Editorial

4 pages, 175 KiB

Open AccessEditorial

Stabilization and Resuscitation of Newborns

by Bernhard Schwaberger

Children 2022, 9(10), 1492; https://doi.org/10.3390/children9101492 - 28 Sep 2022

Viewed by 1141

The majority of newborns do not need medical interventions to manage the neonatal transition after birth [...] Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

Research

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9 pages, 44664 KiB

Open AccessArticle

The Use of a Disposable Umbilical Clamp to Secure an Umbilical Venous Catheter in Neonatal Emergencies—An Experimental Feasibility Study

by Bernhard Schwaberger, Christoph Schlatzer, Daniel Freidorfer, Marlies Bruckner, Christina H. Wolfsberger, Lukas P. Mileder, Gerhard Pichler and Berndt Urlesberger

Children 2021, 8(12), 1093; https://doi.org/10.3390/children8121093 - 26 Nov 2021

Cited by 1 | Viewed by 2637

Abstract

Recent guidelines recommend the umbilical venous catheter (UVC) as the optimal vascular access method during neonatal resuscitation. In emergencies the UVC securement may be challenging and time-consuming. This experimental study was designed to test the feasibility of new concepts for the UVC securement. [...] Read more.

Recent guidelines recommend the umbilical venous catheter (UVC) as the optimal vascular access method during neonatal resuscitation. In emergencies the UVC securement may be challenging and time-consuming. This experimental study was designed to test the feasibility of new concepts for the UVC securement. Umbilical cord remnants were catheterized with peripheral catheters and secured with disposable umbilical clamps. Three different securement techniques were investigated. Secure 1: the disposable umbilical clamp was closed at the level of the inserted catheter. Secure 2: the clamp was closed at the junction of the catheter and plastic wings. Secure 3: the setting of Secure 2 was combined with an umbilical tape. The main outcomes were the feasibility of fluid administration and the maximum force to release the securement. This study shows that inserting peripheral catheters into the umbilical vein and securing them with disposable umbilical clamps is feasible. Rates of lumen obstruction and the effectiveness of the securement were superior with Secure 2 and 3 compared to Secure 1. This new approach may be a rewarding option for umbilical venous catheterization and securement particularly in low-resource settings and for staff with limited experience in neonatal emergencies. However, although promising, these results need to be confirmed in clinical trials before being introduced into clinical practice. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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Graphical abstract

18 pages, 1351 KiB

Open AccessFeature PaperArticle

Approach to the Connection between Meconium Consistency and Adverse Neonatal Outcomes: A Retrospective Clinical Review and Prospective In Vitro Study

by Hueng-Chuen Fan, Fung-Wei Chang, Ying-Ru Pan, Szu-I Yu, Kuang-Hsi Chang, Chuan-Mu Chen and Ching-Ann Liu

Children 2021, 8(12), 1082; https://doi.org/10.3390/children8121082 - 24 Nov 2021

Cited by 7 | Viewed by 3028

Abstract

Whether meconium-stained amniotic fluid (MSAF) serves as an indicator of fetal distress is under debate; however, the presence of MSAF concerns both obstetricians and pediatricians because meconium aspiration is a major contributor to neonatal morbidity and mortality, even with appropriate treatment. The present [...] Read more.

Whether meconium-stained amniotic fluid (MSAF) serves as an indicator of fetal distress is under debate; however, the presence of MSAF concerns both obstetricians and pediatricians because meconium aspiration is a major contributor to neonatal morbidity and mortality, even with appropriate treatment. The present study suggested that thick meconium in infants might be associated with poor outcomes compared with thin meconium based on chart reviews. In addition, cell survival assays following the incubation of various meconium concentrations with monolayers of human epithelial and embryonic lung fibroblast cell lines were consistent with the results obtained from chart reviews. Exposure to meconium resulted in the significant release of nitrite from A549 and HEL299 cells. Medicinal agents, including dexamethasone, L-Nω-nitro-arginine methylester (L-NAME), and NS-398 significantly reduced the meconium-induced release of nitrite. These results support the hypothesis that thick meconium is a risk factor for neonates who require resuscitation, and inflammation appears to serve as the primary mechanism for meconium-associated lung injury. A better understanding of the relationship between nitrite and inflammation could result in the development of promising treatments for meconium aspiration syndrome (MAS). Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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Graphical abstract

10 pages, 1899 KiB

Open AccessArticle

Iatrogenic Blood Loss in Very Low Birth Weight Infants and Transfusion of Packed Red Blood Cells in a Tertiary Care Neonatal Intensive Care Unit

by Ahmed Aboalqez, Philipp Deindl, Chinedu Ulrich Ebenebe, Dominique Singer and Martin Ernst Blohm

Children 2021, 8(10), 847; https://doi.org/10.3390/children8100847 - 25 Sep 2021

Cited by 8 | Viewed by 1739

Abstract

An adequate blood volume is important for neonatal adaptation. The study objective was to quantify the cumulative iatrogenic blood loss in very low birth weight (VLBW) infants by blood sampling and the necessity of packed red cell transfusions from birth to discharge from [...] Read more.

