scholarly journals Higher versus Lower Oxygen Concentration during Respiratory Support in the Delivery Room in Extremely Preterm Infants: A Pilot Feasibility Study

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 942
Author(s):  
Brenda Hiu Yan Law ◽  
Elizabeth Asztalos ◽  
Neil N. Finer ◽  
Maryna Yaskina ◽  
Maximo Vento ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Oxygen Concentration ◽  
Feasibility Study ◽  
Delivery Room ◽  
Preterm Neonates ◽  
Post Intervention ◽  
Hospital Policy ◽  
Deferred Consent ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Background: Optimal starting oxygen concentration for delivery room resuscitation of extremely preterm infants (<29 weeks) remains unknown, with recommendations of 21–30% based on uncertain evidence. Individual patient randomized trials designed to answer this question have been hampered by poor enrolment. Hypothesis: It is feasible to compare 30% vs. 60% starting oxygen for delivery room resuscitation of extremely preterm infants using a change in local hospital policy and deferred consent approach. Study design: Prospective, single-center, feasibility study, with each starting oxygen concentration used for two months for all eligible infants. Population: Infants born at 23 + 0–28 + 6 weeks’ gestation who received delivery room resuscitation. Study interventions: Initial oxygen at 30% or 60%, increasing by 10–20% every minute for heart rate < 100 bpm, or increase to 100% for chest compressions. Primary outcome: Feasibility, defined by (i) achieving difference in cumulative supplied oxygen concentration between groups, and (ii) post-intervention rate consent >50%. Results: Thirty-four infants were born during a 4-month period; consent was obtained in 63%. Thirty (n = 12, 30% group; n = 18, 60% group) were analyzed, including limited data from eight who died or were transferred before parents could be approached. Median cumulative oxygen concentrations were significantly different between the two groups in the first 5 min. Conclusion: Randomized control trial of 30% or 60% oxygen at the initiation of resuscitation of extremely preterm neonates with deferred consent is feasible. Trial registration: Clinicaltrials.gov NCT03706586

Opinions of paediatricians who teach neonatal resuscitation about resuscitation practices on extremely preterm infants in the delivery room

2016 ◽  
Vol 42 (11) ◽  
pp. 725-728 ◽  
Author(s):  
Cristiane Ribeiro Ambrosio ◽  
Adriana Sanudo ◽  
Alma M Martinez ◽  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Feasibility Study of Early Blood Pressure Management in Extremely Preterm Infants

2012 ◽  
Vol 161 (1) ◽  
pp. 65-69.e1 ◽  
Author(s):  
Beau J. Batton ◽  
Lei Li ◽  
Nancy S. Newman ◽  
Abhik Das ◽  
Kristi L. Watterberg ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Preterm Infants ◽  
Feasibility Study ◽  
Pressure Management ◽  
Blood Pressure Management ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

2017 ◽  
Vol 34 (12) ◽  
pp. 1227-1233 ◽  
Author(s):  
Mohamed Shalabi ◽  
Adel Mohamed ◽  
Brigitte Lemyre ◽  
Khalid Aziz ◽  
Daniel Faucher ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Intestinal Perforation ◽  
Preterm Neonates ◽  
Network Database ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Using Data ◽  
Spontaneous Intestinal Perforation

Background There have been recent concerns regarding the higher rates of spontaneous intestinal perforation (SIP) in preterm infants that have been exposed to intrapartum magnesium sulfate (MgSO4). Objective To assess the association between intrapartum MgSO4 exposure and necrotizing enterocolitis (NEC) and/or SIP in extremely preterm neonates. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born at < 28 weeks' gestation admitted to neonatal units in Canada between 2011 and 2014 were divided into two groups: those exposed antenatally to MgSO4 and those unexposed. Stratified analyses for infants born between 22 and 25 weeks' gestation and those born between 26 and 27 weeks' gestation were conducted. The primary outcome was intestinal injury, identified as either NEC or SIP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Results We compared 2,300 unexposed infants with 2,055 exposed infants. There was no difference in the odds of NEC (9.88% exposed vs. 9.59% unexposed; aOR: 0.92; 95% CI: 0.75–1.14) or SIP (3.4% exposed vs. 3.39% unexposed; aOR: 1.05; 95% CI: 0.75–1.48) between the two groups. Conclusion Antenatal exposure to MgSO4 was not associated with NEC or SIP in extremely preterm infants.

