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The study aims to establish the role of late aEEG (scored by Burdjalov) in predicting brain maturation as well as abnormalities evaluated at term equivalent age (TEA) by brain MRI.91 infants born before 30 wks gestation underwent an aEEG monitoring at 32 wks postconceptional age (PCA). aEEG, was correlated with TEA MRI, scored by Kidokoro.A significant correlation between the aEEG score and the MRI scores was found. The same results were obtained for the aEEG continuity score; cyclicity and bandwidth scores were associated with grey matter and cerebellar MRI items. Moreover, a correlation between aEEG and cEEG recorded both at 32 and 40 wks PCA, was found.aEEG monitoring can be predictive of MRI findings at TEA, suggesting that it could be implemented as a useful tool to support ultrasound to help identify neonates who will benefit from early intervention services.

PurposeThe objective of this study was to investigate the effectiveness of an original Lung UltraSound Targeted Recruitment (LUSTR) protocol to improve the success of lung recruitment maneuvers (LRMs), performed as a rescue approach in critically ill neonates, as compared to the standard oxygenation-guided LRM. MethodsAll the LUSTR maneuvers, performed in infants with 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 (which is inversely proportional to the severity of the respiratory insufficiency) 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 variation of the Oxygen Saturation Index (OSI) and the rate of air-leaks.ResultsEach group was constituted 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), and delta OSI (8.2±6.8 vs 2.8±2.2, p = 0.01). These results remained significant after adjusting for confounding variables through multiple linear regressions. All the LRMs in the LUSTR group obtained the sonographic resolution of the lung derecruitment. Patient position before and during LRM was modified more frequently in the LUSTR group. The incidence of pneumothorax was lower, although not reaching statistical significance, in the LUSTR-group (0 vs 14.3%, p = 0.15).ConclusionThe LUSTR protocol may be a more effective and potentially safer option than the oxygenation-based procedure to guide open lung ventilation in neonates.

PurposeThe objective of this study was to investigate the effectiveness of an original Lung UltraSound Targeted Recruitment (LUSTR) protocol to improve the success of lung recruitment maneuvers (LRMs), performed as a rescue approach in critically ill neonates, as compared to the standard oxygenation-guided LRM.MethodsAll the LUSTR maneuvers, performed in infants with oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this retrospective case-control study (LUSTR-group). The LUSTR-group was matched by the initial S/F ratio (which is inversely proportional to the severity of the respiratory insufficiency) 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 variation of the Oxygen Saturation Index (OSI) and the rate of air-leaks.ResultsEach group was constituted by 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), and OSI (8.2±6.8 vs 2.8±2.2, p = 0.01). These results remained significant after adjusting for confounding variables through multiple linear regressions. All the LRM in the LUSTR group showed signs of lung recruitability and obtained the sonographic resolution of the lung derecruitment. Patient position before and during LRM was modified more frequently in the LUSTR group. A trend towards decreased rates of pneumothorax was observed in the LUSTR-group (0 vs 14.3%, p = 0.15).ConclusionThe LUSTR protocol may be a more effective and potentially safer option than the oxygenation-based procedure to guide open lung ventilation in neonates.

The study of respiratory mechanics in infants requires a noninvasive accurate measurement of the lung volume changes (DeltaVL). Optoelectronic plethysmography (OEP) allows the assessment of DeltaVL through the measurement of the chest wall surface motion and it has been proved to be accurate in adults. The aim of this study was to apply OEP to newborns and to validate it by comparison to pneumotachography. Twenty term and preterm newborns (GA = 34 +/- 5 wk) in stable condition were studied during 1 to 2 min periods of quiet breathing in supine position. Airway opening flow was measured by applying a facemask connected to a pneumotachograph (PNT) and integrated to provide the DeltaVL. Chest wall volume changes were simultaneously measured by OEP. The tidal volume values measured by pneumotachography and by OEP were compared for each breath. A total of 771 breaths from all patients were considered. Bland-Altmann analysis showed a mean difference of -0.08 mL and a limit of agreement ranging from -2.98 to 2.83 mL. Linear regression analysis demonstrated good correlation between the two techniques (r = 0.95, q = 1.00 mL, m = 0.96). OEP provides accurate measurements of DeltaVL in newborns and may be useful to study respiratory mechanics and breathing patterns during spontaneous breathing and mechanical ventilation.

Objective: To evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI). Methods: A retrospective study conducted in a single third level Italian centre (2005–2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation – MV, nasal continuous positive airway pressure – N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV). Results: During the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2). Conclusions: In this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.

