Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study

2018 ◽  
Vol 104 (3) ◽  
pp. F274-F279 ◽  
Author(s):  
Thomas E Bachman ◽  
Christopher J L Newth ◽  
Narayan P Iyer ◽  
Patrick A Ross ◽  
Robinder G Khemani
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Term Infants ◽  
Postmenstrual Age ◽  
Preterm Group

ObjectiveDescribe the likelihood of hypoxemia and hyperoxemia across ranges of oxygen saturation (SpO2), during mechanical ventilation with supplemental oxygenation.DesignRetrospective observational study.SettingUniversity affiliated tertiary care neonatal intensive care unit.PatientsTwo groups of neonates based on postmenstrual age (PMA): <32 weeks (n=104) and >36 weeks (n=709).Main measuresHypoxemia was defined as a PaO2 <40 mm Hg, hyperoxemia as a PaO2 of >99 mm Hg and normoxemia as a PaO2 of 50–80 mm Hg. Twenty-five per cent was defined as marked likelihood of hypoxemia or hyperoxemia.ResultsFrom these infants, 18 034 SpO2–PaO2 pairs were evaluated of which 10% were preterm. The PMA (median and IQR) of the two groups were: 28 weeks (27–30) and 40 weeks (38–41). With SpO2 levels between 90% and 95%, the likelihoods of hypoxemia and hyperoxemia were low and balanced. With increasing levels of SpO2, the likelihood of hyperoxemia increased. It became marked in the preterm group when SpO2 was 99%–100% (95% CI 29% to 41%) and in the term group with SpO2 levels of 96%–98% (95% CI 29% to 32%). The likelihood of hypoxemia increased as SpO2 decreased. It became marked in both with SpO2 levels of 80%–85% (95% CI 20% to 31%, 24% to 28%, respectively).ConclusionsThe likelihood of a PaO2 <40 mm Hg is marked with SpO2 below 86%. The likelihood of a PaO2 >99 mm Hg is marked in term infants with SpO2 above 95% and above 98% in preterm infants. SpO2 levels between 90% and 95% are appropriate targets for term and preterm infants.

Auditory Brainstem Response in Preterm Infants in the Neonatal Intensive Care Unit

2020 ◽  
pp. 019459982095518
Author(s):  
Diogo Raposo ◽  
João Orfão ◽  
Marco Menezes ◽  
Mafalda Trindade-Soares ◽  
Ana Guimarães ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Preterm Infants ◽  
Auditory Brainstem Response ◽  
Neonatal Intensive Care ◽  
Auditory Brainstem ◽  
Term Infants ◽  
Congenital Cytomegalovirus ◽  
Brainstem Response

Objective To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. Study Design Case series with chart review. Setting Secondary care hospital. Methods Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. Results The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, −0.35 to −0.22; P = .026; 95% CI, −0.33 to −0.00; P = .001; 95% CI, −0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, −0.36 to −0.01; P = .042). Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI −1.72 to −0.09; P = .030; 95% CI, −14.55 to −0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, −0.49 to −0.01; P = .038). Conclusions These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.

scholarly journals Late Growth and Changes in Body Composition Influence Odds of Developing Retinopathy of Prematurity among Preterm Infants

Nutrients ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 78
Author(s):  
Ellen C. Ingolfsland ◽  
Jacob L. Haapala ◽  
Lauren A. Buckley ◽  
Ellen W. Demarath ◽  
Sixto F. Guiang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Body Composition ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Body Fat ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Postnatal Growth ◽  
Postmenstrual Age

Background: While postnatal growth in the first month of life is known to impact retinopathy of prematurity (ROP) risk, the impact of growth later in hospitalization, during critical times of retinal vascularization, remains unknown. The purpose of this study was to assess if postnatal growth and body composition during the second half of neonatal intensive care unit hospitalization were associated with severity of retinopathy of prematurity in very low birth weight preterm infants. Methods: Prospective observational pilot study of 83 infants born <32 weeks gestation and <1500 g, conducted at a Level IV neonatal intensive care unit. Body composition was measured during the second half of hospitalization. Infants were evaluated for retinopathy of prematurity. Logistic regression was performed. Results: Greater gains in fat mass, fat-free mass, and percent body fat from 32 to 37 weeks postmenstrual age and higher % body fat at term postmenstrual age were associated with decreased odds of ≥stage 2 retinopathy of prematurity (p < 0.05). Conclusions: Improved growth later in neonatal intensive care unit hospitalization and increased adiposity at term may reduce odds of severe retinopathy of prematurity.

scholarly journals SENTINEL1: Two-Season Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis

2019 ◽  
Vol 37 (04) ◽  
pp. 421-429 ◽  
Author(s):  
Evan J. Anderson ◽  
John P. DeVincenzo ◽  
Eric A. F. Simões ◽  
Leonard R. Krilov ◽  
Michael L. Forbes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Syncytial Virus ◽  
Observational Study ◽  
Preterm Infants ◽  
Gestational Age ◽  
Invasive Mechanical Ventilation ◽  
Syncytial Virus ◽  
Birth Hospitalization

Objective The SENTINEL1 observational study characterized confirmed respiratory syncytial virus hospitalizations (RSVH) among U.S. preterm infants born at 29 to 35 weeks' gestational age (wGA) not receiving respiratory syncytial virus (RSV) immunoprophylaxis (IP) during the 2014 to 2015 and 2015 to 2016 RSV seasons. Study Design All laboratory-confirmed RSVH at participating sites during the 2014 to 2015 and 2015 to 2016 RSV seasons (October 1–April 30) lasting ≥24 hours among preterm infants 29 to 35 wGA and aged <12 months who did not receive RSV IP within 35 days before onset of symptoms were identified and characterized. Results Results were similar across the two seasons. Among infants with community-acquired RSVH (N = 1,378), 45% were admitted to the intensive care unit (ICU) and 19% required invasive mechanical ventilation (IMV). There were two deaths. Infants aged <6 months accounted for 78% of RSVH observed, 84% of ICU admissions, and 91% requiring IMV. Among infants who were discharged from their birth hospitalization during the RSV season, 82% of RSVH occurred within 60 days of birth hospitalization discharge. Conclusion Among U.S. preterm infants 29 to 35 wGA not receiving RSV IP, RSVH are often severe with almost one-half requiring ICU admission and about one in five needing IMV.

Considerations for Touch and Massage in the Neonatal Intensive Care Unit

2000 ◽  
Vol 19 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Joy Browne
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Short Term ◽  
Term Infants ◽  
Developmental Care ◽  
The Family ◽  
Potential Impact

AN EXPANDING BODY OF research has documented the short-term advantages of gentle touch and massage for healthy term infants and some growing and medically stable preterm infants. These findings have provided the impetus for extension of massage techniques to very small, fragile newborns, promoting the utilization of new personnel in NICUs specifically to provide massage therapy for newborns. It is important, before engaging in these approaches, for professionals in the NICU to consider the potential impact of massage on the infant and the family. It is also imperative that professionals in the NICU take into account the current growing knowledge base regarding developmental care and the implications for decision making regarding provision of stimuli of any sort to fragile, sick newborns in the NICU.

Observational study found that even small variations in light can wake up very preterm infants in a neonatal intensive care unit

2018 ◽  
Vol 107 (7) ◽  
pp. 1191-1197 ◽  
Author(s):  
Claire Zores ◽  
André Dufour ◽  
Thierry Pebayle ◽  
Ilana Dahan ◽  
Dominique Astruc ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Very Preterm Infants ◽  
Very Preterm
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