scholarly journals Reference values for diaphragm electrical activity (Edi) in newborn infants

2021 ◽  
Author(s):  
Varappriyangga Gurumahan ◽  
Sriganesh Thavalingam ◽  
Tim Schindler ◽  
John Smyth ◽  
Kei Lui ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Reference Values ◽  
Newborn Infants ◽  
Feeding Tube ◽  
Respiratory Support ◽  
Neurally Adjusted Ventilatory Assist ◽  
Term Infants ◽  
Term Neonates ◽  
Diaphragm Electrical Activity ◽  
The Mean

Background: Neurally adjusted ventilatory assist (NAVA) is an emerging mode of respiratory support that uses the electrical activity of the diaphragm (Edi) to provide synchronised inspiratory pressure support, proportional to an infant’s changing inspiratory effort. Data on Edi reference values for neonates are limited. The objective of this study was to establish reference Edi values for preterm and term neonates. Methods: This was a prospective observational study of newborn infants breathing spontaneously in room air. The Edi signal was monitored by a specialised intragastric feeding tube with embedded electrodes positioned at the level of the diaphragm. Edi minimums and peaks were recorded continuously for four hours. Results: 24 newborn infants (16 preterm [<37 weeks’ gestation]; 8 term) were studied. All infants were breathing comfortably in room air at the time of study. Edi data were successfully captured in all infants. The mean (±SD) Edi minimum was 3.02 (±0.94) µV and the mean Edi peak was 10.13 (±3.50) µV. In preterm infants the mean (±SD) Edi minimum was 3.05 (±0.91) µV and the mean Edi peak was 9.36 (±2.13) µV. In term infants the mean (±SD) Edi minimum was 2.97 (±1.05) µV and the mean Edi peak was 11.66 (±5.14) µV. Conclusion: Reference Edi values were established for both preterm and term neonates. These values can be used as a guide when using diaphragm-triggered modes on respiratory support in newborn infants.

scholarly journals Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury

2021 ◽  
Author(s):  
Ling Liu ◽  
Daijiro Takahashi ◽  
Haibo Qui ◽  
Arthur S. Slutsky ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Lung Injury ◽  
Electrical Activity ◽  
Esophageal Pressure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Diaphragm Electrical Activity ◽  
New Zealand White Rabbits ◽  
Ventilatory Assist ◽  
Resistive Loading ◽  
Inspiratory Activity ◽  
The Mean

Background During conventional Neurally Adjusted Ventilatory Assist (NAVA), the electrical activity of the diaphragm (EAdi) is used for triggering and cycling-off inspiratory assist, with a fixed PEEP (so called “Triggered Neurally Adjusted Ventilatory Assist” or “tNAVA”). However, significant post-inspiratory activity of the diaphragm can occur, believed to play a role in maintaining end-expiratory lung volume. Adjusting pressure continuously, in proportion to both inspiratory and expiratory EAdi (Continuous NAVA, or cNAVA), would not only offer inspiratory assist for tidal breathing, but also may aid in delivering a “neurally adjusted PEEP”, and more specific breath-by-breath unloading. Methods Nine adult New Zealand white rabbits were ventilated during independent conditions of: resistive loading (RES1 or RES2), CO2 load (CO2) and acute lung injury (ALI), either via tracheotomy (INV) or non-invasively (NIV). There were a total of six conditions, applied in a non-randomized fashion: INV-RES1, INV-CO2, NIV-CO2, NIV-RES2, NIV-ALI, INV-ALI. For each condition, tNAVA was applied first (3 min), followed by 3 min of cNAVA. This comparison was repeated 3 times (repeated cross-over design). The NAVA level was always the same for both modes, but was newly titrated for each condition. PEEP was manually set to zero during tNAVA. During cNAVA, the assist during expiration was proportional to the EAdi. During all runs and conditions, ventilator-delivered pressure (Pvent), esophageal pressure (Pes), and diaphragm electrical activity (EAdi) were measured continuously. The tracings were analyzed breath-by-breath to obtain peak inspiratory and mean expiratory values. Results For the same peak Pvent, the distribution of inspiratory and expiratory pressure differed between tNAVA and cNAVA. For each condition, the mean expiratory Pvent was always higher (for all conditions 4.0 ± 1.1 vs. 1.1 ± 0.5 cmH2O, P < 0.01) in cNAVA than in tNAVA. Relative to tNAVA, mean inspiratory EAdi was reduced on average (for all conditions) by 19 % (range 14 %–25 %), p < 0.05. Mean expiratory EAdi was also lower during cNAVA (during INV-RES1, INV-CO2, INV-ALI, NIV-CO2 and NIV-ALI respectively, P < 0.05). The inspiratory Pes was reduced during cNAVA all 6 conditions (p < 0.05). Unlike tNAVA, during cNAVA the expiratory pressure was comparable with that predicted mathematically (mean difference of 0.2 ± 0.8 cmH2O). Conclusion Continuous NAVA was able to apply neurally adjusted PEEP, which led to a reduction in inspiratory effort compared to triggered NAVA.

