Articles de revues : « Ventilated preterm newborn »

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Smith, Lynne M., Machiko Ikegami, Glenda C. Calvario, James Surdilla et M. Gore Ervin. « Renal responses to angiotensin II receptor blockade in ventilated preterm newborn lambs ». Reproduction, Fertility and Development 11, n^o 8 (1999) : 419. http://dx.doi.org/10.1071/rd00009.

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Renal and cardiovascular immaturity has been linked with poor outcomes in the premature human newborn. Despite extensive study in the fetus, the contribution of the renin–angiotensin system to renal and cardiovascular function in the premature newborn has not been well characterized. To evaluate the angiotensin II contribution to preterm newborn renal and cardiovascular functions, preterm (120-day) and near-term (136-day) lambs were Caesarean delivered and ventilated. One hour following delivery, animals were randomized to receive angiotensin II receptor-blockade (saralasin; 20 g kg–1 min–1) or saline (CON). Prior to blockade, mean SEM values for urine flow (UFlow), urinary sodium excretion (UNaV), and fractional excretion of sodium (FENa) were similar in all groups. Angiotensin II receptor-blockade decreased Uflow, UNaV and FENa in the 120-day group with no changes in the 136-day animals. No changes in mean arterial pressure, or plasma angiotensin II, aldosterone, and renin activity levels were noted at either gestational age. Conclusions: (1) angiotensin II contributes to the regulation of renal function in 120-day preterm lambs without changing blood pressure and (2) angiotensin II-mediated feedback inhibition of renin release is uncoupled in preterm newborns.

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Berry, LM, M. Ikegami, E. Woods et MG Ervin. « Postnatal renal adaptation in preterm and term lambs ». Reproduction, Fertility and Development 7, n^o 3 (1995) : 491. http://dx.doi.org/10.1071/rd9950491.

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The present experiments determined if increases in renal reabsorptive capacity during the transition from fetal to neonatal life are gestation dependent. Renal function was studied in chronically-catheterized fetal lambs (133 +/- 1 days; term, 145-150 days). Additionally, renal function was studied in anaesthetized, ventilated, caesarean-delivered preterm lambs (109-139 days gestation) and term lambs (148 days gestation), and in 2-day-old spontaneously-delivered term lambs. Newborns < or = 120 days old received surfactant to facilitate ventilation and maintenance of physiologic blood gases. Two hours after caesarian delivery, urine osmolality, urine flow, glomerular filtration rate (GFR), and fractional sodium excretion (FENa) values were similar for all gestations. Relative to fetal values, caesarean-delivered newborn renal values included lower urine flow rates (0.20 +/- 0.03 v. 0.05 +/- 0.01 mL min-1 kg-1), higher urine osmolalities (118 +/- 15 v. 422 +/- 16 mOsmol kg-1 H2O), and no differences in GFR or FENa. Relative to caesarean-delivered newborns, 2-day newborn renal function included higher values for GFR (0.7 +/- 0.1 v. 3.0 +/- 0.1 mL min-1 kg-1) and urine osmolality (724 +/- 32 mosmol kg-1 H2O), and lower FENa (7.0 +/- 1.5 v. 0.2 +/- 0.02%), and urine flow (0.005 +/- 0.003 mL min-1 kg-1). The 132- and 139-day animals were ventilated for 5 h and 10 h respectively; the only functional change at 10 h was a decrease in FENa (7.0 +/- 1.5 v. 2.8 +/- 0.1%). It is concluded that: (1) relative to fetal animals, renal adaptive responses in anaesthetized, ventilated newborns begin within 2 h following caesarian delivery; (2) initial adaptive responses are not gestation dependent after 109 days; and (3) the combined effects of ventilation and/or anaesthesia delay postnatal renal adaptations for at least 10 h after birth.

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Pryor, Emily J., Marcus J. Kitchen, Michelle K. Croughan, Kelly J. Crossley, Megan J. Wallace, Katie Lee, Arjan B. te Pas, Erin V. McGillick et Stuart B. Hooper. « Improving lung aeration in ventilated newborn preterm rabbits with a partially aerated lung ». Journal of Applied Physiology 129, n^o 4 (1 octobre 2020) : 891–900. http://dx.doi.org/10.1152/japplphysiol.00426.2020.

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Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. Using phase contrast X-ray imaging, we showed that combining a long inflation time (1.0 s) with surfactant improved lung mechanics and aeration in the immediate newborn period. The current clinical practice of using short inflation times during iPPV might be suboptimal, and a different approach is needed.

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Allison, Beth J., Domenic A. LaRosa, Samantha K. Barton, Stuart Hooper, Valerie Zahra, Mary Tolcos, Kyra Y. Y. Chan et al. « Dose-dependent exacerbation of ventilation-induced lung injury by erythropoietin in preterm newborn lambs ». Journal of Applied Physiology 126, n^o 1 (1 janvier 2019) : 44–50. http://dx.doi.org/10.1152/japplphysiol.00800.2018.

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Erythropoietin (EPO) is being trialled in preterm infants to reduce brain injury, but high doses increase lung injury in ventilated preterm lambs. We aimed to determine whether early administration of lower doses of EPO could reduce ventilation-induced lung injury and systemic inflammation in preterm lambs. Ventilation was initiated in anaesthetized preterm lambs [125 ± 1 (SD) days gestation] using an injurious strategy for the first 15 min. Lambs were subsequently ventilated with a protective strategy for a total of 2 h. Lambs were randomized to receive either intravenous saline (Vent; n = 7) or intravenous 300 ( n = 5), 1,000 (EPO1000; n = 5), or 3,000 (EPO3000; n = 5) IU/kg of human recombinant EPO via an umbilical vein. Lung tissue was collected for molecular and histological assessment of inflammation and injury and compared with unventilated control lambs (UVC; n = 8). All ventilated groups had similar blood gas and ventilation parameters, but EPO1000 lambs had a lower fraction of inspired oxygen requirement and lower alveolar–arterial difference in oxygen. Vent and EPO lambs had increased lung interleukin (IL)-1β, IL-6, and IL-8 mRNA, early lung injury genes connective tissue growth factor, early growth response protein 1, and cysteine-rich 61, and liver serum amyloid A3 mRNA compared with UVCs; no difference was observed between Vent and EPO groups. Histological lung injury was increased in Vent and EPO groups compared with UVCs, but EPO3000 lambs had increased lung injury scores compared with VENT only. Early low-doses of EPO do not exacerbate ventilation-induced lung inflammation and injury and do not provide any short-term respiratory benefit. High doses (≥3,000 IU/kg) likely exacerbate lung inflammation and injury in ventilated preterm lambs. NEW & NOTEWORTHY Trials are ongoing to assess the efficacy of erythropoietin (EPO) to provide neuroprotection for preterm infants. However, high doses of EPO increase ventilation-induced lung injury (VILI) in preterm lambs. We investigated whether early lower doses of EPO may reduce VILI. We found that lower doses did not reduce, but did not increase, VILI, while high doses (≥3,000 IU/kg) increase VILI. Therefore, lower doses of EPO should be used in preterm infants, particularly those receiving respiratory support.

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Ueda, T., M. Ikegami et A. H. Jobe. « Developmental changes of sheep surfactant : in vivo function and in vitro subtype conversion ». Journal of Applied Physiology 76, n^o 6 (1 juin 1994) : 2701–6. http://dx.doi.org/10.1152/jappl.1994.76.6.2701.

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Developmental differences in the intrinsic characteristics of surfactant have not been evaluated. Therefore, heavy-subtype surfactant was recovered from alveolar washes of 132-, 139-, and 148-day preterm lambs, 2- to 3-day-old newborn ventilated lambs, and adult sheep. The density of heavy-subtype surfactant and surfactant protein-A-to-saturated phosphatidylcholine ratios increased significantly with developmental age. In contrast, percent conversion from heavy to light surfactant forms was more rapid for surfactant from preterm animals than for surfactant from mature or adult animals. The function of the heavy-subtype surfactant was tested by treating ventilated 27-day gestational age preterm rabbits. The surfactant from the most immature animals was less effective at improving compliance or maintaining lung volumes on deflation than was surfactant from newborn or adult animals. These results demonstrate intrinsic and functional differences in surfactant from developing compared with mature sheep that correlated with the surfactant protein-A-content. The pattern of changes indicates that the preterm animal is at a disadvantage, because the surfactant is intrinsically abnormal relative to that of the adult.

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Ervin, M. Gore, Steven R. Seidner, M. Michelle Leland, Machiko Ikegami et Alan H. Jobe. « Direct fetal glucocorticoid treatment alters postnatal adaptation in premature newborn baboons ». American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 274, n^o 4 (1 avril 1998) : R1169—R1176. http://dx.doi.org/10.1152/ajpregu.1998.274.4.r1169.

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Abnormalities of premature newborn adaptation after preterm birth result in significant perinatal mortality and morbidity. We assessed the effects of short-term (24 h) fetal betamethasone exposure on preterm newborn baboon pulmonary and cardiovascular regulation and renal sodium handling during the first 24 h after birth. Male fetal baboons ( Papio) (124-day gestation, term 185 days) received ultrasound-guided intramuscular injections of saline ( n = 5) or betamethasone (0.5 mg/kg; n = 5). Fetuses were cesarean delivered 24 h later, treated with 100 mg/kg surfactant, and ventilated by adjusting peak inspiratory pressures to maintain[Formula: see text] values of 35–50 mmHg for 24 h. Betamethasone- vs. saline-treated mean ± SE newborn body weights (0.45 ± 0.02 vs. 0.41 ± 0.01 kg) were similar. Although prenatal betamethasone did not affect postnatal lung function ([Formula: see text], arterial/alveolar O2 gradient, or dynamic compliance), plasma hormone (cortisol or thyroxine), or catecholamine levels, mean arterial pressure (25 ± 1 vs. 32 ± 1 mmHg), plasma sodium concentration (132 ± 2 vs. 138 ± 1 meq/l), glomerular filtration rate (0.07 ± 0.02 vs. 0.16 ± 0.02 ml ⋅ min−1 ⋅ kg−1), and renal total sodium reabsorption (1.5 ± 0.5 vs. 16.0 ± 3.0 μeq ⋅ min−1 ⋅ kg−1) values were significantly lower in saline-treated than in betamethasone-treated newborns at 24 h. We conclude that despite the fact that there are no pulmonary and endocrine effects, antenatal glucocorticoid exposure alters premature newborn baboon vascular and renal glomerular function and improves sodium reabsorption after preterm delivery.

