.2%, -7% to 7%, p=0.96) or with cognitive scores <85 (2%, -5% to 9%, p=0.5). Five-minute SpO2 >80% was associated with decreased disability/death (14%, 7% to 21%) and cognitive scores >85 (10%, 3% to 18%, p=0.01). Multinomial regression analysis noted decreased death with 5-minute SpO2 ≥80% (odds (95% CI) 09.62, 0.98 to 0.96) and gestation (0.52, 0.41 to 0.65), relative to children without death or NDI. CONCLUSION Initial FiO2 was not associated with difference in risk of disability/death at 2 years in infants <32 weeks' gestation but CIs were wide. Substantial benefit or harm cannot be excluded. Larger randomised studies accounting for patient differences, for example, gestation and gender are urgently needed.
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Affiliation(s)
- Ju Lee Oei
- Newborn Intensive Care Unit, The Royal Hospital for Women, Randwick, New South Wales, Australia .,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Vishal Kapadia
- Department of Pediatrics, Howard Hughes Medical Institute-University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ola Didrik Saugstad
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Denise Rook
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nuria Boronat
- La Fe Health Research Institute, La Fe University and Polytechnic Hospital, Valencia, Spain.,Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Valerie Thamrin
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - John Smyth
- Newborn Intensive Care Unit, The Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ian M Wright
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Kei Lui
- Newborn Intensive Care Unit, The Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital AMC, Amsterdam, The Netherlands.,Department of Pediatrics, Amsterdam UMC-VUMC location, Amsterdam, The Netherlands
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Maximo Vento
- La Fe Health Research Institute, La Fe University and Polytechnic Hospital, Valencia, Spain.,Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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10
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Kapadia V, Griswold E, Newcomer K, Tillman B, Mwangi J, Terauchi S. BPI22-020: Better Together: Why Palliative Care Should be Incorporated Early in Patients With Advanced Head and Neck Cancer. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7304] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vishal Kapadia
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Elisa Griswold
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Kelley Newcomer
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Brittny Tillman
- 1 University of Texas Southwestern Medical Center, Dallas, TX
- 2 C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Jane Mwangi
- 3 Parkland Health & Hospital System, Dallas, TX
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11
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Stocks EF, Jaleel M, Smithhart W, Burchfield PJ, Thomas A, Mangona KLM, Kapadia V, Wyckoff M, Kakkilaya V, Brenan S, Brown LS, Clark C, Nelson DB, Brion LP. Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age. J Perinatol 2022; 42:761-768. [PMID: 35173286 PMCID: PMC8853308 DOI: 10.1038/s41372-022-01334-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We previously reported an increase in pneumothorax after implementing delivery room (DR) continuous positive airway pressure (CPAP) for labored breathing or persistent cyanosis in ≥35-week gestational age (GA) neonates unexposed to DR-positive pressure ventilation (DR-PPV). We hypothesized that pneumothorax would decrease after de-implementing DR-CPAP in those unexposed to DR-PPV or DR-O2 supplementation (DR-PPV/O2). STUDY DESIGN In a retrospective cohort excluding DR-PPV the primary outcome was DR-CPAP-related pneumothorax (1st chest radiogram, 1st day of life). In a subgroup treated by the resuscitation team and admitted to the NICU, the primary outcome was DR-CPAP-associated pneumothorax (1st radiogram, no prior PPV) without DR-PPV/O2. RESULTS In the full cohort, occurrence of DR-CPAP-related pneumothorax decreased after the intervention (11.0% vs 6.0%, P < 0.001). In the subgroup, occurrence of DR-CPAP-associated pneumothorax decreased after the intervention (1.4% vs. 0.06%, P < 0.001). CONCLUSION The occurrence of CPAP-associated pneumothorax decreased after avoiding DR-CPAP in ≥35-week GA neonates without DR-PPV/O2.
