Author: "Martin Keszler" - Searchworks@Jio Institute Digital Library Search Results

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51. Time to Abandon Your Comfort Zone?*

Author: Martin Keszler
Subjects: medicine.medical_specialty, business.industry, Respiration, Infant, Newborn, MEDLINE, Critical Care and Intensive Care Medicine, Respiration, Artificial, Work of breathing, Pediatrics, Perinatology and Child Health, Physical therapy, medicine, Humans, business, Work of Breathing
Published: 2020

52. Considering the Validity of the SAIL Trial—A Navel Gazers Guide to the SAIL Trial

Author: Peter G Davis, Martin Keszler, Haresh Kirpalani, Sarah J. Ratcliffe, and Elizabeth E. Foglia
Subjects: medicine.medical_specialty, Evidence-based practice, sustained inflation, resuscitation, Design elements and principles, methodological recommendations, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, newborn, 030225 pediatrics, medicine, 030212 general & internal medicine, Positive pressure ventilation, business.industry, evidence based practice, Delivery room, lcsh:RJ1-570, clinical trial, lcsh:Pediatrics, 3. Good health, Clinical trial, Sustained inflation, Perspective, Pediatrics, Perinatology and Child Health, Physical therapy, delivery, preterm, business
Abstract: This article explores the validity of the Sustained Aeration Inflation for Infant Lungs (SAIL) randomized controlled clinical trial. The SAIL trial enrolled 460 infants out of a planned 600, but the trial was stopped early for harm. We ask here, whether there were any threats to validity in the trial as conducted. We then explore what design elements of the trial could have been improved upon. Finally, we consider what the implications are for future trials in this arena. Clinical Trial Registration: www.clinicaltrials.gov, Identifier: NCT02139800.
Published: 2019

53. Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision

Author: Elisabeth C. McGowan, Abbot. R. Laptook, Jean Lowe, Myriam Peralta-Carcelen, Dhuly Chowdhury, Rosemary D. Higgins, Susan R. Hintz, Betty R. Vohr, Richard A. Polin, Abbott R. Laptook, Martin Keszler, Angelita M. Hensman, Barbara Alksninis, Kristin M. Basso, Robert Burke, Melinda Caskey, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Emilee Little, Elisa Vieira, Victoria E. Watson, Suzy Ventura, Michele C. Walsh, Avroy A. Fanaroff, Anna Marie Hibbs, Deanne E. Wilson-Costello, Nancy S. Newman, Allison H. Payne, Bonnie S. Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G. Friedman, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Edward F. Donovan, Cathy Grisby, Kate Bridges, Barbara Alexander, Estelle E. Fischer, Holly L. Mincey, Jody Hessling, Teresa L. Gratton, Lenora Jackson, Kristin Kirker, Greg Muthig, Jean J. Steichen, Stacey Tepe, Kimberly Yolton, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein, Patricia L. Ashley, William F. Malcolm, Kathy J. Auten, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Melody B. Lohmeyer, Joanne Finkle, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Linda Manor, Diane Warner, Janice Wereszczak, David P. Carlton, Barbara J. Stoll, Ira Adams-Chapman, Ellen C. Hale, Yvonne Loggins, Stephanie Wilson Archer, Gregory M. Sokol, Brenda B. Poindexter, Anna M. Dusick, Lu-Ann Papile, Susan Gunn, Faithe Hamer, Dianne E. Herron, Abbey C. Hines, Carolyn Lytle, Heike M. Minnich, Lucy Smiley, Leslie Dawn Wilson, Pablo J. Sanchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Abhik Das, Dennis Wallace, Marie G. Gantz, W. Kenneth Poole, Jamie E. Newman, Jeanette O'Donnell Auman, Margaret M. Crawford, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Alexis S. Davis, Andrew W. Palmquist, Melinda S. Proud, Barbara Bentley, Elizabeth Bruno, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Jean G. Kohn, Casey Krueger, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Anne Furey, Ellen Nylen, Waldemar A. Carlo, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Fred J. Biasini, Kristen C. Johnston, Kathleen G. Nelson, Cryshelle S. Patterson, Vivien A. Phillips, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, Yvonne E. Vaucher, David Kaegi, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Wade Rich, Edward F. Bell, Tarah T. Colaizy, Michael J. Acarregui, Dan L. Ellsbury, John A. Widness, Karen J. Johnson, Donia B. Campbell, Diane L. Eastman, Jacky R. Walker, Jane E. Brumbaugh, Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, Sylvia Fajardo-Hiriart, Arielle Rigaud, Maria Calejo, Silvia M. Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L. Watterberg, Jean R. Lowe, Janell F. Fuller, Robin K. Ohls, Conra Backstrom Lacy, Andrea F. Duncan, Rebecca Montman, Barbara Schmidt, Haresh Kirpalani, Sara B. DeMauro, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Dale L. Phelps, Ronnie Guillet, Satyan Lakshminrusimha, Julie Babish Johnson, Linda J. Reubens, Cassandra A. Horihan, Diane Hust, Rosemary L. Jensen, Emily Kushner, Joan Merzbach, Gary J. Myers, Mary Rowan, Holly I.M. Wadkins, Melissa Bowman, Julianne Hunn, Stephanie Guilford, Deanna Maffett, Farooq Osman, Diane Prinzing, Anne Marie Reynolds, Michael G. Sacilowski, Ashley Williams, Karen Wynn, Kelley Yost, William Zorn, Lauren Zwetsch, Kathleen A. Kennedy, Jon E. Tyson, Georgia E. McDavid, Nora I. Alaniz, Julie Arldt-McAlister, Katrina Burson, Patricia W. Evans, Carmen Garcia, Charles Green, Beverly Foley Harris, Margarita Jiminez, Janice John, Patrick M. Jones, Layne M. Lillie, Anna E. Lis, Karen Martin, Sara C. Martin, Brenda H. Morris, M. Layne Poundstone, Peggy Robichaux, Shawna Rodgers, Saba Siddiki, Maegan C. Simmons, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Myra H. Wyckoff, Luc P. Brion, Roy J. Heyne, Walid A. Salhab, Charles R. Rosenfeld, Diana M. Vasil, Lijun Chen, Alicia Guzman, Gaynelle Hensley, Melissa H. Leps, Nancy A. Miller, Janet S. Morgan, Sally S. Adams, Catherine Twell Boatman, Elizabeth T. Heyne, Linda A. Madden, Lizette E. Torres, Roger G. Faix, Bradley A. Yoder, Karen A. Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, Shawna Baker, Karie Bird, Jill Burnett, Michael Steffen, Jennifer J. Jensen, Sarah Winter, Karen Zanetti, T. Michael O'Shea, Robert G. Dillard, Lisa K. Washburn, Barbara G. Jackson, Nancy Peters, Korinne Chiu, Deborah Evans Allred, Donald J. Goldstein, Raquel Halfond, Carroll Peterson, Ellen L. Waldrep, Cherrie D. Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Athina Pappas, John Barks, Rebecca Bara, Laura A. Goldston, Girija Natarajan, Mary Christensen, Stephanie A. Wiggins, Diane White, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, Joanne Williams, and Elaine Romano
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, Birth weight, Gestational Age, Prenatal care, Article, 03 medical and health sciences, 0302 clinical medicine, Child Development, stomatognathic system, Pregnancy, 030225 pediatrics, medicine, Hospital discharge, Humans, 030212 general & internal medicine, School education, Retrospective Studies, business.industry, Extremely preterm, Child Protective Services, Infant, Newborn, Infant, Cognition, Prenatal Care, Patient Discharge, United States, stomatognathic diseases, Foster care, Increased risk, Child, Preschool, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, business, Follow-Up Studies
Abstract: OBJECTIVE: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. STUDY DESIGN: For infants born at
Published: 2019

54. Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia

Author: Jane E. Brumbaugh, Edward F. Bell, Scott F. Grey, Sara B. DeMauro, Betty R. Vohr, Heidi M. Harmon, Carla M. Bann, Matthew A. Rysavy, J. Wells Logan, Tarah T. Colaizy, Myriam A. Peralta-Carcelen, Elisabeth C. McGowan, Andrea F. Duncan, Barbara J. Stoll, Abhik Das, Susan R. Hintz, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Angelita M. Hensman, Elisa Vieira, Emilee Little, Robert T. Burke, Bonnie E. Stephens, Barbara Alksninis, Carmena Bishop, Mary L. Keszler, Teresa M. Leach, Victoria E. Watson, Andrea M. Knoll, Michele C. Walsh, Avroy A. Fanaroff, Nancy S. Newman, Deanne E. Wilson-Costello, Allison Payne, Monika Bhola, Gulgun Yalcinkaya, Bonnie S. Siner, Harriet G. Friedman, Elizabeth Roth, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Brenda B. Poindexter, Stephanie Merhar, Kimberly Yolton, Teresa L. Gratton, Cathy Grisby, Kristin Kirker, Sandra Wuertz, David P. Carlton, Ira Adams-Chapman, Ellen C. Hale, Yvonne C. Loggins, Diane I. Bottcher, Colleen Mackie, Sheena L. Carter, Maureen Mulligan LaRossa, Lynn C. Wineski, Gloria V. Smikle, Angela Leon-Hernandez, Salathiel Kendrick-Allwood, C. Michael Cotten, Ronald N. Goldberg, Ricki F. Goldstein, William F. Malcolm, Patricia L. Ashley, Joanne Finkle, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Diane Warner, Janice Wereszczak, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Lu Ann Papile, Abbey C. Hines, Dianne E. Herron, Susan Gunn, Lucy Smiley, Kathleen A. Kennedy, Jon E. Tyson, Julie Arldt-McAlister, Katrina Burson, Allison G. Dempsey, Patricia W. Evans, Carmen Garcia, Margarita Jiminez, Janice John, Patrick M. Jones, M. Layne Lillie, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shawna Rodgers, Saba Khan Siddiki, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Dennis Wallace, Marie G. Gantz, Jamie E. Newman, Jeanette O'Donnell Auman, Margaret Crawford, Jenna Gabrio, David Leblond, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, Valerie Y. Chock, David K. Stevenson, Marian M. Adams, M. Bethany Ball, Barbara Bentley, Maria Elena DeAnda, Anne M. Debattista, Beth Earhart, Lynne C. Huffman, Magdy Ismael, Casey E. Krueger, Andrew W. Palmquist, Melinda S. Proud, Elizabeth N. Reichert, Meera N. Sankar, Nicholas H. St. John, Heather L. Taylor, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Ellen Nylen, Anne Furey, Cecelia E. Sibley, Ana K. Brussa, Waldemar A. Carlo, Namasivayam Ambalavanan, Kirstin J. Bailey, Fred J. Biasini, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Richard V. Rector, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, Yvonne E. Vaucher, David Kaegi, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Wade Rich, Radmila West, Michelle L. Baack, Dan L. Ellsbury, Laurie A. Hogden, Jonathan M. Klein, John M. Dagle, Karen J. Johnson, Tracy L. Tud, Chelsey Elenkiwich, Megan M. Henning, Megan Broadbent, Mendi L. Schmelzel, Jacky R. Walker, Claire A. Goeke, Kristi L. Watterberg, Robin K. Ohls, Conra Backstrom Lacy, Sandra Brown, Janell Fuller, Carol Hartenberger, Jean R. Lowe, Sandra Sundquist Beauman, Mary Ruffner Hanson, Tara Dupont, Elizabeth Kuan, Barbara Schmidt, Haresh Kirpalani, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Ronnie Guillet, Gary J. Myers, Satyan Lakshminrusimha, Anne Marie Reynolds, Michelle E. Hartley-McAndrew, Holly I.M. Wadkins, Michael G. Sacilowski, Linda J. Reubens, Rosemary L. Jensen, Joan Merzbach, William Zorn, Osman Farooq, Deanna Maffett, Ashley Williams, Julianne Hunn, Stephanie Guilford, Kelley Yost, Mary Rowan, Diane M. Prinzing, Karen Wynn, Cait Fallone, Ann Marie Scorsone, Myra H. Wyckoff, Luc P. Brion, Roy J. Heyne, Diana M. Vasil, Sally S. Adams, Lijun Chen, Maria M. De Leon, Frances Eubanks, Alicia Guzman, Elizabeth T. Heyne, Linda A. Madden, Nancy A. Miller, Lizette E. Lee, Lara Pavageau, Pollieanna Sepulveda, Cathy Twell Boatman, Roger G. Faix, Bradley A. Yoder, Mariana Baserga, Karen A. Osborne, Shawna Baker, Karie Bird, Jill Burnett, Susan Christensen, Brandy Davis, Jennifer O. Elmont, Jennifer J. Jensen, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Stephen D. Minton, D. Melody Parry, Carrie A. Rau, Susan T. Schaefer, Mark J. Sheffield, Cynthia Spencer, Mike Steffen, Kimberlee Weaver-Lewis, Sarah Winter, Kathryn D. Woodbury, Karen Zanetti, Seetha Shankaran, Sanjay Chawla, Beena G. Sood, Athina Pappas, Girija Natarajan, Monika Bajaj, Rebecca Bara, Mary E. Johnson, Laura Goldston, Stephanie A. Wiggins, Mary K. Christensen, Martha Carlson, John Barks, Diane F. White, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, and Elaine Romano
Subjects: Male, Pediatrics, medicine.medical_specialty, CBCL, behavioral disciplines and activities, Language Development, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Cognition, 030225 pediatrics, mental disorders, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Child Behavior Checklist, Motor skill, Bronchopulmonary Dysplasia, Problem Behavior, business.industry, Confounding, Postmenstrual Age, Infant, Newborn, medicine.disease, Bronchopulmonary dysplasia, Motor Skills, Child, Preschool, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Infant Behavior, Gestation, Female, business
Abstract: To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD).We studied children born at 22-26 weeks of gestation and assessed at 22-26 months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36 weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior.Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P .001) and pervasive developmental problems (P .001) increased with worsening BPD grade. Sleep problems (P = .008) and aggressive behavior (P = .023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values .05).BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.
Published: 2019

55. The BIT:S (Bronchopulmonary Dysplasia Interdisciplinary Team: Severe) Initiative at Women and Infants Hospital of Rhode Island

Author: Robin L, McKinney, Khushbu, Shukla, Karen, Daigle, James, Zeigler, Michael, Muller, and Martin, Keszler
Subjects: Adult, Male, Patient Care Team, Infant, Newborn, Infant, Rhode Island, Gestational Age, Standard of Care, Patient Discharge, Young Adult, Infant, Extremely Premature, Humans, Female, Bronchopulmonary Dysplasia
Abstract: Bronchopulmonary dysplasia (BPD) is a major cause of morbidity and mortality in surviving extremely preterm infants, with long-term morbidity disproportionately affecting children with severe BPD (sBPD). Infants with sBPD experience multiple organ system dysfunction. To best treat these complicated patients, we created a multidisciplinary team in 2011 consisting of multiple pediatric subspecialists with a specific interest in sBPD. In the past six years, 150 patients have been referred to our multidisciplinary team, with 131 of the 150 patients discharged home, 65% on home oxygen. Twelve were transferred to the Pediatric Intensive Care Unit (PICU), 3 to a level 2 nursery and 4 died. The multidisciplinary BPD team has standardized the care of children with sBPD and complex medical problems and improved outpatient referral to subspecialists.
Published: 2019