An adequate blood volume is important for neonatal adaptation. The study objective was to quantify the cumulative iatrogenic blood loss in very low birth weight (VLBW) infants by blood sampling and the necessity of packed red cell transfusions from birth to discharge from the hospital. In total, 132 consecutive VLBW infants were treated in 2019 and 2020 with a median birth weight of 1180 g (range 370–1495 g) and a median length of stay of 54 days (range 0–154 days) were included. During the initial four weeks of life, the median absolute amount of blood sampling was 16.5 mL (IQR 12.3–21.1 mL), sampling volume was different with 14.0 mL (IQR 12.1–16.2 mL) for non-transfused infants and 21.6 mL (IQR 17.5–29.4 mL) for transfused infants. During the entire length of stay, 31.8% of the patients had at least one transfusion. In a generalized logistic regression model, the cumulative amount of blood sampling (p < 0.01) and lower hematocrit at birth (p = 0.02) were independent predictors for the necessity of blood transfusion. Therefore, optimized patient blood management in VLBW neonates should include sparse blood sampling to avoid iatrogenic blood loss. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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10 pages, 1537 KiB

Open AccessFeature PaperArticle

Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

by Amy L. Lesneski, Payam Vali, Morgan E. Hardie, Satyan Lakshminrusimha and Deepika Sankaran

Children 2021, 8(7), 594; https://doi.org/10.3390/children8070594 - 14 Jul 2021

Cited by 3 | Viewed by 2581

Abstract

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO₂ by 10 min after birth. Optimal oxygen saturation (SpO₂) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our [...] Read more.

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO₂ by 10 min after birth. Optimal oxygen saturation (SpO₂) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (Q_PA), carotid (Q_CA)and ductal (Q_DA) blood flows between standard (85–94%) and high (95–99%) SpO₂ targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO₂ targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO₂ targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO₂ target (7.4 (4.4–10.8) min) compared to standard SpO₂ target (31.5 (21–66.2) min, p = 0.03). Q_PA was significantly higher during the first 10 min after birth with higher SpO₂ target. At 60 min after birth, the Q_PA, Q_CA and Q_DA were not different between the groups. To conclude, targeting SpO₂ of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase Q_PA but no differences were observed at 60 min. Clinical studies comparing low and high SpO₂ targets assessing hemodynamics and neurodevelopmental outcomes are warranted. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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15 pages, 2853 KiB

Open AccessEditor’s ChoiceArticle

Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series

by Ravindra Pawar, Vijay Gavade, Nivedita Patil, Vijay Mali, Amol Girwalkar, Vyankatesh Tarkasband, Sanjog Loya, Amit Chavan, Narendra Nanivadekar, Rahul Shinde, Uday Patil and Satyan Lakshminrusimha

Children 2021, 8(7), 572; https://doi.org/10.3390/children8070572 - 02 Jul 2021

Cited by 68 | Viewed by 19696

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of [...] Read more.

Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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9 pages, 1243 KiB

Open AccessArticle

Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest

by Deepika Sankaran, Payam Vali, Praveen Chandrasekharan, Peggy Chen, Sylvia F. Gugino, Carmon Koenigsknecht, Justin Helman, Jayasree Nair, Bobby Mathew, Munmun Rawat, Lori Nielsen, Amy L. Lesneski, Morgan E. Hardie, Ziad Alhassen, Houssam M. Joudi, Evan M. Giusto, Lida Zeinali, Heather K. Knych, Gary M. Weiner and Satyan Lakshminrusimha

Children 2021, 8(6), 464; https://doi.org/10.3390/children8060464 - 01 Jun 2021

Cited by 10 | Viewed by 5246

Abstract

The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2–4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This [...] Read more.