scholarly journals Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury

2021 ◽  
Author(s):  
Ling Liu ◽  
Daijiro Takahashi ◽  
Haibo Qui ◽  
Arthur S. Slutsky ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Lung Injury ◽  
Electrical Activity ◽  
Esophageal Pressure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Diaphragm Electrical Activity ◽  
New Zealand White Rabbits ◽  
Ventilatory Assist ◽  
Resistive Loading ◽  
Inspiratory Activity ◽  
The Mean

Background During conventional Neurally Adjusted Ventilatory Assist (NAVA), the electrical activity of the diaphragm (EAdi) is used for triggering and cycling-off inspiratory assist, with a fixed PEEP (so called “Triggered Neurally Adjusted Ventilatory Assist” or “tNAVA”). However, significant post-inspiratory activity of the diaphragm can occur, believed to play a role in maintaining end-expiratory lung volume. Adjusting pressure continuously, in proportion to both inspiratory and expiratory EAdi (Continuous NAVA, or cNAVA), would not only offer inspiratory assist for tidal breathing, but also may aid in delivering a “neurally adjusted PEEP”, and more specific breath-by-breath unloading. Methods Nine adult New Zealand white rabbits were ventilated during independent conditions of: resistive loading (RES1 or RES2), CO2 load (CO2) and acute lung injury (ALI), either via tracheotomy (INV) or non-invasively (NIV). There were a total of six conditions, applied in a non-randomized fashion: INV-RES1, INV-CO2, NIV-CO2, NIV-RES2, NIV-ALI, INV-ALI. For each condition, tNAVA was applied first (3 min), followed by 3 min of cNAVA. This comparison was repeated 3 times (repeated cross-over design). The NAVA level was always the same for both modes, but was newly titrated for each condition. PEEP was manually set to zero during tNAVA. During cNAVA, the assist during expiration was proportional to the EAdi. During all runs and conditions, ventilator-delivered pressure (Pvent), esophageal pressure (Pes), and diaphragm electrical activity (EAdi) were measured continuously. The tracings were analyzed breath-by-breath to obtain peak inspiratory and mean expiratory values. Results For the same peak Pvent, the distribution of inspiratory and expiratory pressure differed between tNAVA and cNAVA. For each condition, the mean expiratory Pvent was always higher (for all conditions 4.0 ± 1.1 vs. 1.1 ± 0.5 cmH2O, P < 0.01) in cNAVA than in tNAVA. Relative to tNAVA, mean inspiratory EAdi was reduced on average (for all conditions) by 19 % (range 14 %–25 %), p < 0.05. Mean expiratory EAdi was also lower during cNAVA (during INV-RES1, INV-CO2, INV-ALI, NIV-CO2 and NIV-ALI respectively, P < 0.05). The inspiratory Pes was reduced during cNAVA all 6 conditions (p < 0.05). Unlike tNAVA, during cNAVA the expiratory pressure was comparable with that predicted mathematically (mean difference of 0.2 ± 0.8 cmH2O). Conclusion Continuous NAVA was able to apply neurally adjusted PEEP, which led to a reduction in inspiratory effort compared to triggered NAVA.

scholarly journals Production of granulocyte colony-stimulating factor in vitro by monocytes from preterm and term neonates [see comments]

