Impaired hemodynamics in neonatal sepsis increase the mortality.
Objective
Studying the changes in hemodynamics and peripheral perfusion in premature infants with suspected sepsis and comparing them with stable matched controls.
Methods
Left (LVO) and right ventricular output (RVO), and superior vena cava (SVC) flow were measured using echocardiography in newborn infants with suspected sepsis after DOL 7. Measurements were repeated 3 times q 24 h and when antibiotics were discontinued. Anterior cerebral artery RI and oxygenation of the brain and the kidney were measured by near infrared spectroscopy (NIRS). Vital parameters were monitored. Controls were studied once; matched with cases for GA, BW, and postnatal age.
Results
Twelve preterm infants (GA 26.8 ± 2.5 wks; BW 843 ± 225 g) were studied at postnatal age 13.5 (7- 60) days and compared to 12 stable matched controls. Four cases had a positive blood culture, six had an elevated CrP, and 2 had an elevated IL8 only. LVO showed an increase over time reaching a maximum of 404 ± 104 ml/kg/min on the 3rd measurement point (p = 0.046 compared to the 1st measurement) and was higher compared to controls (p = 0.04). SVC flow showed a trend towards increase over time. The control group had a higher SVC flow at the initial measurement (p = 0.05). No significant change in RVO, NIRS, Doppler parameters, and in blood pressure over time or compared to controls, although five cases required circulatory support either by volume therapy, catecholamines or both.
Conclusions
Suspected sepsis was associated with haemodynamic changes which may have implications for clinical management.
Background Surveys from the USA, Australia and Spain exemplify wide variations in airway management of very low birth weight infants (VLBW) at birth. No data was available from German speaking countries under the GNPI directive. We sought to investigate the airway management in the delivery room (DR) management of very low birth weight neonates (VLBW) in Germany (D), Switzerland (CH) and Austria (A). Methods Data on airway management of VLBW in the DR was obtained in a prospective, questionnaire-based international survey. Results In total 249 units were approached, recall rate: 75.4%. Management guidelines existed in 94% of units. Statistically significant differences were found regarding the provision of 24hr neonatal service: D 96.8%, A 100%, CH 84.0% (p=0.014); use of devices for respiratory support: self-inflating bags (SI-bags): D 98.3%; A 80.0% and CH 76.9% (p=0.0001); flow-inflating bags D 1.7%, A 20.0%, CH 23.1% (p=0.0001); use of pressure-controlled manual ventilation devices (Perivent®): D 41.7%; A 81.8%; 20.0% (P=0.002); pressure control by respirator D 48.2%, Au 18.2%, CH 16.7% (p=0.003); and regarding dosage of Surfactant: D 100mg/kg (89.2%), A 100–200mg/kg (62.5%) and CH 100mg/kg (85.9%) (p=0.0001). No statistically significant differences were found regarding use and monitoring of oxygen and target oxygen saturation levels. Conclusion We found very heterogeneous protocols for the airway management of VLBW infants. Airway management of VLBW in German speaking countries is not always conform to recommendations given by ILCOR. Methods should be refined to distribute and incorporate the best available evidence from clinical research without delay into the care of VLBW infants.
Preterm infants must establish regular respirations at delivery. Sustained inflations may establish lung volume faster than short inflations.
Objective
To determine whether a ventilation strategy including sustained inflations, compared with standard intermittent positive pressure ventilation, reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks' postmenstrual age without harm in extremely preterm infants.
Design, Setting, and Participants
Unmasked, randomized clinical trial (August 2014 to September 2017, with follow-up to February 15, 2018) conducted in 18 neonatal intensive care units in 9 countries. Preterm infants 23 to 26 weeks' gestational age requiring resuscitation with inadequate respiratory effort or bradycardia were enrolled. Planned enrollment was 600 infants. The trial was stopped after enrolling 426 infants, following a prespecified review of adverse outcomes.
Interventions
The experimental intervention was up to 2 sustained inflations at maximal peak pressure of 25 cm H2O for 15 seconds using a T-piece and mask (n = 215); standard resuscitation was intermittent positive pressure ventilation (n = 211).
