scholarly journals Caffeine in preterm infants: where are we in 2020?

2020 ◽  
Vol 6 (1) ◽  
pp. 00330-2019 ◽  
Author(s):  
Laura Moschino ◽  
Sanja Zivanovic ◽  
Caroline Hartley ◽  
Daniele Trevisanuto ◽  
Eugenio Baraldi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Current Knowledge ◽  
Neurological Impairment ◽  
Pulmonary Complications ◽  
Cognitive Outcome ◽  
Therapeutic Drug ◽  
Non Invasive ◽  
Optimal Dosing ◽  
Respiratory Management

The incidence of preterm birth is increasing, leading to a growing population with potential long-term pulmonary complications. Apnoea of prematurity (AOP) is one of the major challenges when treating preterm infants; it can lead to respiratory failure and the need for mechanical ventilation. Ventilating preterm infants can be associated with severe negative pulmonary and extrapulmonary outcomes, such as bronchopulmonary dysplasia (BPD), severe neurological impairment and death. Therefore, international guidelines favour non-invasive respiratory support. Strategies to improve the success rate of non-invasive ventilation in preterm infants include pharmacological treatment of AOP. Among the different pharmacological options, caffeine citrate is the current drug of choice. Caffeine is effective in reducing AOP and mechanical ventilation and enhances extubation success; it decreases the risk of BPD; and is associated with improved cognitive outcome at 2 years of age, and pulmonary function up to 11 years of age. The commonly prescribed dose (20 mg·kg−1 loading dose, 5–10 mg·kg−1 per day maintenance dose) is considered safe and effective. However, to date there is no commonly agreed standardised protocol on the optimal dosing and timing of caffeine therapy. Furthermore, despite the wide pharmacological safety profile of caffeine, the role of therapeutic drug monitoring in caffeine-treated preterm infants is still debated. This state-of-the-art review summarises the current knowledge of caff­eine therapy in preterm infants and highlights some of the unresolved questions of AOP. We speculate that with increased understanding of caffeine and its metabolism, a more refined respiratory management of preterm infants is feasible, leading to an overall improvement in patient outcome.

scholarly journals 49 NEUROLOGICAL IMPAIRMENT AT ONE YEAR PREDICTS NEUROLOGICAL AND COGNITIVE OUTCOME AT EIGHT YEARS IN VERY PRETERM INFANTS

1991 ◽  
Vol 30 (6) ◽  
pp. 636-636 ◽  
Author(s):  
S C Roth ◽  
J Baudin ◽  
J Townsend ◽  
D C McCormick ◽  
A D Edwards ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neurological Impairment ◽  
Cognitive Outcome ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
One Year

scholarly journals Changes in Respiratory Management and the Impact on Bronchopulmonary Dysplasia

2021 ◽  
Author(s):  
Jane Chung ◽  
Anjali Iyengar ◽  
Laura Santry ◽  
Eric Swanson ◽  
Jonathan M Davis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Bronchopulmonary Dysplasia ◽  
Clinical Course ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Respiratory Management ◽  
Wide Range ◽  
Surfactant Administration ◽  
The Impact

Objective: Non-invasive respiratory support has reduced the need for mechanical ventilation and surfactant administration in very premature neonates. We sought to determine how the increased use of non-invasive ventilation and less surfactant instillation has impacted the development of bronchopulmonary dysplasia (BPD) and compared BPD outcome applying four currently used definitions. Study Design: This is a retrospective, single center cohort study of neonates born at less than 28 weeks gestation between 2010 and 2018. A respiratory practice change (less surfactant and more non-invasive ventilation) occurred in 2014 following participation in the SUPPORT trial. Therefore, patients were divided into 2 epochs to compare postnatal respiratory and clinical course and BPD outcomes across four currently relevant definitions (VON, NICHD, Canadian, NRN). Results: Clinical and demographic variables were similar between epochs. Despite significant differences in maternal and infant characteristics and clinical course, the incidence of BPD was not significantly different between the 2 epochs regardless of the BPD definition utilized. There was a wide range in the incidence of BPD depending on the definition used. Conclusions: Despite decreased use of invasive mechanical ventilation and surfactant administration between the two epochs, the incidence of BPD did not change and there was wide variation depending on the definition used. A better understanding of the risk factors associated with BPD and a consensus definition is urgently needed in order to facilitate the conduct of clinical trials and the development of novel therapeutic interventions to improve outcome.

scholarly journals Effects of Early Respiratory Physiotherapy on Spontaneous Respiratory Activity of Preterm Infants: Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
Alessia Di Polito ◽  
Arianna Del Vecchio ◽  
Milena Tana ◽  
Patrizia Papacci ◽  
Anna Laura Vento ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Respiratory Activity ◽  
Trigger Point ◽  
Work Of Breathing ◽  
Delivery Room ◽  
Respiratory Support ◽  
Control Group ◽  
Non Invasive ◽  
Digital Pressure