56. Sustained Inflation of Infant Lungs: From Bench to Bedside and Back Again

Author: Martin Keszler
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Sheep, business.industry, MEDLINE, Infant, Newborn, Infant, Critical Care and Intensive Care Medicine, Bench to bedside, Sustained inflation, medicine, Animals, Humans, Intensive care medicine, business, Lung
Published: 2019

57. Ventilator Strategies to Reduce Lung Injury and Duration of Mechanical Ventilation

Author: Martin Keszler and Nelson Claure
Subjects: Mechanical ventilation, medicine.medical_specialty, Lung, business.industry, medicine.medical_treatment, Atelectasis, respiratory system, Lung injury, Pulmonary compliance, medicine.disease, medicine.anatomical_structure, Breathing, Medicine, Lung volumes, business, Intensive care medicine, Tidal volume
Abstract: Despite appropriate emphasis on noninvasive respiratory support when feasible, mechanical ventilation remains a mainstay of therapy in the most immature infants. Although it is often lifesaving, invasive mechanical ventilation has many untoward effects on the brain and the lungs, especially in extremely low-gestational-age newborns, and thus avoidance of mechanical ventilation in favor of noninvasive respiratory support is seen as one of the most important steps in preventing neonatal morbidity. When mechanical ventilation is required, the goal is to wean the patient from invasive ventilation as soon as feasible in order to minimize ventilator-associated lung injury (VALI). VALI is initiated by some form of biophysical injury (most often excessive tissue stretch), which in turn triggers a release of mediators and activated leukocytes leading to biotrauma and initiating the complex cascade of lung injury and eventual repair. The overarching goal of respiratory support is to minimize adverse effects on the infant’s lungs, hemodynamics, and brain while supporting adequate gas exchange. Ventilation settings must be individualized to address each patient’s specific condition but must include the dual objectives of optimizing lung volume/preventing atelectasis and avoiding excessively large tidal volume. The open lung strategy improves lung compliance, minimizes oxygen requirement, avoids surfactant inactivation, and achieves even tidal volume distribution. Prevention of excessive tidal volume minimizes volutrauma and hypocapnia, the two most important and potentially preventable elements of lung and brain injury.
Published: 2019

58. Preface

Author: Peter G. Davis, Martin Keszler, and Eduardo Bancalari
Published: 2019

59. Contributors

Author: Steven H. Abman, Namasivayam Ambalavanan, Lisa M. Askie, Eduardo Bancalari, Vineet Bhandari, Waldemar A. Carlo, Jeanie L.Y. Cheong, Nelson Claure, Peter A. Dargaville, Peter G. Davis, Juliann M. Di Fiore, Lex W. Doyle, Stuart B. Hooper, Thomas A. Hooven, Alan H. Jobe, Suhas G. Kallapur, Martin Keszler, Martin Kluckow, Charitharth Vivek Lal, Matthew M. Laughon, Brett J. Manley, Richard J. Martin, Leif D. Nelin, Shahab Noori, Howard B. Panitch, Won Soon Park, Richard A. Polin, Rashmin C. Savani, Vidhi P. Shah, Ilene R.S. Sosenko, Robin H. Steinhorn, Bernard Thébaud, Rose M. Viscardi, Gary M. Weiner, Shu Wu, Myra H. Wyckoff, Bradley A. Yoder, and Karen C. Young
Published: 2019

60. Patient-Ventilator Interaction

Author: Nelson Claure, Martin Keszler, and Eduardo Bancalari
Published: 2019

61. Automation of Respiratory Support

Author: Nelson Claure, Martin Keszler, and Eduardo Bancalari
Published: 2019

62. Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants

Author: Jennifer O. Elmont, Holly I.M. Wadkins, M. Bethany Ball, Michele C. Walsh, Satyan Lakshminrusimha, Susan T. Schaefer, Toni Mancini, Melody Parry, Haresh Kirpalani, Jon E. Tyson, Gennie Bose, Namasivayam Ambalavanan, Megan M. Henning, Ann Marie Scorsone, Sanjay Chawla, Marie G. Gantz, Carl L. Bose, Seetha Shankaran, Kimberlee Weaver-Lewis, Diane I. Bottcher, John D.E. Barks, Rosemary D. Higgins, Leif D. Nelin, Kathryn D. Woodbury, Karen J. Johnson, Jennifer Donato, Stephanie Wilson Archer, Dennis Wallace, David Leblond, Tracy L. Tud, Chelsey Elenkiwich, Stephen D. Minton, Prabhu S. Parimi, Sandra Sundquist Beauman, Meena Garg, Andrew A. Bremer, Constance Orme, Anna Maria Hibbs, Mary Hanson, Joanne Finkle, Pablo J. Sánchez, Michael G. Sacilowski, Courtney Park, Laurie A. Hogden, Elizabeth Kuan, Diane F. White, Mendi L. Schmelzel, Deanna Maffett, Kathleen A. Kennedy, Sarvin Ghavam, Brandy Davis, Edward F. Bell, Martin Keszler, David P. Carlton, Emily Li, Jacky R. Walker, Elizabeth N. Reichert, Sharon L. Wright, Claire A. Goeke, Elizabeth Eason, Tara McNair, Sara B. DeMauro, Brenda B. Poindexter, Colleen Mackie, Eugenia K. Pallotto, Rachel Geller, Yvonne Loggins, Carol Hartenberger, Daisy Rochez, Waldemar A. Carlo, Frances Eubanks, Hallie Baugher, Barry Eggleston, Diane Prinzing, Teresa Chanlaw, Kandace McGrath, Carrie A. Rau, Barbara Schmidt, Stephanie Guilford, Kristin Kirker, Melinda S. Proud, Kristin M. Zaterka-Baxter, Ginger Rhodes-Ryan, Premini Sabaratnam, Georgia E. McDavid, Pollieanna Sepulvida, Cathy Grisby, Ronnie Guillet, Soraya Abbasi, Gregory M. Sokol, Mary Rowan, Abbot R. Laptook, Patricia Luzader, Myra H. Wyckoff, Luc P. Brion, Melanie Stein, Bogdan Panaitescu, Sara C. Handley, Karen Martin, Carl T. D'Angio, William E. Truog, Elisa Vieira, Kristi L. Watterberg, Allison Knutson, Cheri Gauldin, Manndi C. Loertscher, Rachel A. Jones, Jacqueline McCool, Lisa Gaetano, Bradley A. Yoder, Monica V. Collins, Ronald N. Goldberg, Michelle L. Baack, Julie C. Shadd, John M. Dagle, Mariana Baserga, Jill Burnett, Anne Marie Reynolds, Sudarshan R. Jadcherla, Emily K. Stephens, Anne Holmes, Earl Maxson, Ravi Mangal Patel, Kimberley A. Fisher, Jonathan Snyder, Rosemary L. Jensen, Jeanette O'Donnell Auman, Kirsten Childs, Stephanie L. Merhar, Angelita M. Hensman, Neha Kumbhat, Jane E. Brumbaugh, R. Jordan Williams, Eric C. Eichenwald, Maria M. DeLeon, Carla Bann, Krisa P. Van Meurs, Mark J. Sheffield, Trisha Marchant, Christine Catts, Robin K. Ohls, Claudia Pedrozza, Amir M. Khan, Conra Backstrom Lacy, Shirley S. Cosby, C. Michael Cotten, Aasma S. Chaudhary, Diana M. Vasil, Donna Hall, Janice Bernhardt, Alexis S. Davis, Kurt Schibler, Valerie Y. Chock, Erna Clark, Kyle Binion, Jonathan M. Klein, Dan L. Ellsbury, Richard A. Polin, Janell Fuller, Abhik Das, Julie Gutentag, Susan Christensen, Dianne E. Herron, Jenna Gabrio, Megan Broadbent, Lucille St. Pierre, Donna White, Cindy Clark, Elizabeth E. Foglia, Matthew M. Laughon, Stephen D. Kicklighter, Tarah T. Colaizy, David K. Stevenson, Girija Natarajan, and Uday Devaskar
Subjects: Male, medicine.medical_specialty, Gestational Age, Umbilical cord, Article, Umbilical Cord, Milking, 03 medical and health sciences, 0302 clinical medicine, Primary outcome, 030225 pediatrics, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Cerebral Intraventricular Hemorrhage, Retrospective Studies, Extremely premature, Obstetrics, business.industry, Infant, Newborn, Retrospective cohort study, medicine.disease, Constriction, medicine.anatomical_structure, Intraventricular hemorrhage, Hospital outcomes, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, Cord clamping, business
Abstract: OBJECTIVE: To compare in-hospital outcomes after umbilical cord milking versus delayed cord clamping among infants
Published: 2021

63. Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic–Ischemic Encephalopathy in the Late Hypothermia Trial

Author: Abbot R. Laptook, Seetha Shankaran, Patrick Barnes, Nancy Rollins, Barbara T. Do, Nehal A. Parikh, Shannon Hamrick, Susan R. Hintz, Jon E. Tyson, Edward F. Bell, Namasivayam Ambalavanan, Ronald N. Goldberg, Athina Pappas, Carolyn Huitema, Claudia Pedroza, Aasma S. Chaudhary, Angelita M. Hensman, Abhik Das, Myra Wyckoff, Amir Khan, Michelle C. Walsh, Kristi L. Watterberg, Roger Faix, William Truog, Ronnie Guillet, Gregory M. Sokol, Brenda B. Poindexter, Rosemary D. Higgins, Michael S. Caplan, Richard A. Polin, Martin Keszler, William Oh, Betty R. Vohr, Elizabeth C. McGowan, Barbara Alksninis, Kristin Basso, Joseph Bliss, Carmena Bishop, Robert T. Burke, William Cashore, Melinda Caskey, Dan Gingras, Nicholas Guerina, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Martha R. Leonard, Emilee Little, Bonnie E. Stephens, Elisa Vieira, Victoria E. Watson, Anna Maria Hibbs, Deanne E. Wilson-Costello, Nancy S. Newman, Beau Batton, Monika Bhola, Juliann M. Di Fiore, Harriet G. Friedman, Bonnie S. Siner, Eileen K. Stork, Gulgun Yalcinkaya, Arlene Zadell, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Kimberly Yolton, Cathy Grisby, Teresa L. Gratton, Stephanie Merhar, Sandra Wuertz, C. Michael Cotten, Kimberley A. Fisher, Sandra Grimes, Joanne Finkle, Ricki F. Goldstein, Kathryn E. Gustafson, William F. Malcolm, Patricia L. Ashley, Kathy J. Auten, Melody B. Lohmeyer, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Cindy Clark, Diane D. Warner, Janice Wereszcsak, Sofia Aliaga, David P. Carlton, Barbara J. Stoll, Ellen C. Hale, Yvonne Loggins, Diane I. Bottcher, Colleen Mackie, Maureen Mulligan LaRossa, Ira Adams-Chapman, Lynn C. Wineski, Sheena L. Carter, Stephanie Wilson Archer, Heidi M. Harmon, Lu-Ann Papile, Anna M. Dusick, Susan Gunn, Dianne E. Herron, Abbey C. Hines, Darlene Kardatzke, Carolyn Lytle, Heike M. Minnich, Leslie Richard, Lucy C. Smiley, Leslie Dawn Wilson, Kathleen A. Kennedy, Elizabeth Allain, Carrie M. Mason, Julie Arldt-McAlister, Katrina Burson, Allison G. Dempsey, Andrea F. Duncan, Patricia W. Evans, Carmen Garcia, Charles E. Green, Margarita Jimenez, Janice John, Patrick M. Jones, M. Layne Lillie, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shannon McKee, Patti L. Pierce Tate, Shawna Rodgers, Saba Khan Siddiki, Daniel K. Sperry, Sharon L. Wright, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Jennifer L. Grothause, Dennis Wallace, Marie G. Gantz, Kristin M. Zaterka-Baxter, Margaret M. Crawford, Scott A. McDonald, Jamie E. Newman, Jeanette O'Donnell Auman, Carolyn M. Petrie Huitema, James W. Pickett, Patricia Yost, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Barbara Bentley, Valerie Y. Chock, Elizabeth F. Bruno, Alexis S. Davis, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Jean G. Kohn, Casey E. Krueger, Melinda S. Proud, William D. Rhine, Nicholas H. St. John, Heather Taylor, Hali E. Weiss, Waldemar A. Carlo, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Richard V. Rector, Sally Whitley, Tarah T. Colaizy, Jane E. Brumbaugh, Karen J. Johnson, Diane L. Eastman, Michael J. Acarregui, Jacky R. Walker, Claire A. Goeke, Jonathan M. Klein, Nancy J. Krutzfield, Jeffrey L. Segar, John M. Dagle, Julie B. Lindower, Steven J. McElroy, Glenda K. Rabe, Robert D. Roghair, Lauritz R. Meyer, Dan L. Ellsbury, Donia B. Campbell, Cary R. Murphy, Vipinchandra Bhavsar, Robin K. Ohls, Conra Backstrom Lacy, Sandra Sundquist Beauman, Sandra Brown, Erika Fernandez, Andrea Freeman Duncan, Janell Fuller, Elizabeth Kuan, Jean R. Lowe, Barbara Schmidt, Haresh Kirpalani, Sara B. DeMauro, Kevin C. Dysart, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl D'Angio, Satyan Lakshminrusimha, Nirupama Laroia, Gary J. Myers, Kelley Yost, Stephanie Guilford, Rosemary L. Jensen, Karen Wynn, Osman Farooq, Anne Marie Reynolds, Holly I.M. Wadkins, Ashley Williams, Joan Merzbach, Patrick Conway, Melissa Bowman, Michele Hartley-McAndrew, William Zorn, Cait Fallone, Kyle Binion, Constance Orme, Ann Marie Scorsone, Luc P. Brion, Lina F. Chalak, Roy J. Heyne, Lijun Chen, Diana M. Vasil, Sally S. Adams, Catherine Twell Boatman, Alicia Guzman, Elizabeth T. Heyne, Lizette E. Lee, Melissa H. Leps, Linda A. Madden, Nancy A. Miller, Emma Ramon, Bradley A. Yoder, Karen A. Osborne, Cynthia Spencer, R. Edison Steele, Mike Steffen, Karena Strong, Kimberlee Weaver-Lewis, Shawna Baker, Sarah Winter, Karie Bird, Jill Burnett, Beena G. Sood, Rebecca Bara, Kirsten Childs, Lilia C. De Jesus, Bogdan Panaitescu, Sanjay M.D. Chawla, Jeannette E. Prentice, Laura A. Goldston, Eunice Hinz Woldt, Girija Natarajan, Monika Bajaj, John Barks, Mary Christensen, and Stephanie A. Wiggins
Subjects: Male, Pediatrics, medicine.medical_specialty, Developmental Disabilities, Subgroup analysis, Severity of Illness Index, Article, Hypoxic Ischemic Encephalopathy, 03 medical and health sciences, 0302 clinical medicine, Hypothermia, Induced, Predictive Value of Tests, 030225 pediatrics, Multicenter trial, medicine, Humans, 030212 general & internal medicine, medicine.diagnostic_test, Neonatal encephalopathy, business.industry, Infant, Newborn, Area under the curve, Infant, Magnetic resonance imaging, Hypothermia, medicine.disease, Magnetic Resonance Imaging, Hypoxia-Ischemia, Brain, Pediatrics, Perinatology and Child Health, Gestation, Female, medicine.symptom, business, Infant, Premature
Abstract: Objective To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours. Study design Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age. Results Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively. Conclusions MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia–ischemia. Trial registration Clinicaltrials.gov: NCT00614744 .
Published: 2021