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Affiliation(s)
- Edward F. Stocks
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,grid.266900.b0000 0004 0447 0018Present Address: Oklahoma University, Norman, OK USA
| | - Mambarambath Jaleel
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - William Smithhart
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,Present Address: Newborn Associates, Jackson, MO USA
| | - Patti J. Burchfield
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Anita Thomas
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Kate Louise M. Mangona
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Vishal Kapadia
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Myra Wyckoff
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Shelby Brenan
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,Present Address: Pediatrix, Colorado Springs, CO USA
| | - L. Steven Brown
- grid.417169.c0000 0000 9359 6077Parkland Health & Hospital System, Dallas, TX USA
| | - Christopher Clark
- grid.417169.c0000 0000 9359 6077Parkland Health & Hospital System, Dallas, TX USA
| | - David B. Nelson
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,grid.417169.c0000 0000 9359 6077Parkland Health & Hospital System, Dallas, TX USA
| | - Luc P. Brion
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
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12
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Sotiropoulos JX, Oei JL, Schmölzer GM, Hunter KE, Williams JG, Webster AC, Vento M, Kapadia V, Rabi Y, Dekker J, Vermeulen MJ, Sundaram V, Kumar P, Saugstad OD, Seidler AL. NETwork Meta-analysis Of Trials of Initial Oxygen in preterm Newborns (NETMOTION): A Protocol for Systematic Review and Individual Participant Data Network Meta-Analysis of Preterm Infants <32 Weeks' Gestation Randomized to Initial Oxygen Concentration for Resuscitation. Neonatology 2022; 119:517-524. [PMID: 35785768 DOI: 10.1159/000525127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Internationally recognized guidelines recommend the judicious use of low oxygen (21-30%), titrated to peripheral oxygen saturation targets, for the initiation of resuscitation of very and extremely preterm infants (<32 weeks' gestation). However, despite more than 10 randomized controlled trials on this question, the ideal initial oxygen concentration for this group of vulnerable infants remains uncertain. AIMS This study aims to assess the effect of various initial oxygen concentrations on (1) all-cause mortality, chronic lung disease, intraventricular hemorrhage, and retinopathy of prematurity; and (2) reaching the prescribed oxygen saturation targets by 5 min after birth, in preterm infants requiring resuscitation. METHODS We will conduct a systematic review and network meta-analysis using individual participant data. Studies of preterm infants <32 weeks' gestation, randomized to initial oxygen concentration, will be included. We will systematically search medical databases and trial registries for eligible studies (published or unpublished). Records will be screened by two independent reviewers, with conflicts resolved by the inclusion of a third reviewer. Identified initial oxygen concentrations will be grouped into the following nodes: low (≤30%), intermediate (60%), and high (≥90%) oxygen. A two-step random-effects contrast-based network meta-regression will be calculated to compare and rank different oxygen concentrations. Analyses will be intention-to-treat, with the primary outcome of all-cause mortality. DISCUSSION This is the first individual participant data network meta-analysis of initial oxygen concentrations for the resuscitation of preterm infants. This novel approach may address long-standing uncertainty regarding optimal oxygen supplementation practice for the resuscitation of preterm infants <32 weeks' gestation.
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Affiliation(s)
- James X Sotiropoulos
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia, .,School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia, .,Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia,
| | - Ju Lee Oei
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Georg M Schmölzer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Kylie E Hunter
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan G Williams
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Angela C Webster
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Maximo Vento
- University and Polytechnic Hospital La Fe, Valencia, Spain.,Health Research Institute La Fe, Valencia, Spain
| | - Vishal Kapadia
- Department of Pediatrics, U.T. Southwestern Medical Center, Dallas, Texas, USA
| | - Yacov Rabi
- Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Janneke Dekker
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ola D Saugstad
- Department of Pediatrics, U.T. Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Research, Rikshospitalet, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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13
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Sotiropoulos JX, Kapadia V, Vento M, Rabi Y, Saugstad OD, Kumar RK, Schmölzer GM, Zhang H, Yuan Y, Lim G, Kusuda S, Arimitsu T, Nguyen TT, Kitsommart R, Yeo KT, Oei JL. Oxygen for the delivery room respiratory support of moderate-to-late preterm infants. An international survey of clinical practice from 21 countries. Acta Paediatr 2021; 110:3261-3268. [PMID: 34473855 DOI: 10.1111/apa.16091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/31/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
Abstract
AIM The aim of this study was to determine clinician opinion regarding oxygen management in moderate-late preterm resuscitation. METHODS An anonymous online questionnaire was distributed through email/social messaging platforms to neonatologists in 21 countries (October 2020-March 2021) via REDCap. RESULTS Of the 695 respondents, 69% had access to oxygen blenders and 90% had pulse oximeters. Respondents from high-income countries were more likely to have oxygen blenders than those from middle-income countries (72% vs. 66%). Most initiated respiratory support with FiO2 0.21 (43%) or 0.3 (36%) but only 45% titrated FiO2 to target SpO2 . Most (89%) considered heart rate as a more important indicator of response than SpO2 . Almost all (96%) supported the need for well-designed trials to examine oxygenation in moderate-late preterm resuscitation. CONCLUSION Most clinicians resuscitated moderate-late preterm infants with lower initial FiO2 but some cannot/will not target SpO2 or titrate FiO2 . Most consider heart rate as a more important indicator of infant response than SpO2 .Large and robust clinical trials examining oxygen use for moderate-late preterm resuscitation, including long-term neurodevelopmental outcomes, are supported amongst clinicians.
