Elective transfers of preterm neonates to regional centres on non-invasive respiratory support is cost effective and increases tertiary care bed capacity

2017 ◽  
Vol 107 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Hussein Zein ◽  
Kamran Yusuf ◽  
Renee Paul ◽  
Derek Kowal ◽  
Sumesh Thomas
Keyword(s):  
Tertiary Care ◽  
Cost Effective ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Non Invasive ◽  
Bed Capacity

Association of Antenatal Terbutaline and Respiratory Support Requirements in Preterm Neonates

2021 ◽  
Author(s):  
Buranee Yangthara ◽  
Visanu Kittiarpornpon ◽  
Pitiporn Siripattanapipong ◽  
Walaiporn Bowornkitiwong ◽  
Ratchada Kitsommart ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Non Invasive ◽  
Antenatal Steroids ◽  
Respiratory Outcomes ◽  
Record Review ◽  
Retrospective Medical Record Review

Background: Before the advent of antenatal steroids, early non-invasive respiratory support (NIV) and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). Objectives: To study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with gestational age (GA) of < 32 weeks. And to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with GA of 32 to 36 weeks. Method: A retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. Result: 1,794 infants were included, 234 (13.0%) had GA < 32 weeks and 1,560 (86.9%) had GA 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio (aOR) = 0.40, 95% confident interval (CI) 0.19 to 0.82, p = 0.012) in infants of GA < 32 weeks, but not in infants with GA 32 to 36 weeks. Antenatal terbutaline was not associated with RDS or BPD, but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01 to 0.98; p = 0.048), in infants of GA < 32 weeks. Conclusion: In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants of GA < 32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration.

50 Poractant alfa versus bovine lipid extract surfactant for respiratory distress syndrome in preterm infants: A prospective comparative effectiveness cohort study

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e35-e36
Author(s):  
Brigitte Lemyre ◽  
Thierry Lacaze-Masmonteil ◽  
Prakesh Shah ◽  
Jaya Bodani ◽  
Stefanie Doucette ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Comparative Effectiveness ◽  
Neonatal Intensive Care ◽  
Total Duration ◽  
Lipid Extract ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Perinatal Medicine ◽  
Very Preterm Infants ◽  
Non Invasive

Abstract Primary Subject area Neonatal-Perinatal Medicine Background There is a paucity of comparative effectiveness data for bovine lipid extract surfactant (BLES) and poractant alfa (Curosurf). Objectives To compare duration of respiratory support and short-term outcomes in very preterm infants treated with bovine lipid extract surfactant and poractant alfa. Design/Methods We performed a prospective, multicentre, comparative effectiveness study. Thirteen Canadian level III neonatal intensive care units (NICUs) provided bovine lipid extract surfactant to infants born &lt;32 weeks’ gestational age (GA) for a set period of time in the year 2019 (3 to 9 months), then changed to poractant alfa for the remainder of the year. The primary outcome was total duration of respiratory support (invasive and non-invasive). We utilized the Canadian Neonatal Network database for all study data. Results A total of 968 eligible infants (530 infants &lt; 28 weeks’ GA and 438 infants 280-316weeks’ GA) were included, of which 494 received bovine lipid extract surfactant and 474 received poractant alfa. In unadjusted analysis, no difference was observed in total duration of any respiratory support (median 38 vs. 40.5 days). After adjusting for baseline characteristics and accounting for cluster effects, infants treated with poractant alfa spent a median of 4.16 fewer days on respiratory support (95% CI 0.05, 8.28 days). This reduction was observed in the subgroup of infants 280-316 weeks’ GA, but not in those &lt; 28 weeks’ GA, and was explained by their shorter time on non-invasive respiratory support. No differences were observed in the need to re-dose surfactant, hospital mortality, bronchopulmonary dysplasia, or length of stay in NICU. Conclusion Administration of poractant alfa was associated with shorter median duration of respiratory support compared to bovine lipid extract surfactant in preterm neonates &lt; 32 weeks’ GA.

scholarly journals Peripheral Perfusion Index as a Marker of Sepsis in Preterm Neonates

2021 ◽  
Author(s):  
Jasmine Singh ◽  
Suksham Jain ◽  
Deepak Chawla ◽  
Shivani Randev ◽  
Supreet Khurana
Keyword(s):  
Predictive Value ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Perfusion Index ◽  
Preterm Neonates ◽  
Care Hospital ◽  
Suspected Sepsis ◽  
Clinical Sepsis ◽  
Non Invasive ◽  
Hospital Acquired