The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2–4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This volume of flush may not be adequate to push epinephrine to the right atrium in the absence of intrinsic cardiac activity during CC. The objective of our study was to evaluate the effect of 1-mL and 2.5-mL flush volumes after UVC epinephrine administration on the incidence and time to achieve return of spontaneous circulation (ROSC) in a near-term ovine model of perinatal asphyxia induced cardiac arrest. After 5 min of asystole, lambs were resuscitated per Neonatal Resuscitation Program (NRP) guidelines. During resuscitation, lambs received epinephrine through a UVC followed by 1-mL or 2.5-mL normal saline flush. Hemodynamics and plasma epinephrine concentrations were monitored. Three out of seven (43%) and 12/15 (80%) lambs achieved ROSC after the first dose of epinephrine with 1-mL and 2.5-mL flush respectively (p = 0.08). Median time to ROSC and cumulative epinephrine dose required were not different. Plasma epinephrine concentrations at 1 min after epinephrine administration were not different. From our pilot study, higher flush volume after first dose of epinephrine may be of benefit during neonatal resuscitation. More translational and clinical trials are needed. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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7 pages, 1167 KiB

Open AccessArticle

Cardiac Output and Cerebral Oxygenation in Term Neonates during Neonatal Transition

by Nariae Baik-Schneditz, Bernhard Schwaberger, Lukas Mileder, Nina Höller, Alexander Avian, Berndt Urlesberger and Gerhard Pichler

Children 2021, 8(6), 439; https://doi.org/10.3390/children8060439 - 24 May 2021

Cited by 7 | Viewed by 2391

Abstract

The immediate transition from foetus to neonate includes substantial changes, especially concerning the cardiovascular system. Furthermore, the brain is one of the most vulnerable organs to hypoxia during this period. According to current guidelines for postnatal stabilization, the recommended parameters for monitoring are [...] Read more.

The immediate transition from foetus to neonate includes substantial changes, especially concerning the cardiovascular system. Furthermore, the brain is one of the most vulnerable organs to hypoxia during this period. According to current guidelines for postnatal stabilization, the recommended parameters for monitoring are heart rate (HR) and arterial oxygen saturation (SpO₂). Recently, there is a growing interest in advanced monitoring of the cardio-circulatory system and the brain to get further objective information about the neonate’s condition during the immediate postnatal transition after birth. The aim of the present study was to combine cardiac output (CO) and brain oxygenation monitoring in term neonates after caesarean section in order to analyse the potential influence of CO on cerebral oxygenation during neonatal transition. This was a monocentric, prospective, observational study. For non-invasive cardiac output measurements, the electrical velocimetry (EV) method (Aesculon Monitor, Osypka Medical, CA, USA) was used. The pulse oximeter probe for SpO₂ and HR measurements was placed on the right hand or wrist. The cerebral tissue oxygen index (cTOI) was measured using a NIRO-200NX monitor with the near-infrared spectroscopy (NIRS) transducer on the right frontoparietal head. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, mean CO was calculated from six 10 s periods (with beat-to-beat analysis). During the study period, 99 term neonates were enrolled. Data from neonates with uncomplicated transitions were analysed. CO showed a tendency to decrease until minute 10. During the complete observational period, there was no significant correlation between CO and cTOI. The present study was the first to investigate a possible correlation between CO and cerebral oxygenation in term infants during the immediate neonatal transition. In term infants with uncomplicated neonatal transition after caesarean section, CO did not correlate with cerebral oxygenation. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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15 pages, 1198 KiB

Open AccessArticle

Mechanical Ventilation, Partial Pressure of Carbon Dioxide, Increased Fraction of Inspired Oxygen and the Increased Risk for Adverse Short-Term Outcomes in Cooled Asphyxiated Newborns

by Stamatios Giannakis, Maria Ruhfus, Mona Markus, Anja Stein, Thomas Hoehn, Ursula Felderhoff-Mueser and Hemmen Sabir

Children 2021, 8(6), 430; https://doi.org/10.3390/children8060430 - 21 May 2021

Cited by 7 | Viewed by 1924

Abstract

Neonates treated with therapeutic hypothermia (TH) following perinatal asphyxia (PA) suffer a considerable rate of disability and mortality. Several risk factors associated with adverse outcomes have been identified. Mechanical ventilation might increase the risk for hyperoxia and hypocapnia in cooled newborns. We carried [...] Read more.