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Affiliation(s)
- James X. Sotiropoulos
- Faculty of Medicine School of Women’s and Children’s Health University of New South Wales Sydney NSW Australia
- Department of Newborn Care The Royal Hospital for Women Randwick NSW Australia
| | - Vishal Kapadia
- Department of Pediatrics U.T. Southwestern Medical Center Dallas TX USA
| | - Maximo Vento
- Health Research Institute La Fe Valencia Spain
- University and Polytechnic Hospital La Fe Valencia Spain
| | - Yacov Rabi
- Department of Pediatrics Alberta Children's Hospital Research Institute University of Calgary Calgary AB Canada
| | - Ola D. Saugstad
- Northwestern University Chicago USA
- University of Oslo Oslo Norway
| | | | - 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
| | - Huyan Zhang
- Division of Neonatology Department of Pediatrics Children's Hospital of Philadelphia Philadelphia and University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
- Guangzhou Women and Children’s Medical Center Tianhe District Guangzhou China
| | - Yuan Yuan
- Guangzhou Women and Children’s Medical Center Tianhe District Guangzhou China
| | - Gina Lim
- Department of Pediatrics Ulsan University Hospital Ulsan South Korea
| | - Satoshi Kusuda
- Department of Pediatrics Faculty of Medicine Kyorin University Tokyo Japan
| | - Takeshi Arimitsu
- Department of Pediatrics Keio University School of Medicine Tokyo Japan
| | - Tinh Thu Nguyen
- Department of Pediatrics University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
| | - Ratchada Kitsommart
- Division of Neonatology Department of Pediatrics Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Kee Thai Yeo
- Department of Neonatology KK Women’s and Children’s Hospital Singapore Singapore
| | - Ju Lee Oei
- Faculty of Medicine School of Women’s and Children’s Health University of New South Wales Sydney NSW Australia
- Department of Newborn Care The Royal Hospital for Women Randwick NSW Australia
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14
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Kapadia V, Oei JL, Finer N, Rich W, Rabi Y, Wright IM, Rook D, Vermeulen MJ, Tarnow-Mordi WO, Smyth JP, Lui K, Brown S, Saugstad OD, Vento M. Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis. Resuscitation 2021; 167:209-217. [PMID: 34425156 PMCID: PMC8603874 DOI: 10.1016/j.resuscitation.2021.08.023] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. METHODS Medline and EMBASE were searched from 01/01/1990 to 12/01/2020. RCTs of low vs high initial oxygen concentration which recorded serial heart rate (HR) and oxygen saturation (SpO2) during resuscitation of infants <32 weeks gestational age were eligible. Individual patient level data were requested from the authors. Newborns receiving chest compressions in the DR and those with no recorded HR in the first 2 min after birth were excluded. Prolonged bradycardia (PB) was defined as HR < 100 bpm for ≥2 min. Individual patient data analysis and pooled data analysis were conducted. RESULTS Data were collected from 720 infants in 8 RCTs. Neonates with PB had higher odds of hospital death before [OR 3.8 (95% CI 1.5, 9.3)] and after [OR 1.7 (1.2, 2.5)] adjusting for potential confounders. Bradycardia occurred in 58% infants, while 38% had PB. Infants with bradycardia were more premature and had lower birth weights. The incidence of bradycardia in infants resuscitated with low (≤30%) and high (≥60%) oxygen was similar. Neonates with both, PB and SpO2 < 80% at 5 min after birth had higher odds of hospital mortality. [OR 18.6 (4.3, 79.7)]. CONCLUSION In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.
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Affiliation(s)
- Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, TX, USA.
| | - Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Neil Finer
- Department of Neonatology, University of California San Diego, San Diego, CA, USA
| | - Wade Rich
- Department of Neonatology, University of California San Diego, San Diego, CA, USA
| | - Yacov Rabi
- University of Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Alberta, Canada
| | - Ian M Wright
- Illawarra Health and Medical Research Institute and Graduate Medicine, The University of Wollongong, Wollongong, NSW, Australia
| | - Denise Rook
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - John P Smyth
- Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Kei Lui
- Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Steven Brown
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Ola D Saugstad
- Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, USA
| | - Maximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
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15
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Dainty KN, Atkins DL, Breckwoldt J, Maconochie I, Schexnayder SM, Skrifvars MB, Tijssen J, Wyllie J, Furuta M, Aickin R, Acworth J, Atkins D, Couto TB, Guerguerian AM, Kleinman M, Kloeck D, Nadkarni V, Ng KC, Nuthall G, Ong YKG, Reis A, Rodriguez-Nunez A, Schexnayder S, Scholefield B, Tijssen J, Voorde PVD, Wyckoff M, Liley H, El-Naggar W, Fabres J, Fawke J, Foglia E, Guinsburg R, Hosono S, Isayama T, Kawakami M, Kapadia V, Kim HS, McKinlay C, Roehr C, Schmolzer G, Sugiura T, Trevisanuto D, Weiner G, Greif R, Bhanji F, Bray J, Breckwoldt J, Cheng A, Duff J, Eastwood K, Gilfoyle E, Hsieh MJ, Lauridsen K, Lockey A, Matsuyama T, Patocka C, Pellegrino J, Sawyer T, Schnaubel S, Yeung J. Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation 2021; 162:20-34. [PMID: 33577966 DOI: 10.1016/j.resuscitation.2021.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. OBJECTIVE To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. DATA SOURCES Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. STUDY SELECTION 3200 titles were retrieved in the initial search; 36 ultimately included for review. DATA EXTRACTION Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. RESULTS The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. LIMITATIONS English language only; lack of randomized control trials; quality of the publications. CONCLUSIONS Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes. PROSPERO REGISTRATION NUMBER CRD42020140363.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada.
| | - Dianne L Atkins
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jan Breckwoldt
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ian Maconochie
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Steve M Schexnayder
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Markus B Skrifvars
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janice Tijssen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jonathan Wyllie
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Marie Furuta
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Richard Aickin
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jason Acworth
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Dianne Atkins
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Thomaz Bittencourt Couto
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Anne-Marie Guerguerian
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Monica Kleinman
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - David Kloeck
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Vinay Nadkarni
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kee-Chong Ng
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Gabrielle Nuthall
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Yong-Kwang Gene Ong
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Amelia Reis
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Antonio Rodriguez-Nunez
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Steve Schexnayder
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Barney Scholefield
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janice Tijssen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Patrick van de Voorde
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Myra Wyckoff
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Helen Liley
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Walid El-Naggar
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jorge Fabres
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Joe Fawke
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Elizabeth Foglia
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ruth Guinsburg
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Shigeharu Hosono
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Tetsuya Isayama
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Mandira Kawakami
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Vishal Kapadia
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Han-Suk Kim
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Chris McKinlay
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Charles Roehr
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Georg Schmolzer
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Takahiro Sugiura
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Daniele Trevisanuto
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Gary Weiner
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Robert Greif
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Farhan Bhanji
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janet Bray
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jan Breckwoldt
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Adam Cheng
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jonathan Duff
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kathryn Eastwood
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Elaine Gilfoyle
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ming-Ju Hsieh
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kasper Lauridsen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Andrew Lockey
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Tasuku Matsuyama
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Catherine Patocka
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jeffrey Pellegrino
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Taylor Sawyer
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Sebastian Schnaubel
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Joyce Yeung
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
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16
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Abstract
Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO2) and how FiO2 should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO2) target within the first 5-10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) <32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO2 and (2) the target SpO2 within the first 5-10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO2 of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA <29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO2 0.3 and adjusting the FiO2 to reach SpO2 of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate <100 bpm for >2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO2 in the first 10 min of life and a heart rate >100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.
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Affiliation(s)
- Ola Didrik Saugstad
- Department of Pediatric Research, University of Oslo, Oslo, Norway.,Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ju Lee Oei
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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17
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Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MHM, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O’Neil B, Yong-Kwang Ong G, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, Fran Hazinski M. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2019; 140:e826-e880. [DOI: 10.1161/cir.0000000000000734] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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Cao T, Johnson A, Coogle J, Zuzelski A, Fitzgerald S, Kapadia V, Stoltzfus K. Incidence and Characteristics Associated with Hospital Readmission after Discharge to Home Hospice. J Palliat Med 2019; 23:233-239. [PMID: 31513454 DOI: 10.1089/jpm.2019.0246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/22/2022] Open
Abstract
Background: Home hospice is designed to provide comfort to patients at the end of their life and hospital readmission is incongruent with this goal. Objective: The purpose of this study was to investigate the incidence of and characteristics associated with hospital readmissions from home hospice over a two-year period. Design/Subjects: This was a retrospective cohort study of 705 inpatients discharged from a quaternary academic medical center to home hospice from January 1, 2016 to December 31, 2017. Measures: The primary outcome was incidence of hospital readmission after discharge to home hospice. Multivariate regression with stepwise forward selection was used to identify characteristics associated with readmission. Results: The incidence of readmission was found to be 10.50% (n = 74), and the median days from discharge to readmission were 32.50 days (interquartile range = 14.00, 75.00). Reasons for readmission were: unanticipated new medical issue (n = 33, 44.59%), uncontrolled symptoms (n = 25, 33.78%), misunderstanding of hospice status (n = 12, 16.22%), and caregiver distress (n = 4, 5.41%). The following characteristics were associated with readmission: female versus male (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.16-3.32), non-white versus white (OR = 2.40; 95% CI: 1.36-4.24), and hospice diagnosis of cardiac disease versus all other diagnoses (OR = 4.40; 95% CI: 2.06-9.37). Conclusions: Compared with prior studies, our findings showed a lower incidence of readmission, 10.50%, from home hospice. In addition, those who are female, non-white, or have a hospice diagnosis of cardiac disease are more likely to be readmitted.