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Lakshminrusimha, Satyan, Sylvia F. Gugino, Krishnamurthy Sekar, Stephen Wedgwood, Carmon Koenigsknecht, Jayasree Nair et Bobby Mathew. « Inhaled Nitric Oxide at Birth Reduces Pulmonary Vascular Resistance and Improves Oxygenation in Preterm Lambs ». Children 8, n^o 5 (11 mai 2021) : 378. http://dx.doi.org/10.3390/children8050378.

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Resuscitation with 21% O2 may not achieve target oxygenation in preterm infants and in neonates with persistent pulmonary hypertension of the newborn (PPHN). Inhaled nitric oxide (iNO) at birth can reduce pulmonary vascular resistance (PVR) and improve PaO2. We studied the effect of iNO on oxygenation and changes in PVR in preterm lambs with and without PPHN during resuscitation and stabilization at birth. Preterm lambs with and without PPHN (induced by antenatal ductal ligation) were delivered at 134 d gestation (term is 147–150 d). Lambs without PPHN were ventilated with 21% O2, titrated O2 to maintain target oxygenation or 21% O2 + iNO (20 ppm) at birth for 30 min. Preterm lambs with PPHN were ventilated with 50% O2, titrated O2 or 50% O2 + iNO. Resuscitation with 21% O2 in preterm lambs and 50%O2 in PPHN lambs did not achieve target oxygenation. Inhaled NO significantly decreased PVR in all lambs and increased PaO2 in preterm lambs ventilated with 21% O2 similar to that achieved by titrated O2 (41 ± 9% at 30 min). Inhaled NO increased PaO2 to 45 ± 13, 45 ± 20 and 76 ± 11 mmHg with 50% O2, titrated O2 up to 100% and 50% O2 + iNO, respectively, in PPHN lambs. We concluded that iNO at birth reduces PVR and FiO2 required to achieve target PaO2.

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Wada, Norihisa, M. Gore Ervin et Machiko Ikegami. « Effect of ventilation style on cardiovascular and renal adaptation in preterm newborn lambs ». American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 275, n^o 3 (1 septembre 1998) : R836—R843. http://dx.doi.org/10.1152/ajpregu.1998.275.3.r836.

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Renal adaptive responses during the 24 h after delivery in term newborn lambs include marked increases in both glomerular filtration rate (GFR) and sodium reabsorption. This study investigated the effects of ventilation style on cardiovascular, renal, and endocrine adaptations in preterm newborn lambs. Lambs ( n = 62) were delivered by cesarean section at 131 days gestation (term = 150 days), treated with surfactant, and randomized to one of three ventilation strategies: high-frequency oscillation (12 Hz), high rate (50 breaths/min; tidal volume = 8 ml/kg), or low rate (15 breaths/min; tidal volume = 15 ml/kg). Lambs (5 or 6/group) were ventilated for 2, 5, 10, and 24 h to maintain arterial[Formula: see text] between 45 and 50 mmHg. Plasma vasopressin levels decreased to <25 pg/ml by 10 h, and fractional sodium excretion decreased to <1% by 16 h in all groups. However, cardiac output, renal plasma flow, and GFR values did not change over time for any of the groups. The style of ventilation employed had no measurable effects on overall cardiovascular, renal, or endocrine function. We conclude in ventilated preterm lambs that 1) the ventilation style does not affect the time course for postnatal adaptation, 2) adaptive changes in renal tubular sodium reabsorption are evident by 16 h after birth, and 3) changes in preterm newborn renal sodium reabsorption occur in the absence of postnatal changes in renal plasma flow or GFR.

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Sharma, Ravi, et Swapnil Baheti. « Outcome of neonatal ventilation : a prospective and cross-sectional study in tertiary care centre ». International Journal of Contemporary Pediatrics 4, n^o 5 (23 août 2017) : 1820. http://dx.doi.org/10.18203/2349-3291.ijcp20173793.

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Background: Neonatal mortality accounts for nearly two thirds of infant mortality and half of under 5 mortalities in India. It is possible to increase neonatal survival and improve the quality of life only through prompt and adequate management of critically ill newborn. Mechanical ventilation has become a must to enhance neonatal survival and is an essential component of neonatal intensive care.Methods: Hospital based prospective, cross-sectional study from 1st July 2012 to 30th June 2013. All NICU admitted neonate requiring mechanical ventilation were included. It was a descriptive, cross-sectional study of a prospective data.Results: Indication of mechanical ventilation: Out of 72 neonates studied, majority of preterm were ventilated for RDS - 34 (89.5%) and majority of Full term were ventilated for MAS - 16 (100%) followed by HIE - 8 (88.89%). Out of 38 RDS cases, 30 (79%) were ventilated till 4-7 days duration and 3 (7.9%) required ventilation for >10 days. Out of 16 MAS cases, 10 (62.5%) were ventilated for 4-7 days duration and none required prolonged ventilation. Duration of ventilation is not statistically associated with indication of mechanical ventilation with p=0.301.Conclusions: Mechanical and Pulmonary complications of mechanical ventilation are not statistically significant for outcome of mechanical ventilation but it increases length of NICU stay. Hypotension on ventilator, requirement of more than 3 ionotropes were associated with high mortality.

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Berry, D., A. Jobe et M. Ikegami. « Leakage of macromolecules in ventilated and unventilated segments of preterm lamb lungs ». Journal of Applied Physiology 70, n^o 1 (1 janvier 1991) : 423–29. http://dx.doi.org/10.1152/jappl.1991.70.1.423.

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The movement of macromolecules into and out of unventilated lung segments was evaluated in prematurely delivered and ventilated lambs. Seven lambs at 130 days gestational age had a bronchial balloon placed at birth before the first breath to obstruct the left lower lobe. Surfactant and 131I-albumin were instilled into the left lower lobe while surfactant and 125I-albumin were instilled into the remaining lung, and 70,000 molecular weight [3H]dextran was given into the vascular space at birth. Twenty-five percent of the lung by weight was not ventilated, and 24% of the total leak of dextran from the vascular space was recovered in the unventilated lungs at 3 h. An epithelial leak of protein from the two lung regions was documented by the loss of 11.4 and 18.4% of the labeled albumins in the nonventilated and ventilated lung regions, the appearance of 4.9 and 7.5% of the airway-instilled albumin in the vascular space from the nonventilated and ventilated lung regions, and the recovery of the labeled albumins in the carcasses of the lambs. The bidirectional flux of macromolecules was larger in the ventilated than in the nonventilated lung regions, indicating that ventilation can increase the leak of protein in the preterm lung. The lung areas that were never exposed to ventilation or oxygen also demonstrated a large bidirectional flux of macromolecules, a finding not present in the fetus, fullterm newborn, or adult. These findings indicate that ventilation is not solely responsible for the increased protein leak found in preterm lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

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Choudhury, S. Roy, et Sushma Nangia. « Surgical Conditions Masquarading as Respiratory Distress ». Journal of Neonatology 21, n^o 4 (décembre 2007) : 243–45. http://dx.doi.org/10.1177/097321790702100408.

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Newborn infants are nose breathers, particularly when asleep. Any obstruction to the nasal passage leads to compulsive oral breathing. The features of airway obstruction are stridor, respiratory distress, apnea, cyanosis, tachypnoea, suprasternal, intercostal, and costal margin retractions. There are various congenital, inflammatory, traumatic and mass lesions that should be considered in the evaluation of respiratory distress in the newborn infant. Endoscopic examination of the airway has now become a virtual possibility in all age group patients which has revolutionized the diagnosis and management of airway obstruction. The number of patients with long term airway problems has increased with the increasing number of survival of ventilated and preterm neonates.

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Ervin, M. Gore, James F. Padbury, Daniel H. Polk, Machiko Ikegami, Lynne M. Berry et Alan H. Jobe. « Antenatal glucocorticoids alter premature newborn lamb neuroendocrine and endocrine responses to hypoxia ». American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 279, n^o 3 (1 septembre 2000) : R830—R838. http://dx.doi.org/10.1152/ajpregu.2000.279.3.r830.

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Glucocorticoids are administered for preterm labor to improve postnatal adaptation. We assessed the effect of antenatal betamethasone (Beta) treatment on preterm newborn lamb neuroendocrine [catecholamine, arginine vasopressin (AVP)] and endocrine [triiodothyronine (T3), ANG II, and atrial natriuretic factor (ANF)] adaptive responses following delivery and a hypoxic challenge. Beta treatment included direct fetal injection at 0.2 (F0.2; n = 8) or 0.5 (F0.5; n = 7) mg/kg estimated fetal body weight or maternal injection with 0.2 ( n = 8) or 0.5 mg/kg (M0.5; n = 8). Control animals received fetal and maternal intramuscular injections of saline ( n = 8). After 24 h, lambs were delivered by cesarean section, surfactant treated, and ventilated for 4 h. Relative to the control lambs, 3 h after delivery, there was a marked suppression of plasma cortisol, epinephrine, norepinephrine, and ANG II levels and elevated plasma T3 and ANF levels, systolic blood pressure, and left ventricular contractility (dP/d t; F0.5 and M0.5) values in F0.5 and both maternal Beta-treated groups. However, Beta treatment augmented the cardiac output, cortisol, norepinephrine, AVP, and ANF responses to 20 min of hypoxia (Po 2 = 25–30 mmHg). We concluded that short-term (24 h) antenatal glucocorticoid exposure 1) alters preterm newborn postnatal blood pressure regulation in the face of marked depression of plasma cortisol, catecholamine, and ANG II levels and 2) augments the postnatal neuroendocrine and endocrine responses to a hypoxic challenge.

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Allen, Victoria, Margaret Oulton, Dora Stinson, Josee MacDonald et Alexander Allen. « Alveolar metabolism of natural vs. synthetic surfactants in preterm newborn rabbits ». Journal of Applied Physiology 90, n^o 1 (1 janvier 2001) : 198–204. http://dx.doi.org/10.1152/jappl.2001.90.1.198.