Abstract Background: Tactile maneuvers stimulating spontaneous respiratory activity in preterm infants are recommended since birth, but data on how and how often these maneuvers are applied in clinical practice are unknown. In the last years, most preterm newborns with respiratory failure are preferentially managed with non-invasive respiratory support and by stimulating spontaneous respiratory activity from the delivery room and in Neonatal Intensive Care Unit (NICU), in order to avoid the risks of intubation and prolonged mechanical ventilation.Methods: Preterm infants with gestational age ≤ 30 weeks not intubated in the delivery room and requiring non-invasive respiratory support at birth will be eligible for the study. They will be randomized and allocated to one of two treatment groups: 1) the Study Group infants will be subject to the technique of respiratory facilitation within the first 24 h of life, according to the reflex stimulations, by the physiotherapist. The newborn is placed in supine decubitus and a slight digital pressure is exerted on a hemithorax. The respiratory facilitation technique will be performed for about three minutes and repeated for a total of 4/6 times in sequence, three times a day until spontaneous respiratory activity is achieved, thus no respiratory support is required; 2) the Control Group Infants will take part exclusively in the Individualized Postural Care program. They will perform the technique of respiratory facilitation and autogenous drainage. The primary outcome of the study will be the incidence of intubation and mechanical ventilation in the first week of life. Discussion: The technique of respiratory facilitation is based on reflex stimulations, applied early to preterm infant. Slight digital pressure is exerted on a "trigger point” of each hemithorax, to stimulate the respiratory activity with subsequent increase of the ipsilateral pulmonary minute ventilation and to facilitate the contralateral pulmonary expansion. This mechanism will determine the concatenation of input to all anatomical structures in relation to the area being treated, to promote spontaneous respiratory activity and reducing work of breathing, avoiding or minimizing the use of invasive respiratory support.Trial registration: UMIN-CTR Clinical Trial, Identifier: UMIN000036066, Registered March 1, 2019. Protocol 1. https://www.umin.ac.jp/ctr

Duration of mechanical ventilation and neurodevelopment in preterm infants

2019 ◽  
Vol 104 (6) ◽  
pp. F631-F635 ◽  
Author(s):  
Roos J S Vliegenthart ◽  
Anton H van Kaam ◽  
Cornelieke S H Aarnoudse-Moens ◽  
Aleid G van Wassenaer ◽  
Wes Onland
Keyword(s):  
Mechanical Ventilation ◽  
Regression Analysis ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Neurodevelopmental Outcomes ◽  
Respiratory Management ◽  
Increased Risk

ObjectiveTo investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV.DesignRetrospective cohort study.SettingSingle neonatal intensive care unit in Amsterdam.PatientsAll ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.Main outcome measuresNeurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.ResultsDuring the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).ConclusionEven in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.

Saliva versus Plasma Therapeutic Drug Monitoring of Gentamicin in Jordanian Preterm Infants. Development of a Physiologically-Based Pharmacokinetic (PBPK) Model and Validation of Class II Drugs of Salivary Excretion Classification System

Drug Research ◽  
2020 ◽  
Vol 70 (10) ◽  
pp. 455-462
Author(s):  
Nasir Idkaidek ◽  
Salim Hamadi ◽  
Rabab Bani-Domi ◽  
Ibrahim Al-Adham ◽  
Motasem Alsmadi ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Adverse Effects ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Drug Monitoring ◽  
Pbpk Model ◽  
Therapeutic Drug ◽  
Non Invasive ◽  
Physiologically Based Pharmacokinetic ◽  
Physiologically Based

AbstractGentamicin has proven to be a very successful treatment for bacterial infection, but it also can cause adverse effects, especially ototoxicity, which is irreversible. Therapeutic drug monitoring (TDM) in saliva is a more convenient non-invasive alternative compared to plasma. A physiologically-based pharmacokinetic (PBPK) model of gentamicin was built and validated using previously-published plasma and saliva data. The validated model was then used to predict experimentally-observed plasma and saliva gentamicin TDM data in Jordanian pediatric preterm infant patients measured using sensitive LCMS/MS method. A correlation was established between plasma and saliva exposures. The developed PBPK model predicted previously reported gentamicin levels in plasma, saliva and those observed in the current study. A good correlation was found between plasma and saliva exposures. The PBPK model predicted that gentamicin in saliva is 5–7 times that in plasma, which is in agreement with observed results. Saliva can be used as an alternative for TDM of gentamicin in preterm infant patients. Exposure to gentamicin in plasma and saliva can reliably be predicted using the developed PBPK model in patients.

scholarly journals RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shravani Maram ◽  
Srinivas Murki ◽  
Sidharth Nayyar ◽  
Sandeep Kadam ◽  
Tejo Pratap Oleti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Gestational Age ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Open Label ◽  
Non Invasive ◽  
Nasal Injury

AbstractNasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. Nasal injury is a common problem with the interfaces used. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. This is an open-label, parallel-arm, gestational age-stratified, bi-centric, randomized control trial including neonates between 28 and 34 weeks gestational age and birth weight > 1000 g needing nCPAP. The size of the interface was chosen as per the manufacturer’s recommendation. Of the 229 neonates enrolled, 112 were randomized to RAM cannula with Cannulaide and 117 to Hudson prong. The baseline characteristics were similar. Any nasal injury at CPAP removal was significantly lower in the RAM cannula with Cannulaide group [6 (5.4%) vs. 31 (26.4%); risk ratio—0.77 (95% CI 0.69–0.87); p = 0.0001]. The incidence of moderate to severe nasal injury, need for mechanical ventilation within 72 h of age, duration of oxygen, and requirement of nCPAP for > 3 days were similar. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation.Trail registration: CTRI/2019/03/018333, http://www.ctri.nic.in.

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