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Affiliation(s)
- Thuy Cao
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Amy Johnson
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Justin Coogle
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Adam Zuzelski
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Sharon Fitzgerald
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Vishal Kapadia
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ky Stoltzfus
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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19
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Smithhart W, Wyckoff MH, Kapadia V, Jaleel M, Kakkilaya V, Brown LS, Nelson DB, Brion LP. Delivery Room Continuous Positive Airway Pressure and Pneumothorax. Pediatrics 2019; 144:peds.2019-0756. [PMID: 31399490 DOI: 10.1542/peds.2019-0756] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 05/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In 2011, the Neonatal Resuscitation Program (NRP) added consideration of continuous positive airway pressure (CPAP) for spontaneously breathing infants with labored breathing or hypoxia in the delivery room (DR). The objective of this study was to determine if DR-CPAP is associated with symptomatic pneumothorax in infants 35 to 42 weeks' gestational age. METHODS We included (1) a retrospective birth cohort study of neonates born between 2001 and 2015 and (2) a nested cohort of those born between 2005 and 2015 who had a resuscitation call leading to admission to the NICU and did not receive positive-pressure ventilation. RESULTS In the birth cohort (n = 200 381), pneumothorax increased after implementation of the 2011 NRP from 0.4% to 0.6% (P < .05). In the nested cohort (n = 6913), DR-CPAP increased linearly over time (r = 0.71; P = .01). Administration of DR-CPAP was associated with pneumothorax (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 4.4-6.8); the OR was higher (P < .001) in infants receiving 21% oxygen (OR: 8.5; 95% CI: 5.9-12.3; P < .001) than in those receiving oxygen supplementation (OR: 3.5; 95% CI: 2.5-5.0; P < .001). Among those with DR-CPAP, pneumothorax increased with gestational age and decreased with oxygen administration. CONCLUSIONS The use of DR-CPAP is associated with increased odds of pneumothorax in late-preterm and term infants, especially in those who do not receive oxygen in the DR. These findings could be used to clarify NRP guidelines regarding DR-CPAP in late-preterm and term infants.
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Affiliation(s)
- William Smithhart
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
| | | | | | | | - David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, Texas; and
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
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20
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Stine CN, Koch J, Brown LS, Chalak L, Kapadia V, Wyckoff MH. Quantitative end-tidal CO 2 can predict increase in heart rate during infant cardiopulmonary resuscitation. Heliyon 2019; 5:e01871. [PMID: 31245640 PMCID: PMC6581839 DOI: 10.1016/j.heliyon.2019.e01871] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/30/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
Aim To determine the end-tidal CO2 (ETCO2) value that predicts a HR > 60 beats per minute (bpm) with the best sensitivity and specificity during neonatal/infant cardiopulmonary resuscitation (CPR) defined as chest compressions ± epinephrine in neonates/infants admitted to a CVICU/PICU. Methods This was a retrospective cohort study from 1/1/08 to 12/31/12 of all infants ≤6 month of age who received CPR and had ETCO2 documented during serial resuscitations in the pediatric (PICU) or pediatric cardiovascular intensive care units (CVICU) of Children's Medical Center of Dallas. A receiver operator characteristic (ROC) curve was generated to determine the ETCO2 cut-off with the best sensitivity and specificity for predicting HR > 60 bpm. Each ETCO2 value was correlated to the infant's HR at that specific time. Results CPR was provided for 165 infants of which 49 infants had quantitative ETCO2 documented so only these infants were included. The majority were in the CVICU (81%) and intubated (84%). Mean gestational age was 36 ± 3 weeks and median age (interquartile range) at time of CPR was 30 (16-96) days. An ETCO2 between 17 and 18 mmHg correlated with the highest sensitivity and specificity for return of a HR > 60 bpm. Area under the curve for the ROC is 0.835. Conclusions This study provides critical clinical information regarding correlation between ETCO2 values and an adequate rise in heart rate in neonates and young infants during CPR. Quantitative ETCO2 monitoring allows CPR to progress uninterrupted without need to pause to check heart rate every 60 seconds until the critical ETCO2 threshold is reached. Quantitative ETCO2 monitoring as an adjunct to cardiac monitoring during infant CPR might enhance perfusion and improve outcomes.