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We compared the recoveries of four surfactant preparations: two natural [term fetal rabbit surfactant (FRS) and adult rabbit surfactant (ARS)] and two commercially available preparations [apoprotein-based Survanta (S) and synthetic Exosurf (E)] from 27-day gestation rabbit pups treated at birth and ventilated up to 120 min. At 5, 60, and 120 min, we measured the recovery of the heavy-aggregate, metabolically active form (H) and the light-aggregate, nonsurface active metabolic breakdown form (L) of alveolar surfactant and determined the phospholipid content and composition of the intracellularly stored lamellar body (LB) pool. Pups treated with FRS had <15% loss of H by 2 h. ARS-treated pups had a >50% loss of H by 1 h, and E- and S-treated pups had ∼50% loss by 5 min, with a slower rate of continuing loss of up to 80% by 2 h. The major losses of H phospholipid were not explained by the L-form recovery. LB phospholipid significantly increased only in the E-treated pups and only at 2 h. FRS provides a biologically active form (H) of surfactant that appeared to remain in the airway for a significantly longer time than the other surfactant preparations. The unique properties of FRS merit further study.

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Allison, B. J., S. B. Hooper, E. Coia, G. Jenkin, A. Malhotra, V. Zahra, A. Sehgal et al. « Does growth restriction increase the vulnerability to acute ventilation-induced brain injury in newborn lambs ? Implications for future health and disease ». Journal of Developmental Origins of Health and Disease 8, n^o 5 (9 août 2017) : 556–65. http://dx.doi.org/10.1017/s204017441700037x.

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Fetal growth restriction (FGR) and preterm birth are frequent co-morbidities, both are independent risks for brain injury. However, few studies have examined the mechanisms by which preterm FGR increases the risk of adverse neurological outcomes. We aimed to determine the effects of prematurity and mechanical ventilation (VENT) on the brain of FGR and appropriately grown (AG, control) lambs. We hypothesized that FGR preterm lambs are more vulnerable to ventilation-induced acute brain injury. FGR was surgically induced in fetal sheep (0.7 gestation) by ligation of a single umbilical artery. After 4 weeks, preterm lambs were euthanized at delivery or delivered and ventilated for 2 h before euthanasia. Brains and cerebrospinal fluid (CSF) were collected for analysis of molecular and structural indices of early brain injury. FGRVENT lambs had increased oxidative cell damage and brain injury marker S100B levels compared with all other groups. Mechanical ventilation increased inflammatory marker IL-8 within the brain of FGRVENT and AGVENT lambs. Abnormalities in the neurovascular unit and increased blood–brain barrier permeability were observed in FGRVENT lambs, as well as an altered density of vascular tight junctions markers. FGR and AG preterm lambs have different responses to acute injurious mechanical ventilation, changes which appear to have been developmentally programmed in utero.

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Polglase, Graeme R., Stuart B. Hooper, Andrew W. Gill, Beth J. Allison, Kelly J. Crossley, Timothy JM Moss, Ilias Nitsos, J. Jane Pillow et Martin Kluckow. « Intrauterine inflammation causes pulmonary hypertension and cardiovascular sequelae in preterm lambs ». Journal of Applied Physiology 108, n^o 6 (juin 2010) : 1757–65. http://dx.doi.org/10.1152/japplphysiol.01336.2009.

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Chorioamnionitis increases the risk and severity of persistent pulmonary hypertension of the newborn in preterm infants. Exposure of preterm fetal lambs to intra-amniotic (IA) lipopolysaccharide (LPS) induces chorioamnionitis, causes hypertrophy of pulmonary resistance arterioles, and alters expression of pulmonary vascular growth proteins. We investigated the cardiopulmonary and systemic hemodynamic consequences of IA LPS in preterm lambs. Pregnant ewes received IA injection of LPS ( n = 6) or saline (controls; n = 8) at 122 days gestation, 7 days before exteriorization, instrumentation, and delivery of the fetus with pulmonary and systemic flow probes and catheters at 129 days gestation. Newborn lambs were ventilated, targeting a tidal volume of 6–7 ml/kg and a positive end-expiratory pressure (PEEP) of 4 cmH2O. At 30 min, all lambs underwent a PEEP challenge: PEEP was increased by 2 cmH2O at 10-min intervals to 10 cmH2O and then decreased similarly to 4 cmH2O. Ventilation parameters, arterial blood flows, and pressures were recorded in real-time for 90 min. LPS lambs had higher total protein in bronchoalveolar lavage fluid ( P < 0.002), increased medial thickness of arteriolar walls ( P = 0.013), and right ventricular hypertrophy ( P = 0.012). Compared with controls, LPS lambs had worse oxygenation ( P < 0.001), decreased pulmonary blood flow ( P = 0.05), and higher pulsatility index ( P < 0.001) and pulmonary ( P < 0.001) and systemic arterial pressures ( P = 0.005) than controls. Intra-amniotic LPS increased right-to-left shunting across the ductus arteriosus ( P = 0.018) and decreased left ventricular output ( P < 0.001). We conclude that inflammation and pulmonary remodeling induced by IA LPS adversely alters pulmonary hemodynamics with subsequent cardiovascular and systemic sequelae, which may predispose the preterm lamb to persistent pulmonary hypertension of the newborn.

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Tingay, David G., Anna Lavizzari, Cornelis E. E. Zonneveld, Anushi Rajapaksa, Emanuela Zannin, Elizabeth Perkins, Don Black et al. « An individualized approach to sustained inflation duration at birth improves outcomes in newborn preterm lambs ». American Journal of Physiology-Lung Cellular and Molecular Physiology 309, n^o 10 (15 novembre 2015) : L1138—L1149. http://dx.doi.org/10.1152/ajplung.00277.2015.

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A sustained first inflation (SI) at birth may aid lung liquid clearance and aeration, but the impact of SI duration relative to the volume-response of the lung is poorly understood. We compared three SI strategies: 1) variable duration defined by attaining volume equilibrium using real-time electrical impedance tomography (EIT; SIplat); 2) 30 s beyond equilibrium (SIlong); 3) short 30-s SI (SI30); and 4) positive pressure ventilation without SI (no-SI) on spatiotemporal aeration and ventilation (EIT), gas exchange, lung mechanics, and regional early markers of injury in preterm lambs. Fifty-nine fetal-instrumented lambs were ventilated for 60 min after applying the allocated first inflation strategy. At study completion molecular and histological markers of lung injury were analyzed. The time to SI volume equilibrium, and resultant volume, were highly variable; mean (SD) 55 (34) s, coefficient of variability 59%. SIplat and SIlong resulted in better lung mechanics, gas exchange and lower ventilator settings than both no-SI and SI30. At 60 min, alveolar-arterial difference in oxygen was a mean (95% confidence interval) 130 (13, 249) higher in SI30 vs. SIlong group (two-way ANOVA). These differences were due to better spatiotemporal aeration and tidal ventilation, although all groups showed redistribution of aeration towards the nondependent lung by 60 min. Histological lung injury scores mirrored spatiotemporal change in aeration and were greatest in SI30 group ( P < 0.01, Kruskal-Wallis test). An individualized volume-response approach to SI was effective in optimizing aeration, homogeneous tidal ventilation, and respiratory outcomes, while an inadequate SI duration had no benefit over positive pressure ventilation alone.

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Ikegami, Machiko, Timothy J. M. Moss, Suhas G. Kallapur, Neil Mulrooney, Boris W. Kramer, Ilias Nitsos, Cindy J. Bachurski, John P. Newnham et Alan H. Jobe. « Minimal lung and systemic responses to TNF-α in preterm sheep ». American Journal of Physiology-Lung Cellular and Molecular Physiology 285, n^o 1 (juillet 2003) : L121—L129. http://dx.doi.org/10.1152/ajplung.00393.2002.

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TNF-α has been associated with chorioamnionitis and the subsequent development of bronchopulmonary dysplasia in preterm infants. We asked whether bioactive recombinant ovine TNF-α could induce chorioamnionitis, lung inflammation, lung maturation, and systemic effects in fetal sheep. We compared the responses to IL-1α, a cytokine known to induce these responses in preterm sheep. Intra-amniotic TNF-α caused no chorioamnionitis, no lung maturation, and a very small increase in inflammatory cells in the fetal lung after 5 h, 2 days (d), and 7 d. In contrast, IL-1α induced inflammation and lung maturation. TNF-α given into the airways at birth increased granulocytes in the bronchoalveolar lavage fluid of ventilated preterm lungs and decreased the mRNA for surfactant protein C but did not adversely effect postnatal lung function. An intravascular injection of IL-1α caused a systemic inflammatory response in fetal sheep, whereas there was no fetal response to intravascular TNF-α. Fetal and newborn preterm sheep are minimally responsive to TNF-α. Therefore, the presence of a mediator such as TNF-α in a developing animal does not necessarily mean that it is causing the responses anticipated from previous results in adult animals.

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Mannan, Md Abdul, Nasim Jahan, Shahed Iqbal, Navila Ferdous, Subir Dey, Tashmin Farhana et Nondita Nazma. « Short Term Outcome of Preterm Neonates Required Mechanical Ventilation ». Chattagram Maa-O-Shishu Hospital Medical College Journal 15, n^o 2 (6 mars 2017) : 9–13. http://dx.doi.org/10.3329/cmoshmcj.v15i2.31796.