64. Effect of inspiratory flow rate on the efficiency of carbon dioxide removal at tidal volumes below instrumental dead space

Author: Martin Keszler and Edward H. Hurley
Subjects: medicine.medical_specialty, Dead space, Flow (psychology), law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, law, 030225 pediatrics, Tidal Volume, medicine, Humans, Normocapnia, Lung, Tidal volume, 030219 obstetrics & reproductive medicine, Pulmonary Gas Exchange, business.industry, Obstetrics and Gynecology, Washout, Respiratory Dead Space, General Medicine, Mechanics, Carbon Dioxide, Respiration, Artificial, Surgery, Volumetric flow rate, chemistry, Pediatrics, Perinatology and Child Health, Carbon dioxide, Ventilation (architecture), business
Abstract: Objective The ability to ventilate babies with tidal volumes (V T s) below dead space has been demonstrated both in vivo and in vitro, though it appears to violate classical respiratory physiology. We hypothesised that this phenomenon is made possible by rapid flow of gas that penetrates the dead space allowing fresh gas to reach the lungs and that the magnitude of this phenomenon is affected by flow rate or how rapidly air flows through the endotracheal tube. Methods We conducted two bench experiments. First, we measured the time needed for complete CO 2 washout from a test lung to assess how fixed V T but different inflation flow rates affect ventilation. For the second experiment, we infused carbon dioxide at a low rate into the test lung, varied the inflation flow rate and adjusted the V T to maintain stable end tidal carbon dioxide (ETCO 2 ). Results At all tested V T s, lower flow rate increased the time it took for CO 2 to washout from the test lung. The effect was most pronounced for V T s below dead space. The CO 2 steady-state experiment showed that ETCO 2 increased when the flow rate decreased. Ventilating with a slower flow rate required a nearly 20% increase in V T for the same effective alveolar ventilation. Conclusions Inflation flow rate affects the efficiency of CO 2 removal with low V T . Our results are relevant for providers using volume-controlled ventilation or other modes that use low inflation flow rates because the V T required for normocapnia will be higher than published values that were generated using pressure-limited ventilation modes with high inflation flows.
Published: 2016

65. Persistent Pulmonary Hypertension of the Newborn

Author: Satyan Lakshminrusimha and Martin Keszler
Subjects: Pediatric, Clinical Trials and Supportive Activities, Clinical Sciences, Perinatal Period - Conditions Originating in Perinatal Period, Cardiovascular, Article, 3. Good health, 03 medical and health sciences, Rare Diseases, 0302 clinical medicine, Clinical Research, 030225 pediatrics, Infant Mortality, Pediatrics, Perinatology and Child Health, Respiratory, 030212 general & internal medicine, Lung
Abstract: Persistent pulmonary hypertension of the newborn (PPHN) is often secondary to parenchymal lung disease (such as meconium aspiration syndrome) or lung hypoplasia (with congenital diaphragmatic hernia) but can also be idiopathic. PPHN is characterized by elevated pulmonary vascular resistance, resulting in right-to-left shunting of blood and hypoxemia. The diagnosis of PPHN is based on clinical evidence of labile hypoxemia often associated with differential cyanosis and confirmed by echocardiography. Lung volume recruitment with optimal use of positive end-expiratory pressure or mean airway pressure and/or surfactant is very important in secondary PPHN due to parenchymal lung disease. Other management strategies include optimal oxygenation, avoiding respiratory and metabolic acidosis, blood pressure stabilization, sedation, and pulmonary vasodilator therapy. Failure of these measures leads to consideration of extracorporeal membrane oxygenation, although this rescue therapy is needed less frequently with advances in medical management. Randomized clinical trials with long-term follow-up are required to evaluate various therapeutic strategies in PPHN.
Published: 2015

66. Survey of Ventilation Practices in the Neonatal Intensive Care Units of the United States and Canada: Use of Volume-Targeted Ventilation and Barriers to Its Use

Author: Martin Keszler and Ashish Gupta
Subjects: medicine.medical_specialty, Canada, Cross-sectional study, Infant, Newborn, Diseases, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Intensive Care Units, Neonatal, medicine, Humans, Lack of knowledge, Practice Patterns, Physicians', Response rate (survey), 030219 obstetrics & reproductive medicine, Practice patterns, business.industry, Neonatal ventilation, Infant, Newborn, Obstetrics and Gynecology, Volume targeted ventilation, Respiration, Artificial, United States, Cross-Sectional Studies, Health Care Surveys, Pediatrics, Perinatology and Child Health, Ventilation (architecture), Emergency medicine, business
Abstract: Objective To provide current data on ventilation practices and use of volume-targeted ventilation (VTV) in neonatal intensive care units of the United States and Canada, to identify the perceived barriers to the implementation of VTV, and to assess the knowledge base of appropriate initial tidal volume (VT ) settings for different hypothetical clinical scenarios. Study Design This was a cross-sectional online survey of individual neonatologists practicing in the United States and Canada. Results We received 387 responses (estimated response rate: ∼20%). Use of VTV was much higher in Canada (81%) compared with 39% in the United States. In the United States, VTV use is highest in the Northwest at 77% and lowest in the Northeast at 32.5%. The chief barrier to use of VTV was lack of knowledge about VTV and lack of appropriate equipment. The five clinical scenarios revealed that the majority of responders failed to select appropriate evidence-based VT for the specific scenario. Conclusion Pressure-controlled ventilation remains the predominant approach to neonatal ventilation in the United States, while VTV is the preferred mode in Canada. Despite available data and important pathophysiological differences between patients, there is insufficient understanding of how to choose an appropriate VT in a variety of common clinical scenarios among users of VTV.
Published: 2018

67. Weaning of Moderately Preterm Infants from the Incubator to the Crib: A Randomized Clinical Trial

Author: Seetha Shankaran, Edward F. Bell, Abbot R. Laptook, Shampa Saha, Nancy S. Newman, S. Nadya J. Kazzi, John Barks, Barbara J. Stoll, Rebecca Bara, Jenna Gabrio, Kirsten Childs, Abhik Das, Rosemary D. Higgins, Waldemar A. Carlo, Pablo J. Sánchez, David P. Carlton, Lara Pavageau, William F. Malcolm, Carl T. D'Angio, Robin K. Ohls, Brenda B. Poindexter, Gregory M. Sokol, Krisa P. Van Meurs, Tarah T. Colaizy, Ayman Khmour, Karen M. Puopolo, Meena Garg, Michele C. Walsh, Richard A. Polin, Martin Keszler, Angelita M. Hensman, Elisa Vieira, Anna Marie Hibbs, Bonnie S. Siner, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Suhas G. Kallapur, Cathy Grisby, Barbara Alexander, Estelle E. Fischer, Lenora Jackson, Kristin Kirker, Jennifer Jennings, Sandra Wuertz, Greg Muthig, C. Michael Cotten, Ronald N. Goldberg, Theresa Roach, Joanne Finkle, Kimberley A. Fisher, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Cindy Clark, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Ellen C. Hale, Yvonne Loggins, Diane I. Bottcher, Stephanie Wilson Archer, Heidi Harmon, Dianne E. Herron, Shirley I. Wright-Coltart, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Julie Gutentag, Courtney Park, Julie C. Shadd, Margaret Sullivan, Jennifer L. Grothause, Melanie Stein, Erna Clark, Rox Ann Sullivan, Dennis Wallace, Kristin M. Zaterka-Baxter, Margaret Crawford, Jeanette O'Donnell Auman, David K. Stevenson, Lou Ann Herfert, M. Bethany Ball, Gabrielle T. Goodlin, Melinda S. Proud, R. Jordan Williams, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Teresa Chanlaw, Rachel Geller, Dan L. Ellsbury, Jane E. Brumbaugh, Karen J. Johnson, Donia B. Campbell, Jacky R. Walker, Kristi Watterberg, Conra Backstrom Lacy, Sandy Sundquist Beauman, Carol Hartenberger, Haresh Kirpalani, Eric C. Eichenwald, Sara B. DeMauro, Noah Cook, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara Cucinotta, Satyan Lakshminrusimha, Ronnie Guillet, Ann Marie Scorsone, Julianne Hunn, Rosemary Jensen, Holly I.M. Wadkins, Stephanie Guilford, Ashley Williams, Myra Wyckoff, Luc P. Brion, Diana M. Vasil, Lijun Chen, Lizette E. Torres, Athina Pappas, Bogdan Panaitescu, Shelley Handel, Diane F. White, Mary Christensen, and Stephanie A. Wiggins
Subjects: Male, Pediatrics, Incubators, Infant, and Human Development Neonatal Research Network, Reproductive health and childbirth, Low Birth Weight and Health of the Newborn, Infant Equipment, law.invention, incubator, Incubators, 0302 clinical medicine, Randomized controlled trial, law, Neonatal, Infant Mortality, 030212 general & internal medicine, Pediatric, Obstetrics, weaning, Incubator, General Medicine, Patient Discharge, Intensive Care Units, Gestation, Female, Patient Safety, medicine.symptom, Infant, Premature, medicine.medical_specialty, Clinical Trials and Supportive Activities, MEDLINE, Weaning, Article, Child health, Paediatrics and Reproductive Medicine, moderately preterm infants, 03 medical and health sciences, Preterm, Clinical Research, 030225 pediatrics, Intensive Care Units, Neonatal, medicine, Humans, Trial registration, Adverse effect, Premature, business.industry, Body Weight, Infant, Newborn, Infant, temperature, Human Movement and Sports Sciences, Perinatal Period - Conditions Originating in Perinatal Period, Length of Stay, Newborn, Eunice Kennedy Shriver National Institute of Child Health, Good Health and Well Being, randomized controlled trial, Pediatrics, Perinatology and Child Health, business, Weight gain
Abstract: ObjectiveTo assess whether length of hospital stay is decreased among moderately preterm infants weaned from incubator to crib at a lower vs higher weight.Study designThis trial was conducted in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants with gestational ages 29-33 weeks, birthweight
Published: 2018

68. Pulmonary Hypertension Associated with Hypoxic-Ischemic Encephalopathy-Antecedent Characteristics and Comorbidities

Author: Scott A. McDonald, Sonia L. Bonifacio, Abhik Das, Satyanarayana Lakshminrusimha, Martin Keszler, Seetha Shankaran, Ronnie Guillet, Abbot R. Laptook, Rosemary D. Higgins, Sanjay Chawla, Beena G. Sood, and Krisa P. Van Meurs
Subjects: Male, Resuscitation, Data Interpretation, medicine.medical_treatment, Hypothermia, Comorbidity, Reproductive health and childbirth, Cardiovascular, Pediatrics, 0302 clinical medicine, Hypothermia, Induced, Infant Mortality, Meconium aspiration syndrome, 030212 general & internal medicine, Lung, Pediatric, Asphyxia Neonatorum, Brain, Pulmonary, asphyxia, Hematology, Statistical, Meconium Aspiration Syndrome, Infectious Diseases, Anesthesia, Data Interpretation, Statistical, Hypoxia-Ischemia, Brain, Hypertension, Female, acidosis, medicine.symptom, Acidosis, Maternal Age, cooling, Hypertension, Pulmonary, Intellectual and Developmental Disabilities (IDD), Encephalopathy, Clinical Trials and Supportive Activities, Article, Paediatrics and Reproductive Medicine, 03 medical and health sciences, Clinical Research, 030225 pediatrics, Hypoxia-Ischemia, Extracorporeal membrane oxygenation, medicine, Humans, 6.7 Physical, Asphyxia, business.industry, hypoxia, Induced, Infant, Newborn, Infant, Evaluation of treatments and therapeutic interventions, Human Movement and Sports Sciences, Length of Stay, Perinatal Period - Conditions Originating in Perinatal Period, medicine.disease, Newborn, Pulmonary hypertension, Brain Disorders, Good Health and Well Being, Pediatrics, Perinatology and Child Health, Pulmonary hemorrhage, business
Abstract: Objective To determine the characteristics of term infants with persistent pulmonary hypertension of the newborn (PPHN) associated with moderate or severe hypoxic ischemic encephalopathy (HIE). Methods We compared infants with and without PPHN enrolled in 2 randomized trials of therapeutic hypothermia: the induced hypothermia trial of cooling to 33.5°C for 72 hours vs normothermia, and the “usual-care” arm (33.5°C for 72 hours) of the optimizing cooling trial. Results Among 303 infants with HIE from these 2 studies, 67 (22%) had PPHN and 236 (78%) did not. We compared infants with PPHN with those without PPHN. The proportion of patients treated with therapeutic hypothermia was similar in PPHN and no-PPHN groups (66% vs 65%). Medication use during resuscitation (58% vs 44%), acidosis after birth (pH: 7.0 ± 0.2 vs 7.1 ± 0.2), severe HIE (43% vs 28%), meconium aspiration syndrome (39% vs 7%), pulmonary hemorrhage (12% vs 3%), culture-positive sepsis (12% vs 3%), systemic hypotension (65% vs 28%), inhaled nitric oxide therapy (64% vs 3%), and extracorporeal membrane oxygenation (12% vs 0%) were more common in the PPHN group. Length of stay (26 ± 21 vs 16 ± 14 days) and mortality (27% vs 16%) were higher in the PPHN group. Conclusions PPHN is common among infants with moderate/severe HIE and is associated with severe encephalopathy, lung disease, sepsis, systemic hypotension, and increased mortality. The prevalence of PPHN was not different between those infants receiving therapeutic hypothermia at 33.5°C in these 2 trials (44/197 = 22%) compared with infants receiving normothermia in the induced hypothermia trial (23/106 = 22%).
Published: 2018

69. Volume-targeted ventilation: one size does not fit all. Evidence-based recommendations for successful use

Author: Martin Keszler
Subjects: medicine.medical_specialty, Evidence-based practice, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, 030225 pediatrics, Intensive Care Units, Neonatal, medicine, Ventilator settings, Tidal Volume, Humans, 030212 general & internal medicine, Intensive care medicine, business.industry, Extremely preterm, Respiration, Infant, Newborn, Obstetrics and Gynecology, Volume targeted ventilation, General Medicine, Respiration, Artificial, Pediatrics, Perinatology and Child Health, Ventilation (architecture), Practice Guidelines as Topic, business, Ventilator Weaning
Abstract: Despite level 1 evidence for important benefits of volume-targeted ventilation (VTV), many vulnerable extremely preterm infants continue to be exposed to traditional pressure-controlled ventilation. Lack of suitable equipment and a lack of appreciation of the fact that ‘one size does NOT fit all’ appear to contribute to the slow uptake of VTV. This review attempts to improve clinicians’ understanding of the way VTV works and to provide essential information about evidence-based tidal volume (VT) targets. Focus on underlying lung pathophysiology, individualised ventilator settings and VTtargets are keys to successful use of VTV thereby improving important clinical outcomes.
Published: 2018

