Preventing extubation failure in preterm infants: nasal CPAP remains the standard of care

Abstract Background Worldwide 13 million babies born prematurely every year have increased susceptibility to infection and require adequate immunization. Hexavalent vaccines against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae type b are standard of care in pediatric vaccination and are particularly important for preterm infants. Hexyon® is registered in Europe since April 2013. Methods Considering birth data from official national databases and only countries with periods of exclusive use of Hexyon from 2013-19, we estimated the total number of preterm infants (<37weeks GA) vaccinated with Hexyon. Results Since registration, Hexyon has been used in 23 European countries and exclusively used in the following: Austria, Feb-2017 to present; Belgium, Jul-2014 (Flanders)/Sep-2015 (Overall) to present; Bulgaria, Nov-2014 to Dec-2016; Croatia, Jan-2016 to present; Denmark, Feb-2016 to Apr-2017; Italy, Apr-2016 to present, exclusivity based on Regions; Macedonia, Oct-2015 to present; Norway, Feb-2017 to present; Romania, Apr-2015 to Dec-2017. The estimated total number of preterm infants during these periods of exclusive use is 183 000. Assuming 90% vaccination coverage, ∼164 700 preterm infants received at least 1 dose of this vaccine. From the analysis of the post-marketing safety data available to date, no new risk has been identified in preterm infants. Conclusions Hexyon has become a standard for hexavalent immunization in infants, regardless of the gestational age at birth. More than 90 million doses have been administered worldwide, including the estimated 164 000 preterm infants in the 9 European countries considered here. The EU Marketing Authorization granted in 2013 with no contraindication for use in preterm infants, was renewed in 2018 and the black triangle was removed confirming that the safety of Hexyon is well established. The marketing authorization holder continues to support evidence generation for use in preterm infants. Key messages Hexyon/Hexacima/Hexaxim has become a standard for hexavalent immunization in infants including for preterm infants (<37weeks GA); around 164 000 preterm infants in 9 European countries received it. The safety of Hexyon/Hexacima/Hexaxim is well established, no new risk has been identified in preterm infants from the analysis of the post-marketing safety data available to date.

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Fifteen-minute consultation: ABCDE approach to nutritional assessment in preterm infants

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2020-320928 ◽

2021 ◽

pp. edpract-2020-320928

Author(s):

Nicholas D Embleton

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Systematic Approach ◽

Nutritional Assessment ◽

Standard Of Care ◽

Dietary Intakes ◽

Nutrient Delivery ◽

Metabolic Outcomes ◽

Early Parenteral Nutrition ◽

Mother’S Own Milk

The last 20 years has seen dramatic improvements in the survival of preterm infants due to improved antenatal and neonatal care. Closer attention to nutrition means early parenteral nutrition and mother’s own milk are considered as standard of care. Many uncertainties remain however, such as optimal macronutrient intakes for longer term cognitive and metabolic outcomes, and the optimal probiotic regime to reduce the risk of necrotising enterocolitis. Nutrition involves macronutrients and micronutrients, immunonutrients, microbiomic aspects and nutrient delivery. It is also clear that there are behavioural and psychological aspects, and strongly held beliefs for parents and professionals that affect practice. While many healthcare professionals (HCPs) are aware of several key nutritional concepts on the neonatal intensive care unit (NICU), many HCPs lack a concise, systematic approach. This article provides a brief approach to nutritional assessment for use on the NICU summarised as ABCDE: A—anthropometry, B—biochemistry, C—clinical, D—dietary intakes, E—environment and evaluation.

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PS-381 Nasal High Frequency Ventilation Is Not More Effective Than Noninvasive Ventilation To Prevent Extubation Failure In Very Preterm Infants

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-307384.679 ◽

2014 ◽

Vol 99 (Suppl 2) ◽

pp. A250.2-A250

Author(s):

AO Menshykova ◽

DO Dobryanskyy ◽

ZV Salabay ◽

YB Kuzminov

Keyword(s):

Preterm Infants ◽

Noninvasive Ventilation ◽

High Frequency ◽

Extubation Failure ◽

High Frequency Ventilation ◽

Very Preterm Infants ◽

Very Preterm ◽

Frequency Ventilation

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Heated Humidified High-Flow Nasal Cannula for Prevention of Extubation Failure in Preterm Infants

The Indian Journal of Pediatrics ◽

10.1007/s12098-016-2280-2 ◽

2017 ◽

Vol 84 (4) ◽

pp. 262-266 ◽

Cited By ~ 10

Author(s):

Sasivimon Soonsawad ◽

Buranee Swatesutipun ◽

Anchalee Limrungsikul ◽

Pracha Nuntnarumit

Keyword(s):

Preterm Infants ◽

Extubation Failure ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

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USING LU SCORE TO PREDICT EXTUBATION FAILURE IN PRETERM INFANTS SHOULD CONSIDER GESTATIONAL AGE AT BIRTH

10.22541/au.159863522.21322912 ◽

2020 ◽

Author(s):

Almudena Alonso Ojembarrena ◽

Francesco Raimondi

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Extubation Failure ◽

Gestational Age At Birth ◽

Age At Birth

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Probiotics and Necrotizing Enterocolitis: Finding the Missing Pieces of the Probiotic Puzzle

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-17.4.308 ◽

2012 ◽

Vol 17 (4) ◽

pp. 308-328 ◽

Cited By ~ 5

Author(s):

Sherry A. Luedtke ◽

Jacob T. Yang ◽

Heather E. Wild

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Causes Of Death ◽

Standard Of Care ◽

Mortality Rates ◽

Probiotic Supplementation ◽

Shed Light

Necrotizing enterocolitis (NEC) is one of the leading causes of death in the neonatal intensive care unit. Morbidity and mortality rates significantly increase with decreases in gestational age and birth weight. Strong evidence suggests probiotic prophylaxis may significantly decrease the incidence of NEC and should therefore be incorporated into the standard of care for preterm infants. However, debate still remains because of limitations of completed studies. The purpose of this review was to provide an overview of the controversies regarding probiotic use in preterm infants and to shed light on the practical considerations for implementation of probiotic supplementation.