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Background: Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the western world and neighboring countries, neonatal ventilation in our country is still in its infancy. To analyze the common indications and outcome of preterm neonates required mechanical ventilation.Methods: This was a retrospective observational study conducted on preterm neonates required mechanical ventilation over a period of 12 months (July 2013 to June 2014).Results: A total of 50 neonates were mechanically ventilated during the study period of which 68% (n=34) survived. The survival rate was higher (77%) in 34- <37 weeks Gestational Age (GA) group and gradually declined in 30- <34 weeks (71%) & 27- <30 weeks (56%) GA. The neonates with Birth Weight (BW) ? 2500gm were higher survivals which was 100% and lower in 1500-2499gm (81%), 1000-1499gm (68%) and 800-999gm (33%) BW groups. Inborn neonates (68%) showed marginally higher survivals than outborn (66%) and also more survivals observed in preterm baby girls (72%) than boys (65%). RDS (62%) was the commonest indication for ventilation followed by Neonatal Sepsis (14%), Perinatal Asphyxia (PNA-10%), Congenital Pneumonia (8%) and Pneumothorax (6%). And found higher survivals in RDS (77%) than other indications which were in Pneumothorax (66%), PNA (60%), Sepsis (57%) and Pneumonia (50%). RDS (n=31) with surfactant therapy (n=14) recovered earlier <7 days (71.43%) than non surfactant therapy neonates (n=17), they required prolonged ventilator support over 7days (82.35%).Conclusions: Mechanical ventilation reduces the neonatal mortality, hence facilities for neonatal ventilation should be included in the regional and central hospitals providing intensive care for neonates.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 9-13

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Kanic, Zlatka, Vojko Kanic et Tina Hojnik. « Enalapril and Acute Kidney Injury in a Hypertensive Premature Newborn – Should It Be Used or Not ? » Journal of Pediatric Pharmacology and Therapeutics 26, n^o 6 (16 août 2021) : 638–42. http://dx.doi.org/10.5863/1551-6776-26.6.638.

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Extremely low birth weight infants (birth weight ≤1000 g) have a significantly lower nephron number. The glomerular filtration rate (GFR) is usually sufficient under normal conditions but is unable to meet the needs during stress, which results in acute kidney injury (AKI). We describe the case of an extremely low birth weight infant (970 g) with a gestational age of 27 weeks (immature preterm) who was mechanically ventilated because of hyaline membrane disease. AKI with anuria and a rise in serum creatinine to 3.4 mg/dL developed in the second week. Diuresis was restored after diuretics and dopamine were administered intravenously and kidney function recovered in the next two weeks. However, he slowly became hypertensive, so intravenous enalapril was introduced in the 6th week. After the third dose, he suffered another AKI. After cessation of enalapril, kidney function recovered over the next few days. Although angiotensin-converting enzyme inhibitors (ACEi) may cause kidney injury, it can be used with great caution in the treatment of hypertension or heart failure in preterm infants. There remains a real dilemma of whether enalapril should be used in extremely low birth weight immature infants.

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Cummings, JJ, BA Holm, PA Nickerson, WH Ferguson et EA Egan. « Pre- versus post-ventilatory surfactant treatment in surfactant-deficient preterm lambs ». Reproduction, Fertility and Development 7, n^o 5 (1995) : 1333. http://dx.doi.org/10.1071/rd9951333.

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Twenty lambs at 127 days' gestation (term is 145 days) were randomly assigned to receive Infasurf (Calf Lung Surfactant Extract, ONY Inc., Amherst, NY) as an intratracheal bolus (3 mliter kg-1) either into a fluid-filled lung before ventilation (n = 10), or after ventilation for 5 min (n = 10). All lambs were surfactant-deficient by analysis of lung liquid obtained before surfactant administration. Lambs were then mechanically ventilated for 4 h. Oxygenation for the lambs given surfactant before ventilation did not change during the experiment; a/A pO2 was 0.50 +/- 0.13 at 1 h and 0.52 +/- 0.17 at 4 h. For the lambs given surfactant after initial ventilation, oxygenation decreased over time; a/A pO2 decreased from 0.48 +/- 0.23 at 1 h to 0.37 +/- 0.22 at 4 h (P < 0.05). Compliance, as calculated from the Ventilator Efficiency Index (VEI), improved over time in both groups, but was always significantly higher for lambs given surfactant before ventilation (P = 0.03). Histologic examination of the lungs revealed no differences between the groups; no evidence of epithelial denudation or hyaline membrane formation was seen in either group. Thus, ventilation of surfactant-deficient newborn lambs for 5 min before surfactant administration results in significantly decreased lung function when compared with surfactant administration before ventilation. These differences in lung function are not dependent on a histopathologic injury to the lung. It is possible that unevenness of deposition of the surfactant in an air-filled lung, compared to more uniform deposition in a fluid-filled unventilated lung, produces these differences.

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Bland, Richard D., Con Yee Ling, Kurt H. Albertine, David P. Carlton, Amy J. MacRitchie, Ronald W. Day et Mar Janna Dahl. « Pulmonary vascular dysfunction in preterm lambs with chronic lung disease ». American Journal of Physiology-Lung Cellular and Molecular Physiology 285, n^o 1 (juillet 2003) : L76—L85. http://dx.doi.org/10.1152/ajplung.00395.2002.

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Chronic lung injury from prolonged mechanical ventilation after premature birth inhibits the normal postnatal decrease in pulmonary vascular resistance (PVR) and leads to structural abnormalities of the lung circulation in newborn sheep. Compared with normal lambs born at term, chronically ventilated preterm lambs have increased pulmonary arterial smooth muscle and elastin, fewer lung microvessels, and reduced abundance of endothelial nitric oxide synthase. These abnormalities may contribute to impaired respiratory gas exchange that often exists in infants with chronic lung disease (CLD). Nitric oxide inhalation (iNO) reduces PVR in human infants and lambs with persistent pulmonary hypertension. We wondered whether iNO might have a similar effect in lambs with CLD. We therefore studied the effect of iNO on PVR in lambs that were delivered prematurely at ∼125 days of gestation (term = 147 days) and mechanically ventilated for 3 wk. All of the lambs had chronically implanted catheters for measurement of pulmonary vascular pressures and blood flow. During week 2 of mechanical ventilation, iNO at 15 parts/million for 1 h decreased PVR by ∼20% in 12 lambs with evolving CLD. When the same study was repeated in eight lambs at the end of week 3, iNO had no significant effect on PVR. To see whether this loss of iNO effect on PVR might reflect dysfunction of lung vascular smooth muscle, we infused 8-bromo-guanosine 3′,5′-cyclic monophosphate (cGMP; 150 μg · kg-1 · min-1 iv) for 15–30 min in four of these lambs at the end of week 3. PVR consistently decreased by 30–35%. Lung immunohistochemistry and immunoblot analysis of excised pulmonary arteries from lambs with CLD, compared with control term lambs, showed decreased soluble guanylate cyclase (sGC). These results suggest that loss of pulmonary vascular responsiveness to iNO in preterm lambs with CLD results from impaired signaling, possibly related to deficient or defective activation of sGC, the intermediary enzyme through which iNO induces increased vascular smooth muscle cell cGMP and resultant vasodilation.

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Tracy, M. « How safe is intermittent positive pressure ventilation in preterm babies ventilated from delivery to newborn intensive care unit ? » Archives of Disease in Childhood - Fetal and Neonatal Edition 89, n^o 1 (1 janvier 2004) : 84F—87. http://dx.doi.org/10.1136/fn.89.1.f84.

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Singh, Devika, et Gerhard Fusch. « 26 Investigating Noise Exposure to Newborn Infants with Respiratory Support : Methodological Considerations ». Paediatrics & ; Child Health 27, Supplement_3 (1 octobre 2022) : e13-e13. http://dx.doi.org/10.1093/pch/pxac100.025.

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Abstract Background Excessive noise in the NICU may lead to serious long-term effects on hearing impairment and sensory development in newborns. As such, the maximum recommended noise level is 45 dBA. Reported studies regarding noise exposure of ventilated preterm infants show inconsistent results; however, these studies also vary considerably in their methodology in terms of noise ascertainment (Table 1). We hypothesize that the study methodology significantly influenced data quality. Objectives Our aim is to investigate if measured ventilator noise levels from previous literature could potentially be the result of methodological shortfalls of the study design rather than perceivable noise levels. Design/Methods A ventilator circuit was set up using nCPAP and high frequency mode with nasal prongs. Noise levels were measured using a commercially calibrated noise meter. Three different scenarios were tested. (1) Measurements were taken at different angles of (0°to 180°), with 180° facing the end of the nasal prongs, without a mannequin, with the membrane/orifice of the noise meter placed 2 mm laterally from the prongs. (2) Noise levels were measured at 180° at distances of 0 to 20 mm from the nasal prongs. (3) Measurements were taken in the oral cavity of a life-size intubation mannequin of a newborn baby. Results Overall, the noise levels produced at different settings varied significantly, ranging from 45.7 dB to 82.2 dB. The average environmental background noise was 44.4 dB. Noise levels typically increased as the angle increased, with the highest noise level at 180° for both high frequency and nCPAP mode, at 58.4 dB and 58.2 dB, respectively (Figure 1). Noise levels recorded at high frequency were slightly higher than nCPAP values. Furthermore, in regards to distance, the highest mean value, 82.2 dB was recorded with the noise meter approximately 3 mm from the nasal prongs, with the lowest mean value, 47.6 dB, being recorded at ~20 mm. During trials with the mannequin, the lowest value, 50.1 dB, was recorded at the entrance of the mouth with slightly higher values being recorded within the oral cavity. Conclusion The results indicate that small changes in experimental settings, such as positioning and distance from the nasal prongs, can greatly influence noise levels, particularly above the recommended levels for neonates. In summary, some study results are potentially influenced more by the study design than the device type or ventilator setting. Further research and detailed reporting in the NICU is recommended.

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Ehrhardt, Harald, Tina Pritzke, Prajakta Oak, Melina Kossert, Luisa Biebach, Kai Förster, Markus Koschlig, Cristina M. Alvira et Anne Hilgendorff. « Absence of TNF-α enhances inflammatory response in the newborn lung undergoing mechanical ventilation ». American Journal of Physiology-Lung Cellular and Molecular Physiology 310, n^o 10 (15 mai 2016) : L909—L918. http://dx.doi.org/10.1152/ajplung.00367.2015.