70. Sustained inflation during neonatal resuscitation

Author: Martin Keszler
Subjects: medicine.medical_specialty, Functional Residual Capacity, Resuscitation, medicine.medical_treatment, Infant, Premature, Diseases, law.invention, Positive-Pressure Respiration, Randomized controlled trial, law, medicine, Humans, Intensive care medicine, Lung, Bronchopulmonary Dysplasia, Randomized Controlled Trials as Topic, Mechanical ventilation, Evidence-Based Medicine, business.industry, Delivery Rooms, Infant, Newborn, Retrospective cohort study, Evidence-based medicine, medicine.disease, Clinical trial, Intraventricular hemorrhage, Sustained inflation, Practice Guidelines as Topic, Pediatrics, Perinatology and Child Health, business, Bronchoalveolar Lavage Fluid, Infant, Premature, Neonatal resuscitation
Abstract: Purpose of review Sustained inflation performed shortly after birth to help clear lung fluid and establish functional residual capacity in preterm infants is gaining popularity, but definitive evidence for its effectiveness is lacking. Although there is a sound physiologic basis for this approach, and much preclinical experimental evidence of effectiveness, the results of recent animal studies and clinical trials have been inconsistent. Recent findings The most recent data from a multicenter randomized trial suggest a modest benefit of sustained inflation in reducing the need for mechanical ventilation in extremely-low-birth-weight infants. However, the impact may be more modest than earlier retrospective cohort comparisons suggested. The trend toward more airleak and a higher rate of intraventricular hemorrhage is worrisome. Sustained inflation may be ineffective unless some spontaneous respiratory effort is present. Several on-going trials should further clarify the putative benefits of sustained inflation. Summary Delivery room sustained inflation is an attractive concept that holds much promise, but widespread clinical application should await definitive evidence from on-going clinical trials.
Published: 2015

71. Tidal Volume Requirement in Mechanically Ventilated Infants with Meconium Aspiration Syndrome

Author: Martin Keszler, Saumya Sharma, Shane Clark, and Kabir Abubakar
Subjects: medicine.medical_specialty, Respiratory rate, Partial Pressure, Dead space, medicine.medical_treatment, Cohort Studies, Positive-Pressure Respiration, Extracorporeal Membrane Oxygenation, Functional residual capacity, Respiratory Rate, Tidal Volume, Meconium aspiration syndrome, medicine, Humans, Tidal volume, Retrospective Studies, Mechanical ventilation, business.industry, Infant, Newborn, Obstetrics and Gynecology, Carbon Dioxide, medicine.disease, Respiration, Artificial, Surgery, Meconium Aspiration Syndrome, Case-Control Studies, Anesthesia, Pediatrics, Perinatology and Child Health, Breathing, Blood Gas Analysis, business, Respiratory minute volume
Abstract: Objective The aim of the study is to test the hypothesis that increased physiologic dead space and functional residual capacity seen in meconium aspiration syndrome (MAS) results in higher tidal volume (VT) requirement to achieve adequate ventilation. Study Design Retrospective review of infants with MAS admitted to our hospital from 2000 to 2010 managed with conventional ventilation. Demographics, ventilator settings, VT, respiratory rate (RR), and blood gas values were recorded. Minute ventilation (MV) was calculated as RR × VT. Only VT values with corresponding partial pressure of carbon dioxide (Pa co 2) between 35 and 60 mm Hg were included. Mean VT/kg and MV/kg were calculated for each patient. Forty infants ventilated for lung disease other than MAS or pulmonary hypoplasia served as controls. Results Birth weights of the 28 MAS patients and 40 control infants were similar (3,330 ± 500 g and 3,300 ± 640 g). Two patients in each group required extracorporeal membrane oxygenation. Infants with MAS required 26% higher VT and 42% higher MV compared with controls to maintain equal Pa co 2. Conclusion Infants with MAS require larger VT and higher total MV to achieve similar alveolar ventilation, consistent with pathophysiology of MAS. Our findings provide the first reference data to guide selection of VT in infants with MAS.
Published: 2015

72. Assisted Ventilation of the Neonate E-Book : Assisted Ventilation of the Neonate E-Book

Author: Jay P. Goldsmith, Edward Karotkin, Gautham Suresh, Martin Keszler, Jay P. Goldsmith, Edward Karotkin, Gautham Suresh, and Martin Keszler
Subjects: Newborn infants, Evidence-based medicine, Respiratory therapy for newborn infants, Artificial respiration
Abstract: Extensively updated and featuring a new editorial team, the 6th Edition of Assisted Ventilation of the Neonate, by Drs. Jay P. Goldsmith, Edward Karotkin, Gautham Suresh, and Martin Keszler, continues to be a must-have reference for the entire NICU. Still the only fully comprehensive guide in this fast-changing area, it provides expert guidance on contemporary management of neonatal respiratory diseases, with an emphasis on evidence-based pharmacologic and technologic advances to improve outcomes and quality of life in newborns. A new full-color design and chapter layout combine for quick and easy reference. Covers everything you need to know about respiratory management in neonates: general principles and concepts; assessment, diagnosis and monitoring methods; therapeutic respiratory interventions; adjunctive interventions; and special situations and outcomes. Covers basic concepts of pulmonary pathophysiology and gives practical guidance on providing neonatal respiratory support with a variety of techniques, so you can learn both basic and advanced methods in one volume. Offers more than 30 appendices that help you quickly find normal values, assessment charts, ICU flow charts, procedure steps and other useful, printable forms. Reflects the rapid evolution of approaches to respiratory care, including the shift to non-invasive support, as well as changes in oxygenation targets, high-flow nasal therapy, volume ventilation, and sophisticated microprocessor-controlled ventilators. Completely new information on many previously covered topics, including ethical and legal issues related to neonatal mechanical ventilation. Features 11 entirely new chapters, including Radiography, Lung Ultrasound and Other Imaging Modalities; Non-invasive Monitoring of Gas Exchange; Airway Evaluation: Bronchoscopy, Laryngoscopy, Tracheal Aspirates; Special Ventilation Techniques; Cardiovascular Therapy and PPHN; and Quality Improvement in Respiratory Care. Includes new opening summaries that highlight key information in each chapter.
Published: 2017

73. Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage

Author: Heike M. Minnich, Ivan D. Frantz, Karen J. Johnson, William E Truog, Sandra Brown, Ronnie Guillet, Myriam Peralta-Carcelen, Rosemary D. Higgins, Haresh Kirpalani, Kathryn E. Gustafson, Leslie Dawn Wilson, Gregory M Sokol, Catherine Twell Boatman, Edward F. Bell, Janet S. Morgan, W. Kenneth Poole, Amanda D. Soong, Jeanette O'Donnell Auman, Avroy A. Fanaroff, Katrina Burson, Gulgun Yalcinkaya, Monica Konstantino, Leif D. Nelin, Bradley A. Yoder, Carin Kiser, Kristin M. Basso, Marian M. Adams, Neil N. Finer, Dennis Wallace, Hali E. Weiss, Deanna Maffett, Hallam Hurt, Fred J. Biasini, Meena Garg, Laura Cole, Kathleen A. Kennedy, Julianne Hunn, Lucy Miller, Anne Holmes, Farooq Osman, Barbara Schmidt, Anna Marie Hibbs, Walid A. Salhab, Karen A. Osborne, M. Bethany Ball, Laura A. Goldston, Silvia M. Frade Eguaras, Faithe Hamer, Julie Babish Johnson, Ruth Everett-Thomas, Patti L. Pierce Tate, Maria Calejo, Michele C. Walsh, Eugenia K. Pallotto, Rachel Geller, Roger G. Faix, Melissa H. Leps, Maria Elena DeAnda, Ronald N. Goldberg, Marie G. Gantz, Sally Whitley, Nehal A. Parikh, Michelle Harwood Berkowits, Seetha Shankaran, Andrew W. Palmquist, Andrea Halbrook, Kimberlee Weaver-Lewis, Theresa M. Leach, Ira Adams-Chapman, Janice Bernhardt, Sarah Ryan, Maynard Rasmussen, Edward F. Donovan, Diana M. Vasil, Carroll Peterson, Jamie E. Newman, Bonnie E. Stephens, Karen A. Wynn, Myra H. Wyckoff, David P. Carlton, Jody Hessling, Barbara Alexander, Katherine A. Foy, Abbot R. Laptook, Michael Steffen, Sudarshan R. Jadcherla, Suzy Ventura, Raquel Halfond, Ana K. Brussa, Charles R. Rosenfeld, Ellen Waldrep, Peggy Robichaux, Donald J. Goldstein, Monika Bhola, Brenda H. Morris, Clarence Demetrio, Erica Burnell, Brenda B. Poindexter, Martha D. Carlson, Sharon L. Wright, Linda A. Madden, Michael S. Caplan, Isabell B. Purdy, Athina Pappas, Barbara Bentley, Carol Hartenberger, Patricia W. Evans, John A. Widness, Marsha Gerdes, Stephanie Wilson Archer, Kimberly Yolton, Christine G. Butler, Roy J. Heyne, Joanne Williams, Gaynelle Hensley, Carl L. Bose, Lu Ann Papile, Richard A. Polin, Brenda L. MacKinnon, JoAnn Poulsen, Anne Marie Reynolds, T. Michael O'Shea, Charles R. Bauer, Gary J. Myers, Joanne Finkle, Maegan C. Simmons, Shahnaz Duara, Arielle Rigaud, Jill Burnett, Jacky R. Walker, Lauren Zwetsch, Ellen Nylen, Margarita Jiminez, Christine A. Fortney, Angelita M. Hensman, Ellen C. Hale, Joan Merzbach, Teresa L. Gratton, Yvonne E. Vaucher, Kathy Arnell, Holly I.M. Wadkins, Sara Kryzwanski, Nancy A. Miller, Susan R. Hintz, Elaine Romano, Betty R. Vohr, Sara B. DeMauro, Donia B. Campbell, Dara M. Cucinotta, Anna Bodnar, Kristy Domnanovich, Angela Argento, Georgia E. McDavid, Kurt Schibler, Patricia L. Ashley, Margaret M. Crawford, Casey E. Krueger, Bonnie S. Siner, Sally S. Adams, Jane E. Brumbaugh, Korinne Chiu, Janice Wereszczak, Satyanarayana Lakshminrusimha, Jon E. Tyson, Carolyn Lytle, Toni Mancini, Nancy Peters, Gennie Bose, Cryshelle S. Patterson, Katharine Johnson, Barbara J. Stoll, Kristin Kirker, Gail Hounshell, Melinda S. Proud, Janet Taft, Dale L. Phelps, Keith Owen Yeates, Kathy Johnson, Dan L. Ellsbury, Martin Keszler, Leslie Rodrigues, Jennifer J. Jensen, Barbara Alksninis, Sandra Grimes, Wade Rich, Stephanie A. Wiggins, Krisa P. Van Meurs, Yvonne Loggins, M. Layne Poundstone, David Kaegi, Elizabeth T. Heyne, Sheena L. Carter, Patricia Cervone, Richard V. Rector, John M. Fiascone, Nora I. Alaniz, Helina Pierre, Waldemar A. Carlo, Kimberley A. Fisher, Elisabeth C. McGowan, Robert G. Dillard, Greg Muthig, Sarah Martin, Carolyn M. Petrie Huitema, Barbara G. Jackson, Brian G. Tang, Melinda Caskey, Vivien Phillips, Soraya Abbasi, Michael J. Acarregui, Andrea Garcia, Robert T. Burke, Aasma S. Chaudhary, Luc P. Brion, Jean G. Kohn, Kelley Yost, Melody B. Lohmeyer, Allison F. Payne, Harriet Friedman, Victoria E. Watson, William Oh, Nancy S. Newman, John Barks, Andrea H. Duncan, Pablo J. Sánchez, Mary Lenore Keszler, Deborah Evans Allred, Rosemary L. Jensen, Karie Bird, Kristin M. Zaterka-Baxter, Ann B. Cook, Alicia Guzman, Holly L. Mincey, Gail E. Besner, Kate Bridges, Sylvia Fajardo-Hiriart, Matthew M. Laughon, Cathy Grisby, Robin K. Ohls, Rebecca Bara, Karen Zanetti, Anne M. DeBattista, Tarah T. Colaizy, William F. Malcolm, Cherrie D. Welch, Judy Bernbaum, Melissa Whalen Morris, Kathleen G. Nelson, Scott A. McDonald, Emily Kushner, Abbey C. Hines, Sheila Greisman, Ashley Williams, Estelle E. Fischer, Lenora Jackson, Harris C. Jacobs, Cheri Gauldin, Alexandra Stoerger, Deanne E. Wilson-Costello, Rebecca Montman, Monica V. Collins, Mary Christensen, Charles Green, Mary Johnson, David K. Stevenson, Lijun Chen, Cecelia E. Sibley, Lisa K. Washburn, Maureen Mulligan LaRossa, Lizette E. Torres, Kathy J. Auten, Chris Henderson, U. Devaskar, Leigh Ann Smith, Janell Fuller, Diane L. Eastman, Anna E. Lis, Dianne E. Herron, Kristen C. Johnston, Anna M. Dusick, Martha G. Fuller, Anne Furey, Howard W. Kilbride, Jean R. Lowe, Elizabeth F. Bruno, Saba Siddiki, Abhik Das, Linda J. Reubens, Richard A. Ehrenkranz, Namasivayam Ambalavanan, Cynthia Spencer, Ricki F. Goldstein, Lynne C. Huffman, Teresa Chanlaw, Patricia Luzader, Carl T. D'Angio, Diane Hust, Radmila West, Beverly Foley Harris, Sarah Winter, Conra Backstrom Lacy, Shawna Baker, Shirley S. Cosby, C. Michael Cotten, and Kristi L. Watterberg
Subjects: Male, Pediatrics, medicine.medical_specialty, Gestational Age, Infant, Premature, Diseases, Bayley Scales of Infant Development, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, Longitudinal Studies, Original Investigation, Cerebral Hemorrhage, Retrospective Studies, Ultrasonography, business.industry, Cerebral Palsy, Infant, Newborn, Gestational age, Brain, Gross Motor Function Classification System, Odds ratio, medicine.disease, Prognosis, Intraventricular hemorrhage, Bronchopulmonary dysplasia, Neurodevelopmental Disorders, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, Female, business, 030217 neurology & neurosurgery, Ventriculomegaly, Hydrocephalus
Abstract: Importance Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. Objective To characterize the outcomes of extremely preterm neonates younger than 27 weeks’ gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks’ postmenstrual age. Design, Setting, and Participants This longitudinal observational study was conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks’ gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks’ postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. Main Outcomes and Measures The main outcome was neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. Results Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95% CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95% CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95% CI, 2.08-6.51), death/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (OR, 1.09; 95% CI, 0.76-1.57). Behavioral outcomes did not differ. Conclusions and Relevance Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.
Published: 2017

74. Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants

Author: Namasivayam Ambalavanan, Sarah McGregor, Teresa Chanlaw, Abbot R. Laptook, Martin Keszler, Shampa Saha, Sudarshan R. Jadcherla, Stephanie A. Wiggins, Stephanie Guilford, Waldemar A. Carlo, Greg Muthig, Karen Martin, Michele C. Walsh, Patricia Luzader, Nehal A. Parikh, Nancy S. Newman, David P. Carlton, Carl T. D'Angio, Eugenia K. Pallotto, Rachel Geller, Richard A. Polin, Anne Holmes, Satyan Lakshminrusimha, Dennis Wallace, Holly I.M. Wadkins, Anna Marie Hibbs, Carl L. Bose, Jeanette O'Donnell Auman, Cindy Clark, Haresh Kirpalani, Girija Natarajan, Jodi A. Ulloa, Jon E. Tyson, Julie Arldt-McAlister, Barbara J. Stoll, Edward F. Bell, Ronald N. Goldberg, Yvonne Loggins, Marliese Dion Nist, Lenora Jackson, Jacky R. Walker, Jane E. Brumbaugh, Cheri Gauldin, John D.E. Barks, Rosemary L. Jensen, Donia B. Campbell, Rosemary D. Higgins, Bonnie S. Siner, Monica V. Collins, Toni Mancini, Ann Marie Scorsone, Janice Bernhardt, Seetha Shankaran, Kristin M. Zaterka-Baxter, Jennifer Fuller, Lizette E. Torres, Kathy Johnson, Karen J. Johnson, Luc P. Brion, Margaret M. Crawford, Leif D. Nelin, Diane I. Bottcher, Julianne Hunn, Carol Hartenberger, Carmen Garcia, M. Bethany Ball, Shirley S. Cosby, Marissa E. Jones, Matthew M. Laughon, Diane F. White, Barbara Alexander, Pablo J. Sánchez, Meena Garg, Uday Devaskar, Estelle E. Fischer, Ellen C. Hale, Sharon L. Wright, Athina Pappas, Conra Backstrom Lacy, Mary Christensen, Tarah T. Colaizy, David K. Stevenson, Lijun Chen, Shelley Handel, Rebecca Bara, Kristin Kirker, Melinda S. Proud, Dan L. Ellsbury, Betty R. Vohr, Sara B. DeMauro, Cathy Grisby, Robin K. Ohls, Tara Wolfe, Diana M. Vasil, Dara M. Cucinotta, Kimberley A. Fisher, Soraya Abbasi, Stephanie Wilson Archer, Joanne Finkle, Myra H. Wyckoff, Elisa Vieira, Suhas G. Kallapur, Dianne E. Herron, Jenna Gabrio, Howard W. Kilbride, Jennifer Jennings, Abhik Das, Julie Gutentag, Sandy Sundquist Beauman, Greg Sokol, Ashley Williams, Angelita M. Hensman, Krisa P. Van Meurs, Aasma S. Chaudhary, Georgia E. McDavid, Elizabeth Rodgers, and Sandra Wuertz
Subjects: Adult, medicine.medical_specialty, Leukomalacia, Periventricular, Resuscitation, Gestational Age, Antenatal steroid, Article, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Neonatal Screening, Pregnancy, Risk Factors, 030225 pediatrics, medicine, Humans, Prospective Studies, Registries, Obstetrics, business.industry, Cesarean Section, Infant, Newborn, Gestational age, Brain, Infant, Stepwise regression, medicine.disease, Cystic Periventricular Leukomalacia, Chorioamnionitis, Logistic Models, Pediatrics, Perinatology and Child Health, Infant, Small for Gestational Age, Gestation, Small for gestational age, Female, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Neonatal resuscitation, Infant, Premature, Ventriculomegaly, Hydrocephalus
Abstract: OBJECTIVES: To describe the frequency and findings of cranial imaging in moderately preterm (MPT) infants (born at 29 0/7–33 6/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. STUDY DESIGN: We used data from the Neonatal Research Network MPT Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age (GA), antenatal steroids and center. RESULTS: Among 7,021 infants, 4,184 (60%) underwent cranial imaging. These infants had lower GAs and birth weights and higher rates of birth weight small-for-gestation, outborn birth, cesarean delivery; neonatal resuscitation and treatment with surfactant, compared with those without imaging (P < .0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3–4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%) and ventriculomegaly (6.6%). Histological chorioamnionitis [OR 1.47; 95% C.I.:1.19–1.83], GA [0.95; 95% C.I.: 0.94–0.97], antenatal steroids [OR 0.55; 95% C.I.: 0.41–0.74] and cesarean delivery [OR 0.66; 95% C.I.: 0.53–0.81] were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging [OR 2.08; 95% CI: 1.10–3.92]. On the CART model, cesarean delivery, center, antenatal steroids and chorioamnionitis, in that order, predicted abnormal imaging. CONCLUSIONS: Among the 60% of MPT infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in MPT infants is needed.
Published: 2017

75. Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Author: Abbot R. Laptook, Edward F. Bell, Seetha Shankaran, Nansi S. Boghossian, Myra H. Wyckoff, Sarah Kandefer, Michele Walsh, Shampa Saha, Rosemary Higgins, Richard A. Polin, Martin Keszler, Betty R. Vohr, Angelita M. Hensman, Elisa Vieira, Emilee Little, Avroy A. Fanaroff, Anna Marie Hibbs, Nancy S. Newman, Bonnie S. Siner, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Suhas G. Kallapur, Cathy Grisby, Barbara Alexander, Estelle E. Fischer, Lenora Jackson, Kristin Kirker, Jennifer Jennings, Sandra Wuertz, Greg Muthig, Edward F. Donovan, Jody Hessling, Marcia Worley Mersmann, Holly L. Mincey, C. Michael Cotten, Ronald N. Goldberg, Joanne Finkle, Kimberley A. Fisher, Kathy J. Auten, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Cindy Clark, Barbara J. Stoll, David P. Carlton, Ellen C. Hale, Yvonne Loggins, Diane I. Bottcher, Stephanie Wilson Archer, Linda L. Wright, Elizabeth M. McClure, Brenda B. Poindexter, Gregory M. Sokol, Dianne E. Herron, James A. Lemons, Diana D. Appel, Lucy C. Miller, Pablo J. Sanchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Nehal A. Parikh, Marliese Dion Nist, Jennifer Fuller, Julie Gutentag, Marissa E. Jones, Sarah McGregor, Elizabeth Rodgers, Jodi A. Ulloa, Tara Wolfe, Abhik Das, Dennis Wallace, W. Kenneth Poole, Kristin M. Zaterka-Baxter, Margaret Crawford, Jenna Gabrio, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, Betty K. Hastings, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Melinda S. Proud, Waldemar A. Carlo, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Uday Devaskar, Meena Garg, Teresa Chanlaw, Rachel Geller, Tarah T. Colaizy, Dan L. Ellsbury, Jane E. Brumbaugh, Karen J. Johnson, Donia B. Campbell, Jacky R. Walker, Kristi L. Watterberg, Robin K. Ohls, Conra Backstrom Lacy, Sandra Sundquist Beauman, Carol Hartenberger, Barbara Schmidt, Haresh Kirpalani, Noah Cook, Sara B. DeMauro, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara Cucinotta, Carl T. D'Angio, Ronnie Guillet, Satyan Lakshminrusimha, Dale L. Phelps, Ann Marie Reynolds, Julianne Hunn, Rosemary Jensen, Holly I.M. Wadkins, Stephanie Guilford, Ashley Williams, Michael Sacilowski, Linda Reubens, Erica Burnell, Mary Rowan, Karen Wynn, Deanna Maffett, Luc P. Brion, Diana M. Vasil, Lijun Chen, Lizette E. Torres, Walid A. Salhab, Susie Madison, Gay Hensley, Nancy A. Miller, Alicia Guzman, Kathleen A. Kennedy, Jon E. Tyson, Julie Arldt-McAlister, Carmen Garcia, Karen Martin, Georgia E. McDavid, Sharon L. Wright, Esther G. Akpa, Patty A. Cluff, Anna E. Lis, Claudia I. Franco, Athina Pappas, John Barks, Rebecca Bara, Shelley Handel, Geraldine Muran, Diane F. White, Mary Christensen, and Stephanie A. Wiggins
Subjects: Male, Pediatrics, medicine.medical_specialty, Fever, Hospital mortality, Hypothermia, Infant, Premature, Diseases, Logistic regression, Child health, Article, Body Temperature, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Risk Factors, 030225 pediatrics, Intensive Care Units, Neonatal, Medicine, Humans, 030212 general & internal medicine, Hospital Mortality, business.industry, Extremely preterm, Infant, Newborn, Infant newborn, United States, Logistic Models, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, business
Abstract: To evaluate the temperature distribution among moderately preterm (MPT, 29-33 weeks) and extremely preterm (EPT,29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012-2013, the change in admission temperature distribution for EPT infants between 2002-2003 and 2012-2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants.Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002-2003 and 2012-2013 were compared.MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P .01), including the percentage36.5°C (38.6% vs 40.9%), 36.5°C-37.5°C (57.3% vs 52.9%), and37.5°C (4.2% vs 6.2%). For EPT infants in 2012-2013 compared with 2002-2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality.Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.
Published: 2017

76. Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

Author: Sanjay Chawla, Girija Natarajan, Seetha Shankaran, Benjamin Carper, Luc P. Brion, Martin Keszler, Waldemar A. Carlo, Namasivayam Ambalavanan, Marie G. Gantz, Abhik Das, Neil Finer, Ronald N. Goldberg, C. Michael Cotten, Rosemary D. Higgins, Alan H. Jobe, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, William Oh, Angelita M. Hensman, Dan Gingras, Susan Barnett, Sarah Lillie, Kim Francis, Dawn Andrews, Kristen Angela, Michele C. Walsh, Avroy A. Fanaroff, Nancy S. Newman, Bonnie S. Siner, Kurt Schibler, Edward F. Donovan, Vivek Narendran, Kate Bridges, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L. Mincey, Jody Hessling, Kathy J. Auten, Kimberly A. Fisher, Katherine A. Foy, Gloria Siaw, Barbara J. Stoll, Susie Buchter, Anthony Piazza, David P. Carlton, Ellen C. Hale, Stephanie Wilson Archer, Brenda B. Poindexter, James A. Lemons, Faithe Hamer, Dianne E. Herron, Lucy C. Miller, Leslie D. Wilson, Mary Anne Berberich, Carol J. Blaisdell, Dorothy B. Gail, James P. Kiley, W. Kenneth Poole, Margaret Cunningham, Betty K. Hastings, Amanda R. Irene, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, James W. Pickett, Dennis Wallace, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Melinda S. Proud, Ivan D. Frantz, John M. Fiascone, Anne Furey, Brenda L. MacKinnon, Ellen Nylen, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Maynard R. Rasmussen, Paul R. Wozniak, Wade Rich, Kathy Arnell, Renee Bridge, Clarence Demetrio, Edward F. Bell, John A. Widness, Jonathan M. Klein, Karen J. Johnson, Shahnaz Duara, Ruth Everett-Thomas, Kristi L. Watterberg, Robin K. Ohls, Julie Rohr, Conra Backstrom Lacy, Dale L. Phelps, Nirupama Laroia, Linda J. Reubens, Erica Burnell, Pablo J. Sánchez, Charles R. Rosenfeld, Walid A. Salhab, James Allen, Alicia Guzman, Gaynelle Hensley, Melissa H. Lepps, Melissa Martin, Nancy A. Miller, Araceli Solis, Diana M. Vasil, Kerry Wilder, Kathleen A. Kennedy, Jon E. Tyson, Brenda H. Morris, Beverly Foley Harris, Anna E. Lis, Sarah Martin, Georgia E. McDavid, Patti L. Tate, Sharon L. Wright, Bradley A. Yoder, Roger G. Faix, Jill Burnett, Jennifer J. Jensen, Karen A. Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, T. Michael O'Shea, Nancy J. Peters, Beena G. Sood, Rebecca Bara, Elizabeth Billian, Mary Johnson, Richard A. Ehrenkranz, Harris C. Jacobs, Vineet Bhandari, Pat Cervone, Patricia Gettner, Monica Konstantino, JoAnn Poulsen, and Janet Taft
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Positive pressure, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, 030225 pediatrics, Fraction of inspired oxygen, medicine, Intubation, Humans, 030212 general & internal medicine, Continuous positive airway pressure, Treatment Failure, Respiratory Distress Syndrome, Newborn, business.industry, Infant, Newborn, Gestational age, Pulmonary Surfactants, medicine.disease, Surgery, Bronchopulmonary dysplasia, Anesthesia, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Airway Extubation, Apgar score, Female, Morbidity, business, Infant, Premature
Abstract: Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov : NCT00233324 .
Published: 2017

77. Weaning from Mechanical Ventilation

Author: Guilherme M. Sant'Anna and Martin Keszler
Subjects: Mechanical ventilation, business.industry, medicine.medical_treatment, Anesthesia, Medicine, Weaning, business
Published: 2017

78. Physiologic Principles

Author: Kabir Abubakar and Martin Keszler
Subjects: 03 medical and health sciences, 0302 clinical medicine, business.industry, 030225 pediatrics, Medicine, 030212 general & internal medicine, business
Published: 2017

79. Contributors

Author: Kabir Abubakar, Namasivayam Ambalavanan, Robert M. Arensman, Eduardo Bancalari, Keith J. Barrington, Jonathan F. Bean, Edward F. Bell, David M. Biko, Laura D. Brown, Jessica Brunkhorst, Waldemar A. Carlo, Robert L. Chatburn, Nelson Claure, Clarice Clemmens, Christopher E. Colby, Sherry E. Courtney, Peter G. Davis, Eugene M. Dempsey, Robert Diblasi, Jennifer Duchon, Jonathan M. Fanaroff, William W. Fox, Debbie Fraser, John T. Gallagher, Jay P. Goldsmith, Malinda N. Harris, William W. Hay, Robert M. Insoft, Erik A. Jensen, Jegen Kandasamy, Edward H. Karotkin, Martin Keszler, John P. Kinsella, Haresh Kirpalani, Derek Kowal, Satyan Lakshminrusimha, John D. Lantos, Krithika Lingappan, Akhil Maheshwari, Mark C. Mammel, George T. Mandy, Richard J. Martin, Kathryn L. Maschhoff, Bobby Mathew, Patrick Joseph McNamara, D. Andrew Mong, Colin J. Morley, Leif D. Nelin, Donald Morley Null, Louise S. Owen, Allison H. Payne, Jeffrey M. Perlman, Joseph Piccione, Richard Alan Polin, Yacov Rabi, Aarti Raghavan, Matthew A. Rainaldi, Tara M. Randis, Lawrence Rhein, Guilherme Sant’Anna, Edward G. Shepherd, Billie Lou Short, Nalini Singhal, Roger F. Soll, Amuchou S. Soraisham, Nishant Srinivasan, Daniel Stephens, Gautham K. Suresh, Andrea N. Trembath, Anton H. van Kaam, Maximo Vento, Michele C. Walsh, Julie Weiner, Gary M. Weiner, Dany E. Weisz, Bradley A. Yoder, and Huayan Zhang
Published: 2017

