Neonatology
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Comparative Study
Sustained inflations: comparing three neonatal resuscitation devices.
Some national resuscitation guidelines advocate using sustained initial inflations (2-3 s) for babies requiring resuscitation. Inflation times ≥10 s have been used for preterm infants. ⋯ The T-piece provided consistent PIP during a single 10 s sustained inflation with less variation in pressure compared with the flow-inflating bag. Sustained inflations >3 s were difficult to achieve with a self-inflating bag.
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Increased survival rates for extremely low birth weight infants have been reported. However, survival rates and prognoses of extremely preterm infants, such as infants born at 22 weeks of gestation, are still poor. ⋯ In our study, all infants admitted to the NICU at a gestational age of 22 weeks were discharged from the hospital alive. This might suggest that infants after 22 weeks' gestation be considered eligible for active treatment in Japan, though considering the size of the material, generalizibility of the results cannot be considered guaranteed.
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Review Meta Analysis
In search of the optimal oxygen saturation for extremely low birth weight infants: a systematic review and meta-analysis.
The optimal arterial oxygen saturation in the first weeks of life is unknown for immature newborn infants. ⋯ A low oxygen saturation approach reduces severe retinopathy of prematurity by 50%, i.e., from 20.9 to 9.5%, and bronchopulmonary dysplasia/lung problems by 25%, i.e., from 40.8 to 29.7%. Further randomized trials are needed to provide definite conclusions and to assess whether reducing oxygen saturation has an impact on mortality among very and extremely low birth weight infants.
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Extremely low-dose dexamethasone to facilitate extubation in mechanically ventilated preterm babies.
Bronchopulmonary dysplasia (BPD) is a major respiratory complication of extreme prematurity. Dexamethasone is effective in reducing ventilation requirements in babies with BPD, but follow-up studies have raised concerns about long-term neurological sequelae. Few studies have investigated the lowest dose effective for weaning from mechanical ventilation. ⋯ This short dexamethasone course appears effective in facilitating extubation. Randomised trials with long-term follow-up are needed to determine the role of extremely low-dose dexamethasone in preterm babies with evolving BPD.
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Opinions and practice regarding end-of-life decisions in neonatal medicine show considerable variations between countries. A recent change of the legal framework, together with an ongoing debate among French neonatologists, led the French Society of Neonatology to reconsider and update its previous recommendations. ⋯ This statement provides the principles identified by French neonatologists on which to base their decisions concerning the ending of life. Arguments are set forth, discussed and compared with international statements and previously published considerations.