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Bronchopulmonary dysplasia (BPD), characterized by impaired alveolarization and vascularization in association with lung inflammation and apoptosis, often occurs after mechanical ventilation with oxygen-rich gas (MV-O2). As heightened expression of the proinflammatory cytokine TNF-α has been described in infants with BPD, we hypothesized that absence of TNF-α would reduce pulmonary inflammation, and attenuate structural changes in newborn mice undergoing MV-O2. Neonatal TNF-α null (TNF-α−/−) and wild type (TNF-α+/+) mice received MV-O2 for 8 h; controls spontaneously breathed 40% O2. Histologic, mRNA, and protein analysis in vivo were complemented by in vitro studies subjecting primary pulmonary myofibroblasts to mechanical stretch. Finally, TNF-α level in tracheal aspirates from preterm infants were determined by ELISA. Although MV-O2 induced larger and fewer alveoli in both, TNF-α−/− and TNF-α+/+ mice, it caused enhanced lung apoptosis (TUNEL, caspase-3/-6/-8), infiltration of macrophages and neutrophils, and proinflammatory mediator expression (IL-1β, CXCL-1, MCP-1) in TNF-α−/− mice. These differences were associated with increased pulmonary transforming growth factor-β (TGF-β) signaling, decreased TGF-β inhibitor SMAD-7 expression, and reduced pulmonary NF-κB activity in ventilated TNF-α−/− mice. Preterm infants who went on to develop BPD showed significantly lower TNF-α levels at birth. Our results suggest a critical balance between TNF-α and TGF-β signaling in the developing lung, and underscore the critical importance of these key pathways in the pathogenesis of BPD. Future treatment strategies need to weigh the potential benefits of inhibiting pathologic cytokine expression against the potential of altering key developmental pathways.

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Ojha, Shalini, Janine Abramson et Jon Dorling. « Sedation and analgesia from prolonged pain and stress during mechanical ventilation in preterm infants : is dexmedetomidine an alternative to current practice ? » BMJ Paediatrics Open 6, n^o 1 (mai 2022) : e001460. http://dx.doi.org/10.1136/bmjpo-2022-001460.

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Mechanical ventilation is an uncomfortable and potentially painful intervention. Opioids, such as morphine and fentanyl, are used for analgesia and sedation but there is uncertainty whether they reduce pain in mechanically ventilated infants. Moreover, there may be short-term and long-term adverse consequences such as respiratory depression leading to prolonged mechanical ventilation and detrimental long-term neurodevelopmental effects. Despite this, opioids are widely used, possibly due to a lack of alternatives.Dexmedetomidine, a highly selective alpha-2-adrenergic agonist with analgesic and sedative effects, currently approved for adults, has come into use in newborn infants. It provides analgesia and simulates natural sleep with maintenance of spontaneous breathing and upper airway tone. Although data on pharmacokinetics–pharmacodynamics in preterm infants are scant, observational studies report that using dexmedetomidine in conjunction with opioids/benzodiazepines or on its own can reduce the cumulative exposure to opioids/benzodiazepines. As it does not cause respiratory depression, dexmedetomidine could enable quicker weaning and extubation. Dexmedetomidine has also been suggested as an adjunct to therapeutic hypothermia in hypoxic ischaemic encephalopathy and others have used it during painful procedures and surgery. Dexmedetomidine infusion can cause bradycardia and hypotension although most report clinically insignificant effects.The increasing number of publications of observational studies and clinical use demonstrates that dexmedetomidine is being used in newborn infants but data on safety and efficacy are scant and not of high quality. Importantly, there are no data on long-term neurodevelopmental impact on preterm or term-born infants. The acceptance of dexmedetomidine in routine clinical practice must be preceded by clinical evidence. We need adequately powered and well-designed randomised controlled trials investigating whether dexmedetomidine alone or with opioids/benzodiazepines in infants on mechanical ventilation reduces the need for opioids/benzodiazepine and improves neurodevelopment at 24 months and later as compared with the use of opioids/benzodiazepines alone.

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Kroon, Andreas A., Veronica DelRiccio, Irene Tseu, Brian P. Kavanagh et Martin Post. « Mechanical ventilation-induced apoptosis in newborn rat lung is mediated via FasL/Fas pathway ». American Journal of Physiology-Lung Cellular and Molecular Physiology 305, n^o 11 (1 décembre 2013) : L795—L804. http://dx.doi.org/10.1152/ajplung.00048.2013.

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Mechanical ventilation induces pulmonary apoptosis and inhibits alveolar development in preterm infants, but the molecular basis for the apoptotic injury is unknown. The objective was to determine the signaling mechanism(s) of ventilation (stretch)-induced apoptosis in newborn rat lung. Seven-day-old rats were ventilated with room air for 24 h using moderate tidal volumes (8.5 ml/kg). Isolated fetal rat lung epithelial and fibroblast cells were subjected to continuous cyclic stretch (5, 10, or 17% elongation) for up to 12 h. Prolonged ventilation significantly increased the number of apoptotic alveolar type II cells (i.e., terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling and anti-cleaved caspase-3 immunochemistry) and was associated with increased expression of the apoptotic mediator Fas ligand (FasL). Fetal lung epithelial cells, but not fibroblasts, subjected to maximal (i.e., 17%, but not lesser elongation) cyclic stretch exhibited increased apoptosis (i.e., nuclear fragmentation and DNA laddering), which appeared to be mediated via the extrinsic pathway (increased expression of FasL and cleaved caspase-3, -7, and -8). The intrinsic pathway appeared not to be involved [minimal mitochondrial membrane depolarization (JC-1 flow analysis) and no activation of caspase-9]. Universal caspases inhibition and neutralization of FasL abrogated the stretch-induced apoptosis. Prolonged mechanical ventilation induces apoptosis of alveolar type II cells in newborn rats and the mechanism appears to involve activation of the extrinsic death pathway via the FasL/Fas system.

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Guržanova-Durnev, Liljana, Elizabeta Zisovska et Božidarka Đošić-Markovska. « CORD BLOOD SUPEROXIDE DISMUTASE AND GLUTATHIONE PEROXIDASE ACTIVITY IN PREMATURE INFANTS / AKTIVNOST SUPEROKSID-DISMUTAZE I GLUTATION-PEROKSIDAZE KOD PREVREMENO RODENE DECE ». Journal of Medical Biochemistry 33, n^o 2 (1 avril 2013) : 208–15. http://dx.doi.org/10.2478/jomb-2013-0042.

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Summary Background: Birth involves strong oxidative stress for the infant, implying an increased production of free radicals. The aims of this study were to assess the antioxidant response to oxidative insult at birth, by estimating the superoxide dismu- tase (SOD) and glutathione peroxidase (GPX) activity in umbilical cord blood, and to evaluate their dependency on the degree of maturation of the newborns. Methods: In the present study, 60 preterm infants (study group) as well as a full-term healthy reference group (A=53) were included. Additionally, the preterms were divided in 3 groups according to their condition at the end of the 1st week of life: preterm control (B=25), on oxygen support (C= 18), and ventilated group (D= 17). Results: The obtained results indicate markedly lower antioxidant capacity of the preterm infants: they had significantly lower SOD and GPX activity than the full-term infants (pcO.OOl, for both). Investigated antioxidants also showed significant differences between the groups of preterms. SOD activity was higher in preterms with postnatal respiratory fail- ure compared to preterm control (p<0.001). On the con- trary, GPX activity was decreased in the oxygen supported group (10%) and even more in the ventilated group (28.5%) (p< 0.001, for both). The newborns enzyme activities were also profoundly modulated by the gestational age and birth weight, specifically the GPX. Conclusions: Because of their deficient and inadequate antioxidant protection, preterm newborns are more suscep- tible to oxidant injury at birth.

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James, Mary, Anuja J. S. et Praveen Jacob Ninan. « Clinical profile of neonatal candidiasis in newborn nursery ». International Journal of Contemporary Pediatrics 5, n^o 2 (22 février 2018) : 334. http://dx.doi.org/10.18203/2349-3291.ijcp20180034.

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Background: Candidiasis refers to infection with fungi of the genus candida. Candida infections are frequent and major causes of septicemia in neonatal intensive care units and are associated with high morbidity and mortality. Low birth weight preterm infants are especially vulnerable to these devastating infections. Candida infections are a major cause of septicemia in neonatal ICUs and may affect 1.6% to 12.9% of very low birth weight infants. The smaller the infant is, the greater is the likelihood for systemic fungal infection to develop.Methods: 40 Newborns with culture proven candidiasis admitted in new-born nursery of Government T. D Medical College, Alappuzha, were selected for the study. The significance of different parameters such as gender, gestational age, birth weight, Apgar score, duration of hospital stays, central venous catheter and use of third generation cephalosporins were analysed. Clinical profile like apnoea, feed intolerance, requirement of ventilator support, temperature instability, thrombocytopenia, hyperglycemia etc. were analyzed.Results: Out of 40 newborns 39 were preterms, 42% of study population were having a birth weight of 1-1.5 kg, 33% with a birth weight of 1.5-2 kg and 20% with a birth weight of <1 kg.75% of the study population were hospitalized for >1 week. In the study group 58% had feed intolerance, 52.5% needed ventilator support, 52.5% had temperature instability, 70% had thrombocytopenia 50% had apnea and 4% had hyperglycemia. The overall survival was 60%.Conclusions: Prematurity, low birth weight and prolonged hospital stay were associated with increased risk of candidiasis. Feed intolerance, increased need for ventilator support, apnea, temperature instability and thrombocytopenia were significant clinical parameters.

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Pai, Vinita B., et Milap C. Nahata. « Aerosolized Furosemide in the Treatment of Acute Respiratory Distress and Possible Bronchopulmonary Dysplasia in Preterm Neonates ». Annals of Pharmacotherapy 34, n^o 3 (mars 2000) : 386–92. http://dx.doi.org/10.1345/aph.19060.

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OBJECTIVE: To review the efficacy and safety of inhaled furosemide in the treatment of acute respiratory distress and possible bronchopulmonary dysplasia (BPD) in preterm neonates receiving ventilator and oxygen support. DATA SOURCES: A MEDLINE search was performed from January 1966 to December 1998 using the key words inhaled or aerosolized furosemide, BPD, preterm, neonate, and infant newborn. STUDY SELECTION AND DATA EXTRACTION: All clinical trials involving the use of inhaled furosemide in ventilator- and oxygen-dependent preterm neonates with acute respiratory distress and possible BPD were evaluated. DATA SYNTHESIS: Inhaled furosemide 1 and 2 mg/kg has improved pulmonary function in preterm neonates without significant adverse effects. However, only a single dose of inhaled furosemide was used in these trials, and pulmonary functions were monitored for only two or four hours after administration. CONCLUSIONS: Inhaled furosemide may be effective, but studies are needed to determine the optimal dosage regimen and long-term risks and benefits of its use in these patients.