80. Tidal Volume-Targeted Ventilation

Author: Martin Keszler and Colin J Morley
Subjects: Hydrology, 03 medical and health sciences, 0302 clinical medicine, business.industry, law, 030225 pediatrics, Ventilation (architecture), Medicine, 030212 general & internal medicine, business, Tidal volume, law.invention
Published: 2017

81. Preface

Author: Jay P. Goldsmith, Edward H. Karotkin, Martin Keszler, and Gautham K. Suresh
Published: 2017

82. Milrinone in congenital diaphragmatic hernia - a randomized pilot trial: study protocol, review of literature and survey of current practices

Author: Jenna Gabrio, Leif D. Nelin, Jonathan M. Klein, Kevin P. Lally, Krisa P. Van Meurs, Abhik Das, Stephanie Guilford, Rosemary D. Higgins, Aasma S. Chaudhary, Kristin M. Zaterka-Baxter, Haresh Kirpalani, Patricia R. Chess, Namasivayam Ambalavanan, Satyan Lakshminrusimha, Ashley Williams, Marie G. Gantz, María V. Fraga, Dhuly Chowdhury, Holly L. Hedrick, Michael Cotten, Bradley A. Yoder, and Martin Keszler
Subjects: Sildenafil, Oxygenation index, medicine.medical_treatment, Clinical Trials and Supportive Activities, lcsh:Medicine, Review, Persistent pulmonary hypertension, Pulmonary hypertension, 03 medical and health sciences, chemistry.chemical_compound, Pulmonary hypoplasia, 0302 clinical medicine, Rare Diseases, Clinical Research, 030225 pediatrics, Intensive care, Infant Mortality, Extracorporeal membrane oxygenation, Medicine, Phosphodiesterase, 030212 general & internal medicine, Lung, 2. Zero hunger, Pediatric, business.industry, lcsh:R, Congenital diaphragmatic hernia, Evaluation of treatments and therapeutic interventions, Perinatal Period - Conditions Originating in Perinatal Period, medicine.disease, 3. Good health, Oxygen, Orphan Drug, Good Health and Well Being, chemistry, Anesthesia, 6.1 Pharmaceuticals, Milrinone, business, Digestive Diseases, medicine.drug
Abstract: BackgroundCongenital diaphragmatic hernia (CDH) is commonly associated with pulmonary hypoplasia and pulmonary hypertension (PH). PH associated with CDH (CDH-PH) is frequently resistant to conventional pulmonary vasodilator therapy including inhaled nitric oxide (iNO) possibly due to right and left ventricular dysfunction. Milrinone is an intravenous inotrope and lusitrope with pulmonary vasodilator properties and has been shown anecdotally to improve oxygenation in PH. We developed this pilot study to determine if milrinone infusion would improve oxygenation in neonates ≥36weeks postmenstrual age (PMA) with CDH.Methods/designData on pulmonary vasodilator management and outcome of CDH patients was collected from 18 university NICUs affiliated with the Neonatal Research Network (NRN) from 2011 to 2012. The proposed pilot will be a masked, placebo-controlled, multicenter, randomized trial of 66 infants with CDH with an oxygenation index (OI) ≥10 or oxygen saturation index (OSI) ≥5. The primary outcome is the oxygenation response, as determined by change in OI at 24h after initiation of study drug. As secondary outcomes, we will determine oxygenation at 48h and 72h post-infusion, right ventricular pressures on echocardiogram and the incidence of systemic hypotension, arrhythmias, intracranial hemorrhage, survival without extracorporeal membrane oxygenation, and chronic lung disease (oxygen need at 28days postnatal age). Finally, we will evaluate the pulmonary and nutritional status at 4, 8 and 12months of age using a phone questionnaire.ResultsThree hundred thirty-seven infants with CDH were admitted to NRN NICUs in 2011 and 2012 of which 275 were ≥36weeks PMA and were exposed to the following pulmonary vasodilators: iNO (39%), sildenafil (17%), milrinone (17%), inhaled epoprostenol (6%), intravenous epoprostenol (3%), and intravenous PGE1 (1%). ECMO was required in 36% of patients. Survival to discharge was 71%.DiscussionCDH is an orphan disease with high mortality with few randomized trials evaluating postnatal management. Intravenous milrinone is a commonly used medication in neonatal/pediatric intensive care units and is currently used in 17% of patients with CDH within the NRN. This pilot study will provide data and enable further studies evaluating pulmonary vasodilator therapy in CDH.Trial registrationClinicalTrials.gov; NCT02951130; registered 14 October 2016.
Published: 2017

83. Aerosolized Albuterol Sulfate Delivery under Neonatal Ventilatory Conditions: In Vitro Evaluation of a Novel Ventilator Circuit Patient Interface Connector

Author: Krzysztof Chmura, Jan Mazela, Martin Keszler, Arkadiusz Moskal, Timothy J. Gregory, Tomasz R. Sosnowski, Ewa Florek, Maksymilian Kulza, Lucyna Kramer, and Christopher Henderson
Subjects: Pulmonary and Respiratory Medicine, Ventilator circuit, medicine.medical_treatment, Albuterol Sulfate, Pharmaceutical Science, Drug Delivery Systems, Administration, Inhalation, Materials Testing, Humans, Medicine, Albuterol, Pharmacology (medical), Continuous positive airway pressure, Particle Size, Chromatography, High Pressure Liquid, Aerosols, Ventilators, Mechanical, Intermittent mandatory ventilation, Inhalation, business.industry, Nebulizers and Vaporizers, Respiration, Spectrum Analysis, Infant, Newborn, Equipment Design, Respiration, Artificial, Bronchodilator Agents, Nebulizer, Control of respiration, Anesthesia, Breathing, business, Infant, Premature
Abstract: Aerosolized medications that have been used in infants receiving ventilatory support have not been shown to be effective clinically among the smallest patients. The aim of this study was to characterize the delivery of aerosolized albuterol sulfate in vitro under simulated neonatal ventilatory conditions using a novel ventilator circuit/patient interface connector.A Babylog(®) ventilator (VN500(®); Draeger), a novel ventilator circuit/patient interface (VC) connector (Afectair(®); Discovery Laboratories, Inc.), a TwinStar(®) HME (Draeger) low-volume filter, and either a test lung (Draeger) or lung simulator ASL 5000(®) (IngmarMed) were used. Intermittent mandatory ventilation conditions were set to replicate the most typical ventilation conditions for premature infants. Continuous positive airway pressure was also used to measure aerosol delivery with active respiratory drive from the patient. Albuterol sulfate (0.5 mg/mL) was loaded into the drug reservoir of a Misty Finity(®) nebulizer (Airlife(®); Cardinal Health) and connected to the ventilator circuit either via a "T" connector as described by the manufacturer [standard of care (SoC)] or via the VC connector. Albuterol extracted from the filters was analyzed using qualified high-performance liquid chromatography. In addition, a laser diffraction spectrometry (Spraytec(®); Malvern) and white-light spectrometry (Welas model 2100; Palas GmbH) were used to determine particle size distribution (PSD).Compared with SoC, the amount of albuterol delivered using the VC connector was significantly greater (p0.001) under simulated neonatal ventilatory conditions. Additionally, the PSD profile of albuterol sulfate delivered using the VC connector was more representative of the PSD profile directly from the nebulizer.The use of the VC connector increased the delivery of albuterol sulfate and resulted in a PSD profile at the patient interface that is more consistent with the PSD profile of the selected nebulizer when compared with SoC. This VC connector may be a useful, new approach for the delivery of aerosolized medications to neonates requiring positive pressure ventilatory support.
Published: 2014

84. Volume Guarantee Ventilation

Author: Martin Keszler
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, 030212 general & internal medicine
Published: 2016

85. Bunnell Life Pulse High-Frequency Jet Ventilator

Author: Martin Keszler
Subjects: Food and drug administration, Jet (fluid), Optics, Materials science, business.industry, Pinch valve, Acoustics, Suction catheter, business, health care economics and organizations, Pulse (physics)
Abstract: The Bunnell Life Pulse® is the only Food and Drug Administration (FDA)-approved neonatal HFJV device currently available in the USA. Other HFJV devices manufactured abroad have been used in Europe and elsewhere.
Published: 2016

86. Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm

Author: David P. Carlton, Julie Arldt-McAlister, Maegan C. Simmons, Jody Hessling, Rebecca Bara, W. Kenneth Poole, Charles R. Rosenfeld, Brenda B. Poindexter, Andrea M. Knoll, Colleen Mackie, Kurt Schibler, Gregory M. Sokol, Dennis Wallace, Kathy J. Auten, Karen J. Johnson, Georgia E. McDavid, Yvonne Loggins, M. Bethany Ball, Carmen Garcia, Lucy Miller, Nancy A. Miller, Athina Pappas, Ellen C. Hale, Allison H. Payne, Kristin M. Basso, Carol H. Hartenberger, Carolyn M. Petrie Huitema, Shawna Rodgers, Edward F. Donovan, Estelle E. Fischer, Kristi L. Watterberg, Karen Martin, Gaynelle Hensley, Michele C. Walsh, Avroy A. Fanaroff, Luc P. Brion, Tarah T. Colaizy, Jon E. Tyson, David K. Stevenson, Lijun Chen, Kate Bridges, Andrew W. Palmquist, Seetha Shankaran, Marian M. Adams, Anna Maria Hibbs, Sara B. DeMauro, Dianne E. Herron, Diane I. Bottcher, Anna E. Lis, Girija Natarajan, John A. Widness, Marie G. Gantz, Emilee Little, Stephanie Wilson Archer, Shirley S. Cosby, Melissa H. Leps, Namasivayam Ambalavanan, Rosemary D. Higgins, Leslie Dawn Wilson, Joanne Finkle, C. Michael Cotten, Walid A. Salhab, Barbara D. Alexander, Ronald N. Goldberg, Barbara J. Stoll, Abhik Das, Elizabeth E. Foglia, Mary Hanson, Elisa Vieira, Beverly Foley Harris, Myra H. Wyckoff, Conra Backstrom Lacy, Diana M. Vasil, Kimberley A. Fisher, Holly L. Mincey, Magdy Ismail, Martin Keszler, A. R. Laptook, Sara C. Martin, Kristin Kirker, Melinda S. Proud, Robin K. Ohls, Kristin M. Zaterka-Baxter, Alicia Guzman, Angelita M. Hensman, Margaret M. Crawford, Nancy S. Newman, Lizette E. Lee, Benjamin Carper, Waldemar A. Carlo, Jennifer A. Keller, Krisa P. Van Meurs, Lenora Jackson, Greg Muthig, Monica V. Collins, Cathy Grisby, Patti L. Pierce Tate, Satyan Lakshminrusimha, Stacey Tepe, Katrina Burson, Kathleen A. Kennedy, Michael S. Caplan, Jeanette O'Donnell Auman, Sandra Sundquist Beauman, Jacky R. Walker, Lara Pavageau, Edward F. Bell, Janet S. Morgan, and Barbara Schmidt
Subjects: Pediatrics, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Retinopathy of prematurity, Retrospective cohort study, medicine.disease, Odds, 03 medical and health sciences, Pulse oximetry, ALARM, 0302 clinical medicine, Bronchopulmonary dysplasia, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, medicine, sense organs, 030212 general & internal medicine, skin and connective tissue diseases, business, Oxygen saturation (medicine)
Abstract: Objective To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO2) alarm limits on neonatal mortality and morbidity among infants born very preterm. Study design This was a retrospective cohort study of infants born very preterm in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants were classified based on treatment at a hospital with an SpO2 alarm policy change and study epoch (before vs after policy change). We used a generalized linear mixed model to determine the effect of hospital group and epoch on the primary outcomes of mortality and severe retinopathy of prematurity (ROP) and secondary outcomes of necrotizing enterocolitis, bronchopulmonary dysplasia, and any ROP. Results There were 3809 infants in 10 hospitals with an SpO2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO2 alarm settings. Mortality was lower in hospitals without a policy change (aOR 0.63; 95% CI 0.50-0.80) but did not differ between epochs in policy change hospitals. The odds of bronchopulmonary dysplasia were greater for hospitals with a policy change (aOR 1.65; 95% CI 1.36-2.00) but did not differ for hospitals without a policy change. Severe ROP and necrotizing enterocolitis did not differ between epochs for either group. The adjusted odds of any ROP were lower in recent years in both hospital groups. Conclusions Changing SpO2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.
Published: 2019

87. The Impact of Time Interval between Extubation and Reintubation on Death or Bronchopulmonary Dysplasia in Extremely Preterm Infants

Author: Wissam Shalish, Sanjay Chawla, Robert E. Kearney, Guilherme M. Sant'Anna, Doina Precup, Karen A. Brown, Martin Keszler, Lara J. Kanbar, Bogdan Panaitescu, Smita Rao, Lajos Kovacs, and Alyse Laliberte
Subjects: Male, Time Factors, 030309 nutrition & dietetics, Birth weight, medicine.medical_treatment, Gestational Age, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Intensive Care Units, Neonatal, 030225 pediatrics, mental disorders, Intubation, Intratracheal, medicine, Humans, Infant, Very Low Birth Weight, Prospective Studies, Bronchopulmonary Dysplasia, Mechanical ventilation, 0303 health sciences, business.industry, Extremely preterm, Confounding, Infant, Newborn, Infant, Gestational age, medicine.disease, Respiration, Artificial, 3. Good health, Bronchopulmonary dysplasia, Case-Control Studies, Infant, Extremely Premature, Anesthesia, Pediatrics, Perinatology and Child Health, Airway Extubation, Female, Risk Adjustment, Observational study, business
Abstract: Objective To explore the relation between time to reintubation and death or bronchopulmonary dysplasia (BPD) in extremely preterm infants. Study design This was a subanalysis from an ongoing multicenter observational study. Infants with birth weight ≤1250 g, requiring mechanical ventilation, and undergoing their first elective extubation were prospectively followed throughout hospitalization. Time to reintubation was defined as the time interval between first elective extubation and reintubation. Univariate and multivariate logistic regression analyses were performed to evaluate associations between time to reintubation, using different observation windows after extubation (24-hour intervals), and death/BPD (primary outcome) or BPD among survivors (secondary outcome). aORs were computed with and without the confounding effects of cumulative mechanical ventilation duration. Results Of 216 infants included for analysis, 103 (48%) were reintubated at least once after their first elective extubation. Reintubation was associated with lower gestational age/weight and greater morbidities compared with infants never reintubated. After adjusting for confounders, reintubation within observation windows ranging between 24 hours and 3 weeks postextubation was associated with increased odds of death/BPD (but not BPD among survivors), independent of the cumulative mechanical ventilation duration. Reintubation within 48 hours from extubation conferred higher risk-adjusted odds of death/BPD vs other observation windows. Conclusions Although reintubation after elective extubation was independently associated with increased likelihood of death/BPD in extremely preterm infants, the greatest risk was attributable to reintubation within the first 48 hours postextubation. Prediction models capable of identifying the highest-risk infants may further improve outcomes.
Published: 2019