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A Prediction Model of Extubation Failure Risk in Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2021.693320 ◽

2021 ◽

Vol 9 ◽

Author(s):

Zimei Cheng ◽

Ziwei Dong ◽

Qian Zhao ◽

Jingling Zhang ◽

Su Han ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prediction Model ◽

Preterm Infants ◽

Gestational Age ◽

Distress Syndrome ◽

Extubation Failure ◽

Concordance Index ◽

Training Cohort

Objectives: This study aimed to identify variables and develop a prediction model that could estimate extubation failure (EF) in preterm infants.Study Design: We enrolled 128 neonates as a training cohort and 58 neonates as a validation cohort. They were born between 2015 and 2020, had a gestational age between 250/7 and 296/7 weeks, and had been treated with mechanical ventilation through endotracheal intubation (MVEI) because of acute respiratory distress syndrome. In the training cohort, we performed univariate logistic regression analysis along with stepwise discriminant analysis to identify EF predictors. A monogram based on five predictors was built. The concordance index and calibration plot were used to assess the efficiency of the nomogram in the training and validation cohorts.Results: The results of this study identified a 5-min Apgar score, early-onset sepsis, hemoglobin before extubation, pH before extubation, and caffeine administration as independent risk factors that could be combined for accurate prediction of EF. The EF nomogram was created using these five predictors. The area under the receiver operator characteristic curve was 0.824 (95% confidence interval 0.748–0.900). The concordance index in the training and validation cohorts was 0.824 and 0.797, respectively. The calibration plots showed high coherence between the predicted probability of EF and actual observation.Conclusions: This EF nomogram was a useful model for the precise prediction of EF risk in preterm infants who were between 250/7 and 296/7 weeks' gestational age and treated with MVEI because of acute respiratory distress syndrome.

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VALUE OF NASAL-CPAP (nCPAP) IN STABLE PRETERM INFANTS BREATHING ROOM AIR: A RANDOMIZED CONTROLLED TRIAL

Pediatric Research ◽

10.1203/00006450-199709000-00182 ◽

1997 ◽

Vol 42 (3) ◽

pp. 412-412

Author(s):

Hesham E Abdel-Hady ◽

Samiha W Mohareb ◽

Mohamed T Khashaba ◽

Mohamed M Abu-Alkhair ◽

Gorm Greisen

Keyword(s):

Randomized Controlled Trial ◽

Preterm Infants ◽

Controlled Trial ◽

Nasal Cpap ◽

Randomized Controlled ◽

Breathing Room

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Hexavalent vaccines in preterm infants: an update by Italian Society of Pediatric Allergy and Immunology jointly with the Italian Society of Neonatology

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0742-7 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 4

Author(s):

E. Chiappini ◽

C. Petrolini ◽

C. Caffarelli ◽

M. Calvani ◽

F. Cardinale ◽

...

Keyword(s):

Adverse Events ◽

Preterm Infants ◽

Gestational Age ◽

Standard Of Care ◽

Vaccination Schedule ◽

Italian Society ◽

System Response ◽

Term Infants ◽

Hexavalent Vaccine ◽

Increased Risk

AbstractHexavalent vaccines, protecting against six diseases (diphtheria, tetanus, pertussis [DTaP], poliovirus, hepatitis B virus [HBV], and Haemophilus influenzae type b [Hib], are routinely the standard of care in Europe. The use of combined vaccines allows the reduction of number of injections and side effects, the reduction of costs, and the increase in adherence of the family to the vaccination schedule both in terms of the number of doses and timing. The safety profile, efficacy and effectiveness of hexavalent vaccines have been extensively documented in infants and children born at term, and data are accumulating in preterm infants. Hexavalent vaccines are particularly important for preterm infants, who are at increased risk for severe forms of vaccine preventable diseases. However, immunization delay has been commonly reported in this age group. All the three hexavalent vaccines currently marketed in Italy can be used in preterm infants, and recent data confirm that hexavalent vaccines have a similar or lower incidence of adverse events in preterm compared to full-term infants; this is likely due to a weaker immune system response and reduced ability to induce an inflammatory response in preterm infants. Apnoea episodes are the adverse events that can occur in the most severe preterm infants and / or with history of respiratory distress. The risk of apnoea after vaccination seems to be related to a lower gestational age and a lower birth weight, supporting the hypothesis that it represents an unspecific response of the preterm infant to different procedures. High seroprotection rates have been reported in preterm infants vaccinated with hexavalent vaccine. However, a lower gestational age seems to be associated with lower antibody titres against some vaccine antigens (e.g. HBV, Hib, poliovirus serotype 1, and pertussis), regardless of the type of hexavalent vaccine used. Waiting for large effectiveness studies, hexavalent vaccines should be administered in preterm infants according to the same schedule recommended for infants born at term, considering their chronological age and providing an adequate monitoring for cardio-respiratory events in the 48–72 h after vaccination, especially for infants at risk of recurrence of apnoea.

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