Association Between Neonatal Care Practices and Efficacy of Exogenous Human Surfactant: Results of a Bicenter Randomized Trial

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 552-560
Author(s):  
Mikko Hallman ◽  
T. Allen Merritt ◽  
Kristina Bry ◽  
Charles Berry
Keyword(s):  
Airway Pressure ◽  
Fluid Intake ◽  
Ductus Arteriosus ◽  
Neonatal Care ◽  
Mean Airway Pressure ◽  
Oxygen Requirement ◽  
Good Outcome ◽  
Surfactant Substitution ◽  
Care Practices ◽  
The Impact

The purpose of this study was to analyze the impact of neonatal care practices on the efficacy of exogenous human surfactant. Two hundred newborns (gestational age 24.0 to 29.9 weeks, lecithin-sphingomyelin ratio less than 2 or absent phosphatidylglycerol, and requirement of mechanical ventilation at birth) participated in a randomized bicenter trial of human surfactant substitution. In only one of the two sites (site 2) surfactant substitution decreased the severity of respiratory failure and increased neonatal survival without bronchopulmonary dysplasia. For analysis of three-way association, continuous variables describing patient characteristics and treatment were dichotomized at the median. The following variables were significantly associated with good outcome in site 1 and 2 and with surfactant substitution in site 2: low oxygen requirement during first three neonatal days, low mean airway pressure during second and third day, low Paco2 during first two neonatal days, and no ligation of ductus arteriosus. Low fluid intake during the first three days and low colloid intake during the first two days of life were associated with good outcome in both sites. The ratio between mean airway pressure and the oxygen requirement was higher in site 2 than in site 1 during the first day of life. Fluid intake and ventilatory management may influence the efficacy of exogenous surfactant.

Differential effect of recruitment maneuvres on pulmonary blood flow and oxygenation during HFOV in preterm lambs

2008 ◽  
Vol 105 (2) ◽  
pp. 603-610 ◽  
Author(s):  
Graeme R. Polglase ◽  
Timothy J. M. Moss ◽  
Ilias Nitsos ◽  
Beth J. Allison ◽  
J. Jane Pillow ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lung Volume ◽  
Airway Pressure ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Oxygenation Index ◽  
Preterm Neonates ◽  
Mean Airway Pressure ◽  
Lung Volume Recruitment ◽  
High Frequency Oscillatory

The effects of lung volume recruitment manouvres on pulmonary blood flow (PBF) during high-frequency oscillatory ventilation (HFOV) in preterm neonates are unknown. Since increased airway pressure adversely affects PBF, we compared the effects of two HFOV recruitment strategies on PBF and oxygenation index (OI). Preterm lambs (128 ± 1 day gestation; term ∼150 days) were anesthetized and ventilated using HFOV (10 Hz, 33% tI) with a mean airway pressure (Pao) of 15 cmH2O. Lung volume was recruited by either increasing Pao to 25 cmH2O for 1 min, repeated five times at 5-min intervals (Sigh group; n = 5) or stepwise (5 cmH2O) changes in Pao at 5-min intervals incrementing up to 30 cmH2O then decrementing back to 15 cmH2O (Ramp group; n = 6). Controls ( n = 5) received constant HFOV at 15 cmH2O. PBF progressively decreased (by 45 ± 4%) and OI increased (by 15 ± 6%, indicating reduced oxygenation) in controls during HFOV, which was similar to the changes observed in the Sigh group of lambs. In the Ramp group, PBF fell (by 54 ± 10%) as airway pressure increased ( r2 = 0.99), although the PBF did not increase again as the Pao was subsequently reduced. The OI decreased (by 47 ± 9%), reflecting improved oxygenation at high Pao levels during HFOV in the Ramp group. However, high Pao restored retrograde PBF during diastole in four of six lambs, indicating the restoration of right-to-left shunting through the ductus arteriosus. Thus the choice of volume recruitment maneuvre influences the magnitude of change in OI and PBF that occurs during HFOV. Despite significantly improving OI, the ramp recruitment approach causes sustained changes in PBF.

