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The article describes the case study of a 6-week-old male infant with persistent respiratory distress and head bobbing. Topics include the patient's complex neonatal history; symptoms observed at home, such as tachypnea, retractions, and head bobbing that fluctuated in severity; and diagnostic assessments, including normal chest radiographs, echocardiogram showing minor heart findings, and elevated bilirubin levels without definitive respiratory or cardiac diagnoses.

Background: Nasal continuous positive airway pressure (NCPAP) is a common mode of respiratory support in neonatal intensive care units. Our objective was to compare whether NCPAP given with nasal prongs compared with a nasal mask reduces the pain scores in preterm infants with respiratory distress. Methods: Preterm infants on NCPAP due to respiratory distress were included in the study. All infants received NCPAP via the Infant Flow SiPAP The COVERS pain scale was used to score the infants' pain Each infant was studied alternating between nasal prongs and a nasal mask. Heart rate, respiratory rate, oxygen saturation, and transcutaneous CO2 (tcCO2) were monitored. Blood pressure and the infants' pain scores were determined every 30 minutes and the average of measurements was taken. Results: The median (interquartile range) values of pain scores, respiratory rates, oxygen saturations, tcCO2 levels, and systolic blood pressures differed significantly and favored the nasal mask. Conclusions: This study demonstrates that continuous positive airway pressure via a nasal mask leads to a significant reduction in pain scores without altering the respiratory parameters of babies. On the basis of this study, it is possible to conclude that NCPAP applied via nasal mask may be a good alternative to NCPAP applied via nasal prongs. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population. [ABSTRACT FROM AUTHOR]

Respiratory Distress Syndrome (RDS) remains a significant challenge in neonatal intensive care, particularly in preterm infants who suffer from surfactant deficiency, leading to alveolar collapse, decreased lung compliance, and impaired gas exchange. While conventional mechanical ventilation (CMV) is the current standard of care, it often involves cyclic alveolar recruitment and derecruitment, which can contribute to ventilator-induced lung injury (VILI). Airway Pressure Release Ventilation (APRV) is a mode of ventilation that maintains continuous alveolar recruitment through prolonged high-pressure phases while allowing spontaneous breathing, potentially reducing VILI. This protocol outlines the rationale, initial settings, adjustments, monitoring, and weaning strategies for using APRV to manage RDS in preterm infants. The paper also emphasizes the importance of adjusting Tlow (time at low pressure) to maintain the T-PEFR (peak expiratory flow rate termination point) at 75% with changes in lung compliance to prevent overinflation and underinflation, highlighting the need for further studies to validate APRV's safety, efficacy, and optimal use in this population. [ABSTRACT FROM AUTHOR]

The article presents a neonatal case where cardiac tamponade developed as a complication of a peripherally inserted central catheter (PICC). Topics discussed include the potential risks associated with PICC placement, the management of pericardial effusion, and the importance of timely detection and intervention to prevent severe outcomes.

BACKGROUND: High-flow nasal cannula (HFNC) systems employ different methods to provide aerosol to patients. This study compared delivery efficiency, particle size, and regional deposition of aerosolized bronchodilators during HFNC in neonatal, pediatric, and adult upper-airway and lung models between a proximal aerosol adapter and distal aerosol circuit chamber. METHODS: A filter was connected to the upper airway to a spontaneously breathing lung model. Albuterol was nebulized using the aerosol adapter and circuit at different clinical flow settings. The aerosol mass deposited in the upper airway and lung was quantified. Particle size was measured with a laser diffractometer. Regional deposition was assessed with a gamma camera at each nebulizer location and patient model with minimum flow settings. RESULTS: Inhaled lung doses ranged from 0.2-0.8% for neonates, 0.2-2.2% for the small child, and 0.5-5.2% for the adult models. Neonatal inhaled lung doses were not different between the aerosol circuit and adapter, but the aerosol circuit showed marginally greater lung doses in the pediatric and adult patient models. Impacted aerosols and condensation in the non-heated HFNC and aerosol delivery components contributed to the dispersion of coarse liquid droplets, high deposition (11-44%), and occlusion of the supine neonatal upper airway. In contrast, the upright pediatric and adult upper-airway models had minimal deposition (0.3-7.0%) and high fugitive losses (~24%) from liquid droplets leaking out of the nose. The high impactive losses in the aerosol adapter (56%) were better contained than in the aerosol circuit, resulting in less cannula sputter (5% vs 22%), fewer fugitive losses (18% vs 24%), and smaller inhaled aerosols (5 µm vs 13 µm). CONCLUSIONS: The inhaled lung dose was low (1-5%) during HFNC. Approaches that streamline aerosol delivery are needed to provide safe and effective therapy to patients receiving aerosolized medications with this HFNC system. [ABSTRACT FROM AUTHOR]

Background: Preterm neonates are repeatedly exposed to many stressors in initial days of life such as environmental stressor (light and noise) and caregiver interventions (weighing, oral and tracheal suctioning, drawing blood samples, etc.). If preterm neonates' stress is not recognized and left untreated, there may be long-term effects. Objective: To assess the neonatal stress behavior among preterm neonates admitted in neonatal intensive care unit (NICU), Nehru Hospital, PGIMER, Chandigarh. Methodology: A descriptive study was conducted to assess neonatal stress behavior among preterm neonates admitted in NICU, Nehru Hospital, PGIMER, Chandigarh. Ethical clearance was taken from Institutional Ethics Committee of PGIMER, Chandigarh. Total 100 participants admitted in NICU during the period of July–December 2022 were enrolled for the study using consecutive sampling technique. Data was collected by interviewing mother using interview schedule. It comprised of sociodemographic cum clinical profile of the preterm neonate. Observation was made by using—(a) modified infant positioning assessment tool (IPAT), (b) neonatal stress scale, and (c) preterm neonate's behavior assessment scale. Results: The present study shows that 88% of the preterm neonates show moderate stress and 70% of preterm neonates exhibit suspected abnormal behavioral response in terms of autonomic visceral subsystems, while 54% of the preterm neonates show suspected abnormal behavioral response in terms of state regulation attention interaction subsystem. Conclusion: The present study concluded that moderate stress level and suspected abnormal behavioral response were found among hospitalized preterm neonates. [ABSTRACT FROM AUTHOR]

BACKGROUND: A multidisciplinary comprehensive protocol to use bubble continuous positive airway pressure (bCPAP) as the primary respiratory support in the delivery room (DR) and the NICU was introduced. With this study, we aimed to assess the association of this change with respiratory outcomes over time. METHODS: Infants with gestational age <32 weeks and birth weight <1250 g admitted between January 2012 and June 2020 were included and categorized into 4 periods, including preimplementation (P0: 2012-2014), and post-implementation (P1: 2014-2016, P2: 2016-2018, P3: 2018-2020). The primary outcome was the rates of death and severe bronchopulmonary dysplasia (BPD), and the secondary outcomes included the rates of DR and NICU intubation ≤7 days of age, need of surfactant, and pneumothorax. Multivariate logistic regression models accounting for relevant risk factors were used to calculate adjusted odds ratios (ORs). RESULTS: The study included 440 infants (P0 = 90, P1 = 91, P2 = 128, P3 = 131). Over time, more infants were free of BPD (P < .001), and the rates of death and severe BPD decreased significantly: P1 = OR 1.21 (95% confidence interval [CI] 0.56-2.67), P2 = OR 0.45 (95% CI 0.20-0.99), and P3 = OR 0.37 (95% CI 0.15-0.84). DR intubation decreased from 66% (P0) to 24% (P3) in the entire cohort (P < .001) and from 96% (P0) to 40% (P3) in infants <26 weeks of age (P < .001). The need for NICU intubation was similar (P = .98), with a decreased need for surfactant (P 5 .001) occurring at higher FiO2 (P0 = 0.35 vs P3 = 0.55, P < .001). Pneumothorax rates were unchanged. CONCLUSIONS: In very preterm infants, the implementation of a comprehensive bCPAP protocol led to a significant and consistent improvement in respiratory practices and the rates of death and severe BPD. [ABSTRACT FROM AUTHOR]