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Affiliation(s)
| | - Josh Koch
- Division of Cardiac Critical Care, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - L. Steven Brown
- Department of Health System Research, Parkland Memorial Hospital, Dallas, TX, USA
| | - Lina Chalak
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishal Kapadia
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myra H. Wyckoff
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Ashtekar S, Mishra S, Kapadia V, Nag P, Singh G. Workplace Heat Exposure Management in Indian Construction Workers Using Cooling Garment. Workplace Health Saf 2018; 67:18-26. [PMID: 30303042 DOI: 10.1177/2165079918785388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Construction workers are at high risk of heat-related illnesses during summer months in India. The personal cooling garment (PCG) is a microclimate assistive device that provides protection from heat stress. The applicability and efficacy of wearing PCG for the physiological and subjective responses were tested on 29 healthy construction workers at actual field worksites. During the test, the climatic conditions were 103.64 ± 38.3°F dry bulb temperature, 41.2 ± 13.4% relative humidity, and wet bulb globe temperature 91.43 ± 39.92°F. Mean weighted skin temperature was significantly lowered by 38.66 ± 33.98°F when wearing PCG as compared with wearing habitual clothing (HC), 32.36 ± 33.44°F ( p < .05). Mean sweat loss was also significantly lower when wearing PCG: 0.365 ± 0.257 kg as compared with wearing HC: 0.658 ± 0.342 kg ( p < .05). Heart rate, along with back and chest skin temperatures were significantly reduced with wearing PCG. The present study suggests that PCG provides an affordable way of alleviating the discomfort and physiological strain caused by environmental heat exposure.
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Affiliation(s)
| | | | | | - Pranab Nag
- 1 National Institute of Occupational Health (ICMR)
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22
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Abstract
Oxygen has been used to stabilize newborn infants for more than a century. Over the last two decades, a paradigm shift towards using less oxygen has occurred but without firm evidence of benefit. Using lower levels of oxygen has also added new conundrums to clinical care. Can oxygen delivery to sick newborn babies meet the Goldilocks principle, of being "just right"? This review discusses the history of oxygen use in the delivery room and the impetus to change from the long-established practice of using pure oxygen to using lower oxygen concentrations. The review also highlights knowledge gaps, particularly for oxygen exposure and monitoring, as well as the sequelae of oxygen administration, including short- and long-term outcomes.
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Affiliation(s)
- Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, Texas, USA
| | - Yacov Rabi
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
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23
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Abstract
Oxygen is the most commonly used medicine used during neonatal resuscitation in the delivery room. Oxygen therapy in delivery room should be used judiciously to avoid oxygen toxicity while delivering sufficient oxygen to prevent hypoxia. Measurement of appropriate oxygenation relies on pulse oximetry, but adequate ventilation and perfusion are equally important for oxygen delivery. In this article, we review oxygenation while transitioning from fetal to neonatal life, the importance of appropriate oxygen therapy, its measurement in the delivery room, and current recommendations for oxygen therapy and its limitations.
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Affiliation(s)
- Vishal Kapadia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
| | - Myra H Wyckoff
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA
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24
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Oei JL, Vento M, Rabi Y, Wright I, Finer N, Rich W, Kapadia V, Aune D, Rook D, Tarnow-Mordi W, Saugstad OD. Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: a meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017; 102:F24-F30. [PMID: 27150977 DOI: 10.1136/archdischild-2016-310435] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 01/04/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review outcomes of infants ≤28+6 weeks gestation randomised to resuscitation with low (≤0.3) vs high (≥0.6) fraction of inspired oxygen (FiO2) at delivery. DESIGN Systematic review of randomised controlled trials of low (≤0.3) vs high (≥0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants ≤28+6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. MAIN OUTCOME MEASURES Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). RESULTS A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). CONCLUSIONS There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (≤0.30) or higher (≥0.6) FiO2 in infants ≤28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.
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Affiliation(s)
- Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Maximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Yacov Rabi
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Ian Wright
- Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia
| | - Neil Finer
- Department of Pediatrics, Neonatology, University of California, San Diego, California, USA.,Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Wade Rich
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Denise Rook
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Ola D Saugstad
- Department of Pediatric Research, University of Oslo, Oslo University Hospital, Oslo, Norway
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25
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Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) has examined the effects of various obstetrical perinatal interventions and neonatal delivery room practices on the newborn with particular focus on those born preterm. Studies exploring the effects and safety of various antepartum maternal medications and the effects of the route and timing of delivery are examined. The NRN has contributed key studies to the evidence base for the International Liaison Committee on Resuscitation neonatal resuscitation guidelines. These studies are reviewed including research on timing of cord clamping, the importance of maintaining euthermia immediately after birth, delivery room ventilation strategies, outcomes following delivery room cardiopulmonary resuscitation, and the effects of prolonged resuscitation efforts. In addition, the NRN's detailed outcome data at the lowest gestational ages have greatly influenced on how providers counsel families regarding the appropriateness of resuscitation efforts at the lowest gestational ages.