Blood ◽  
1993 ◽  
Vol 82 (8) ◽  
pp. 2478-2484 ◽  
Author(s):  
KR Schibler ◽  
KW Liechty ◽  
WL White ◽  
RD Christensen
Keyword(s):  
Newborn Infants ◽  
Preterm Neonates ◽  
Granulocyte Colony Stimulating Factor ◽  
Serum Concentrations ◽  
Colony Stimulating Factor ◽  
Term Infants ◽  
Term Neonates ◽  
And Function ◽  
Stimulating Factor

Abstract We postulated that defective generation of granulocyte colony- stimulating factor (G-CSF) by cells of newborn infants might underlie their deficiencies in upregulating neutrophil production and function during bacterial infection. To test this, we isolated monocytes from the blood of preterm neonates, term neonates, and adults and, after stimulation with various concentrations of interleukin-1 alpha (IL-1 alpha) or lipopolysaccharide (LPS), quantified G-CSF concentrations in cell supernatants and G-CSF mRNA in cell lysates. When stimulated with plateau concentrations of IL-1 alpha for 24 hours, G-CSF concentrations were higher in supernatants of adult cells (8,699 +/- 5,529 pg/10(6) monocytes) than in those from term infants (2,557 +/- 442 pg, P < .05) or from preterm infants (879 +/- 348 pg, P < .05 v adults). When stimulated with plateau concentrations of LPS, supernatants of monocytes from preterm neonates had less G-CSF than did those from term neonates or adults. G-CSF mRNA content was low in cells from preterm infants, higher in those from term infants, and highest in those from adults. On the basis of the in vitro studies, we speculated that serum G-CSF concentrations might be less elevated in neutropenic neonates than in neutropenic adults. Indeed, serum concentrations were relatively low in all nonneutropenic subjects; 92 +/- 34 pg/mL (mean +/- SEM) in 10 preterm neonates, 114 +/- 21 pg/mL in 16 term neonates, and 45 +/- 13 pg/mL in 11 healthy adults. Serum concentrations were not elevated in 7 neutropenic neonates (39 +/- 17 pg/mL) but were in 8 neutropenic adults (2101 +/- 942 pg/mL, P < .05 v healthy adults). Other studies suggested that the lower G-CSF production in neonates is not counterbalanced by a heightened sensitivity of G-CSF--responsive progenitors to G-CSF. Therefore, we speculate that newborn infants, particularly those delivered prematurely, generate comparatively low quantities of G-CSF after inflammatory stimulation, and that this might constitute part of the explanation for their defective upregulation of neutrophil production and function during infection.

scholarly journals Effect of Elevated Temperature on Immediate Neurodevelopmental Outcome in Term Neonates with Hypoxic-Ischemic Encephalopathy

2019 ◽  
Vol 9 (3) ◽  
pp. 160-165
Author(s):  
Bithi Debnath ◽  
Naila Zaman Khan ◽  
Dilara Begum ◽  
Asma Begum Shilpi ◽  
Shaheen Akter
Keyword(s):  
Elevated Temperature ◽  
Rectal Temperature ◽  
Neurodevelopmental Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
Term Infants ◽  
Term Neonates ◽  
Risk Of Death ◽  
The Mean ◽  
Ischemic Encephalopathy

Background: Among term infants, hypoxic-ischemic encephalopathy due to acute perinatal asphyxia remains an important cause of neurodevelopmental deficits in childhood. Treatment is currently limited to supportive intensive care, without any specific brain-oriented therapy. Objective: To determine whether the risk of death or moderate/severe neurodevelopmental impairment in term infants with hypoxic-ischemic encephalopathy increases with relatively high skin or rectal temperature between 12 and 72 hours of birth. Materials and Methods: This was a prospective observational study. Asphyxiated newborns who came within 12 hours of birth were enrolled in this study. Both axillary and rectal temperature were recorded 6 hourly for 72 hours and each infant`s temperature for each site were rank ordered. Then mean of all axillary and rectal temperatures of each neonate was calculated. Outcomes were related to temperatures in logistic regression analyses for the elevated/relatively high temperatures and normal/low temperatures group, with adjustment of the level of encephalopathy and gender. Results: The mean axillary temperature was 36.07 ± 6.10C and in 25.71%, 11.92% and 6.32% cases axillary temperatures were >370C, >37.50C and >380C respectively. The mean rectal temperature was 36.8 ± 60C, and in 43.53%, 30.02% and 19.97% cases rectal temperatures were >370C, >37.50C and >380C respectively. Mean ambient temperature was 26.170C. There was significant correlation between axillary and rectal temperatures (r=0.889). For elevated temperature, the odds of death or moderate to severe impairment increased 8.9-fold (CI 0.906–88.18) and the odds of death alone increased 4.6-fold (CI 0.373–56.83). The odds of impairment increased 1.84-fold (CI 0.45– 7.50). Conclusion: Relatively high temperature during usual care after hypoxic-ischemia in term neonates was associated with adverse neurodevelopmental outcomes. J Enam Med Col 2019; 9(3): 160-165