Neonates treated with therapeutic hypothermia (TH) following perinatal asphyxia (PA) suffer a considerable rate of disability and mortality. Several risk factors associated with adverse outcomes have been identified. Mechanical ventilation might increase the risk for hyperoxia and hypocapnia in cooled newborns. We carried out a retrospective study in 71 asphyxiated cooled newborns. We analyzed the association of ventilation status and adverse short-term outcomes and investigated the effect of the former on pCO₂ and oxygen delivery before, during and after TH. Death, abnormal findings on magnetic resonance imaging, and pathological amplitude-integrated electroencephalography traces were used to define short-term outcomes. The need for mechanical ventilation was significantly higher in the newborns with adverse outcomes (38% vs. 5.6%, p = 0.001). Compared to spontaneously breathing neonates, intubated newborns suffered from significantly more severe asphyxia, had significantly lower levels of mean minimum pCO₂ over the first 6 and 72 h of life (HOL) (p = 0.03 and p = 0.01, respectively) and increased supply of inspired oxygen, which was, in turn, significantly higher in the newborns with adverse outcomes (p < 0.01). Intubated newborns with adverse short-term outcomes had lower levels of pCO₂ over the first 36 HOL. In conclusion, need for mechanical ventilation was significantly higher in newborns with more severe asphyxia. In ventilated newborns, level of encephalopathy, lower pCO₂ levels, and increased oxygen supplementation were significantly higher in the adverse short-term outcomes group. Ventilatory parameters need to be carefully monitored in cooled asphyxiated newborns. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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11 pages, 1336 KiB

Open AccessArticle

Inhaled Nitric Oxide at Birth Reduces Pulmonary Vascular Resistance and Improves Oxygenation in Preterm Lambs

by Satyan Lakshminrusimha, Sylvia F. Gugino, Krishnamurthy Sekar, Stephen Wedgwood, Carmon Koenigsknecht, Jayasree Nair and Bobby Mathew

Children 2021, 8(5), 378; https://doi.org/10.3390/children8050378 - 11 May 2021

Cited by 3 | Viewed by 2239

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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Review

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13 pages, 297 KiB

Open AccessReview

The Role of Lung Ultrasound in the Management of the Critically Ill Neonate—A Narrative Review and Practical Guide

by Lukas Aichhorn, Erik Küng, Lisa Habrina, Tobias Werther, Angelika Berger, Berndt Urlesberger and Bernhard Schwaberger

Children 2021, 8(8), 628; https://doi.org/10.3390/children8080628 - 24 Jul 2021

Cited by 13 | Viewed by 3587

Abstract

Lung ultrasound makes use of artifacts generated by the ratio of air and fluid in the lung. Recently, an enormous increase of research regarding lung ultrasound emerged, especially in intensive care units. The use of lung ultrasound on the neonatal intensive care unit [...] Read more.

Lung ultrasound makes use of artifacts generated by the ratio of air and fluid in the lung. Recently, an enormous increase of research regarding lung ultrasound emerged, especially in intensive care units. The use of lung ultrasound on the neonatal intensive care unit enables the clinician to gain knowledge about the respiratory condition of the patients, make quick decisions, and reduces exposure to ionizing radiation. In this narrative review, the possibilities of lung ultrasound for the stabilization and resuscitation of the neonate using the ABCDE algorithm will be discussed. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

11 pages, 893 KiB

Open AccessReview

Accuracy of Pulse Oximetry in the Presence of Fetal Hemoglobin—A Systematic Review

by Ena Pritišanac, Berndt Urlesberger, Bernhard Schwaberger and Gerhard Pichler

Children 2021, 8(5), 361; https://doi.org/10.3390/children8050361 - 30 Apr 2021

Cited by 9 | Viewed by 4981

Abstract

Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence [...] Read more.

Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from −3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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Graphical abstract

10 pages, 258 KiB

Open AccessReview

Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

by Seung Yeon Kim, Gyu-Hong Shim and Georg M. Schmölzer

Children 2021, 8(2), 97; https://doi.org/10.3390/children8020097 - 02 Feb 2021

Cited by 3 | Viewed by 2126

Abstract

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored [...] Read more.

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

Other

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4 pages, 182 KiB

Open AccessBrief Report

In-Silico Evaluation of Anthropomorphic Measurement Variations on Electrical Cardiometry in Neonates

by David B. Healy, Eugene M. Dempsey, John M. O’Toole and Christoph E. Schwarz

Children 2021, 8(10), 936; https://doi.org/10.3390/children8100936 - 18 Oct 2021

Cited by 4 | Viewed by 1408

Abstract

Non-invasive cardiac output methods such as Electrical Cardiometry (EC) are relatively novel assessment tools for neonates and they enable continuous monitoring of stroke volume (SV). An in-silico comparison of differences in EC-derived SV in relation to preset length and weight was performed. EC [...] Read more.

