<b><i>Introduction:</i></b> Currently, INSURE (Intubation-Surfactant-Extubation) and LISA (Less Invasive Surfactant Administration) are two recommended techniques for surfactant delivery to newborns with respiratory distress syndrome. The aim of this study was to evaluate the feasibility, safety, tolerability of a new technique of surfactant administration in newborns without anesthesia or laryngoscopy: Fiberscope Assisted Surfactant Therapy (FAST). <b><i>Methods:</i></b> This monocentric, prospective, nonrandomized, pilot feasibility study was conducted from January to December 2021. Spontaneously breathing infants born ≥28 weeks gestational age with respiratory distress syndrome received surfactant by a 1.5 French catheter inserted in the trachea using a flexible endoscope without anesthesia, while maintaining a continuous positive expiratory pressure. The learning curve of this new technique by caregivers was studied during training sessions on high fidelity mannequins. <b><i>Results:</i></b> Eight infants born ≥28 weeks of gestation with a birth weight of 1,000 g–2,685 g were included in the study. FAST was successfully performed in each case without anesthesia, second dose of surfactant or mechanical ventilation. One hour after FAST, a decrease of FiO<sub>2</sub> and PCO<sub>2</sub> and an increase of arterial pressure and pH were recorded with medians of individual differences of −0.9, −4 mm Hg, 6.5 mm Hg, and 0.06, respectively. The learning curves of 13 physicians showed a rapid mastery of FAST from the third attempt onwards (mean duration of 113, 66, and 50 s for 1st, 2nd, and 3rd attempts, respectively, 29–37 s for further attempts). <b><i>Conclusion:</i></b> FAST may be considered as a possible new minimally invasive surfactant therapy technique for neonates ≥28 weeks with mild respiratory distress syndrome.
Active ending of the life of a newborn baby is a crime. Yet its clandestine practise is a reality in several European countries. In this paper, we defend the necessity to institute a proper legal frame for what we define as active neonatal euthanasia. The only legal attempt so far, the Dutch Groningen protocol, is not satisfactory. We critically analyse this protocol, as well as several other clinical practises and philosophical stances. Furthermore, we have tried to integrate our opinions as clinicians into a law project, with the purpose of pinpointing several issues, specific of perinatality that should be addressed by such a law. In conclusion, we argue that the legalisation of neonatal euthanasia under exceptional circumstances is the only way to avoid all the "well-intentioned" malpractices associated with ending life at the very dawn of it.
Some dramatic clinical situations, rare yet recurrent such as perinatal asphyxia, open the door to the taboo issue of active ending of life of newborn babies. Law and morals explicitely forbid it, while they both open their arms to the booming neonatal palliative care. Yet this taboo leads to two paradoxes. Some of these babies will die, in due palliative care, despite their parents’ fierce will to support their handicap. Whereas other babies will survive in awful conditions, to the great dismay of their parents and the medical team which are both deprived of the “liberty” of offering death. In these exceptional circumstances, the limit between therapeutic obstinacy, palliative care and active end-of-life is indeed particularly blurred. Through a clinical case, we try to shed light onto these extremely complex ethical questions arising at the very dawn of life.
Abstract Interleukin (IL)‐23 is a heterodimeric cytokine of the IL‐12 family. Human IL‐23 is known to induce interferon (IFN)‐γ production and proliferation in T cells, preferentially in the CD45RO + memory subset. Yet, its role in the differentiation of human naive T cells remains largely unknown. We investigated the effect of recombinant human (rh)IL‐23 on cord blood CD4 + and CD8 + T cells during polyclonal activation. The IL‐23 receptor complex was not detectable in resting naive T cells. Nevertheless, both IL‐23 receptor subunits, IL‐12Rβ1 and IL‐23R, were rapidly induced after activation in both naive CD4 + and CD8 + T cells. In both cell types, rhIL‐23 enhanced IFN‐γ production. This effect was demonstrable as early as 2 days after activation, illustrating that a functional IL‐23 receptor is rapidly induced in naive T cells upon activation. In naive CD8 + T cells, rhIL‐23 specifically induced the secretion of IL‐17, a pro‐inflammatory cytokine. Moreover, rhIL‐23 significantly increased the production of IL‐10 in both naive CD4 + and CD8 + T cells. IL‐17 and IL‐10 levels were not affected by the addition of rhIL‐12. We conclude that IL‐23 induces a specific cytokine profile, remarkably distinct from IL‐12, in activated human naive T cells.