88. Update on Mechanical Ventilatory Strategies

Author: Martin Keszler
Subjects: Mechanical ventilation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Respiratory physiology, respiratory system, Lung injury, medicine.disease, Bronchopulmonary dysplasia, Pediatrics, Perinatology and Child Health, medicine, Breathing, Lung volumes, Intensive care medicine, business, Tidal volume, Positive end-expiratory pressure
Abstract: Mechanical ventilation is essential for survival of many extremely premature infants, but all forms of positive pressure ventilation are to some degree injurious to the lungs. A variety of sophisticated devices are used to provide respiratory support, yet substantial uncertainty remains regarding the optimal ways in which these tools can be used to minimize ventilator-associated lung injury. A good understanding of the unique aspects of respiratory physiology of extremely preterm infants is key to obtaining the greatest benefit from modern ventilator technology. Early lung volume recruitment with adequate end-expiratory pressure, avoidance of volutrauma during the immediate postnatal period, and noninvasive respiratory support as the initial strategy are now accepted as important factors in minimizing lung injury. Volume-targeted ventilation combined with optimal lung volume strategies to ensure that the tidal volume is evenly distributed throughout an open lung seems to be the best approach to lower the incidence of bronchopulmonary dysplasia.
Published: 2013

89. Contents Vol. 104, 2013

Author: Martin Stocker, Andrea Clarici, Matteo Fontana, Mete Akisu, Stefano Bembich, Satz Mengensatzproduktion, Martin Keszler, Mehmet Nevzat Cizmeci, Katharine A.G. Squires, Stefano Massaccesi, Olaf Dammann, Camilia R. Martin, Pracha Nuntnarumit, Peter A. Dargaville, Mehmet Kenan Kanburoglu, Anne Greenough, Natthachai Muangyod, Roger F. Soll, Anniina Palojärvi, Ahmet Zulfikar Akelma, Chris E. Williams, Sergio Demarini, Thomas M. Berger, Sture Andersson, Hilal Andan, Anant Khositseth, Jari Petäjä, Kayihan Akin, Deena-Shefali Patel, Richard A. Ehrenkranz, Julie Bartholomew, Mehmet Yalaz, Ertürk Levent, Gerrard F. Rafferty, Druck Reinhardt Druck Basel, Silke Lee, Nilgün Kültürsay, Ursula Turpeinen, Thibault Senterre, Cecilia Janér, Riccardo Davanzo, Pierpaolo Brovedani, Simon Hannam, Mustafa Mansur Tatli, Olie Chowdhury, Alan Leviton, Minghua L. Chen, Janet L. Peacock, Elizabeth N. Allred, Antonio G De Paoli, Ozge Altun Koroglu, and Onur Erbukucu
Subjects: Pediatrics, medicine.medical_specialty, Traditional medicine, business.industry, Pediatrics, Perinatology and Child Health, Medicine, business, Developmental Biology
Published: 2013

90. Developing a neonatal unit ventilation protocol for the preterm baby

Author: Guilherme M. Sant'Anna and Martin Keszler
Subjects: Mechanical ventilation, Protocol (science), medicine.medical_specialty, business.industry, medicine.medical_treatment, Infant, Newborn, Obstetrics and Gynecology, Pressure support ventilation, Lung injury, Respiration, Artificial, Unit (housing), law.invention, Preterm baby, Clinical Protocols, law, Pediatrics, Perinatology and Child Health, Ventilation (architecture), medicine, Humans, Intubation, business, Intensive care medicine, Infant, Premature
Abstract: Mechanical ventilation is a resource-intensive complex medical intervention associated with high morbidity. Considerable practice style variation exists in most hospitals and is not only confusing for parents, but the lack of consistently high standard of optimal ventilation deprives some infants of the benefits of state-of-the-art care. Developing a unit protocol for mechanical ventilation requires exhaustive research, inclusion of all stake-holders, thoughtful protocol development and careful implementation after a thorough educational process, followed by monitoring. A protocol for respiratory support should be comprehensive, addressing respiratory support in the delivery room, the use of non-invasive support, intubation criteria, surfactant administration, specific ventilation modes and settings, criteria for escalating therapy, weaning protocols, extubation criteria, and post-extubation management. Evidence favors the use of non-invasive support as first line treatment, progressing to assist/control or pressure support ventilation combined with volume guarantee, if needed, and high-frequency ventilation only for specific indications. The open lung strategy is crucial to lung-protective ventilation.
Published: 2012

91. Effect of Volume Guarantee in Preterm Infants on High-Frequency Oscillatory Ventilation: A Pilot Study

Author: Martin Keszler, Shin Kikuchi, Hitoshi Ikegami, Masahiro Enomoto, Mio Sakuma, Yoshinori Katayama, Atsuko Takei, and Hirotaka Minami
Subjects: Male, High-Frequency Ventilation, Gestational Age, Pilot Projects, Hypoxemia, 03 medical and health sciences, 0302 clinical medicine, Hypocapnia, Heart Rate, 030225 pediatrics, Heart rate, medicine, Tidal Volume, Humans, 030212 general & internal medicine, Oximetry, Respiratory system, Hypoxia, Tidal volume, Respiratory Distress Syndrome, Newborn, business.industry, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Infant, Carbon Dioxide, medicine.disease, Volume (thermodynamics), Infant, Extremely Low Birth Weight, Anesthesia, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, medicine.symptom, business, Respiratory minute volume, Infant, Premature
Abstract: Objectives Although adding volume guarantee (VG) to conventional ventilation has been a well-established respiratory management for preterm infants, the evidence of VG combined with high-frequency oscillatory ventilation (HFOV) has not been studied well. The aim of this study was to investigate the effect of VG added to HFOV on respiratory and other physiological parameters. Methods We conducted a pilot study in extremely low-birth-weight infants ventilated with HFOV + VG with stable pulmonary status after 28 days of age. VG was applied for 6 hours and removed for the following 6 hours, and data were collected during these 12 hours. Results Six neonates were included in this study (gestational age: 22w5d–23w6d, birthweight: 424–584 g). High-frequency expired tidal volume per weight and amplitude were similar between periods with and without VG. Fluctuation of SpO2, but not heart rate, was significantly smaller when babies were ventilated with VG than without VG. Fluctuation of minute volume and carbon dioxide diffusion coefficient significantly increased after VG removal. The proportion of time with SpO2 Conclusion This pilot study suggests VG combined with HFOV attenuates fluctuation of SpO2 and CO2 clearance, which may prevent hypoxemia and hypocapnia.
Published: 2016

92. Weaning Infants from Mechanical Ventilation

Author: Guilherme M. Sant'Anna and Martin Keszler
Subjects: medicine.medical_treatment, Airway Extubation, Lung injury, Autonomic Nervous System, Adrenal Cortex Hormones, Risk Factors, Caffeine, Humans, Medicine, Weaning, Diuretics, Physical Therapy Modalities, Mechanical ventilation, Respiratory Distress Syndrome, Newborn, Extubation failure, Nutritional Support, business.industry, Infant, Newborn, Obstetrics and Gynecology, Respiration, Artificial, Infant, Extremely Low Birth Weight, Anesthesia, Pediatrics, Perinatology and Child Health, business, Ventilator Weaning, Infant, Premature
Abstract: Protracted mechanical ventilation is associated with increased morbidity and mortality in preterm infants and thus the earliest possible weaning from mechanical ventilation is desirable. Weaning protocols may be helpful in achieving more rapid reduction in support. There is no clear consensus regarding the level of support at which an infant is ready for extubation. An improved ability to predict when a preterm infant has a high likelihood of successful extubation is highly desirable. In this article, available evidence is reviewed and reasonable evidence-based recommendations for expeditious weaning and extubation are provided.
Published: 2012

93. Effective ventilation at conventional rates with tidal volume below instrumental dead space: a bench study

Author: Maria Brugada Montaner, Kabir Abubakar, and Martin Keszler
Subjects: Models, Anatomic, Leak, medicine.medical_specialty, Respiratory rate, medicine.medical_treatment, Capnography, Respiration, Tidal Volume, medicine, Humans, Continuous positive airway pressure, Tidal volume, Lung, business.industry, Infant, Newborn, Obstetrics and Gynecology, Washout, Respiratory Dead Space, General Medicine, Carbon Dioxide, Respiration, Artificial, Surgery, medicine.anatomical_structure, Infant, Extremely Low Birth Weight, Anesthesia, Pediatrics, Perinatology and Child Health, Breathing, Feasibility Studies, business, Infant, Premature
Abstract: The authors previously showed that 48% of infants800 g were ventilated with tidal volume (VT)dead space (DS) using volume guarantee (VG) ventilation. Here, The authors sought to confirm those findings under the rigorous conditions of a bench study.The authors measured the time to wash out CO2 from a 45-ml test lung using end-tidal CO(2) monitor (ETCO(2)). The test lung was filled with 100% CO(2), then ventilated using VG at VT ranging from DS+2 ml to DS-1.5 ml. With ventilation, ETCO(2) declined exponentially as CO(2) was washed out, the rate being proportional to VT - effective instrumental DS. The time from initiation of ventilation to threshold of accurate detection was determined in triplicate.Halving the theoretical 'alveolar ventilation' (DS+2 ml to DS+1 ml) only increased the elimination time by 26%, not the 100%, as predicted by conventional physiology. CO(2) washout was less efficient, but still occurred even at VT=DS and VT=DS-1.5 ml. Halving the theoretical 'alveolar ventilation' by decreasing respiratory rate from 80 to 40 breaths/min only increased elimination time by 35%, not 100%, as predicted by conventional physiology. Twenty minutes of continuous positive airway pressure prior to ventilation did not alter the elimination time, verifying that CO(2) did not diffuse or leak out of the test lung. Size of the endotracheal tube (ETT; 2.5, 3.0 and 3.5 mm) flow rate (4, 6 and 10 l/min) and inspiratory time (0.25 vs 0.35 s) did not affect the results.Contrary to conventional physiology, effective CO(2) elimination appears to be possible with VTDS even at conventional rates. With small ETT a spike of fresh gas likely penetrates through the DS, rather than pushing it ahead.
Published: 2011

94. Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants

Author: Carmen Garcia, Namasivayam Ambalavanan, Estelle E. Fischer, John D.E. Barks, Rosemary D. Higgins, Kristi L. Watterberg, Mary Christensen, Jeanette O'Donnell Auman, Abbot R. Laptook, Ronnie Guillet, David K. Stevenson, Lijun Chen, Dianne E. Herron, Karen Martin, Conra Backstrom Lacy, Eugenia K. Pallotto, Rachel Geller, Shirley S. Cosby, Teresa Chanlaw, C. Michael Cotten, Myra H. Wyckoff, Yvonne Loggins, Elisa Vieira, Seetha Shankaran, Patricia Luzader, Kristin M. Zaterka-Baxter, Stephanie Wilson Archer, Jenna Gabrio, Jennifer Fuller, Diane I. Bottcher, Haresh Kirpalani, Carl T. D'Angio, Joanne Finkle, Holly I.M. Wadkins, Luc P. Brion, Cindy Clark, Janice Bernhardt, Barbara J. Stoll, Brenda B. Poindexter, Howard W. Kilbride, Jennifer Jennings, Matthew M. Laughon, Suhas G. Kallapur, Meena Garg, Margaret M. Crawford, Satyan Lakshminrusimha, Pablo J. Sánchez, Jon E. Tyson, Uday Devaskar, Abhik Das, Tarah T. Colaizy, Angelita M. Hensman, Jacky R. Walker, Carol Hartenberger, Cathy Grisby, Barbara Alexander, Sarah Kandefer, Robin K. Ohls, Ronald N. Goldberg, Julie Gutentag, Shelley Handel, Kathleen A. Kennedy, Bonnie S. Siner, Sandy Sundquist Beauman, William E Truog, Sharon L. Wright, Athina Pappas, Girija Natarajan, Marliese Dion Nist, Marissa E. Jones, Jodi A. Ulloa, Kristin Kirker, Melinda S. Proud, Betty R. Vohr, Sara B. DeMauro, Nancy S. Newman, Dara M. Cucinotta, Waldemar A. Carlo, Krisa P. Van Meurs, Greg Muthig, Lizette E. Torres, Kimberley A. Fisher, Donia B. Campbell, Edward F. Bell, Lenora Jackson, Rosemary L. Jensen, Cheri Gauldin, Soraya Abbasi, Dan L. Ellsbury, Monica V. Collins, Greg Sokol, Stephanie Guilford, Ellen C. Hale, Ann Marie Scorsone, Barbara Schmidt, Kathy Johnson, Karen J. Johnson, Dennis Wallace, Julianne Hunn, M. Bethany Ball, Anne Holmes, Diane F. White, Richard A. Polin, Noah Cook, Tara Wolfe, Julie Arldt-McAlister, Sudarshan R. Jadcherla, Jane E. Brumbaugh, Shampa Saha, Ashley Williams, Diana M. Vasil, Monika Bajaj, Toni Mancini, Georgia E. McDavid, Elizabeth Rodgers, David P. Carlton, Sandra Wuertz, Rebecca Bara, Aasma S. Chaudhary, Sarah McGregor, Kurt Schibler, Anna Marie Hibbs, Michele C. Walsh, Nehal A. Parikh, Leif D. Nelin, Martin Keszler, Stephanie A. Wiggins, and Carl L. Bose
Subjects: Male, Resuscitation, medicine.medical_treatment, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030225 pediatrics, Outcome Assessment, Health Care, Intubation, Intratracheal, Humans, Rupture of membranes, Medicine, Prospective Studies, Registries, 030212 general & internal medicine, Cardiopulmonary resuscitation, Continuous positive airway pressure, Respiratory system, Continuous Positive Airway Pressure, business.industry, Delivery Rooms, Delivery room, Infant, Newborn, Oxygen Inhalation Therapy, Gestational age, Cardiopulmonary Resuscitation, Anesthesia, Infant, Small for Gestational Age, Pediatrics, Perinatology and Child Health, Female, business, Infant, Premature, Cohort study
Abstract: Objectives To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. Study design This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated. Results Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality. Conclusions The majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay.
Published: 2018

95. Outcome of Preterm Infants with Transient Cystic Periventricular Leukomalacia on Serial Cranial Imaging Up to Term Equivalent Age

