1416: IMPACT OF FLUID RESUSCITATION IN PULMONARY HYPERTENSION WITH SEPSIS ON RESPIRATORY SUPPORT

Abstract Objective The respiratory severity score (RSS) has been demonstrated to be associated with the oxygenation index in intubated newborn infants. We aimed to evaluate the usefulness of RSS with regard to birthweight (BW) in preterm infants for predicting an association with future pulmonary hypertension (PH). Methods Preterm infants with <30 weeks’ gestation and <1250 g BW were reviewed and grouped into two (PH vs. no PH). Basic perinatal characteristics, comorbidities and parameters reflecting lung condition, including duration of invasive mechanical ventilator care, were compared. Respiratory support parameters (FiO2, RSS and RSS/kg) during the first 5 days of birth (0–120 h) were compared between the groups, and receiver operating characteristics curves were produced to evaluate the association with PH. Results RSS/kg, of the three respiratory support parameters, demonstrated significantly higher values in the PH group in the early days of life. Particularly, RSS/kg at day 2 of life had the greatest area under the curve [0.762, 95% confidence interval (CI) 0.655–0.869, p < 0.001] and maintained statistical significance [odds ratio (OR) 1.352, 95% CI 1.055–1.732, p = 0.017] in the multivariable analysis for a potential association with PH, along with gestational age (OR 0.996, 95% CI 0.993–0.999, p = 0.015) and preterm premature rupture of membrane >18 h (OR 4.907, 95% CI 1.436–16.765, p = 0.011). Conclusion RSS/kg is a potential marker associated with the development of PH. Future studies could verify its usefulness as a reliable surrogate for predicting respiratory morbidity in clinical settings.

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Chronic Inflammatory Placental Lesions Correlate With Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants

Pediatric and Developmental Pathology ◽

10.1177/10935266211013625 ◽

2021 ◽

pp. 109352662110136

Author(s):

Amit Sharma ◽

Beena G Sood ◽

Faisal Qureshi ◽

Yuemin Xin ◽

Suzanne M Jacques

Keyword(s):

Pulmonary Hypertension ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Group Development ◽

Respiratory Support ◽

Placental Pathology ◽

Inflammatory Lesions ◽

Extremely Preterm ◽

Extremely Preterm Infants

Objective Correlation of BPD with placental pathology is important for clarification of the multifactorial pathogenesis of BPD; however, previous reports have yielded varying results. We report placental findings in no/mild BPD compared to moderate/severe BPD, and with and without pulmonary hypertension (PH). Methods Eligible infants were 230/7-276/7 weeks gestational age. BPD was defined by the need for oxygen at ≥28 days with severity based on need for respiratory support at ≥36 weeks. Acute and chronic inflammatory placental lesions and lesions of maternal and fetal vascular malperfusion were examined. Results Of 246 eligible infants, 146 (59%) developed moderate/severe BPD. Thirty-four (23%) infants developed PH, all but 1 being in the moderate/severe BPD group. Chronic deciduitis (32% vs 16%, P = .003), chronic chorioamnionitis (23% vs 12%, P = .014), and ≥ 2 chronic inflammatory lesions (13% vs 3%, P = .007) were more frequent in the moderate/severe BPD group. Development of PH was associated with placental villous lesions of maternal vascular malperfusion (30% vs 15%, P = .047). Conclusions The association of chronic inflammatory placental lesions with BPD severity has not been previously reported. This supports the injury responsible for BPD as beginning before birth in some neonates, possibly related to cytokines associated with these chronic inflammatory lesions.

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A Comprehensive Study of Clinical Biomarkers, Use of Inotropic Medications and Fluid Resuscitation in Newborns with Persistent Pulmonary Hypertension

Pediatric Cardiology ◽

10.1007/s00246-014-0992-5 ◽

2014 ◽

Vol 36 (1) ◽

pp. 233-239 ◽

Cited By ~ 2

Author(s):

Janardhan Mydam ◽

Marwan Zidan ◽

Nitin Shashikant Chouthai

Keyword(s):

Pulmonary Hypertension ◽

Fluid Resuscitation ◽

Persistent Pulmonary Hypertension ◽

Clinical Biomarkers ◽

Comprehensive Study

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Ocular hypotonia following pulmonary endarterectomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz269 ◽

2019 ◽

Vol 57 (5) ◽

pp. 1001-1002

Author(s):

Muhammad U Rafiq ◽

Maksym Kovzel ◽

Jason M Ali

Keyword(s):

Pulmonary Hypertension ◽

Clinical Sign ◽

Fluid Resuscitation ◽

Fluid Balance ◽

Complete Resolution ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Visual Disturbance ◽

Pulmonary Endarterectomy ◽

Fluid Removal ◽

Thromboembolic Pulmonary Hypertension

Abstract Significant fluid removal and negative fluid balance is typical of the management of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. In this study, we describe severe ocular hypotonia as an unusual clinical sign in a 72-year-old man immediately following pulmonary endarterectomy. Complete resolution occurred with fluid resuscitation overnight and no residual visual disturbance was reported.

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Massive Fluid Resuscitation Is Required in Neonates with Primary Pulmonary Hypertension

Pediatric Research ◽

10.1203/00006450-199904020-01245 ◽

1999 ◽

Vol 45 (4, Part 2 of 2) ◽

pp. 209A-209A

Author(s):

B Mahmood ◽

A Varma ◽

U P Devaskar

Keyword(s):

Pulmonary Hypertension ◽

Fluid Resuscitation ◽

Primary Pulmonary Hypertension ◽

Massive Fluid

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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