Controversies about the resuscitation of extremely preterm infants in the delivery room

2005 ◽  
Vol 81 (7) ◽  
pp. 3-15 ◽  
Author(s):  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Controversies about the resuscitation of extremely preterm infants in the delivery room

10.2223/1295 ◽  
2005 ◽  
Vol 81 (7) ◽  
pp. 3-15 ◽  
Author(s):  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Guidelines for Resuscitation in the Delivery Room of Extremely Preterm Infants

2004 ◽  
Vol 19 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Giovanna Verlato ◽  
Daniela Gobber ◽  
Donatella Drago ◽  
Lino Chiandetti ◽  
Paola Drigo
Keyword(s):  
Preterm Infants ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Mortality and significant neurosensory impairment in preterm infants: an international comparison

2021 ◽  
pp. fetalneonatal-2021-322288
Author(s):  
Marie Chevallier ◽  
Thierry Debillon ◽  
Brian A Darlow ◽  
Anne R Synnes ◽  
Véronique Pierrat ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Population Based ◽  
Preterm Neonates ◽  
Composite Outcome ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Observational Cohort ◽  
Baseline Characteristics ◽  
French Cohort

ObjectiveTo compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and follow-up data.SettingThree population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).PatientsExtremely preterm neonates of <28 weeks’ gestation in year 2011.Main outcome measuresPrimary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.ResultsOverall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).ConclusionsComposite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.

Peak Inspiratory Pressure During Delivery Room Resuscitation for Infants Born at Less Than 500 Grams.

2020 ◽  
pp. 1-4
Keyword(s):  
Preterm Infants ◽  
Neonatal Resuscitation ◽  
Peak Inspiratory Pressure ◽  
Delivery Room ◽  
Inspiratory Pressure ◽  
Temperature Management ◽  
Pulmonary Mechanics ◽  
Term Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Introduction: With the advent of technological advancement and better scientific understanding it is possible now to successfully resuscitate and save babies born at less than 500 grams. Stabilization of these infants in the delivery room (DR) is one of the goals of the golden hour management. While some factors, including temperature management and airway care have standards, there is paucity of data on the optimal peak inspiratory pressure (PIP). The Neonatal Resuscitation Program (NRP) recommends using the same inflation pressure of 20 cm to 25 cm H2O for preterm infants as used for term infants. Preterm lungs are not the same as term infants. Due to the smaller lung volume, capacities and dynamic pulmonary mechanics, these preterm infants are prone to pulmonary complications including pneumothorax. Therefore, there is need to use PIP judiciously in the DR. Methods and Results: In this brief report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP. The success criteria in the DR were heart rate greater than 100 per minute and adequate oxygen saturations minute by minute per NRP guidelines with minimal use of supplemental oxygen. Conclusion: While we need good prospectively designed studies to document the ideal PIP for these extreme preterm infants, we suggest a PIP lower than the currently recommended may be sufficient for some extremely preterm infants.

scholarly journals Predictive Role of Urinary Metabolic Profile for Abnormal MRI Score in Preterm Neonates

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Maria Luisa Tataranno ◽  
Serafina Perrone ◽  
Mariangela Longini ◽  
Caterina Coviello ◽  
Maria Tassini ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Infants ◽  
Early Identification ◽  
Metabolic Profile ◽  
Area Under The Curve ◽  
Preterm Neonates ◽  
Resonance Spectroscopy ◽  
Equivalent Age ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Background and Objective. Early identification of neonates at risk for brain injury is important to start appropriate intervention. Urinary metabolomics is a source of potential, noninvasive biomarkers of brain disease. We studied the urinary metabolic profile at 2 and 10 days in preterm neonates with normal/mild and moderate/severe MRI abnormalities at term equivalent age.Methods. Urine samples were collected at two and 10 days after birth in 30 extremely preterm infants and analyzed using proton magnetic resonance spectroscopy. A 3 T MRI was performed at term equivalent age, and images were scored for white matter (WM), cortical grey matter (cGM), deep GM, and cerebellar abnormalities. Infants were divided in two groups: normal/mild and moderately/severely abnormal MRI scores.Results. No significant clustering was seen between normal/mild and moderate/severe MRI scores for all regions at both time points. The ROC curves distinguished neonates at 2 and 10 days who later developed a markedly less mature cGM score from the others (2 d: area under the curve (AUC) = 0.72, specificity (SP) = 65%, sensitivity (SE) = 75% and 10 d: AUC = 0.80, SP = 78%, SE = 80%) and a moderately to severely abnormal WM score (2 d: AUC = 0.71, specificity (SP) = 80%, sensitivity (SE) = 72% and 10 d: AUC = 0.69, SP = 64%, SE = 89%).Conclusions. Early urinary spectra of preterm infants were able to discriminate metabolic profiles in patients with moderately/severely abnormal cGM and WM scores at term equivalent age. Urine spectra are promising for early identification of neonates at risk of brain damage and allow understanding of the pathogenesis of altered brain development.

Sign in / Sign up

Export Citation Format

Share Document