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed to identify the usage extent and clinical application of nHFOV in Romania. Methods: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU's size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. Results: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10–17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Conclusions: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. [ABSTRACT FROM AUTHOR]

Background: Respiratory distress syndrome is a critical respiratory illness that affects premature newborns and can lead to very severe, unfavorable consequences as a result of hypoxia, Aim: To assess the relationship between Ischemia Modified Albumin (IMA) and the prognosis of RDS in preterm patients, Patients and methods: This was prospective case control study performed on 90 newborn infants in the NICU of Al-Zahra University Hospital, Faculty of Medicine for Girls, and Tala General Hospital in Menoufia governorate from November 2020 to November 2021. Patients were divided into two groups: Preterm group (n=45, GA=36 weeks) and full term group (n=45, GA>36 weeks). They followed up by clinical examination and laboratory investigational study until their outcome either discharge either death. Results: IMA was significantly higher among patients who needed mechanical ventilation. Duration of mechanical ventilation correlated positively with IMA levels, with statistical significance difference. Increased IMA levels were associated with an increased total hospital stay duration. Regarding outcome, IMA levels were significantly higher among patients who died, with a statistically significant difference. At a cut-off value equal to 222.8, IMA had 100% sensitivity and 98.3% specificity to predict a poor outcome for pre-term infants with respiratory distress, Conclusion: Ischemia-modified albumin could be used as a diagnostic modality for respiratory distress syndrome among premature neonates with high reliability and reproducibility. It could also be utilized as a predictor of disease outcome. [ABSTRACT FROM AUTHOR]

Background and Objective: Quality of nursing care has an important role in providing the highest care to neonates in the neonatal intensive care unit. Improvement in the quality of nursing care is a main goal of the nurses. The study aimed to assess the quality of nursing care for neonates with Respiratory Distress Syndrome. Methods: A descriptive cross-sectional study was conducted on 50 nurses at neonatal intensive care units in teaching hospitals (Rapareen Teaching Hospital for Children and Maternity Teaching Hospital) in Erbil city. A convenience sampling technique was used to collect the data. Two tools were used to collect the data which was developed by the researcher: the first tool was a self-administered questionnaire which contained two parts (socio-demographic characteristics, and questions related to neonatal respiratory distress syndrome), and the second tool was an observational checklist that was used to assess the quality of nursing care for NRDS. The Statistical Package for Social Science was used to analyze the data (version 23) presenting descriptive and inferential statistics, including the chi-square test, Fisher exact test, frequency, and percentage. Results: More than half (54%) of the nurses were within the age group of 25-34 years. 62% of the nurses graduated from the college of nursing, 58% of the nurses were female, and the majority (88%) of the nurses were married. The highest percentage (64%) of the nurses had a good level of knowledge, while the highest percentage (74%) of the nurses had a fair level of quality nursing care. A highly significant association was found between the quality of nursing care with educational level and the duration of the training course. Also, there was a weak positive correlation between the level of nurses' knowledge and the quality of nursing. Conclusion: Based on the study findings of the present study, it was concluded that the highest percentage of the nurses had a good level of knowledge, and the high percentage of the nurses had a fair level of quality nursing care. [ABSTRACT FROM AUTHOR]

Background Respiratory disorders in premature neonates often require respiratory support. Continous transcutaneous monitoring is an available non-invasive option to monitor CO2 pressure, substituting the need for blood gas analysis as the gold standard evaluation in practice. Most studies have been conducted on very and extremely preterm neonates, but rarely in late and moderately preterm neonates. Objective To determine the precision and accuracy of transcutaneous CO2 pressure measuring devices compared to arterial blood gas analysis in neonates of 32-36 weeks gestational age who received respiratory support. Methods This diagnostic, cross-sectional study was conducted on 35 late and moderately preterm neonates of 32-36 weeks gestation who received cardiopulmonary resuscitation (CPR) in the Neonatology Unit at Rumah Sakit Cipto Mangunkusumo, Jakarta. Subjects were monitored with a transcutaneous CO2 monitor and blood gas analysis (BGA). The CO2 pressure measurements were made three times from the two devices. Data were analyzed using Spearman's correlation and Bland-Altman tests to determine the precision and accuracy of transcutaneous monitoring by comparing its mean difference (MD) to BGA as the gold standard measurement. Results Spearman's analysis revealed a significant positive correlation between BGA and transcutaneous CO2 monitoring (P<0.001). However, the Bland-Altman test revealed a level of agreement between measuring devices was -14.46 to 6.9, with mean difference of -3.78; indicating poor precision of the transcutaneous evaluation regardless its high accuracy compared to its gold standard. Conclusion The transcutaneous CO2 monitoring device has low precision, but a strong positive correlation to BGA; underlining its high accuracy in practice. Transcutaneous CO2 monitoring cannot replace BGA, the gold standard examination. [ABSTRACT FROM AUTHOR]

Nasal continuous positive airway pressure (NCPAP) is extensively used for preterm infants experiencing respiratory distress syndrome (RDS). Weaning from NCPAP includes direct weaning or gradually extending room air exposure. However, a high-flow nasal cannula (HFNC) is an alternative weaning method. Therefore, this study evaluated the clinical outcomes of HFNC and progressively increasing room air duration as weaning strategies. This study enrolled 46 preterm infants with RDS receiving NCPAP support who underwent the cyclic use of NCPAP and HFNC weaning protocol as the HFNC group; a retrospective analysis included 87 preterm infants weaned from NCPAP by gradually extending room air duration as the room air group. Differences in clinical conditions, complications, and short-term outcomes between the weaning methods were compared. The mean post-menstrual age at initiating NCPAP weaning was lower in the room air group than in the HFNC group (mean ± SD, 35.2 ± 2.3 weeks vs. 33.2 ± 2.5 weeks, p < 0.001). Hospital stay duration and total respiratory therapy days were longer in the HFNC group (96 ± 38 days and 80 ± 37 days, respectively) than in the room air group (78 ± 28 days and 56 ± 25 days, respectively), with p-values of 0.006 and <0.001. In conclusion, employing HFNC for weaning from NCPAP resulted in longer hospital admissions and respiratory therapy days than the room air method. However, further studies with a larger sample size are warranted for a more comprehensive evaluation, given the limited number of enrolled patients. [ABSTRACT FROM AUTHOR]