Main Outcome and Measures
The primary outcome was the rate of BPD or death at 36 weeks' postmenstrual age. There were 27 prespecified secondary efficacy outcomes and 7 safety outcomes, including death at less than 48 hours.
Results
Among 460 infants randomized (mean [SD] gestational age, 25.30 [0.97] weeks; 50.2% female), 426 infants (92.6%) completed the trial. In the sustained inflation group, 137 infants (63.7%) died or survived with BPD vs 125 infants (59.2%) in the standard resuscitation group (adjusted risk difference [aRD], 4.7% [95% CI, −3.8% to 13.1%];P = .29). Death at less than 48 hours of age occurred in 16 infants (7.4%) in the sustained inflation group vs 3 infants (1.4%) in the standard resuscitation group (aRD, 5.6% [95% CI, 2.1% to 9.1%];P = .002). Blinded adjudication detected an imbalance of rates of early death possibly attributable to resuscitation (sustained inflation: 11/16; standard resuscitation: 1/3). Of 27 secondary efficacy outcomes assessed by 36 weeks' postmenstrual age, 26 showed no significant difference between groups.
Conclusions and Relevance
Among extremely preterm infants requiring resuscitation at birth, a ventilation strategy involving 2 sustained inflations, compared with standard intermittent positive pressure ventilation, did not reduce the risk of BPD or death at 36 weeks' postmenstrual age. These findings do not support the use of ventilation with sustained inflations among extremely preterm infants, although early termination of the trial limits definitive conclusions.
<b><i>Introduction:</i></b> There is uncertainty and lack of consensus regarding optimal management of patent ductus arteriosus (PDA). We aimed to determine current clinical practice in PDA management across a range of different regions internationally. <b><i>Materials and Methods:</i></b> We surveyed PDA management practices in neonatal intensive care units using a pre-piloted web-based survey, which was distributed to perinatal societies in 31 countries. The survey was available online from March 2018 to March 2019. <b><i>Results:</i></b> There were 812 responses. The majority of clinicians (54%) did not have institutional protocols for PDA treatment, and 42% reported variable management within their own unit. Among infants <28 weeks (or <1,000 g), most clinicians (60%) treat symptomatically. Respondents in Australasia were more likely to treat PDA pre-symptomatically (44% vs. 18% all countries [OR 4.1; 95% CI 2.6–6.5; <i>p</i> < 0.001]), and respondents from North America were more likely to treat symptomatic PDA (67% vs. 60% all countries [OR 2.0; 95% CI 1.5–2.6; <i>p</i> < 0.001]). In infants ≥28 weeks (or ≥1,000 g), most clinicians (54%) treat symptomatically. Respondents in North America were more likely to treat PDAs in this group of infants conservatively (47% vs. 38% all countries [OR 2.3; 95% CI 1.7–3.2; <i>p</i> < 0.001]), and respondents from Asia were more likely to treat the PDA pre-symptomatically (21% vs. 7% all countries [OR 5.5; 95% CI 3.2–9.8; <i>p</i> < 0.001]). <b><i>Discussion/Conclusion:</i></b> There were marked international differences in clinical practice, highlighting ongoing uncertainty and a lack of consensus regarding PDA management. An international conglomeration to coordinate research that prioritises and addresses these areas of contention is indicated.
To assess the efficacy of a newly developed system for closed loop control of the fraction of inspired oxygen (FiO2) on variation of arterial (SpO2) and on regional tissue oxygen saturation (StO2) in preterm infants with fluctuations in SpO2.Randomised crossover trial comparing automated (auto) to manual FiO2 adjustment (manual) during two consecutive 24 hours periods using a Sophie infant ventilator (SPO2C).Tertiary university medical centre.Twelve very low birthweight infant (VLBWI) (gestational age (median; IQR): (25; 23-26 weeks); birth weight (mean±SD): (667±134 g); postnatal age (mean±SD): (31.5±14 days)).Time within SpO2 target range.There was an increase in time within the intended SpO2 target range (88%-96%) during auto as compared with manual mode (77.8%±7.1% vs 68.5%±7.7% (mean±SD), p<0.001) and a decrease in time below the SpO2 target during the auto period (18.1%±6.4% vs 25.6%±7.6%; p<0.01). There was a dramatic reduction in events with an SpO2 <88% with >180 s duration: (2 (0-10) vs 10 (0-37) events, p<0.001) and the need for manual adjustments. The time the infants spent above the intended arterial oxygen range (4.1%±3.8% vs 5.9%±3.6%), median FiO2, mean SpO2 over time and StO2 in the brain, liver and kidney did not differ significantly between the two periods.Closed-loop FiO2 using SPO2C significantly increased time of arterial SpO2 within the intended range in VLBWI and decreased the need for manual adjustments when compared with the routine adjustment by staff members. StO2 was not significantly affected by the mode of oxygen control.
