A comparison of methods of discontinuing nasal CPAP in premature infants <30 weeks gestation: a feasibility study

Abstract Premature infants and their parents experience significant stress during the perinatal period. Music therapy (MT) may support maternal–infant bonding during this critical period, but studies measuring impact across the infant’s first year are lacking. This nonrandomized feasibility study used quantitative and qualitative methods within a critical realist perspective to evaluate the feasibility, acceptability, and suitability of the treatment arm of the Longitudinal Study of music Therapy’s Effectiveness for Premature infants and their caregivers (LongSTEP) (NCT03564184) trial with a Norwegian cohort (N = 3). Families were offered MT emphasizing parent-led infant-directed singing during neonatal intensive care unit (NICU) hospitalization and across 3 months post-discharge. We used inductive thematic analysis of semi-structured interviews with parents at discharge from NICU and at 3 months and analyzed quantitative variables descriptively. Findings indicate that: (1) parents of premature infants are willing to participate in MT research where parental voice is a main means of musical interaction; (2) parents are generally willing to engage in MT in NICU and post-discharge phases, finding it particularly interesting to note infant responsiveness and interaction over time; (3) parents seek information about the aims and specific processes involved in MT; (4) the selected self-reports are reasonable to complete; and (5) the Postpartum Bonding Questionnaire appears to be a suitable measure of impaired maternal–infant bonding. Parents reported that they were able to transfer resources honed during MT to parent–infant interactions outside MT and recognized parental voice as a central means of building relation with their infants. Results inform the implementation of a subsequent multinational trial that will address an important gap in knowledge.

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Comparison of Methods for Estimating Fecal Carbohydrate Excretion in Premature Infants

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-199310000-00008 ◽

1993 ◽

Vol 17 (3) ◽

pp. 276-282 ◽

Cited By ~ 2

Author(s):

C. Lawrence Kien ◽

Richard E. McClead ◽

Jonathan Kepner ◽

Karen Grotjohn

Keyword(s):

Premature Infants ◽

Comparison Of Methods

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New technics of surfactant instillation therapy during nasal-CPAP in premature infants

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/s-2008-1078775 ◽

2008 ◽

Vol 212 (S 1) ◽

Author(s):

M Nelle ◽

S Minocchieri

Keyword(s):

Premature Infants ◽

Nasal Cpap ◽

Instillation Therapy

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Autologous transplantation of umbilical cord blood-derived cells in extreme preterm infants: protocol for a safety and feasibility study

BMJ Open ◽

10.1136/bmjopen-2019-036065 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036065

Author(s):

Atul Malhotra ◽

Iona Novak ◽

Suzanne Lee Miller ◽

Graham Jenkin

Keyword(s):

Brain Injury ◽

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Feasibility Study ◽

Premature Infants ◽

Umbilical Cord Blood ◽

Mononuclear Cells ◽

Autologous Transplantation ◽

Intravenous Route

IntroductionPreterm brain injury continues to be an important complication of preterm birth, especially in extremely premature infants. Umbilical cord blood-derived cells (UCBCs) are increasingly being evaluated for their neuroprotective and neuroreparative properties in preclinical and clinical studies. There remains a paucity of information on the feasibility and safety of autologous UCBC transplantation in extremely premature infants.Methods and analysisA single centre safety and feasibility study in preterm babies born before 28 weeks gestation. Cord blood will be collected after birth and if sufficient blood is obtained, UCB mononuclear cells will be harvested from the cord blood, characterised and stored. After excluding infants who have already suffered severe preterm brain injury, based on cranial ultrasounds in first week of life, preterm infants will be infused with autologous UCBCs via the intravenous route at a dose of 25–50 million UCBCs/kg body weight of live cells, with the cell number being the maximum available up to 50 million cells/kg. A minimum of 20 infants will be administered autologous UCBCs. Primary outcomes will include feasibility and safety. Feasibility will be determined by access to sufficient cord blood at collection and UCBCs following processing. Safety will be determined by lack of adverse events directly related to autologous UCBC administration in the first few days after cell administration. Secondary outcomes studied will include neonatal and neurodevelopmental morbidities till 2 years of life. Additional outcomes will include cell characteristics of all collected cord blood, and cytokine responses to cell administration in transplanted infants till 36 weeks’ corrected age.Ethics and disseminationMonash Health Human Research Ethics Committee approved this study in December 2019. Recruitment is to commence in July 2020 and is expected to take around 12 months. The findings of this study will be disseminated via peer-reviewed journals and at conferences.Trial registration numberACTRN12619001637134.

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Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants

Journal of Applied Physiology ◽

10.1152/jappl.1990.68.1.141 ◽

1990 ◽

Vol 68 (1) ◽

pp. 141-146 ◽

Cited By ~ 63

Author(s):

M. J. Miller ◽

J. M. DiFiore ◽

K. P. Strohl ◽

R. J. Martin

Keyword(s):

Continuous Positive Airway Pressure ◽

Preterm Infants ◽

Premature Infants ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Nasal Airflow ◽

Pulmonary Resistance ◽

Nasal Cpap ◽

Primary Mechanism ◽

Postconceptional Age

The effects of continuous positive airway pressure (CPAP) on supraglottic and total pulmonary resistance were determined in 10 healthy premature infants (postconceptional age 34 +/- 2 wk, weight at study 1,628 +/- 250 g). Nasal airflow was measured with a mask pneumotachograph, and pressures in the esophagus and oropharynx were measured with a 5-Fr Millar or fluid-filled catheter. Nasal CPAP between 0 and 5 cmH2O correlated well with oropharyngeal pressure (r = 0.94). Total supraglottic resistance, total pulmonary resistance, and supraglottic resistance in inspiration and expiration were measured on increasing CPAP. Total supraglottic resistance decreased from 46 +/- 29 to 17 +/- 16 cmH2O.l-1.s (P less than 0.005) between 0 and 5 cmH2O CPAP, and a delay in return of resistance to control values was seen as CPAP was reciprocally decreased to 0. CPAP produced a decrease in supraglottic resistance in both inspiration and expiration, from 41 +/- 26 to 14 +/- 9 and from 33 +/- 17 to 10 +/- 6 cmH2O.l-1.s, respectively (P less than 0.01). Total pulmonary resistance also decreased from 161 +/- 40 to 95 +/- 24 cmH2O.l-1.s (P less than 0.01) between 0 and 5 cmH2O CPAP. The decrease in total supraglottic resistance in these infants accounted for 60% of the change in total pulmonary resistance, which occurred on CPAP of 5 cmH2O. We speculate that CPAP may decrease supraglottic resistance directly through mechanical splinting of the airway. This effect of CPAP may be the primary mechanism by which this form of therapy reduces apnea with an obstructive component in premature infants.

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