Production of granulocyte colony-stimulating factor in vitro by monocytes from preterm and term neonates [see comments]

Blood ◽  
1993 ◽  
Vol 82 (8) ◽  
pp. 2478-2484 ◽  
Author(s):  
KR Schibler ◽  
KW Liechty ◽  
WL White ◽  
RD Christensen
Keyword(s):  
Newborn Infants ◽  
Preterm Neonates ◽  
Granulocyte Colony Stimulating Factor ◽  
Serum Concentrations ◽  
Colony Stimulating Factor ◽  
Term Infants ◽  
Term Neonates ◽  
And Function ◽  
Stimulating Factor

We postulated that defective generation of granulocyte colony- stimulating factor (G-CSF) by cells of newborn infants might underlie their deficiencies in upregulating neutrophil production and function during bacterial infection. To test this, we isolated monocytes from the blood of preterm neonates, term neonates, and adults and, after stimulation with various concentrations of interleukin-1 alpha (IL-1 alpha) or lipopolysaccharide (LPS), quantified G-CSF concentrations in cell supernatants and G-CSF mRNA in cell lysates. When stimulated with plateau concentrations of IL-1 alpha for 24 hours, G-CSF concentrations were higher in supernatants of adult cells (8,699 +/- 5,529 pg/10(6) monocytes) than in those from term infants (2,557 +/- 442 pg, P < .05) or from preterm infants (879 +/- 348 pg, P < .05 v adults). When stimulated with plateau concentrations of LPS, supernatants of monocytes from preterm neonates had less G-CSF than did those from term neonates or adults. G-CSF mRNA content was low in cells from preterm infants, higher in those from term infants, and highest in those from adults. On the basis of the in vitro studies, we speculated that serum G-CSF concentrations might be less elevated in neutropenic neonates than in neutropenic adults. Indeed, serum concentrations were relatively low in all nonneutropenic subjects; 92 +/- 34 pg/mL (mean +/- SEM) in 10 preterm neonates, 114 +/- 21 pg/mL in 16 term neonates, and 45 +/- 13 pg/mL in 11 healthy adults. Serum concentrations were not elevated in 7 neutropenic neonates (39 +/- 17 pg/mL) but were in 8 neutropenic adults (2101 +/- 942 pg/mL, P < .05 v healthy adults). Other studies suggested that the lower G-CSF production in neonates is not counterbalanced by a heightened sensitivity of G-CSF--responsive progenitors to G-CSF. Therefore, we speculate that newborn infants, particularly those delivered prematurely, generate comparatively low quantities of G-CSF after inflammatory stimulation, and that this might constitute part of the explanation for their defective upregulation of neutrophil production and function during infection.

Immediate Postnatal Microbial Colonization in Sick Term Neonates Admitted to NICU: Prevalence, Microbiota, and Associated Characteristics

2021 ◽  
Author(s):  
Rita P. Verma ◽  
Archana Kota ◽  
Joshua Fogel
Keyword(s):  
Neonatal Intensive Care ◽  
Group B Streptococcus ◽  
Microbial Colonization ◽  
Respiratory Support ◽  
Term Infants ◽  
Term Neonates ◽  
E Coli ◽  
Single Center Study ◽  
Key Points ◽  
Group B