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Haque, Gazi Mohammad Imranul, et Probir Kumar Sarkar. « Diagnosis and Management of Patent Ductus Arteriosus in Newborn : An Update ». Dhaka Shishu (Children) Hospital Journal 36, n^o 1 (26 mars 2021) : 61–66. http://dx.doi.org/10.3329/dshj.v36i1.52643.

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Patent ductus arteriosus is one of the common congenital acyanotic heart disease in neonates, especially in preterm. Patent ductus arteriosus (PDA) is a congenital condition, characterized by a persistent connection between the aorta and the pulmonary artery. Patency of Ductus Arteriosus is essential for fetal survival. Patent ductus arteriosus is one of the most common clinical findings and most frequent source of complications in premature infant. After birth, in term infants, the ductus usually closes within the first day of life, starting with functional closure followed by anatomical closure with vascular remodeling. The persistence of the PDA in preterm infant is inversely related to gestational age and birth weight. The incidence of Patent Ductus Arteriosus is 31% in preterm infant weighing 501 to 1500 gm and gestational age 29 weeks. The treatment options available are conservative medical management, pharmacological therapy or surgical ligation. Conservative medical management involves fluid restriction; watchful waiting and ventilator support. DS (Child) H J 2020; 36(1) : 61-66

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Ancora, Gina, Eugenia Maranella, Arianna Aceti, Luca Pierantoni, Sara Grandi, Luigi Corvaglia et Giacomo Faldella. « Effect of Posture on Brain Hemodynamics in Preterm Newborns Not Mechanically Ventilated ». Neonatology 97, n^o 3 (2010) : 212–17. http://dx.doi.org/10.1159/000253149.

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Aikio, O., ML Pokela et M. Hallman. « Exhaled and nasal nitric oxide in mechanically ventilated preterm and term newborns ». Acta Paediatrica 91, n^o 10 (2 janvier 2007) : 1078–86. http://dx.doi.org/10.1111/j.1651-2227.2002.tb00103.x.

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Kadhim, Mohammed Mahdi, Ruqayah Shlash Mohsin, Nehad Kadhim Hashim et Ali Qais Abdulkafi. « THE ROLE OF CAFFEINE IN NONINVASIVE RESPIRATORY SUPPORT VERSUS AMINOPHYLLINE IN PREMATURITY APNEA ». International Journal of Medical Sciences (IJMS) 2, n^o 2 (15 juin 2022) : 33–40. http://dx.doi.org/10.56981/m0000225.

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Caffeine plays a key role in noninvasive respiratory support, easing the transition from invasive to noninvasive support, shortening the length of positive airway pressure support, and lowering BPD risk. Caffeine and aminophylline are effective in decreasing apnoea and facilitating and ventilator weaning in extremely preterm newborns. This study aims to investigate the clinical significance of caffeine and aminophylline in treating premature infants with apnea under varying conditions of oxygen (O2) delivery. The current study included 38 preterm babies with apnea who underwent caffeine or aminophylline treatment at the Al-Mahaweel General Hospital between January and December 2020; the infants were 20 boys and 18 girls, with birth weights ranging from 500 to 1,250 grams. The study came out to the result that caffeine plays a key role in noninvasive respiratory support, easing the transition from invasive to noninvasive support, shortening the length of positive airway pressure support, and lowering BPD risk. Caffeine and aminophylline both are effective in decreasing apnoea and facilitating and ventilator weaning in extremely preterm newborns. Caffeine has therapeutic advantages over aminophylline, such as better enteral absorption, a longer half-life that allows for a single daily dose, reduced side effects, and a good long-term cost/benefit ratio, making it the first choice drug for the cure of apnoea in premature neonates.

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Badurdeen, Shiraz, Peter G. Davis, Stuart B. Hooper, Susan Donath, Georgia A. Santomartino, Alissa Heng, Diana Zannino et al. « Physiologically based cord clamping for infants ≥32+0 weeks gestation : A randomised clinical trial and reference percentiles for heart rate and oxygen saturation for infants ≥35+0 weeks gestation ». PLOS Medicine 19, n^o 6 (23 juin 2022) : e1004029. http://dx.doi.org/10.1371/journal.pmed.1004029.

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Background Globally, the majority of newborns requiring resuscitation at birth are full term or late-preterm infants. These infants typically have their umbilical cord clamped early (ECC) before moving to a resuscitation platform, losing the potential support of the placental circulation. Physiologically based cord clamping (PBCC) is clamping the umbilical cord after establishing lung aeration and holds promise as a readily available means of improving early newborn outcomes. In mechanically ventilated lambs, PBCC improved cardiovascular stability and reduced hypoxia. We hypothesised that PBCC compared to ECC would result in higher heart rate (HR) in infants needing resuscitation, without compromising safety. Methods and findings Between 4 July 2018 and 18 May 2021, infants born at ≥32+0 weeks’ gestation with a paediatrician called to attend were enrolled in a parallel-arm randomised trial at 2 Australian perinatal centres. Following initial stimulation, infants requiring further resuscitation were randomised within 60 seconds of birth using a smartphone-accessible web link. The intervention (PBCC) was to establish lung aeration, either via positive pressure ventilation (PPV) or effective spontaneous breathing, prior to cord clamping. The comparator was early cord clamping (ECC) prior to resuscitation. The primary outcome was mean HR between 60 to 120 seconds after birth, measured using 3-lead electrocardiogram, extracted from video recordings blinded to group allocation. Nonrandomised infants had deferred cord clamping (DCC) ≥120 seconds in the observational study arm. Among 508 at-risk infants enrolled, 123 were randomised (n = 63 to PBCC, n = 60 to ECC). Median (interquartile range, IQR) for gestational age was 39.9 (38.3 to 40.7) weeks in PBCC infants and 39.6 (38.4 to 40.4) weeks in ECC infants. Approximately 49% and 50% of the PBCC and ECC infants were female, respectively. Five infants (PBCC = 2, ECC = 3, 4% total) had missing primary outcome data. Cord clamping occurred at a median (IQR) of 136 (126 to 150) seconds in the PBCC arm and 37 (27 to 51) seconds in the ECC arm. Mean HR between 60 to 120 seconds after birth was 154 bpm (beats per minute) for PBCC versus 158 bpm for ECC (adjusted mean difference −6 bpm, 95% confidence interval (CI) −17 to 5 bpm, P = 0.39). Among 31 secondary outcomes, postpartum haemorrhage ≥500 ml occurred in 34% and 32% of mothers in the PBCC and ECC arms, respectively. Two hundred ninety-five nonrandomised infants (55% female) with median (IQR) gestational age of 39.6 (38.6 to 40.6) weeks received DCC. Data from these infants was used to create percentile charts of expected HR and oxygen saturation in vigorous infants receiving DCC. The trial was limited by the small number of infants requiring prolonged or advanced resuscitation. PBCC may provide other important benefits we did not measure, including improved maternal–infant bonding and higher iron stores. Conclusions In this study, we observed that PBCC resulted in similar mean HR compared to infants receiving ECC. The findings suggest that for infants ≥32+0 weeks’ gestation who receive brief, effective resuscitation at closely monitored births, PBCC does not provide additional benefit over ECC (performed after initial drying and stimulation) in terms of key physiological markers of transition. PBCC was feasible using a simple, low-cost strategy at both cesarean and vaginal births. The percentile charts of HR and oxygen saturation may guide clinicians monitoring the transition of at-risk infants who receive DCC. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000621213.

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Mohamed, Rasha. « Comparative Study of Two Different Approaches for Managing of Mechanically Ventilated Extremely Preterm Newborns ». British Journal of Medicine and Medical Research 7, n^o 7 (10 janvier 2015) : 585–97. http://dx.doi.org/10.9734/bjmmr/2015/16151.

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Naseer, Amber, Riffat Farrukh, Shaheen Masood, Sarwat Sultana et Qamar Rizvi. « Outcome, Clinical Profile and Risk Factors for Mortality of Neonates Necessitating Mechanical Ventilation ». Pakistan Journal of Medical and Health Sciences 15, n^o 12 (30 décembre 2021) : 3485–87. http://dx.doi.org/10.53350/pjmhs2115123485.

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Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p <0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results

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Tasneem, Farhana, Mohammad Monir Hossain, Salahuddin Mahmud et Syed Shafi Ahmed. « Clinical profile of fungal sepsis in new born : a tertiary centre experience from Bangladesh ». Journal of Pediatrics & ; Neonatal Care 10, n^o 6 (28 décembre 2020) : 170–73. http://dx.doi.org/10.15406/jpnc.2020.10.00432.

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Background: Candida infections are frequent and major causes of septicemia in neonatal intensive care units and are associated with high morbidity and mortality. Low birth weight preterm infants are especially vulnerable to these devastating infections. Material and methods: A prospective observational study was done from May 2013 to June 2014 in SCABU (Special Care Baby Unit) & ICU (Intensive Care Unit) of Dhaka Shishu (Children) Hospital, Dhaka. All neonates admitted with suspected clinical sepsis were analyzed in the study. Among which 30 culture positive candida cases were identified and included in this study. Outcome measures assessed was the incidence of candidemia in our NICU with clinical profiles and associated risk factors. Results: Out of 30 newborns 18 (60%) were preterms, 20% of study population were having a birth weight of <1 kg, 23.3% with a birth weight of 1-1.5 kg and 23.3% with a birth weight of 1.5-2.5 kg. 73.4% of the study population were hospitalized for >1 week. In the study group 56.7% had feed intolerance, 53.3% needed ventilator support, 56.7% had temperature instability, 73.3% had thrombocytopenia 63.3% had apnea and 73.3% had jaundice. The overall survival was 63.3%. Conclusions Low birth weight, prematurity, use of broad spectrum antibiotics, mechanical ventilation and prolonged hospital stay were important risk factors associated with neonatal candidiasis in this study. Thrombocytopenia, feed intolerance, increased requirement for ventilator support, temperature instability, jaundice and apnea were significant clinical parameters noted in babies with culture proven neonatal candidiasis. The overall survival was 63.3% in the study group.

