Neonatology
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Observational Study
Influence of gestational age on dead space and alveolar ventilation in preterm infants ventilated with volume guarantee.
Ventilated preterm infant lungs are vulnerable to overdistension and underinflation. The optimal ventilator-delivered tidal volume (VT) in these infants is unknown and may depend on the extent of alveolarisation at birth. ⋯ VD,app rather than anatomical VD is the major factor influencing increased VD,MM/VT at a younger GA. A volume guarantee setting of 4-5 ml/kg in the Dräger Babylog® 8000 plus ventilator may be inappropriate as a universal target across the GA range of 23-32 weeks. Differences between measured and set VT and the dependence of this difference on GA require further investigation.
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Randomized Controlled Trial
Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain?
Traditionally, 10 years ago, children born preterm often routinely received morphine, especially during mechanical ventilation. Studies in neonatal rats, whose stage of brain development roughly corresponds to that of children born preterm, found negative long-term effects after pain and opioid exposure. ⋯ Although prematurity, opioid exposure and neonatal pain were significantly associated with brain volume, no major associations with neuropsychological functioning or thermal sensitivity were detected. Our findings suggest that morphine administration during neonatal life does not affect neurocognitive performance or thermal sensitivity during childhood in children born preterm without brain damage during early life. Future studies with larger sample sizes are needed to confirm these findings.
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Observational Study
Reference Ranges for Cerebral Tissue Oxygen Saturation Index in Term Neonates during Immediate Neonatal Transition after Birth.
Non-invasive monitoring of the brain with near-infrared spectroscopy (NIRS) during immediate transition after birth is of growing interest. ⋯ The present observational study adds the reference ranges and centile charts of cTOI measured with the NIRO 200NX and cFTOE calculated out of cTOI and SpO2 in neonates during the immediate neonatal transition. Centiles for each instrument will be necessary for future clinical application, since the differences between cTOI and cerebral regional tissue oxygen saturation measured with INVOS 5100C change with increasing regional oxygenation.
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The oxygenation index (OI = mean airway pressure, MAP × FiO2 × 100 : PaO2) is used to assess the severity of hypoxic respiratory failure (HRF) and persistent pulmonary hypertension of the newborn (PPHN). An indwelling arterial line or arterial punctures are necessary to obtain PaO2 for the calculation of OI. Oxygenation can be continuously and noninvasively assessed using pulse oximetry. The use of the oxygen saturation index (OSI = MAP × FiO2 × 100 : SpO2) can be an alternate method of assessing the severity of HRF. ⋯ OSI correlates significantly with OI in infants with HRF. This noninvasive measure may be used to assess the severity of HRF and PPHN in neonates without arterial access.
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Randomized Controlled Trial Multicenter Study
A Randomized Trial of Low-Flow Oxygen versus Nasal Continuous Positive Airway Pressure in Preterm Infants.
Nasal continuous positive airway pressure (nCPAP) stabilizes the residual volume and may decrease the risk of 'atelectotrauma', potentially promoting lung development in neonates. ⋯ Replacing nCPAP by low-flow O2 in preterm infants with GA >26 weeks at the end of the first week of life did not seem to affect the a/A pO2 ratio or weight gain negatively. Thus, prolonged nCPAP seems not to have a positive effect on lung function at 28 days of life and replacement by low-flow O2 could reduce the cost of equipment and increase the ease of nursing.