The European Standards of Care for Newborn Health (ESCNH) were launched in 2018. After three years, the first standards were reassessed and revised to align with current evidence. Moreover, new standards regarding emerging topics were developed. The aim of this paper is to outline the approach adopted for reassessing, revising and developing new standards for the ESCNH. We established a systematic approach to reassess the ESCNH including a public and an expert consultation. The public consultation was open to all stakeholders for feedback whereas the expert consultation followed a targeted consultation method. For developing new standards, a similar process to the original development was implemented. Overall, 20 standards were reassessed and six standards were developed. For the revision process, 23 experts were involved in the targeted consultation method and 253 questionnaires were completed via the open consultation. We demonstrated a systematic approach to update and extend reference standards, which can be applied by other developers of standards. Thereby, we highlighted that including a public and an expert consultation is crucial to improve quality and to ensure that all stakeholder perspectives are integrated. [ABSTRACT FROM AUTHOR]

The standard of care in treating respiratory distress syndrome in preterm infants is respiratory support with nasal continuous positive airway pressure or a combination of continuous positive airway pressure and exogenous surfactant replacement. Endotracheal intubation, the conventional method for surfactant administration, is an invasive procedure associated with procedural and mechanical ventilation complications. The INSURE (intubation, surfactant administration, and extubation soon after) technique is an accepted method aimed at reducing the short-term complications and long-term morbidities related to mechanical ventilation but does not eliminate risks associated with endotracheal intubation and mechanical ventilation. Alternative methods of surfactant delivery that can overcome the problems associated with the INSURE technique are surfactant through a laryngeal mask, surfactant through a thin intratracheal catheter, and aerosolized surfactant delivered using nebulizers. The three alternative methods of surfactant delivery studied in the last two decades have advantages and limitations. More than a dozen randomized controlled trials have aimed to study the benefits of the three alternative techniques of surfactant delivery compared with INSURE as the control arm, with promising results in terms of reduction in mortality, need for mechanical ventilation, and bronchopulmonary dysplasia. The need to find a less invasive surfactant administration technique is a clinically relevant problem. Before broader adoption in routine clinical practice, the most beneficial technique among the three alternative strategies should be identified. This review aims to summarize the current evidence for using the three alternative techniques of surfactant administration in neonates, compare the three techniques, highlight the knowledge gaps, and suggest future directions. Key Points The need to find a less invasive alternative method of surfactant delivery is a clinically relevant problem. Clinical trials that have studied alternative surfactant delivery methods have shown promising results but are inconclusive for broader adoption into clinical practice. Future studies should explore novel clinical trial methodologies and select clinically significant long term outcomes for comparison. [ABSTRACT FROM AUTHOR]

Respiratory complications are the most frequent incidents in pediatric anesthesia after cardiac events. The pediatric respiratory physiology and airway anatomy are responsible for the particular respiratory vulnerability in this stage of life. This article explains the aspects of pulmonary embryogenesis relevant for anesthesia and their impact on the respiration of preterm infants and neonates. The respiratory distress syndrome and bronchopulmonary dysplasia are highlighted as well as the predisposition to apnea of preterm infants and neonates. Due to the anatomical characteristics, the low size ratios and the significantly shorter apnea tolerance, airway management in children frequently represents a challenge. This article gives useful assistance and provides an overview of formulas for calculating the appropriate tube size and depth of insertion. Finally, the pathophysiology and adequate treatment of laryngospasm are explained. [ABSTRACT FROM AUTHOR]

The onset of the COVID-19 pandemic has led to an increased use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS); however, there are ongoing concerns about its associated risks and benefits, making a comprehensive understanding vital for clinical decision-making. This review aims to evaluate the efficacy, risks, and practical implications of ECMO as a therapeutic intervention in severe ARDS secondary to COVID-19. The results indicate that ECMO is a key therapeutic intervention for managing severe COVID-19, but due to its associated risks and resource constraints, its application needs careful consideration. Nurse practitioners need to acquire specialized skills to manage ECMO and stay updated with ongoing research and revised protocols. Given the potential for future virus mutations or pandemics, and finite resources, a multidisciplinary approach to ECMO therapy is necessary. Careful patient selection, strategic resource allocation, and continuous education are pivotal elements for improved patient outcomes. [ABSTRACT FROM AUTHOR]

Stridor is an important symptom which should not be missed, especially in a child. The etiology could be multifactorial and will require a comprehensive investigation into its management. In this case, we discuss the clinician's dilemma in reaching a diagnosis due to various factors which were present in a single patient. This rare benign laryngeal squamous polyp was eventually diagnosed in an 11-week-old boy who presented with acute stridor. The diagnostic dilemma we discuss in this case was due to multiple maternal and fetal factors. He was a premature baby, intubated at birth, there was a maternal tuberculosis infection and he also had a cutaneous hemangioma which were all part of the diagnostic dilemma faced in his management which eventually led to an acquired subglottic stenosis. Our discussion will focus on how a thorough and proper evaluation is needed especially when there are many deceptive clues or signs present in a patient. [ABSTRACT FROM AUTHOR]

Introduction: Patent ductus arteriosus (PDA) causes a substantial increase in morbidities in premature babies by causing changes in organ perfusion. Various echocardiographic parameters are used to diagnose PDA and determine whether it is hemodynamically significant (HsPDA). This study aimed to investigate the role of tissue oxygen saturation in the first 24 hours in predicting HsPDA in high-risk premature babies who received respiratory support because of respiratory distress syndrome. Materials and Methods: In this prospective, observational study, cerebral, renal, and mesenteric regional tissue oxygen saturation levels were monitored by near infrared spectroscopy (NIRS) for the first 24 hours of the lives of preterm babies at ≤ 28 weeks of gestation. The NIRS data of babies with and without HsPDA as diagnosed by echocardiographic examination were compared. Results: Eighty-one premature babies who had HsPDA were included in the study. In the control group 51 premature babies who had not HsPDA were evaluated. The median ± standard deviation (SD) gestational age of the babies included in the study was 26.9 ± 1 weeks, and the mean ± SD birth weight was 880 ± 218 g. Renal and mesenteric NIRS measurements during follow-up were lower in babies with versus without HsPDA, but the difference was not statistically significant. Conclusion: Low renal and mesenteric stO2 values detected on the first day of life in high-risk infants may be associated with HsPDA. More studies are needed to reveal the effects of HsDPA on organs in these vulnerable babies with NIRS monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory distress is the leading cause of admission to neonatal units and is a common indication for medical retrieval. Whilst approximately 25% of births in NSW occur in regional centres, there is a paucity of neonatal research in these settings. Objective: To describe the characteristics and outcomes of term neonates admitted with respiratory distress to two regional special care nurseries (SCNs) and identify variables associated with the need for medical retrieval. Design: We describe a cohort of 629 term infants admitted to the SCN in two regional hospitals, 2015–2019. We describe the admission characteristics, level of respiratory support, biochemical investigations, diagnosis and outcomes. Findings: During the study period, 629 eligible term infants were admitted, retrieval occurred in 29 (4.6%). Those admitted were more often male (66.5%), with a mean gestational age of 39 + 1 weeks (±9 days) and birth weight of 3470 g (±500 g). Infants requiring medical retrieval had higher PaCO2 on blood gas analysis (59.8 mmHg vs. 53.3 mmHg, OR 1.03, p = 0.02). There was no association between maternal GBS status, meconium‐stained liquor, gestational age, or raised inflammatory markers and medical retrieval. Transient tachypnoea of the newborn was the most common diagnosis of neonates admitted to SCN with respiratory distress. Discussion: Among term infants admitted to a SCN for respiratory distress most were male, of a normal birthweight and born in good condition. Within our cohort there was no association between retrieval and maternal GBS colonisation, meconium‐stained liquor or raised infectious biomarkers. Medical retrieval was infrequent and was associated with higher PaCO2 on initial blood gas analysis. Conclusion: We present a large cohort of term newborn infants managed for respiratory distress in a regional setting over a five‐year period. Retrieval was infrequent, and outcomes for the cohort were excellent with no deaths during the study period. [ABSTRACT FROM AUTHOR]