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Affiliation(s)
- Sanjay Chawla
- Wayne State University, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 3901 Beaubien Street, Detroit, Michigan 48201, Phone: (313)745-5638, Fax: (313) 745-5867
| | - Elizabeth Foglia
- The University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Division of Neonatology, 3400 Spruce Ave, 8th Floor Ravdin Building, Phone: (216) 662-3228, Fax: (215) 349-8831
| | - Vishal Kapadia
- The University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9063, Phone: (214) 648-3753, Fax: (214) 648-2481
| | - Myra Wyckoff
- The University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9063, Phone: (214) 648-3753, Fax: (214) 648-2481,Corresponding Author: Phone: (214) 648-3753, Fax: (214) 648-2481,
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Habibian M, Batra R, Gunter H, Aroney G, Sweeny A, Kapadia V, Essack N, Rahman A. Five Years of Sustained Success. Small Changes Can Make Huge Difference in Pneumothorax Prevention. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.344] [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: 10/21/2022]
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27
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Habibian M, Sweeny A, Batra R, Jayasinghe R, Kapadia V, Gunter H, Milne J, Niranjan S, Rahman A. Time to Angiography for NSTEMI Patients. 72% within 72hours, but We Can Still do Better! Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.153] [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: 10/21/2022]
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28
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Shirish A, Kapadia V, Kumar S, Kumar S, Mishra S, Singh G. Effectiveness of a cooling jacket with reference to physiological responses in iron foundry workers. Int J Occup Saf Ergon 2016; 22:487-493. [PMID: 27229302 DOI: 10.1080/10803548.2016.1181484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 10/21/2022]
Abstract
Personal cooling garments (PCGs) have gained increased attention in recent years due to heat stress and strain in the working environment. The present study was conducted in hot environments of an iron foundry to evaluate the efficacy of a battery-operated PCG. Twenty-four workers were exposed to climatic conditions of 35.89 ± 1.25 °C, 35% relative humidity during 90-min work with PCG and habitual clothing (HC). Mean weighted skin temperature was significantly lower by 4.84 ± 1.05 °C compared with HC 0.38 ± 1.02 °C (p < 0.05). A statistically significant difference was also observed for 0.492 ± 0.26 g mean sweat loss in the PCG group compared with 0.775 ± 0.42 g in the HC group (p < 0.05). Heart rate, and back and chest skin temperatures were comparatively more reduced in the PCG group compared with the HC group. PCG provides a practical and economical way of alleviating the physiological effects of heat stress when environmental control is not feasible.
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Affiliation(s)
| | - Vishal Kapadia
- a National Institute of Occupational Health (ICMR) , India
| | - Sanjeev Kumar
- a National Institute of Occupational Health (ICMR) , India
| | - Sunil Kumar
- a National Institute of Occupational Health (ICMR) , India
| | - Sukhdev Mishra
- a National Institute of Occupational Health (ICMR) , India
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29
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Saugstad OD, Aune D, Aguar M, Kapadia V, Finer N, Vento M. Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks. Acta Paediatr 2014; 103:744-51. [PMID: 24716824 DOI: 10.1111/apa.12656] [Citation(s) in RCA: 25] [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: 05/26/2013] [Revised: 02/06/2014] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Abstract
AIM The optimal initial fraction of oxygen (iFiO2 ) for resuscitating/stabilising premature infants is not known. We aimed to study currently available information and provide guidelines regarding the iFiO2 levels needed to resuscitate/stabilise premature infants of ≤32 weeks' gestation. METHODS Our systematic review and meta-analysis studied the effects of low and high iFiO2 during the resuscitation/stabilisation of 677 newborn babies ≤32 weeks' gestation. RESULTS Ten randomised studies were identified covering 321 infants receiving low (0.21-0.30) iFiO2 levels and 356 receiving high (0.60-1.0) levels. Relative risk for mortality was 0.62 (95% CI: 0.37-1.04, I(2) = 0%, p(heterogeneity) = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95% CI: 0.73-1.68, I(2) = 46%, p(heterogeneity) = 0.06); and for intraventricular haemorrhage, it was 0.90 (95% CI: 0.53-1.53, I(2) = 9%, p(heterogeneity) = 0.36). CONCLUSION These data show that reduced mortality approached significance when a low iFiO2 (0.21-0.30) was used for initial stabilisation, compared to a high iFiO2 (0.60-1.0). There was no significant association for bronchopulmonary dysplasia or intraventricular haemorrhage when comparing low and high iFiO2 . Based on present data, premature babies ≤32 weeks' gestation in need of stabilisation in the delivery room should be given an iFiO2 of 0.21-0.30.