Author: Subrata Sarkar, Seetha Shankaran, John Barks, Barbara T. Do, Abbot R. Laptook, Abhik Das, Namasivayam Ambalavanan, Krisa P. Van Meurs, Edward F. Bell, Pablo J. Sanchez, Susan R. Hintz, Myra H. Wyckoff, Barbara J. Stoll, Waldemar A. Carlo, Alan H. Jobe, Michael S. Caplan, Richard A. Polin, Martin Keszler, William Oh, Betty R. Vohr, Angelita M. Hensman, Barbara Alksninis, Kristin M. Basso, Robert Burke, Melinda Caskey, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Emilee Little, Elisabeth C. McGowan, Elisa Vieira, Victoria E. Watson, Suzy Ventura, Michele C. Walsh, Avroy A. Fanaroff, Anna Marie Hibbs, Deanne E. Wilson-Costello, Nancy S. Newman, Allison H. Payne, Bonnie S. Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G. Friedman, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Edward F. Donovan, Cathy Grisby, Kate Bridges, Barbara Alexander, Estelle E. Fischer, Holly L. Mincey, Jody Hessling, Teresa L. Gratton, Lenora Jackson, Kristin Kirker, Greg Muthig, Jean J. Steichen, Stacey Tepe, Marcia Worley Mersmann, Kimberly Yolton, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein, Patricia L. Ashley, William F. Malcolm, Kathy J. Auten, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Melody B. Lohmeyer, Joanne Finkle, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Diane Warner, Janice Wereszczak, David P. Carlton, Ira Adams-Chapman, Ellen C. Hale, Yvonne Loggins, Ann M. Blackwelder, Diane I. Bottcher, Colleen Mackie, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Brenda B. Poindexter, James A. Lemons, Anna M. Dusick, Lu-Ann Papile, Carolyn Lytle, Abbey C. Hines, Heike M. Minnich, Dianne E. Herron, Lucy Smiley, Susan Gunn, Leslie Dawn Wilson, Kathleen A. Kennedy, Jon E. Tyson, Georgia E. McDavid, Esther G. Akpa, Julie Arldt-McAlister, Nora I. Alaniz, Katrina Burson, Pamela J. Bradt, Susan Dieterich, Allison Dempsey, Andrea F. Duncan, Patricia W. Evans, Claudia I. Franco, Carmen Garcia, Charles Green, Beverly Foley Harris, Margarita Jiminez, Janice John, Patrick M. Jones, Layne M. Lillie, Anna E. Lis, Terri Major-Kincade, Karen Martin, Sara C. Martin, Brenda H. Morris, Patricia Ann Orekoya, Stacey Reddoch, Shawna Rodgers, Saba Siddiki, Maegan C. Simmons, Daniel Sperry, Patti L. Pierce Tate, Laura L. Whitely, Sharon L. Wright, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Dennis Wallace, Marie G. Gantz, W. Kenneth Poole, Margaret M. Crawford, Jenna Gabrio, Betty K. Hastings, Jamie E. Newman, Jeanette O'Donnell Auman, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, David K. Stevenson, M. Bethany Ball, Marian M. Adams, Alexis S. Davis, Andrew W. Palmquist, Melinda S. Proud, Barbara Bentley, Elizabeth Bruno, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Jean G. Kohn, Casey Krueger, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Anne Furey, Ellen Nylen, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, Fred J. Biasini, Kristen C. Johnston, Kathleen G. Nelson, Cryshelle S. Patterson, Vivien A. Phillips, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, David Kaegi, Maynard R. Rasmussen, Paul R. Wozniak, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Chris Henderson, Wade Rich, Yvonne E. Vaucher, Tarah T. Colaizy, Michael J. Acarregui, Jane E. Brumbaugh, Dan L. Ellsbury, John A. Widness, Karen J. Johnson, Donia B. Campbell, Diane L. Eastman, Nancy J. Krutzfield, Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, Sylvia Fajardo-Hiriart, Arielle Rigaud, Maria Calejo, Silvia M. Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L. Watterberg, Jean R. Lowe, Tara Dupont, Janell F. Fuller, Robin K. Ohls, Conra Backstrom Lacy, Rebecca Montman, Barbara Schmidt, Haresh Kirpalani, Sara B. DeMauro, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Noah Cook, Carl T. D'Angio, Dale L. Phelps, Ronnie Guillet, Satyan Lakshminrusimha, Julie Babish Johnson, Erica Burnell, Linda J. Reubens, Cassandra A. Horihan, Rosemary L. Jensen, Emily Kushner, Joan Merzbach, Gary J. Myers, Mary Rowan, Holly I.M. Wadkins, Anne Marie Scorsone, Melissa Bowman, Julianne Hunn, Stephanie Guilford, Deanna Maffett, Osman Farooq, Diane Prinzing, Anne Marie Reynolds, Michael G. Sacilowski, Ashley Williams, Karen Wynn, Kelley Yost, William Zorn, Lauren Zwetsch, Luc P. Brion, R. Sue Broyles, Roy J. Heyne, Merle Ipson, Walid A. Salhab, Charles R. Rosenfeld, Diana M. Vasil, Lijun Chen, Alicia Guzman, Gaynelle Hensley, Jackie F. Hickman, Melissa H. Leps, Susie Madison, Nancy A. Miller, Janet S. Morgan, Lara Pavageau, Sally S. Adams, Cristin Dooley, Elizabeth T. Heyne, Lizette E. Lee, Linda A. Madden, Catherine Twell Boatman, Roger G. Faix, Bradley A. Yoder, Karen A. Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, Shawna Baker, Karie Bird, Jill Burnett, Michael Steffen, Jennifer J. Jensen, Sarah Winter, Karen Zanetti, T. Michael O'Shea, Robert G. Dillard, Lisa K. Washburn, Barbara G. Jackson, Nancy J. Peters, Korinne Chiu, Deborah Evans Allred, Donald J. Goldstein, Raquel Halfond, Carroll Peterson, Ellen L. Waldrep, Cherrie D. Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Athina Pappas, Rebecca Bara, Laura A. Goldston, Geraldine Muran, Girija Natarajan, Mary Christensen, Stephanie A. Wiggins, Diane White, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Patricia Gettner, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Elaine Romano, Janet Taft, and Joanne Williams
Subjects: Male, congenital, hereditary, and neonatal diseases and abnormalities, Pediatrics, medicine.medical_specialty, Adverse outcomes, Developmental Disabilities, Leukomalacia, Periventricular, Gestational Age, Article, 03 medical and health sciences, Neonatal Screening, 0302 clinical medicine, Risk Factors, 030225 pediatrics, medicine, Humans, Prospective Studies, cardiovascular diseases, reproductive and urinary physiology, Ultrasonography, business.industry, Term equivalent age, Infant, Newborn, Brain, Infant, Cystic Periventricular Leukomalacia, nervous system diseases, Logistic Models, Increased risk, nervous system, Case-Control Studies, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Gestation, Female, business, 030217 neurology & neurosurgery
Abstract: OBJECTIVE: To determine the outcome of preterm infants whose cystic periventricular leukomalacia “disappeared” on serial screening cranial imaging studies. STUDY DESIGN: Infants ≤26 weeks of gestation born between 2002 and 2012 who had cranial imaging studies at least twice, the most abnormal study at
Published: 2018

96. 1159: SEVERE BRONCHOPULMONARY DYSPLASIA OUTCOMES AFTER THE CREATION OF AN INPATIENT MULTIDISCIPLINARY TEAM

Author: Joseph Schmidhofer, Alyssa L Balasco, Jason T. Machan, Martin Keszler, and Robin L. McKinney
Subjects: medicine.medical_specialty, business.industry, Medicine, Critical Care and Intensive Care Medicine, Multidisciplinary team, business, Intensive care medicine, Severe Bronchopulmonary Dysplasia
Published: 2018

97. INSURE, Infant Flow, Positive Pressure and Volume Guarantee — Tell us what is best: Selection of respiratory support modalities in the NICU

Author: Martin Keszler
Subjects: Respiratory Therapy, medicine.medical_specialty, Positive pressure, Context (language use), Lung injury, Therapeutic goal, Intensive Care Units, Neonatal, medicine, Humans, Disease process, Intensive care medicine, Selection (genetic algorithm), Clinical Trials as Topic, Modalities, Continuous Positive Airway Pressure, business.industry, Infant, Newborn, Obstetrics and Gynecology, Pulmonary Surfactants, Respiration, Artificial, Respiratory support, Respiratory Function Tests, Infant Care, Pediatrics, Perinatology and Child Health, Intubation, business
Abstract: Selecting the optimal mode of respiratory support remains a daily challenge for the practicing neonatologist. We are faced with a bewildering array of modalities and a paucity of definitive studies to guide our decisions. In this context the choice of therapies must be guided by evidence-based guidelines, supplemented by a solid understanding of the pathophysiology of lung injury, an appreciation of the individual patient's specific disease process/physiologic derangement. The sequential application of the least invasive treatment to achieve the relevant therapeutic goal with frequent re-evaluation of the patient's need and possible escalation of support as needed, coupled with the application of lung-protective strategies of respiratory support appears to offer the best chance of minimizing adverse pulmonary and neurodevelopmental outcomes.
Published: 2009

98. The impact of instrumental dead-space in volume-targeted ventilation of the extremely low birth weight (ELBW) infant

Author: Martin Keszler, Kabir Abubakar, and Sepideh Nassabeh-Montazami
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Respiratory rate, Dead space, Pressure support ventilation, Hyperventilation, Tidal Volume, medicine, Humans, Normocapnia, Tidal volume, Retrospective Studies, business.industry, Infant, Newborn, Respiration, Artificial, Surgery, Infant, Extremely Low Birth Weight, Anesthesia, Pediatrics, Perinatology and Child Health, Breathing, Female, medicine.symptom, Pulmonary Ventilation, business, Respiratory minute volume
Abstract: Volume-targeted ventilation is increasingly used in neonatal ventilation to reduce the risk of volutrauma and inadvertent hyperventilation. However, normative data for appropriate tidal volume (V(T)) settings are lacking, especially in extremely low birth weight (ELBW) infants in whom the added dead space (DS) of the flow sensor may be important.To quantify the effect of instrumental dead-space (IDS) on ventilation and to obtain normative data for initial V(T) associated with normocapnia in ELBW infants ventilated with volume guarantee (VG) ventilation.Set and measured V(T), respiratory rate (RR) and arterial blood gas values (ABG) were extracted from charts of babies800 g born between January 2003 and August 2005, who were ventilated with VG. Data were collected at the time of each ABG during the 1st 48 hr of life. Theoretical alveolar minute ventilation (AMV) was calculated as (V(T) - DS) x RR. IDS was measured by filling with water a 2.5 mm endotracheal tube cut to 10 cm with attached hub of the inline suction catheter and flow sensor. We added 0.5 mL/kg to this value to account for distal tracheal/mainstem bronchi DS (anatomical dead space). Descriptive statistics and linear regression were used for analysis.The measured IDS was 2.7 mL. Mean combined DS (instrumental + anatomical) was 3.01 mL. There were 344 paired observations of V(T) and ABG with PaCO(2) in the normocapnic range in 38 infants (mean birth weight 625 g +/- 115 g SD, range 400-790 g) during the study period. The mean pH was 7.30 +/- 0.06 (SD), mean PaCO(2) 43.4 +/- 5.4 Torr. The mean target V(T) was 3.11 +/- 0.64 mL and the measured V(T) was 3.17 +/- 0.73 mL. Despite normocapnia, 47% of the V(T) were equal to or less than estimated DS. Mean theoretical AMV was only 8.7 mL/kg/min. The V(T)/kg needed for normocapnia was inversely related to weight (r = -0.70, P0.01), indicating some effect of the fixed IDS. Mean V(T)/kg of infants500 g was 5.9 +/- 0.3 mL, compared to 4.7 +/- 0.5 mL for those700 g (P0.001).Effective alveolar ventilation occurs with V(T) at or below calculated DS. This can be explained by the fact that at the high flow rates seen in these tiny infants who have extremely short inspiratory times, fresh gas penetrates through the dead space gas, rather than pushing it ahead. Therefore there is no need to forego synchronized and volume targeted ventilation because of dead space concerns. In infants800 g, initial V(T) of 5-6 mL/kg was associated with normocapnia when using assist/control or pressure support ventilation.
Published: 2009

99. Evolution of tidal volume requirement during the first 3 weeks of life in infants <800 g ventilated with Volume Guarantee

Author: Martin Keszler, Sepideh Nassabeh-Montazami, and Kabir Abubakar
Subjects: Male, medicine.medical_specialty, Respiratory rate, Partial Pressure, Birth weight, Infant, Premature, Diseases, Distension, Positive-Pressure Respiration, Permissive hypercapnia, Hyperventilation, Tidal Volume, medicine, Birth Weight, Humans, Normocapnia, Tidal volume, Retrospective Studies, Ventilators, Mechanical, Hypocapnia, business.industry, Infant, Newborn, Obstetrics and Gynecology, General Medicine, Carbon Dioxide, Surgery, Infant, Extremely Low Birth Weight, Anesthesia, Infant Care, Pediatrics, Perinatology and Child Health, Breathing, Female, medicine.symptom, business, Infant, Premature
Abstract: Volume-targeted ventilation is used in neonates to reduce volutrauma and inadvertent hyperventilation. Little is known about appropriate tidal volume (V(T)) settings in extremely low birthweight (ELBW) infants who remain intubated for extended periods.The V(T) required to maintain adequate partial pressure of carbon dioxide (P(CO2) levels changes as the underlying disease evolves in infants ventilated for prolonged periods.To obtain normative data for V(T) associated with normocapnia in ELBW infants ventilated with Volume Guarantee over the first 3 weeks of life.Set and measured V(T), peak pressure, respiratory rate and blood gas values were extracted from the records of babies800 g born January 2003 to August 2005 and ventilated with Volume Guarantee. Data were collected at the time of each blood gas measurement during days 1-2, 5-7 and 14-21. Only the V(T) corresponding to P(CO2) values within a defined normal range were included. Descriptive statistics were used to define the patient cohort. Mean V(T) and P(CO2) for each patient during each epoch was calculated, and these values were analysed by repeated-measures analysis of variance.Twenty-six infants, mean (SD) birth weight 615 (104) g, were included. A total of 828 paired blood gas and V(T) sets were analysed: days 1-2 = 251; days 5-7 = 185; days 14-17 = 216; days 18-21 = 176. P(CO2) values (mean (SD)) rose from 44.0 (5.4) mm Hg on days 1-2 to 46.3 (5.2) mm Hg on days 5-7 and remained stable during days 14-17 and 18-21 (53.9 (6.8) and 53.9 (6.2) mm Hg, respectively). Mean exhaled V(T) rose from 5.15 (0.62) ml/kg on day 1 to 5.24 (0.71) ml/kg on days 5-7, 5.63 (1.0) ml/kg on days 14-17, and 6.07 (1.4) ml/kg on days 18-21 (p0.05).Despite permissive hypercapnia, V(T) requirement rises with advancing postnatal age in ELBW infants. The increase is greatest during the third week of life, which is probably due to distension of the upper airways (acquired tracheomegaly) and increasing heterogeneity of lung inflation (increased alveolar dead space).
Published: 2008

100. Mechanical Ventilation and Bronchopulmonary Dysplasia

Author: Guilherme M. Sant'Anna and Martin Keszler
Subjects: medicine.medical_specialty, Ventilator-associated lung injury, medicine.medical_treatment, Lung injury, Risk Factors, Internal medicine, medicine, Tidal Volume, Humans, Lung volumes, Lung, Tidal volume, Bronchopulmonary Dysplasia, Mechanical ventilation, Noninvasive Ventilation, business.industry, Infant, Newborn, Obstetrics and Gynecology, Pulmonary Surfactants, respiratory system, medicine.disease, Respiration, Artificial, respiratory tract diseases, Oxidative Stress, medicine.anatomical_structure, Bronchopulmonary dysplasia, Pediatrics, Perinatology and Child Health, Cardiology, Breathing, business, Infant, Premature
Abstract: Mechanical ventilation is an important potentially modifiable risk factor for the development of bronchopulmonary dysplasia. Effective use of noninvasive respiratory support reduces the risk of lung injury. Lung volume recruitment and avoidance of excessive tidal volume are key elements of lung-protective ventilation strategies. Avoidance of oxidative stress, less invasive methods of surfactant administration, and high-frequency ventilation are also important factors in lung injury prevention.
Published: 2015

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