Background: Continuous positive airway pressure (CPAP) has been used in children with bronchiolitis for a long time. Currently in the lowresource settings, the method of providing oxygen therapy via bubble CPAP (bCPAP) to children with respiratory distress is not standardized and the existing low-flow oxygen therapy has a high mortality rate. Objectives: To study the effectiveness and safety of bCPAP as a respiratory support in children with respiratory distress. Materials and methods: This prospective observational study was conducted in a tertiary care pediatric intensive care unit (PICU) over a period of 3 months. Children with respiratory distress were administered with bCPAP oxygen therapy. Baseline demographic data, such as age, sex, weight, severity of illness was collected. Changes in heart rate, respiratory rate, saturation, respiratory distress score and failure rate after bCPAP therapy were studied. Results: During the study period, 30 children were recruited. Most common cause of respiratory distress requiring bCPAP was pneumonia (66.7%) followed by pleural effusion (20%) and bronchiolitis (13.3%). The median (IQR) CPAP duration and PICU stay in the study was 48 hours (27-48) and 4 days (4-8), respectively. Heart rate and respiratory rate, respiratory distress score improved significantly after CPAP therapy (p < 0.05). CPAP therapy failed in one child and required invasive ventilation. We did not observe any complications due to bCPAP therapy. Conclusion: The use of bCPAP in the treatment of respiratory distress is safe and effective. [ABSTRACT FROM AUTHOR]

Objective Both high altitude and trisomy 21 (T21) status can negatively impact respiratory outcomes. The objective of this study was to examine the association between altitude and perinatal respiratory support in neonates with T21 compared with those without T21. Study Design This retrospective cohort study used the United States all-county natality files that included live, singleton, in-hospital births from 2015 to 2019. Descriptive statistics for neonates with and without the primary outcome of sustained assisted ventilation (>6 hours) were compared using t -tests and Chi-squared analyses. Multivariable logistic regression was used to determine the association between respiratory support and the presence of T21, and included an interaction term to determine whether the association between respiratory support and the presence of T21 was modified by elevation at delivery. Results A total of 17,939,006 neonates, 4,059 (0.02%) with T21 and 17,934,947 (99.98%) without, were included in the study. The odds of requiring sustained respiratory support following delivery were 5.95 (95% confidence interval [CI]: 5.31, 6.66), 4.06 (95% CI: 2.39, 6.89), 2.36 (95% CI: 1.64, 3.40), and 5.04 (95% CI: 1.54, 16.54) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevations, respectively. The odds of requiring immediate ventilation support following delivery were 5.01 (95% CI: 4.59, 5.46), 5.90 (95% CI: 4.16, 8.36), 2.86 (95% CI: 2.15, 3.80), and 12.08 (95% CI: 6.78, 21.51) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevation, respectively. Conclusion Neonates with T21 have increased odds of requiring respiratory support following delivery when compared with neonates without T21 at all categories of altitude. However, the odds ratios did not increase monotonically with altitude which indicates additional research is critical in understanding the effects of altitude on neonates with T21. Key Points Neonates with T21 have an increased need for perinatal respiratory support at all altitudes. The odds of needing perinatal respiratory support did not increase monotonically with elevation. Additional research is critical to understanding the effects of altitude on neonates with T21. [ABSTRACT FROM AUTHOR]

The less invasive surfactant application (LISA) technology has been widely used to manage breathing in premature infants. Premature infants with respiratory distress syndrome (RDS) were retrospectively analyzed and divided into 2 groups according to the drug delivery methods used: LISA versus traditional pulmonary surfactant injection (INSURE). The decrease of transcutaneous saturation (TcSO2) and heart rate during surfactant delivery in the LISA group was higher than that in the INSURE group (P <.05). Between the 2 groups, there was no significant difference in the change in partial pressure of oxygen/fraction of inspired oxygen value before and after drug delivery; second-use pulmonary surfactant; noninvasive ventilation (NIV) failure rate; incidence of some complications; duration of NIV use; hospitalization time; and mortality (P >.05). However, the incidence of bronchopulmonary dysplasia (BPD) in the LISA group was lower than that in the INSURE group (P <.05). The clinical efficacy of LISA combined with the NIV treatment in premature infants with RDS was clear, and this treatment could reduce the incidence of BPD. [ABSTRACT FROM AUTHOR]

Background: Bubble Continuous Positive Airway Pressure (BCPAP) is reported to be a safer alternative compared to mechanical ventilation in preterm neonates with respiratory distress syndrome (RDS). The objective of this study was to assess the effects of BCPAP on premature neonates with RDS. Methodology: This was an analytic cross-sectional study done over 7 months involving preterm neonates with RDS admitted at the AIC Kijabe Hospital New Born Unit. The duration of BCPAP support, duration of oxygen therapy and oxygen requirements at 36 weeks gestational age (GA), the GA of the infants when full enteral feeds were tolerated, and the complications of BCPAP were documented. Data was analyzed with SPSS version 17.0. Results: Sixty-one preterm neonates were recruited in the study, 54.1% male and 45.9% female. The median duration of BCPAP treatment was 5 days (IQR 3-7 days), and this was significantly associated with birth weight (p=0.044). The median duration of oxygen therapy was 6 days (IQR 4-17 days) and this was significantly associated with GA (p=0.003). Twenty percent of the neonates required oxygen administration at 36 weeks. The median age of full enteral feeds was 18 days (IQR 12-25 days). There were no major complications of BCPAP (pneumothorax, CPAP belly and nasal trauma). The mortality rate of preterm neonates treated with BCPAP was 13.1%. Conclusion BCPAP exhibited a favorable safety profile, with no major complications reported. It is a safe mode of respiratory support for preterm neonates with RDS and should be readily available in all newborn units. [ABSTRACT FROM AUTHOR]