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Affiliation(s)
- Ola Didrik Saugstad
- Division of Women and Children's Health; Department of Pediatric Research; Oslo University Hospital; Rikshospitalet and University of Oslo; Oslo Norway
| | - Dagfinn Aune
- Department of Epidemiology and Public Health; Imperial College; London UK
| | - Marta Aguar
- Division of Neonatology and Health Research Institute; University and Polytechnic Hospital La Fe; Valencia Spain
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine; Department of Pediatrics; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Neil Finer
- Division of Neonatology; University of California San Diego Medical Centre; San Diego CA USA
- Aarhus University Hospital; Aarhus University; Aarhus Denmark
| | - Maximo Vento
- Division of Neonatology and Health Research Institute; University and Polytechnic Hospital La Fe; Valencia Spain
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30
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Abstract
When effective ventilation fails to establish a heart rate of greater than 60 bpm, cardiac compressions should be initiated to improve perfusion. The 2-thumb method is the most effective and least fatiguing technique. A ratio of 3 compressions to 1 breath is recommended to provide adequate ventilation, the most common cause of newborn cardiovascular collapse. Interruptions in compressions should be limited to not diminishing the perfusion generated. Oxygen (100%) is recommended during compressions and can be reduced once adequate heart rate and oxygen saturation are achieved. Limited clinical data are available to form newborn cardiac compression recommendations.
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Affiliation(s)
- Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA
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31
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Abstract
Prenatal closure of the ductus arteriosus (DA) is associated with maternal ingestion of cyclooxygenase inhibitors during pregnancy. We report a case of prenatal DA closure after maternal ingestion of MonaVie, a juice blend containing the cyclooxygenase and nitric oxide synthase inhibitors anthocyanins and proanthocyanidins. A G(2)P(0)Ab(1) woman had an uncomplicated first and second trimester and normal 20-week fetal ultrasound. At 37 weeks, she developed polyhydramnios; a fetal echocardiogram showed right atrial and ventricular (RV) enlargement with RV dysfunction. Immediately after birth, there was pulmonary hypertension by echocardiogram with DA closure, severe RV hypertrophy and dysfunction, and marked right-to-left atrial shunting. Improvement occurred over 3 weeks with the neonate tolerating room air and a follow-up echocardiogram showing minimal atrial shunting and improved RV function. This report shows an association between MonaVie ingestion throughout pregnancy and prenatal DA closure resulting in cardiac dysfunction and pulmonary hypertension at birth.
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Affiliation(s)
- V Kapadia
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
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McKenzie S, Trikilis M, Rahman A, Batra R, Essack N, Aroney G, Kapadia V, Jayasinghe R. The Frequency and Manner of Presentation of Anomalous Coronary Artery Origin in an Unselected Australian Population Undergoing Coronary Angiography. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.750] [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: 11/12/2022]
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Batra R, Mishra A, Jayasinghe R, Bissessor N, Kapadia V, Rahman A, Aroney G, Sedgwick J. Results in complex multivessel and multilesion percutaneous coronary intervention in patients treated with a combination of drug eluting stents and bare metal stents in real world practice. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.078] [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: 11/17/2022]
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Abstract
We evaluated the outcome of a case-finding programme resulting from an epidemiological survey on diabetes and cardiovascular risk factors by re-interviewing 318 persons who had been found to have hypertension and/or diabetes mellitus in a population survey carried out in Fiji 1.5 years earlier in 1980. At re-examination, 34% of the hypertensive patients and 43% of the diabetic patients were not aware of their diagnosis. However, the proportion of treated hypertensive people was tripled and that of diabetic patients doubled. It was not possible to identify the characteristics of the persons who were missed in the follow-up. Many persons who were unaware of their condition regularly used, however, the existing health services available. On the other hand, several initially treated cases had no proper follow-up. More careful planning and development of comprehensive community-based programmes for hypertension and diabetes are needed in Fiji. Simple population screening for hypertension and diabetes may result in an extra work load and limit the available health care resources so that the overall outcome is not satisfactory.
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Affiliation(s)
- J Tuomilehto
- Department of Epidemiology, National Public Health Institute, Helsinki, Finland
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