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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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.
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Most pediatric cardiologists believe that pulse oximetry helps to diagnose critical congenital heart disease in neonates who might otherwise be discharged from the newborn nursery undiagnosed. Some of these patients develop catastrophic cardiac and multi-system failure after the ductus closes and die or suffer severe morbidity. Nevertheless, pulse oximetry is not universally used in the newborn nursery. ⋯ Recent studies, however, show that even cardiologists miss critical congenital heart defects, modern oximeters are stable and reliable, and that the false positive rate is very low, lower than the false positive rate based on physical examination. The benefits probably exceed the cost, and evidence is provided to confirm this. There is no reason not to use pulse oximetry routinely in the newborn nursery.
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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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Variability in the assessment of 'adequate' chest excursion during simulated neonatal resuscitation.
International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing 'adequate' chest excursion lacks objectivity. ⋯ 'Adequate' chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.