Background: Blinding of treatment allocation from treating clinicians in neonatal randomised controlled trials can minimise performance bias, but its effectiveness is rarely assessed. Methods: To examine the effectiveness of blinding a procedural intervention from treating clinicians in a multicentre randomised controlled trial of minimally invasive surfactant therapy versus sham treatment in preterm infants of gestation 25–28 weeks with respiratory distress syndrome. The intervention (minimally invasive surfactant therapy or sham) was performed behind a screen within the first 6 h of life by a 'study team' uninvolved in clinical care including decision-making. Procedure duration and the study team's words and actions during the sham treatment mimicked those of the minimally invasive surfactant therapy procedure. Post-intervention, three clinicians completed a questionnaire regarding perceived group allocation, with the responses matched against actual intervention and categorised as correct, incorrect, or unsure. Success of blinding was calculated using validated blinding indices applied to the data overall (James index, successful blinding defined as > 0.50), or to the two treatment allocation groups (Bang index, successful blinding: −0.30 to 0.30). Blinding success was measured within staff role, and the associations between blinding success and procedural duration and oxygenation improvement post-procedure were estimated. Results: From 1345 questionnaires in relation to a procedural intervention in 485 participants, responses were categorised as correct in 441 (33%), incorrect in 142 (11%), and unsure in 762 (57%), with similar proportions for each of the response categories in the two treatment arms. The James index indicated successful blinding overall 0.67 (95% confidence interval (CI) 0.65–0.70). The Bang index was 0.28 (95% CI 0.23–0.32) in the minimally invasive surfactant therapy group and 0.17 (95% CI 0.12–0.21) in the sham arm. Neonatologists more frequently guessed the correct intervention (47%) than bedside nurses (36%), neonatal trainees (31%), and other nurses (24%). For the minimally invasive surfactant therapy intervention, the Bang index was linearly related to procedural duration and oxygenation improvement post-procedure. No evidence of such relationships was seen in the sham arm. Conclusion: Blinding of a procedural intervention from clinicians is both achievable and measurable in neonatal randomised controlled trials. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed to evaluate surfactant frequency and surfactant indications, as well as lung problems in late preterm infants. STUDY DESIGN: This retrospective and cross-sectional study was carried out by HSU Izmir Dr. Behcet Uz Pediatric Diseases and Surgery Research and Training Hospital. Infants who were born late preterm between January 2016 and January 2022 were hospitalized in the NICU due to respiratory distress in the first 24 hours. Lung problems and surfactant administration of these infants were evaluated. The frequency of surfactant dosages, their indications, and their effects were examined. As the control group, patients who were admitted to the NICU in the same period due to respiratory distress with similar indications but did not receive surfactant were considered. RESULTS: It was observed that surfactant was not administered to 105 infants and surfactant was administered to 106 infants. The median gestational week of the infants included in the study was 35 (34/36) weeks and the birth weight was 2185 (1780/2590) grams. A significant difference was observed in birth weight between the groups (p<0.001). Invasive ventilation was required in 52.1% of all cases and noninvasive ventilation was required in 33.6%. In the delivery room, the need for resuscitation and intubation was higher in the group requiring surfactant (p=0.001). The most common lung pathology in the surfactant group was RDS. CONCLUSION: It must not be forgotten that infants who are born late preterm infants are preterm infants and the evaluation of antenatal steroid administration must not be ignored. [ABSTRACT FROM AUTHOR]

Respiratory distress is a common presentation attended by paramedics. Chest auscultation has been shown to have low accuracy for diagnosing respiratory complaints, and this can lead to inaccurate patient assessment and potentially poor patient outcomes. Conversely, lung ultrasound is a relatively simple exam allowing for rapid differentiation of respiratory complaints with comparable accuracy to more advanced imaging modalities. Evidence suggests that lung ultrasound is easy to learn and apply and could be ideal for assessment of respiratory illness by paramedics. This study aimed to explore the utility of out-of-hospital lung ultrasound performed by intensive care paramedics (ICP) for patients with medical causes of respiratory distress, and explore whether the use of lung ultrasound affects the ICP's clinical impression or management. This was a prospective observational pilot study. After a training program, a sample of ICPs working in metropolitan and regional Victoria, Australia used ultrasound to assess adult patients with respiratory distress and/or dyspnea. ICPs used a handheld point-of-care ultrasound device to scan respiratory patients using a modified protocol, and completed a worksheet with their scan findings. The scans were then reviewed by a subject matter expert for quality and agreement. Ninety-five patients were enrolled over the study period. The average image quality score was 2.68/5, and 56% of scans were of interpretable quality. Interrater agreement (between the ICPs and the subject matter expert) was reported using Cohen's kappa. Moderate overall agreement (0.44) was shown, with the highest reliability reported in A-profile and B-profile (0.49 and 0.57). In 42% of cases performance of the scan affected paramedic clinical impression and/or management. ICPs can perform lung ultrasound with moderate accuracy for some respiratory conditions, and the scans may affect clinical impression and management. Future research should focus on enhanced education, expert feedback, and clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. Methods: A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann--Whitney U test, and area under the curve (AUC). Results: Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. Conclusion: The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time. [ABSTRACT FROM AUTHOR]

Background: Venovenous ECMO is a lifesaving technique for patients with severe respiratory failure. Management of carbon dioxide (CO2) levels at ECMO start is crucial, as recent studies found an association between rapid CO2 shifts and increased incidence of neurological complications. Purpose : To describe the role of end tidal CO2 (etCO2) monitoring at the ECMO start to minimize carbon dioxide shifts. Research design : Retrospective cohort study. Methods: We performed a retrospective analysis of patients who started venovenous ECMO support at our institution between 2011 and 2021. We analysed the minute-by-minute variations of etCO2, ventilatory parameters and arterial blood gas before and after the ECMO start. Results: 36 patients with a complete dataset of parameters were included. After the ECMO start, minute ventilation was progressively reduced from 10.8±;3.3 to 2.9±1.2 L/min (p<0.001). etCO2 did not vary significantly (baseline 37±10 vs 35±9 mmHg 20 minutes after ECMO start, p = 0.36). Despite a stable etCO2 level, a mild drop of arterial CO2 tension (9.5 mmHg, corresponding to a 18% change) was recorded at the first ABG sampled after the ECMO start. No patient developed neurological complications after the ECMO commencement. Conclusion: etCO2 monitoring during ECMO start is feasible and allows to adjust gas flow and ventilator settings to limit changes in arterial CO2 levels. [ABSTRACT FROM AUTHOR]

Respiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. The aim: The study is intended to evaluate the importance of giving antenatal corticosteroids in decreasing respiratory distress syndrome in preterm neonates. Materials and methods: Prospective cohort study done in all preterms delivered in the hospital attached to those admitted in our neonatal intensive care unit during the study duration are taken as the source. All preterm babies are admitted to the neonatal intensive care unit. Results: The overall incidence of RDS in this study was 30 (15 %), among which 7 (7 %) were exposed to steroids, and 23 (23 %) were not exposed to steroids. Antenatal corticosteroids were significantly associated with reduced incidence of RDS in preterms (neonates born between 28-37 weeks of gestational age). The overall incidence of TTN (transient tachypnea) was found to be 46 (28 %) in this study, among which 14 (14 %) were exposed to steroids, and 32 (32 %) were not exposed to steroids. Antenatal corticosteroids were significantly associated with reduced incidence of TTN in preterms. Antenatal corticosteroids significantly reduce the need for supplemental oxygen, NICU admission, need for CPAP and mortality rate. The dose of antenatal corticosteroids was significantly associated with the incidence of RDS and TTN. 2 doses of steroids reduced RDS and TTN significantly compared to the single dose, which was just significantly associated. This study found no significance between RDS and TTN with gestational age, mode of delivery, birth weight and RDS among steroid-exposed babies. Conclusion: The use of antenatal corticosteroids should be promoted because they successfully lowered morbidity and mortality among premature newborns in the population studied. In order to optimise proper and timely prenatal corticosteroid treatment, this study underlines the necessity for quality improvement initiatives. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study was to assess the safety and efficacy of 2 protocols for automatic lung recruitment maneuvers (LRMs) using stepwise increases in PEEP in a neonatal ARDS model. These protocols were designed with lower maximum opening pressures than traditional methods and differ each one in the duration of the opening phases (short vs prolonged). We described hemodynamic changes through invasive monitoring, and we analyzed if the behavior of the variables depends on the duration of the opening phase of the LRM. METHODS: We designed a prospective, experimental study with 10 Landrace x Large White pigs < 48 h old. Under general anesthesia, tracheal intubation, invasive hemodynamic monitoring with a pediatric arterial thermodilution catheter was performed. An ARDS model was developed with bronchoalveolar lavages. Two types of LRMs were performed in each piglet, with a maximum peak inspiratory pressure (PIP) of 30 cm H2O and a PEEP 15 cm H2O applied during 8.5 s in the short LRM and 17 s in the prolonged LRM. A comparative analysis by virtue of the Wilcoxon signed-rank test and a regression analysis using generalized estimation equation were performed. RESULTS: We found that both LRMs were effective regarding oxygenation and respiratory mechanics. Shortening the duration of the opening phase and lowering the maximum opening pressures to PIP 30 and PEEP 15 cm H2O were above the critical opening pressure to reverse alveolar collapse in our neonatal ARDS model. Although we observed hemodynamic variations during both types of LRMs, these were well tolerated. CONCLUSIONS: Our LRM protocols exceeded critical opening pressures to reverse alveolar collapse in our neonatal ARDS model. This range of pressures might involve less hemodynamic disturbance. Duration of the maximum opening pressure step is a determining factor for hemodynamic alterations. [ABSTRACT FROM AUTHOR]