scholarly journals The Impact of Special Care Newborn Unit on Routine Neonatal Care Practices and Survival of Neonates in 250-Bed General Hospital, Sirajganj

2018 ◽  
Vol 30 (2) ◽  
pp. 65-68
Author(s):  
Md Imdadul Haque ◽  
Laila Shamima Sharmin ◽  
Md Sanaul Haque Mia ◽  
Md Rafiqul Islam ◽  
SMQ Hasan
Keyword(s):  
Mortality Rate ◽  
General Hospital ◽  
Neonatal Mortality ◽  
Neonatal Care ◽  
Special Care ◽  
Tertiary Level ◽  
Neonatal Mortality Rate ◽  
District Hospitals ◽  
Care Practices ◽  
The Impact

To address the high infant and neonatal mortality rate in Bangladesh, government has adopted policy to ensure care for neonates from community to tertiary level of health care delivery system. Our country has achieved 4 MDG targets well before 2015. However the pace of reduction of neonatal mortality is much lower than that of older children. For that reason government of Bangladesh through Ministry of Health and Family Welfare established Special Care Neonatal Unit (SCNU) at secondary and tertiary level facilities to improve management of sick newborn. The aim of this study was to evaluate the impact of creating SCNU at district hospitals on newborn care practices and to evaluate the contribution of SCNU in improved neonatal survival. It was an observational study conducted from May 2016 to October 2016at 250-bed General Hospital, Sirajganj. Hospital database was accessed to note the number of neonatal admissions, number of referral to higher centers and neonatal mortality. A questionnaire was prepared to interview mothers of children admitted in SCNU and general pediatric ward. A total of 355 mothers were interviewed. There was a significant reduction in neonatal mortality rate after the establishment of SCNU. There was also significant improvement in the knowledge and awareness among mothers regarding various aspects of neonatal care because of the SCNU.TAJ 2017; 30(2): 65-68

Sustained inflation during HFOV improves pulmonary mechanics and oxygenation

1988 ◽  
Vol 65 (1) ◽  
pp. 368-372 ◽  
Author(s):  
M. C. Walsh ◽  
W. A. Carlo
Keyword(s):  
Functional Residual Capacity ◽  
Airway Pressure ◽  
Blood Gases ◽  
Pulmonary Mechanics ◽  
Mean Airway Pressure ◽  
Arterial Blood ◽  
Sustained Inflation ◽  
Residual Capacity ◽  
Effective Use ◽  
The Impact

Effective use of high-frequency oscillatory ventilation (HFOV) may require maintenance of adequate lung volume to optimize gas exchange. To determine the impact of inflation during HFOV, sustained inflation was applied at pressures of 5, 10, and 15 cmH2O above mean airway pressure for 3, 10, and 30 s to 15 intubated, paralyzed, anesthetized rabbits after saline lavage to induce surfactant deficiency. Arterial blood gases were recorded in all rabbits while static compliance, resistance, time constant, and changes in functional residual capacity were recorded using the interrupter technique and plethysmograph in seven rabbits. Parameters were recorded before and 2 min after sustained inflation. Arterial PO2, compliance of the respiratory system, and functional residual capacity increased after sustained inflation at pressure levels of at least 10 cmH2O and 10-s duration. As the presence or duration of a sustained inflation was increased, oxygenation improved (P less than or equal to 0.01), but arterial PCO2 increased as longer sustained inflations were used (P less than or equal to 0.005). Sustained inflations of 5 cmH2O above mean airway pressure or of 3-s duration were ineffective. We conclude that either a critical pressure or duration of sustained inflation is needed to improve oxygenation and pulmonary mechanics during HFOV.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

scholarly journals Neonatal care practices in Buikwe District, Uganda: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marte Bodil Roed ◽  
Ingunn Marie Stadskleiv Engebretsen ◽  
Robert Mangeni
Keyword(s):  
Health Workers ◽  
Post Partum ◽  
Newborn Care ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Cord Clamping ◽  
Care Practices ◽  
Sub Saharan ◽  
Skin To Skin ◽  
User Perspectives

Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.

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