Objective The immediate postnatal rectal (RC) and nasopharyngeal colonization (NPC), their prevalence, taxa, and associated characteristics were investigated in sick term infants admitted to the neonatal intensive care unit. Study Design In a retrospective cohort single center study, nasopharyngeal (NPCx) and rectal (RCx) microbial cultures were obtained within 20 minutes of birth in mild-to- moderate sick term infants. Associations between the colonization and maternal–neonatal variables, including early neonatal course, were analyzed via logistic regression analysis. Results A total of 154 term infants were admitted for respiratory distress, hypoglycemia, maternal chorioamnionitis (CHO), and suspected neonatal sepsis; out of which, 80 (52%) were NPCx-positive (+) infants. The duration of rupture of membrane (ROM) was higher (15.5 ± 10.0 vs. 11.3 ± 11.0 hours, p = 0.02), while the respiratory support requirement (16.3 vs. 29.7%, p = 0.04) and occurrence of maternal group B Streptococcus (GBS) colonization lower (15.0 vs. 35.1%, p = 0.01) in NPCx+ infants. ROM increased (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01–1.07), and maternal GBS colonization decreased the odds of positive nasopharyngeal cultures (OR: 0.31, 95% CI: 0.14–0.72). The major microorganisms isolated were Staphylococcus epidermidis (41%), α hemolytic Streptococcus (AHS; 16%), Escherichia coli (13%), and GBS (1.06%). Among the enrolled infants, 44 (28.5%) were RCx positive. The need for (11.4 vs. 27.3%, p = 0.03) and days on respiratory support (0.2 ± 0.6 vs. 0.8 ± 2.5, p = 0.03) were lower and the occurrence of CHO higher (41.0 vs. 23.2%, p = 0.04) in the RCx positive infants. Cesarean section (CS) was performed less frequently (18.2 vs. 55.5%, p = 0.001) and decreased the odds of having positive rectal cultures (OR: 0.21, 95% CI: 0.08–0.51). In total, 80% of the RCx positive infants isolated E. coli, and 6.8% Klebsiella. Conclusion In sick term neonates, early NPC is dominated by SE and RC by E. coli. NPC is supported by ROM and declines by maternal GBS colonization, whereas RC decreases with CS. NPC is more common than RC in this population. Key Points

Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity

2011 ◽  
Vol 37 (7) ◽  
pp. 1087-1094 ◽  
Author(s):  
Hadrien Rozé ◽  
Abdelghani Lafrikh ◽  
Virginie Perrier ◽  
Arnaud Germain ◽  
Antoine Dewitte ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Neurally Adjusted Ventilatory Assist ◽  
Diaphragm Electrical Activity ◽  
Ventilatory Assist

Serum Aldosterone Concentrations Related to Sodium Balance in the Newborn Infant

PEDIATRICS ◽  
1974 ◽  
Vol 53 (3) ◽  
pp. 410-413
Author(s):  
Sharon R. Siegel ◽  
Delbert A. Fisher ◽  
William Oh
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Newborn Infants ◽  
Full Term ◽  
Sodium Balance ◽  
Term Infants ◽  
Serum Aldosterone ◽  
Sodium Load ◽  
Sodium Dependent ◽  
The Mean

Serum aldosterone concentrations and sodium (Na) balance were studied between 24 and 48 hours of life in 39 newborn infants of various gestational ages and in infants with or without respiratory distress syndrome (RDS) . The serum aldosterone levels in the neonatal period were high but not related to gestational age. The serum aldosterone levels of small-for-gestational-age (SGA) infants were similar to those of the full-term infants. In normal infants (preterm and full term) and in SGA infants, the mean oral Na intake was 1.0 mEq/kg/24 hr; in this group of infants, no correlation was observed between Na intake and excretion or between Na intake and serum aldosterone concentrations, probably due to the narrow range of Na intake. In preterm infants with RDS, Na was given in larger quantities and by the parenteral route. In this group, significant correlations were observed between Na intake and Na excretion and between Na intake and serum aldosterone concentrations. These data suggest that the expected sodium dependent regulatory mechanism for aldosterone secretion is functional 10 the preterm infants with RDS when given a large sodium load; and that the quantity of Na excretion is consistent with the variations in aldosterone concentrations.

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