To date, the impact of the COVID-19 pandemic on the world's health, economics and politics is still heavy, and efforts to mitigate virus transmission have caused remarkable disruption. From the early onset of the pandemic, generated by SARS-CoV-2 spread, the scientific community was aware of its impact on vulnerable individuals, including pregnant women. The purpose of this paper is to highlight scientific pitfalls and ethical dilemmas emerging from management of severe respiratory distress in pregnant women in order to add evidence to this topic through an ethical debate. In the here-presented paper, three cases of severe respiratory syndrome are analyzed. No specific therapeutic protocol was available to guide physicians in a cost–benefit balance, and unequivocal conduct was not a priori suggested from scientific evidence. However, vaccines' advent, viral variants lurking on the horizon and other possible pandemic challenges make it necessary to maximize the experience gained through these difficult years. Antenatal management of pregnancies complicated by COVID-19 infection with severe respiratory failure is still heterogeneous and ethical concerns must be pointed out. [ABSTRACT FROM AUTHOR]

Background: The benefit of antenatal corticosteroid (ACS) administration for the prevention of neonatal morbidity and mortality has been well described for preterm infants. Some studies have demonstrated a benefit for infants born by elective caesarean section (CS) at late preterm or term gestations. However, the neonatal benefits of ACS are not well described when given to pregnant women with diabetes. Aims: The aim of this study was to evaluate the neonatal outcomes following ACS administration in women with pre‐gestational diabetes mellitus (PGDM) when administered prior to elective CS after 36 weeks gestation. Methods: This retrospective observational study included all women with PGDM who gave birth by elective CS between 36+0 and 38+6 weeks gestation. Neonatal outcomes for exposed participants were compared to outcomes for non‐exposed participants. Results: Of the 306 women identified, 65 (21.2%) were exposed to ACS within seven days prior to birth and 241 (78.8%) were not. Although not statistically significant, ACS‐exposed infants born prior to 38+0 weeks were less likely to require respiratory support or neonatal nursery admission compared to those who were not exposed; however, exposed infants born after 37+0 weeks were more likely to require parenteral treatment for neonatal hypoglycaemia. Conclusion: This study did not demonstrate any statistically significant beneficial or harmful effects of ACS in neonates of women with PGDM who are born by elective CS. While it is plausible that ACS could reduce neonatal respiratory morbidity in this population, further prospective studies evaluating the benefits and harms are required before recommending this practice. [ABSTRACT FROM AUTHOR]

Introduction: Venovenous extracorporeal membrane oxygenation (VV ECMO) is now considered a reasonable option to salvage acute respiratory distress syndrome (ARDS). However, we lack a rodent model for experimental studies. This study was undertaken to establish an animal model of VV ECMO in ARDS rats. Methods: A total of 18 Sprague-Dawley (SD) rats (350 ± 50 g) were used in this study. Using a rat model of oleic acid (OA)-induced ARDS, VV ECMO was established through cavoatrial cannulation of the right jugular vein for venous drainage and venous reinfusion with a specially designed three-cavity catheter. Continuous arterial pressure monitoring was implemented by using a catheter through cannulation of the right femoral artery. The central temperature was monitored with a rectal probe. Arterial blood gas monitoring was implemented by a blood gas analyzer at three-time points: at baseline, 1-hour (after OA modeling), and 3.5-hour (after VV ECMO support). Lung tissue and bronchoalveolar lavage fluid were harvested respectively for protein concentration and pulmonary histologic evaluation to confirm the alleviation of lung injury during VV ECMO. Results: Following ARDS induced by OA, ten rats were successfully established on VV ECMO without failure and survived the ECMO procedure. VV ECMO alleviated lung injury and restored adequate circulation for the return of lung function and oxygenation. VV ECMO was associated with decreased lung injury score, wet/dry weight ratio, and fluid leakage into airspaces. Conclusion: We have established a reliable, economical, and functioning ARDS rat model of VV ECMO. [ABSTRACT FROM AUTHOR]

The use of noninvasive respiratory support is widespread in newborn infants with respiratory distress. As the use of noninvasive respiratory support has increased, so too have the number of modes available. Among these modes, low‐flow nasal cannula and nasal continuous positive airway pressure (NCPAP) have been used for a long time and have known efficacy and safety in newborn infants needing respiratory support. High‐flow nasal cannula (HFNC) has been newly introduced, and its efficacy and safety are currently being investigated. Bilevel nasal continuous positive airway pressure and nasal intermittent positive‐pressure ventilation are often used when NCPAP or HFNC therapy fails. More recently, noninvasive neurally adjusted ventilatory assist and noninvasive high‐frequency oscillatory ventilation have been introduced, and their efficacy and safety are currently under evaluation. Comparison of the efficacy and safety among various modes of noninvasive respiratory support after extubation in preterm infants is helping to clarify the position of each mode. The clarification of the strength and characteristics of each device within the same mode will become important as a future direction of noninvasive respiratory support after extubation in such subjects. However, no research has yet reported on long‐term outcomes in preterm infants receiving noninvasive respiratory support after extubation. Therefore, further research is needed to evaluate the long‐term outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the assessment and care of preterm infants during the initial critical hours after birth, emphasizing the importance of recognizing signs of decompensation, choosing between CPAP and High-Flow Nasal Cannula (HFNC), and monitoring for potential complications such as sepsis, Patent Ductus Arteriosus (PDA), and respiratory distress.