Abstract Background: Neonatal sepsis is a major contributor to neonatal mortality in India. Blood culture, the gold standard for the diagnosis of sepsis takes 48-72 hours while the serological markers have suboptimal diagnostic test characteristics. Perfusion Index (PI) is a real time, non-invasive marker that can detect microcirculatory changes before other clinical manifestation of sepsis. Objective: To determine the diagnostic accuracy of PI in detecting hospital-acquired sepsis before overt clinical manifestations. Material and Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. Participants: Term and preterm neonates admitted to NICU. Methods: PI was continuously monitored in all enrolled neonates. Clinical sepsis was defined using the Neonatal Krankenhaus-Infektions-Surveillance-System (NeoKISS). PI below 1.24 and 0.88 for term and preterm neonates, respectively, was defined as low PI. The time of fall of PI below this value and time of clinical sepsis as per NeoKISS was noted and the difference was calculated. Results: Among 72 neonates (gestational age:32.2±3.2 weeks, birth weight:1420, IQR 1100-1855 g), a total of 93 events of suspected sepsis were noted, of which 70 were sepsis screen positive. 16 events were associated with culture positive sepsis. Using a cut off of 0.88 in preterm neonates, PI yielded a sensitivity of 89.47% (95% CI 78.48% to 96.04%), specificity of 56% (95% CI 34.93% to 75.60%), positive predictive value of 82.26% (95% CI 74.70% to 87.92%), and negative predictive value of 70% (95% CI 50.36% to 84.29%) in detection of hospital acquired sepsis. The positive and negative likelihood ratios came to be 2.03 (95% CI 1.30 to 3.19) and 0.19 (95% CI 0.08 to 0.43), respectively.Conclusion: This study shows that PI might serve as an early, non-invasive marker of hospital acquired sepsis in preterm neonates.

scholarly journals Cyto-histological correlation in diagnosis of gastrointestinal lesions- a prospective study in a tertiary care institute

2020 ◽  
Vol 8 (10) ◽  
pp. 3560
Author(s):  
Swati Aggarwal ◽  
Kavita Mardi ◽  
Shivani Sood ◽  
Vijay Kaushal ◽  
Brij Sharma ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Tertiary Care ◽  
Cost Effective ◽  
Brush Cytology ◽  
Non Invasive ◽  
Care Institute ◽  
Cost Effective Method ◽  
Gastrointestinal Lesions ◽  
Rising Incidence ◽  
A Prospective Study

Background: Gastrointestinal tract is involved by a large number of inflammatory, infectious and neoplastic diseases. There is a worldwide rising incidence of GIT lesions especially neoplasms.Methods: This study was planned to correlate endoscopic and colonoscopic brush cytology with histopathology of gastrointestinal lesions and to determine the spectrum of gastrointestinal lesions in patients subjected to endoscopic brushings and biopsy.Results: Sensitivity of upper GI brush cytology was 95.15% and specificity 90.41%. Sensitivity of colonoscopic brush cytology was 100% and specificity 86.79%. The accuracy of brush cytology came out to be 92.45% in upper GIT and 92.22% in lower GIT.Conclusions: Brush cytology is a non-invasive and cost-effective method to retrieve epithelial cells from a much larger surface area of the mucosa, thus allowing thorough sampling and increasing the diagnostic yield.

scholarly journals Hemodynamic Patterns Determined By Non-Invasive Cw-Doppler Ultrasound Cardiac Monitoring (USCOM) in Preterm Neonates with Respiratory Distress Syndrome During Non-Invasive Respiratory Support

2017 ◽  
Vol 8 (3) ◽  
pp. 41-46
Author(s):  
Vera A. Sergeeva ◽  
Yuri S. Alexandrovich ◽  
Denis M. Strelkov ◽  
Kseniya A. Siniuk
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Diastolic Dysfunction ◽  
Doppler Ultrasound ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Term Neonates ◽  
Non Invasive ◽  
Bedside Method

Aim: To determine the hemodynamic patterns in preterm neonates with respiratory distress syndrome (RDS) using the USCOM-1A technology. Materials and Methods: The USCOM device is a bedside method of evaluating cardiac output (CO) based on continuous-wave Doppler ultrasound. Hemodynamic parameters were measured daily for 7 days in 32 preterm neonates 32 ± 1 weeks of gestation (1688 ± 111 g) with RDS requiring noninvasive respiratory support (NCPAP, NIPPV, HFNC) and no catecholamine support in comparison with 28 healthy term neonates (3100 ± 690 g). Results: At day 1, preterm neonates had lower SVI (18 ± 5 vs 28 ± 8 ml m-2, p = 0.043) and higher SVRI (1585 ± 245 vs 1035 ± 358 dyn s cm-5 m2, p = 0.013) with a tendency for lower cardiac index (2.6 ± 0.8 vs 4.0 ± 1.3 l min-1 m-2, p = 0.089). Together with no difference in SMII, it indicates the presence of diastolic dysfunction with low preload. It is noted that all parameters had not changed by day 7 in preterm neonates, whereas term neonates demonstrated significantly increased SMII reflecting postnatal cardiovascular adaptation. Compared with preterm neonates with RDS requiring NCPAP/NIPPV, preterm neonates requiring HFNC had higher levels of FTc (330 ± 59 vs 388 ± 41 ms, р = 0.045), SVI (13 ± 3 vs 18 ± 4, ml/m2, р = 0.007), SMII (0.41 ± 0.09 vs 0.57 ± 0.21, р = 0.02), and CI (2.2 ± 0.6 vs 4.5 ± 0.9 l/min/m2, р = 0.006). Conclusions:Noninvasive respiratory support in preterm neonates with RDS may lead to diastolic dysfunction that is less prominent in neonates with HFNC.

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