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Carvalho, Clarissa Gutiérrez, Renato Soibelmann Procianoy, Eurico Camargo Neto et Rita C. Silveira. « Preterm Neonates with Respiratory Distress Syndrome : Ventilator-Induced Lung Injury and Oxidative Stress ». Journal of Immunology Research 2018 (2018) : 1–4. http://dx.doi.org/10.1155/2018/6963754.

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Ventilator-induced lung injury is well recognized, and appropriate arterial saturation target is unknown, so gentle modes of ventilation and minimizing oxidative stress have been well studied. Our objective was to analyze any association between the oxygen levels at blood sampling and plasma levels of the interleukins IL-6, IL-1β, IL-10, and IL-8 and TNF-αin preterm newborns under mechanical ventilation (MV) in their first two days.Methods. Prospective cohort including neonates with severe respiratory distress. Blood samples were collected right before and 2 hours after invasive MV. For analysis purposes, newborns were separated according to oxygen requirement: low oxygen (≤30%) and high oxygen (>30%) groups. Interleukins were measured using a commercially available kit.Results. 20 neonates (gestational age 32.2 ± 3 weeks) were evaluated. Median O2saturation levels pre-MV were not different in both oxygen groups. In the high oxygen group, IL-6, IL-8, and TNF-αplasma levels increased significantly after two hours under MV.Conclusions. Despite the small sample studied, data showed that there is a relationship between VILI, proinflammatory cytokines, and oxygen-induced lung injury, but a study considering oxidative marker measurements is needed. It seems that less oxygen may keep safer saturation targets playing a less harmful role.

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S., Subhodh Shetty, J. Ashok Raja et N. Muthukumaran. « Budesonide nebulization in preterm neonates with evolving brochopulmonary dysplasia after 14 days of life : a case series ». International Journal of Contemporary Pediatrics 8, n^o 9 (23 août 2021) : 1594. http://dx.doi.org/10.18203/2349-3291.ijcp20213324.

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Bronchopulmonary dysplasia (BPD) with oxygen dependence at 36 weeks postmenstrual age (PMA), remains an important complication of premature newborns. BPD occurs due to pulmonary inflammation. Reducing pulmonary inﬂammation with postnatal systemic corticosteroids reduces the incidence of BPD but is associated with an increased risk of long and short-term side effects. Local administration of corticosteroids via inhalation might be an effective and safe alternative. Currently, there is no recommendation for use of inhaled corticosteroids in neonatal respiratory care. However, it is being used in neonatal intensive care units (NICU) across the world in ventilator and oxygen-dependent babies. We shared our experience with the use of inhaled budesonide on nine ventilator-dependent very low birth weight (VLBW) preterm neonates in the form of case series and review the literature.

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Garg, Gaurav, Vishal Garg et Amit Prakash. « Percutaneous closure of a large patent ductus arteriosus in a preterm newborn weighing 1400 g without using arterial sheath : an innovative technique ». Cardiology in the Young 28, n^o 3 (13 décembre 2017) : 494–97. http://dx.doi.org/10.1017/s1047951117002475.

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AbstractPercutaneous closure of patent ductus arteriosus is well established in infants weighing >5 kg, but data regarding outcome of preterm especially very low birth weight infants is minimal. Although surgical ligation of patent ductus arteriosus is the preferred and well-accepted modality of treatment after failure of drug therapy in preterm infants, it has also got its own demerits in such a small and fragile subset. Device closure in infants weighing <1.5 kg is rarely attempted because of high chances of complications, especially acute arterial injury due to the arterial sheath. We received a 1.4-kg ventilator-dependent infant for closure of large patent ductus arteriosus. Percutaneous closure of patent ductus arteriosus was done successfully and the infant was discharged on room air with a weight of 1.8 kg. We present here an innovative technique in which successful patent ductus arteriosus device closure was done in a 1.4-kg infant without using arterial sheath.

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Zhou, H., Y. Gao et J. U. Raj. « Antenatal betamethasone therapy augments nitric oxide-mediated relaxation of preterm ovine pulmonary veins ». Journal of Applied Physiology 80, n^o 2 (1 février 1996) : 390–96. http://dx.doi.org/10.1152/jappl.1996.80.2.390.

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Antenatal glucocorticoid therapy improves pulmonary function in preterm newborns. We have determined the effect of antenatal glucocorticoid therapy on nitric oxide-mediated relaxation in pulmonary vessels of preterm lambs. Ovine fetuses (126 days gestation; full term = 150 days) were injected with betamethasone (0.5 mg/kg body wt) or saline. After 48 h, lambs were delivered, ventilated for 3 h, and killed. Isolated fourth-generation pulmonary arteries (2-3 mm diameter) and veins (1.5-2 mm diameter) were suspended in organ chambers filled with modified Krebs-Ringer solution (95% O2-5% CO2) at 37 degrees C, and their isometric tension was recorded. During contractions to endothelin-1 or U-46619 (in the presence of indomethacin), acetylcholine and bradykinin induced endothelium-dependent nitro-L-arginine-inhibitable relaxation in arteries and veins. The relaxation was greater in veins of betamethasone-treated than in those of control lambs. Veins from lambs without endothelium treated with betamethasone were more sensitive to sodium nitroprusside than veins from controls. For arteries, there was no significant difference in relaxation between different groups. Relaxation induced by 8-bromoguanosine 3′,5′-cyclic monophosphate was similar in arteries and veins of different groups. Radioimmunoassay showed that nitric oxide caused a greater increase in guanosine 3′,5′-cyclic monophosphate in betamethasone-treated veins than in controls. These data suggest that antenatal betamethasone therapy augments nitric oxide-mediated relaxation of pulmonary veins of preterm lambs, probably by increasing soluble guanylate cyclase activity of vascular smooth muscle.

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VELDMAN, ALEX, TINA TRAUTSCHOLD, KATJA WEIss, DORIS FISCHER et KARL BAUER. « Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit ». Pediatric Anesthesia 16, n^o 9 (septembre 2006) : 968–73. http://dx.doi.org/10.1111/j.1460-9592.2006.01902.x.

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Paky, F., et CM Koeck. « Pulse oximetry in ventilated preterm newborns : reliability of detection of hyperoxaemia and hypoxaemia, and feasibility of alarm settings ». Acta Paediatrica 84, n^o 6 (juin 1995) : 613–17. http://dx.doi.org/10.1111/j.1651-2227.1995.tb13709.x.

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Sheikh, Mushtaq Ahmad, Altaf Ahmad Bhat, Rukaya Akhthar, Mudassir Ahad Wani et Tariq Wani. « Nasal Trauma in Neonates receiving CPAP And its Prevention in tertiary care hospital. » JMS SKIMS 20, n^o 2 (9 décembre 2017) : 96–100. http://dx.doi.org/10.33883/jms.v20i2.27.

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Objectives: This study was done to evaluate the frequency and severity of nasal trauma secondary to nasal continuous positive airway pressure (NCPAP) in neonates and different methods to reduce the nasal septum injury via CPAP Methods: This is a prospective study carried out in the Neonatal Care Unit (NCU) of LAL DED maternity hospital associated with department of pediatrics Government Medical College, Srinagar, Kashmir. The study included newborns that underwent NCPAP with prongs on admission and those receiving NCPAP after weaning from ventilator, from 1st January 2016 - 1st jan 2017. Neonates noses were monitored from the first day of NCPAP treatment until its weaning. Nasal trauma was reported into Three Grades: (I) Erythema/pressure indentation (II) superficial Erosion and (III) Septal necrosis. Results:-258 newborns were included in study, 136 males and 122 females. All enrolled newborn received CPAP. Babies were randomly allocated to different groups in which no barrier and different barriers were applied. Randomization ofgroup of infants who received no barrier(group 0) and different barriers( group 1,2,&3) was done by systematic allocation, in which first newborn was randomly designated to no barrier group 0 on particular day of admission ,and subsequently alternating with other three groups i.e group 1,group 2, group 3. The mean gestational age, birth weight and CPAP days in each group is 31wk (GA28-35 wks),1200 gms(0.7kg-1.8kg) & 5 days(3-10days) respectively. Incidence of Septal necrosis was 26.7% in the babies that had ‘No barrier applied at septal hudson prongs interface (Group0), which was significantly more (p<0.001) when compared with other three groups, within which its incidence was 2.8% in Cotton applied at septal and hudson prongs interface with glycerine (Group1), 7.1% in Danaplast applied at interface(Group2) and 0.0% in Cotton soaked with normal saline(Group3) respectively. In Group 0 nasal septal injury Grade 1 is (35%),grade 2 (35%),and grade 3(30.0%), in Group 1, grade 1 septal injury is (84%), grade 2(12.7%) & grade 3(2.8%),In Group 2 grade 1 is (65.7%),grade2(30.0%),grade3 (4.3%) and Group3 grade1(80.7%),grade2(19.3%) and Grade3 (0.0%) Conclusions: Nasal trauma is a frequent complication of NCPAP, especially in preterm babies and babies requiring nasal prongs for longer duration. And can be prevented by applying a barrier as in group 1,2 &3 in our study shows statistically significant decreased in severe nasal septal injury. JMS 2017;20(2):96-100

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Seo, Yu Mi, Sook Kyung Yum et In Kyung Sung. « Respiratory Severity Score with Regard to Birthweight during the Early Days of Life for Predicting Pulmonary Hypertension in Preterm Infants ». Journal of Tropical Pediatrics 66, n^o 6 (2 avril 2020) : 561–68. http://dx.doi.org/10.1093/tropej/fmaa013.

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Abstract Objective The respiratory severity score (RSS) has been demonstrated to be associated with the oxygenation index in intubated newborn infants. We aimed to evaluate the usefulness of RSS with regard to birthweight (BW) in preterm infants for predicting an association with future pulmonary hypertension (PH). Methods Preterm infants with <30 weeks’ gestation and <1250 g BW were reviewed and grouped into two (PH vs. no PH). Basic perinatal characteristics, comorbidities and parameters reflecting lung condition, including duration of invasive mechanical ventilator care, were compared. Respiratory support parameters (FiO2, RSS and RSS/kg) during the first 5 days of birth (0–120 h) were compared between the groups, and receiver operating characteristics curves were produced to evaluate the association with PH. Results RSS/kg, of the three respiratory support parameters, demonstrated significantly higher values in the PH group in the early days of life. Particularly, RSS/kg at day 2 of life had the greatest area under the curve [0.762, 95% confidence interval (CI) 0.655–0.869, p < 0.001] and maintained statistical significance [odds ratio (OR) 1.352, 95% CI 1.055–1.732, p = 0.017] in the multivariable analysis for a potential association with PH, along with gestational age (OR 0.996, 95% CI 0.993–0.999, p = 0.015) and preterm premature rupture of membrane >18 h (OR 4.907, 95% CI 1.436–16.765, p = 0.011). Conclusion RSS/kg is a potential marker associated with the development of PH. Future studies could verify its usefulness as a reliable surrogate for predicting respiratory morbidity in clinical settings.