Aim: Routes for surfactant administration for respiratory distress syndrome (RDS) has changed from bolus endotracheal administration together with ongoing mechanical ventilation, to intubation-surfactant administration and rapid extubation (INSURE) method and finally to less invasive surfactant administration (LISA). In this study our aim was to compare respiratory outcomes of LISA and INSURE methods for surfactant delivery in very low birth weight (VLBW) infants. Materials and Methods: This retrospective, single-center study was performed in a one year period in between March 2014-2015. Data of VLBW infants who had diagnosis of RDS and received surfactant treatment via LISA or INSURE techniques were analyzed. Primary outcome of the study was failure of non-invasive respiratory support. Secondary outcomes were bronchopulmonary dysplasia diagnosis and its severity, duration of mechanical ventilation via endotracheal tube, total number of surfactant administered, duration of hospitalization and duration of all sorts of non-invasive respiratory support. Non-invasive ventilatory support failure incidences of LISA group according to gestational ages were also analyzed. Results: Fifty-nine VLBW infants in LISA group and 55 VLBW infants in INSURE group were analyzed. Need for intubation/reintubation (noninvasive ventilatory support failure) was significantly lower in LISA group (31.6% vs 49%, p=0.043). Duration of intubation was significantly longer in INSURE group [0 vs 4 days (median), p=0.001]. Both LISA and INSURE treated infants had similar moderate to severe BPD ratios (26.6% vs 32.7%, p=0.306). We did not observe any reported complications during application of both methods. Intubation ratios were lowest in the group with gestational ages 28-29 weeks (25%). Conclusion: LISA technique for surfactant delivery to preterms with RDS is a safe method ending with lower rates of need for intubation/reintubation. Even if no difference in BPD incidences in between the two groups was observed at the 36th corrected gestational week, intubation duration of infants was significantly lower in LISA group. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of prehospital noninvasive positive pressure ventilation (NIPPV) and standard care for severe respiratory distress. Background: Severe respiratory distress is an important cause of death in adult patients. There is a growing body of research exploring the benefits of nasal intermittent positive pressure ventilation (NIPPV) for patients undergoing severe respiratory distress. However, a systematic review is needed to synthesise and summarise this body of knowledge to identify the effectiveness of NIPPV. This is an update of a meta‐analysis first published in 2014. Design: Meta‐analysis based on PRISMA guidelines. Methods: Databases including PubMed, Embase, Scopus and the Cochrane Library databases were electronically searched to identify randomised controlled trials (RCTs) that reported NIPPV therapy for adult patients with severe respiratory distress. The retrieval time is limited from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Meta‐analysis was performed by using STATA 11.0 software. Results: A total of 10 studies involving 1465 patients were included. The meta‐analysis results showed that compared with standard care, CPAP therapy decreased intubation rate (RR = 0.43, 95% CI: 0.27–0.67, p <.001, I2 = 0.0%), reduced hospital stay (WMD = −4.19, 95% CI: −5.62, −2.77) and ICU stay (WMD = −0.65, 95% CI: −1.09, −0.20) for patients with severe respiratory distress. However, no significant effects of NIPPV were observed on in‐hospital mortality (RR = 0.83, 95% CI: 0.64–1.07) and ICU admission rate (RR = 0.93, 95% CI: 0.73–1.19). Conclusions: Adult patients with NIPPV treatment for severe respiratory distress had a significantly lower intubation rate and shorter hospital and ICU stay, compared with those with standard care. However, no effect of NIPPV on in‐hospital mortality was observed. Further study is needed by enrolling large‐sample original studies. Relevance to clinical practice: Among patients with severe respiratory distress, prehospital NIPPV, compared with standard care, was associated with lower intubation rate and shorter hospital and ICU stay in our study. Although our meta‐analysis did not find a relationship between prehospital NIPPV and in‐hospital mortality and ICU admission rate, which may be limited by the number of studies included and the small sample size. However, our study still suggested that the use of prehospital NIPPV was beneficial to the condition of patients with severe respiratory distress. [ABSTRACT FROM AUTHOR]

The article discusses the management of respiratory diseases for neonates with congenital heart disease (CHD). Topics covered include the cardiopulmonary interactions that may affect the care of neonates with CHD, the pathophysiology of ventilator induced lung injury (VILI) and the strategies to minimize its development, and invasive and noninvasive respiratory support modalities which includes strategies for managing mechanical ventilation.

Background: Respiratory distress syndrome (RDS) is considered a major problem in preterm infants. Surfactant deficiency is the main cause of RDS as it is necessary for lung functions. The treatment of surfactant in neonatology reduced mortality and improved the prognosis of RDS. Aim and objectives: To compare between efficacies of surfactant administration by laryngeal mask technique and minimally invasive surfactant therapy (MIST). Patients and methods : A randomized clinical trial study was carried out at the Neonatal Intensive Care Unit (NICU), Zagazig University Hospitals, on 24 patients who were divided into two groups, all patients received (poractant 120 mg/1.5 mL) and the same dose (200 mg/kg) for surfactant preparation, with close monitoring of the infants. Results: There was no statistically significant difference between both groups as regard FiO2 before intervention while there was a highly significant decrease in FiO2 at 6, 12 and 24 hours in thin tracheal catheter group, on the other hand, each group showed a highly significant decrease in FiO over time after intervention. Also, there was a statistically significant decrease in nasal continuous positive airway pressure (NCPAP) and duration of O2 therapy in thin tracheal catheter group and there was no statistically significant difference between them as regard need for mechanical ventilation or occurrence of death during hospital stay. Conclusion: The endotracheal method is prior to the laryngeal mask method for surfactant alternative therapy. [ABSTRACT FROM AUTHOR]

Objective  Laryngeal mask airway (LMA) has emerged as an alternative surfactant delivery method. The effectiveness of this method for the delivery of surfactant is uncertain. A meta-analysis of randomized control trials (RCTs) comparing LMA with standard methods of surfactant delivery for the outcomes of surfactant dose repetition, oxygen requirement, mechanical ventilation, intubation, mortality, bronchopulmonary dysplasia (BPD), and pneumothorax. Study Design  Systematic review and meta-analysis of RCTs. Homogeneity between studies was analyzed by using I 2 statistics. Risk ratio or mean difference of outcomes was assessed from random effects models. Subgroup analyses were conducted when necessary. Data sources are as follows: Ovid Medline, Embase, and the Cochrane Central Register of Controlled trials from inception till December 2018, bibliographies of identified reviews and trial registries for ongoing studies. RCTs comparing short-term respiratory outcomes in neonates with respiratory distress syndrome who were administered surfactant through an LMA versus standard method of care. Results  Six RCTs were identified, enrolling a total of 357 infants. Administering surfactant via LMA was associated with decreased FiO 2 requirement (mean difference = 1.82 (95% confidence interval [CI]: −6.01–9.66), decreased intubation (risk ratio [RR] = 0.17; 95% CI: 0.05–0.57), and decreased mechanical ventilation (RR = 0.44; 95% CI: 0.31–0.61). There were no significant differences between groups for death, BPD, or pneumothorax. Conclusion  LMA might be an effective alternative method of surfactant delivery; however, further high-quality RCTs with larger sample size and including extreme preterm infants are needed to establish LMA as an alternative technique for surfactant delivery. Key Points Pulmonary surfactants reduce mortality and pulmonary air leaks in newborns with respiratory distress syndrome. Preterm lungs are at risk of volutrauma by mechanical ventilation; laryngoscopy is still traumatic. Surfactant administration via LMA to avoid mechanical ventilation and intubation might be feasible. [ABSTRACT FROM AUTHOR]