Aufgrund verbesserter medizinischer Versorgung überleben heute immer mehr extrem Frühgeborene und haben Chancen auf ein Leben ohne Behinderung. Allerdings darf das Risiko langfristiger Entwicklungsstörungen nicht unterschätzt werden. In dieser Studie wurden 79 von 105 Kinder (75 %), die zwischen 1999 und 2003 vor vollendeter 25. Schwangerschaftswoche in zwei Perinatalzentren geboren wurden, im Alter von 7 bis 10 Jahren standardisiert nachuntersucht hinsichtlich neurologischer, körperlicher, kognitiver Fähigkeiten, schulischer Leistungen, Verhalten und Förderbedarf. Im Mittel lag der Gesamt-IQ bei 87, bei 38 % unter 85. Knapp die Hälfte der Kinder besuchte keine Regelschule. Neben Entwicklungsverzögerungen (64 %) traten gehäuft Entwicklungsstörungen schulischer Fertigkeiten (30 %), Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (17 %) und Autismus-Spektrum-Erkrankungen (6 %) auf. Es bestand erhöhter medizinischer Therapie- sowie schulischer Förderbedarf. Bei extrem Frühgeborenen sind kognitive Einschränkungen, Verhaltensauffälligkeiten und Probleme der schulischen Adaptation häufig und erfordern langfristig Therapien und Fördermaßnahmen.
Background: Sidra Medicine is the first dedicated Children and Maternity hospital in the State of Qatar. This paper describes the preparations for and results of activating quaternary neonatal surgical services in a brand new, "greenfield" hospital. We believe that these are the first published national results of neonatal general surgical services from the Gulf region. Methods: A review of surgical babies below four weeks corrected age from 1st of April 2018 – 31st of March 2020 was undertaken. Patient demographics, primary diagnosis, surgical procedures, 30-day postoperative mortality, overall mortality, and cause of death were recorded. Results: One hundred and sixty-nine babies (169) were identified (44.4% term and 55.6% preterm). Major surgery included laparotomy (76), congenital diaphragmatic hernia repair (20), surgery for anorectal malformations (25), and esophageal atresia (13). One set of conjoined twins were also separated successfully. Fourteen babies died, resulting in overall mortality of 8.3 %. Excluding babies who died of life-limiting conditions, two babies died within 30 days of surgery, resulting in 30 days postoperative mortality rate of 1.2 %. Conclusions: The neonatal surgical mortality rate is comparable with those from top international centers. This low rate could be attributed to the high level of expertise preceded by months of preparations.
Standard neurosurgical procedures for hydrocephalus and open neural tube defects in newborns and infants under 6 months of age were performed by a single neurosurgeon on his own without the help of an assistant or scrub nurse. The objective of this study was to assess the outcome of these procedures in terms of operating time, the presence of bacterial infection, and wound healing. Between 2001 and 2004, a total of 126 procedures were performed on 82 patients under 6 months of age. We observed 1 bacterial and 2 fungal infections. Two infections had already been detected at the beginning of the surgical procedure in cerebrospinal fluid (CSF) specimens obtained from children with Candida ventriculitis. The other infection occurred after leakage of CSF from a myelomeningocele 10 days after initial surgery. Our study suggests that excellent results can be achieved in standard neurosurgical procedures without assistance even in high-risk newborns and infants if resource or other constraints require such an unconventional approach.