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Akar, Selahattin, et Mehmet Turgut. « Do we control gastric residuals unnecessarily in premature newborns ? AGRA study : avoidance of gastric residual aspiration ». World Journal of Pediatric Surgery 3, n^o 1 (janvier 2020) : e000056. http://dx.doi.org/10.1136/wjps-2019-000056.

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Aspiration and evaluation of gastric residuals are commonly performed interventions before each feeding in intensive care units, especially in very low birthweight infants. However, there is no sufficient evidence about the necessity of routine gastric residual aspiration. In this study, we aimed to investigate the time to full enteral intake and the incidence of necrotizing enterocolitis (NEC) in preterm infants in the period with gastric residual aspiration performed before each feeding, and those in the period without gastric residual aspiration.MethodsPreterm infants with a gestational week ≤33 were included in the study. The group with gastric residual control before each feeding consisted of 169 infants, and the group without routine gastric residual aspiration included 122 infants.ResultsThe mean gestational week was 30.37±2.58 and 29.31±3.37 in the group with gastric residual control and in the group without routine residual control, respectively (p<0.05). Birth weight, male gender, and mode of delivery were similar between both groups. The time to full enteral intake was shorter in the group without routine residual control (p<0.05). Total durations of parenteral nutrition, ≥grade 2 NEC, weight at discharge and duration of hospitalization were similar between the groups. Duration of invasive mechanical ventilator support was shorter in the group without routine residual control.ConclusionAvoidance of routine gastric residual aspiration in preterm infants shortens the time to full enteral intake without increasing the incidence of NEC.

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Wong, Jonathan, Soonsawad Sasivimon, Rawan Abu Omar, Michael Dunn, Eugene Ng et Jennifer Beck. « 14 Diaphragmatic Electrical Activity in Preterm Infants on Non-Invasive High Frequency Oscillatory Ventilation (DEAP-NHFO Study) ». Paediatrics & ; Child Health 26, Supplement_1 (1 octobre 2021) : e9-e10. http://dx.doi.org/10.1093/pch/pxab061.010.

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Abstract Primary Subject area Neonatal-Perinatal Medicine Background Continuous Positive Airway Pressure (CPAP) is a common form of non-invasive respiratory support for preterm infants. Non-invasive high frequency ventilation (NHFOV) is a relatively new method of non-invasive respiratory support. NHFOV is being increasingly utilized in clinical practice in an attempt to prevent intubation and minimize ventilator-induced lung injury in preterm infants. Preliminary studies suggest superiority of NHFOV over CPAP, but little is known about its mechanism of action and its effect on respiratory control in the newborn. We hypothesize that NHFOV reduces respiratory drive and improves ventilation, resulting in decreased patient diaphragm energy expenditure, which can be assessed by measuring the electrical activity of the diaphragm (Edi). Objectives The objective of this study is to compare the effects of non-invasive respiratory support delivered by nasal CPAP versus NHFOV on respiratory pattern, as assessed by the Edi in very low birth weight (VLBW) preterm infants. Design/Methods In a prospective, randomized, crossover study, 20 preterm infants with birth weights ≤1500 g requiring CPAP were randomized to either NHFOV or CPAP for 105 min, followed by crossover to the other method for the same duration. Edi was continuously measured by a feeding catheter with miniaturized sensors embedded in its wall (Maquet, Solna). The general sequence was 15 minutes for acclimation to the mode, 75 minutes for a feed to be completed, followed by 15 minutes for breath-by-breath analyses of neural breathing pattern. Primary outcome was difference in the peak Edi between CPAP and NHFOV. Secondary outcomes included difference in other measures of respiratory drive: neural respiratory rate, neural inspiratory time, diaphragm energy expenditure, transcutaneous pCO2, number of apnea episodes on the Edi, and episodes of clinically significant apnea. Results No significant differences in Edi timing, Edi min, Edi peak, apnea, or CO2 were observed between the two modes of respiratory support. Conclusion In this cohort of VLBW preterm infants, neural respiratory pattern was not significantly different between NHFOV and CPAP. With this baseline information in stable preterm infants, it would now be important to assess whether these results hold true in infants with more severe lung disease, where NHFOV is often used as escalating support from CPAP.

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SCHMALISCH, G., R. R. WAUER et B. BÖHME. « Effect of early Ambroxol treatment on lung functions in mechanically ventilated preterm newborns who subsequently developed a bronchopulmonary dysplasia (BPD) ». Respiratory Medicine 94, n^o 4 (avril 2000) : 378–84. http://dx.doi.org/10.1053/rmed.1999.0751.

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Niknafs, Nikoo. « 138 Fluid overload in newborns undergoing abdominal surgery ». Paediatrics & ; Child Health 26, Supplement_1 (1 octobre 2021) : e96-e97. http://dx.doi.org/10.1093/pch/pxab061.109.

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Abstract Primary Subject area Neonatal-Perinatal Medicine Background Infants undergoing abdominal surgery, particularly those born preterm, are at risk of postoperative fluid overload and acute kidney injury due to immature cardiac and renal functions, which could contribute to increased morbidity and mortality. Objectives The purpose of this study was to evaluate the burden of fluid overload and acute kidney injury among newborns undergoing abdominal surgery and the association with adverse neonatal outcomes. Design/Methods Newborns who had undergone laparotomy from January 2017 to June 2019 admitted to a tertiary level Neonatal Intensive Care Unit were included in this retrospective cohort study. Fluid overload was assessed by the maximum percentage change in body weight and the difference between actual and prescribed fluid intake post-operatively. Acute kidney injury was defined as an increase in serum creatinine >1.5 times of baseline or >26 mmol/L, or oliguria (< 0 .5mL/kg/hr over 24-hour). Results There were 60 eligible infants with medians [IQR] gestational age (GA) and birth weight being 29 weeks [25–36] and 1240 grams [721–2871], respectively. Indications for laparotomy included small bowel obstruction (45%), necrotizing enterocolitis (23%), and large bowel obstruction (11.7%). In the first three post-operative days, 24/60 (40%) required inotropes, 5/59 (8.5%) had hyponatremia (<130 mmol/L), and 15/31(48.4%) developed hypoalbuminemia (<20 g/L). 52/60 (86.7%) infants had serum creatinine measured and 4 (6.7%) fulfilled our AKI criteria. The median of actual fluid intake was significantly higher than the prescribed fluid intake in the first 7 post-operative days (p<0.01) [Figure 1]. Medians [IQR] of maximum % change of body weight within the first 3- and 7-days post operation were 6 [3–13] and 11 [5 –17], respectively. While we did not identify any associations between post-operative fluid overload and mortality/bronchopulmonary dysplasia in this cohort, we found that every 1% increase in weight gain within the first 3 days post-operation were associated with an increase in 0.6 day of invasive ventilator support (p=0.012) [Figure 2]. Such correlation still exists after adjusting for GA (p=0.033). Conclusion In our cohort of newborns undergoing abdominal surgery, weight gain within the first three post-operative days was associated with an increase in duration of invasive ventilator support. Fluid overload does not seem to be associated with acute kidney injury. Careful attention to intra and early postoperative fluid balance may play an important role in optimizing outcomes of newborns undergoing abdominal surgery.

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Sanghvi, Avi, et Manish Rasania. « Study of respiratory distress syndrome in newborn with special reference to the role of bubble CPAP in its management ». International Journal of Contemporary Pediatrics 4, n^o 4 (21 juin 2017) : 1334. http://dx.doi.org/10.18203/2349-3291.ijcp20172661.

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Background: Respiratory distress syndrome is the most important cause of morbidity and mortality in preterm neonates. Intermittent positive pressure ventilation with surfactant therapy was standard treatment of RDS. IIPV is invasive, costly and requires expertise. It is not a viable option for many of the resource limited SNCU set ups of our country. Trials have showed that CPAP is noninvasive, easy to use, safe and effective. This study was done to find out effectiveness of CPAP in RDS, and also to find CPAP failure factors.Methods: This was a prospective observational study, carried out at SNCU of Dhiraj hospital, Piparia, Vadodara district, Gujarat, India form February 2014 to March 2015. Neonates with diagnosis of respiratory distress syndrome were included in this study.Results: Total 57 (42 inborn and 15 out born) cases of RDS were analyzed in this study. Incidence of RDS was 3.68% of live births. 5(8.8%) settled down with low flow oxygen only. 24 (42.1%) successfully treated with CPAP only. 15 (26.3%) were treated with CPAP and surfactant. 13 (22.8%) were CPAP failure cases which required ventilator support. The variables significantly associated with failure of CPAP were: no exposure to antenatal steroids (p value of 0.025), grade 3-4 RDS on CXR (p value of 0.03), PDA (p value of 0.0264), sepsis/pneumonia (p value of <0.001) and Silverman Anderson score of ≥7 at admission (p value of 0.001). 3 (5.3%) went on DAMA. 5 (8.8%) expired and 49 (85.9%) were discharged. 4 out of 5 (80%) death occurred in very preterm group. 4 (80%) of death occurred in neonates whose mothers did not receive any dose of antenatal steroid. There was no mortality in neonates who were in need of surfactant and received within 6 hours of life. 75% of neonates having sepsis and asphyxia both along with RDS expired.Conclusions: Bubble CPAP is safe and very effective in low resource settings. CPAP failure is significantly associated with no antenatal steroids, grade 3 to 4 x-ray changes of RDS, Silverman Anderson score of ≥7 at beginning of CPAP, presence of significant PDA and association of sepsis/pneumonia.

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