Background Respiratory distress syndrome (RDS) of prematurity is a major cause of morbidity and mortality in preterm infants, caused by deficiency of pulmonary surfactant and structural immaturity of the lungs. Preterms with RDS should be given a natural surfactant as early as possible. Early surfactant therapy (within 2 h of birth) should be considered for preterms with gestation periods less than or equal to 31 weeks if the need for intubation in the delivery room arises. Lack and unavailability of surfactant in middle-income and low-income countries can occur, and preterms with RDS are treated with ventilation only. Aim The aim of this study was to study the effectiveness of surfactant application in preterms less than 36 weeks with RDS. Short-term effectiveness was monitored by improvement of chest radiograph, oxygen saturation (SpO2), and blood gases with decreasing ventilatory settings after 6 h. Long-term effectiveness was monitored by fate, duration of oxygen therapy, and duration of hospital stay. Moreover, the adverse effects of surfactant were detected. Patients and methods This cross-sectional study was carried out over a period of 18 months in the neonatal ICUs of the Department of Pediatrics, Cairo University hospitals, and included 180 preterms less than 36 weeks of gestational age. We compared 90 preterms less than 36weekswithRDSwhoreceivedmorethanorequal toonedoseofsurfactanttherapy, with 90 controls who had RDS and were eligible for the criteria of administration of surfactant but could not receive surfactant because of its unavailability in the unit at their time of admission. The two groups were compared regarding the period of ventilation, the improvement in ventilator settings and the capillary blood gases after surfactant application, hospital stay, and complications of prematurity. Results Surfactant application significantly improved the preterms, as seen in improvement of radiograph, capillary blood gases, and SpO2. Six hours after administration of surfactant in the case group, 59 (65.6%) cases showed an improvement in capillary blood gases, and after 6 h of ventilation in the control group, only 21 (23.3%) showed improvement in capillary blood gases, with a P value of 0.001. A total of 60 (66.7%) cases had an improved SpO2 after 4 h, but this was seen in only 17 (18.9%) controls, with a P value less than 0.001. Findings of RDS in chest radiograph showed improvement in 60 (66.7%) preterms in the cases group, whereas in the control group, 37 (41.1%) preterms were only improved. However, the mortality rates and the incidence of bronchopulmonary dysplasia were slightly higher in the group that received surfactant, with P values of 0.488 and 0.530, respectively. Conclusion Surfactant application showed significant improvement in preterms with RDS, as seen in improvement of radiograph, capillary blood gases, and SpO2. The mortality rate and the incidence of bronchopulmonary dysplasia were significantly higher in the surfactant group. Risk factors that significantly increased the mortality rates and the hospital stay in cases that received surfactant were very low body weight, gestational age less than 32 weeks, Downe's score more than 7, severe pulmonary hypertension, and late-onset sepsis. Sustainable efforts to provide all preterms with RDS in low-middle income countries with surfactant therapy should be encouraged. [ABSTRACT FROM AUTHOR]

Survival of preterm infants has increased steadily over recent decades, primarily due to improved outcomes for those born before 28 weeks of gestation. However, this has not been matched by similar improvements in longer-term morbidity. One of the key long-term sequelae of preterm birth remains bronchopulmonary dysplasia (also called chronic lung disease of prematurity), contributed primarily by the effect of early pulmonary inflammation superimposed on immature lungs. Non-invasive modes of respiratory support have been rapidly introduced providing modest success in reducing the incidence of bronchopulmonary dysplasia when compared with invasive mechanical ventilation, and improved clinical practice has been reported from population-based studies. We present a comprehensive review of the key modes of non-invasive respiratory support currently used in preterm infants, including their mechanisms of action and evidence of benefit from clinical trials. [ABSTRACT FROM AUTHOR]

Oxygen therapy by appropriate oxygen delivery device (ODD) at different stages is an essential part of hypoxemic respiratory failure management. The choice of ODDs depends on the degree of hypoxemia, precision of delivery, patient comfort, risk of transmission of infection to Health Care Worker (HCW), and the cost. Management of hypoxemic respiratory failure depends on underlying etiology and pathophysiology of the disease process. Study from the current global pandemic of novel coronavirus disease 2019 (COVID-19) showed that the severity of hypoxemia is independently associated with in-hospital mortality and can be an important predictor risk of admission to intensive care unit. In this review, we will discuss the different ODDs, their indication for use along with the advantages and disadvantages. [ABSTRACT FROM AUTHOR]

An introduction is presented on the systematic reviews on the care of preterm and low birth weight (LBW) infants, including infection prevention, thermal care, responsive care, and prevention of injury and pain.

In preterm infants with respiratory distress syndrome (RDS), non-invasive ventilation (NIV) is usually provided using nasal continuous positive airway pressure (NCPAP) or non-invasive mechanical ventilation after surfactant administration by INtubation-SURfactant-Extubation (INSURE) method. Heated humidified high-flow nasal cannula (HHHFNC) is a mode of NIV with advantages of ease of application, less grades of nasal injury and easy handling. This study was done to compare the effectiveness of HHHFNC therapy administration as post-INSURE respiratory support in preterm infants as compared to NCPAP. The primary outcome was to compare the rate of treatment failure within 7 days of randomization to HHHFNC or NCPAP as a post-INSURE ventilatory modality. It was a pilot trial wherein all preterm infants more than 1 kg and more than 28 weeks gestational age with RDS who required surfactant were randomized to receive NCPAP or HHHFNC. Infants with an urgent need for intubation and mechanical ventilation were considered to have treatment failure. Thirty babies were enrolled-15 in each group. Baseline demographic characteristics were comparable. There was no significant difference in the primary outcome of early failure rate, i.e. mechanical ventilation rate within 7 days of starting treatment. There were no significant differences in other outcomes except nasal injury which was significantly lesser in the HHHFNC group. In conclusion, HHHFNC appears to be non-inferior to NCPAP when used in preterm infants more than 28 weeks gestation with RDS as a post-INSURE ventilatory modality. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of an original Lung UltraSound Targeted Recruitment (LUSTR) protocol to improve the success of lung recruitment maneuvers (LRMs), which are performed as a rescue approach in critically ill neonates. All the LUSTR maneuvers, performed on infants with an oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this case−control study (LUSTR-group). The LUSTR-group was matched by the initial S/F ratio and underlying respiratory disease with a control group of lung recruitments performed following the standard oxygenation-guided procedure (Ox-group). The primary outcome was the improvement of the S/F ratio (Delta S/F) throughout the LRM. Secondary outcomes included the rate of air leaks. Each group was comprised of fourteen LRMs. As compared to the standard approach, the LUSTR protocol was associated with a higher success of the procedure in terms of Delta S/F (110 ± 47.3 vs. 64.1 ± 54.6, p = 0.02). This result remained significant after adjusting for confounding variables through multiple linear regressions. The incidence of pneumothorax was lower, although not reaching statistical significance, in the LUSTR-group (0 vs. 14.3%, p = 0.15). The LUSTR protocol may be a more effective and safer option than the oxygenation-based procedure to guide open lung ventilation in neonates, potentially improving ventilation and reducing the impact of ventilator-induced lung injury. [ABSTRACT FROM AUTHOR]

The article discusses a unique program focused on the use of bubble nasal CPAP for critically ill very low birth weight infants. Topics include the impact of bubble nasal CPAP on reducing chronic lung disease and facilitating weaning from mechanical ventilation, the comprehensive two-day course covering various neonatal respiratory care techniques, and the interactive conference format offering workshops and live Q&A to enhance knowledge and practical skills in respiratory support for neonates.