Non-invasive cardiac output methods such as Electrical Cardiometry (EC) are relatively novel assessment tools for neonates and they enable continuous monitoring of stroke volume (SV). An in-silico comparison of differences in EC-derived SV in relation to preset length and weight was performed. EC (ICON, Osypka Medical) was simulated using the “demo” mode for various combinations of length and weight representative of term and preterm infants. One-centimetre length error resulted in a SV-change of 1.8–3.6% (preterm) or 1.6–2.0% (term) throughout the tested weight ranges. One-hundred gram error in weight measurement resulted in a SV-change of 5.0–7.1% (preterm) or 1.5–1.8% (term) throughout the tested length ranges. Algorithms to calculate EC-derived SV incorporate anthropomorphic measurements. Therefore, inaccuracy in physical measurement can impact absolute EC measurements. This should be considered in the interpretation of previous findings and the design of future clinical studies of EC-derived cardiac parameters in neonates, particularly in the preterm cohorts where a proportional change was noted to be greatest. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

6 pages, 760 KiB

Open AccessBrief Report

In Newborn Infants a New Intubation Method May Reduce the Number of Intubation Attempts: A Randomized Pilot Study

by Marlies Bruckner, Nicholas M. Morris, Gerhard Pichler, Christina H. Wolfsberger, Stefan Heschl, Lukas P. Mileder, Bernhard Schwaberger, Georg M. Schmölzer and Berndt Urlesberger

Children 2021, 8(7), 553; https://doi.org/10.3390/children8070553 - 26 Jun 2021

Cited by 2 | Viewed by 2046

Abstract

Severe desaturation or bradycardia often occur during neonatal endotracheal intubation. Using continuous gas flow through the endotracheal tube might reduce the incidence of these events. We hypothesized that continuous gas flow through the endotracheal tube during nasotracheal intubation compared to standard nasotracheal intubation [...] Read more.

Severe desaturation or bradycardia often occur during neonatal endotracheal intubation. Using continuous gas flow through the endotracheal tube might reduce the incidence of these events. We hypothesized that continuous gas flow through the endotracheal tube during nasotracheal intubation compared to standard nasotracheal intubation will reduce the number of intubation attempts in newborn infants. In a randomized controlled pilot study, neonates were either intubated with continuous gas flow through the endotracheal tube during intubation (intervention group) or no gas flow during intubation (control group). Recruitment was stopped early due to financial and organizational issues. A total of 16 infants and 39 intubation attempts were analyzed. The median (interquartile range) number of intubation attempts and number of abandoned intubations due to desaturation and/or bradycardia were 1 (1–2) and 4 (2–5), (p = 0.056) and n = 3 versus n = 20, (p = 0.060) in the intervention group and control group, respectively. Continuous gas flow through the endotracheal tube during intubation seems to be favorable and there are no major unexpected adverse consequences of attempting this methodology. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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6 pages, 548 KiB

Open AccessCase Report

Successful Postnatal Cardiopulmonary Resuscitation Due to Defibrillation

by Lukas Peter Mileder, Nicholas Mark Morris, Stefan Kurath-Koller, Jasmin Pansy, Gerhard Pichler, Mirjam Pocivalnik, Bernhard Schwaberger, Ante Burmas and Berndt Urlesberger

Children 2021, 8(5), 421; https://doi.org/10.3390/children8050421 - 20 May 2021

Cited by 4 | Viewed by 1837

Abstract

An asphyxiated term neonate required postnatal resuscitation. After six minutes of cardio-pulmonary resuscitation (CPR) and two doses of epinephrine, spontaneous circulation returned, but was shortly followed by ventricular fibrillation. CPR and administration of magnesium, calcium gluconate, and sodium bicarbonate did not improve the [...] Read more.

An asphyxiated term neonate required postnatal resuscitation. After six minutes of cardio-pulmonary resuscitation (CPR) and two doses of epinephrine, spontaneous circulation returned, but was shortly followed by ventricular fibrillation. CPR and administration of magnesium, calcium gluconate, and sodium bicarbonate did not improve the neonate’s condition. A counter shock of five Joule was delivered and the cardiac rhythm immediately converted to sinus rhythm. The neonate was transferred to the neonatal intensive care unit and received post-resuscitation care. Due to prolonged QTc and subsequently suspected long-QT syndrome propranolol treatment was initiated. The neonate was discharged home on day 14 without neurological sequelae. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)

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