The aims of the present study were (i) to characterize the relationship between mean airway pressure (PAW) and reactance measured at 5 Hz (reactance of the respiratory system (X RS), forced oscillation technique) and (ii) to compare optimal PAW (P opt) defined by X RS, oxygenation, lung volume (VL), and tidal volume (VT) in preterm lambs receiving high-frequency oscillatory ventilation (HFOV).Nine 132-d gestation lambs were commenced on HFOV at PAW of 14 cmH2O (P start). PAW was increased stepwise to a maximum pressure (P max) and subsequently sequentially decreased to the closing pressure (Pcl, oxygenation deteriorated) or a minimum of 6 cmH2O, using an oxygenation-based recruitment maneuver. X RS, regional V L (electrical impedance tomography), and V T were measured immediately after (t 0 min) and 2 min after (t 2 min) each PAW decrement. P opt defined by oxygenation, X RS, V L, and V T were determined.The PAW-X RS and PAW-VT relationships were dome shaped with a maximum at Pcl+6 cmH2O, the same point as P opt defined by VL. Below Pcl+6 cmH2O, X RS became unstable between t 0 min and t 2 min and was associated with derecruitment in the dependent lung. P opt, as defined by oxygenation, was lower than the P opt defined by X RS, V L, or V T.X RS has the potential as a bedside tool for optimizing PAW during HFOV.

We measured the concentration of interferon-gamma and interleukin-4 in the exhaled breath condensate of children with atopic and nonallergic dermatitis receiving a probiotic supplementation (Lactobacillus reuteri ATCC 55730) or placebo for 8 weeks. We demonstrated that the levels of these cytokines increased and decreased respectively only in atopic subjects receiving active treatment. Our data suggest that the oral administration of a specific probiotic strain in patients with atopic dermatitis can modulate in vivo the cytokine pattern at a different site from intestine.

Several studies have shown that late preterm infants (LPI) are at higher risk for respiratory disorders than term infants. Objective: To evaluate occurrence of respiratory disorders, need for respiratory support, use and timing of specific adjunctive pulmonary therapies in LPI. Methods: Using electronic medical charts, we performed a retrospective analysis of all LPI (34 0/7 to 36 6/7 wks) born from January 2005 to December 2009 in a tertiary level NICU. Results: During the study period, 856/14443 infants born alive were LPI (5.9%). They accounted for 58.9% of preterm births. Majority of LPI were 36 weeks (53.9%), followed by 35 weeks (28.4%) and 34 weeks (17.8%). Transient tachypnea of the newborn (5.8%) was the most common pulmonary illness, followed by respiratory distress syndrome (4.7%), apnea (1.5%), air leak (1.3%) and persistent pulmonary hypertension (0.5%). Composite respiratory morbidity was 12.4%: A total of 69 (8.1%) patients received NCPAP only, 19 (2.2%) mechanical ventilation, 17 (2%) surfactant, 8 (0.9%) chest tube and 4 (0.5%) inhaled nitric oxide. Fig 1 shows the highest levels of respiratory support for each GA. Fig 2 shows times at which each treatment was started. Median length of positive pressure ventilation was 40.5 hours (IQR 16.9-91.6). Mortality was 0.4%. Conclusion: Compared with literature, our population showed lower incidence of mortality, respiratory disorders and need for assisted ventilation, probably due to a great proportion of more mature infants.

Background and aim: Optoelectronic plethysmography (OEP) allows the measurement of lung volume changes through the assessment of chest wall surface motion. It has been shown that it provides an accurate estimation of total and compartmental (rib cage and abdomen) lung volume changes in adults during spontaneous breathing and mechanical ventilation and in spontaneously breathing infants (REF). The aim of the present study is to evaluate the accuracy of OEP in infants during continuous positive airways pressure (CPAP). Methods: 5 infants (GA=27.9±3.6, PNA=3.8±3.6, BW=1077±461) were studied for ∼ 2 minutes at CPAP 0, 4 and 8 cmH2O. Flow was measured at the inlet of a full-face mask by a mesh-type pneumotacograph connected to a differential pressure transducer. Chest wall volume changes were measured by OEP (DVOEP) and compared with lung volume changes obtained by integrating the flow signal (DVPNT). Results: We analysed a total of 602 breaths at 0 cmH2O, 523 at 4 cmH2O, and 150 at 8 cmH2O. The mean difference between DVOEP and DVPNT for all newborns was -0.45±3.92% of Vt at 0 cm H2O, -4.25±9.04% at 4 cmH2O and -8.31±3.87% at 8 cmH2O. Pooling data points from all infants and all pressure levels, Bland-Altman and linear regression analysis showed good agreement between the two measurement techniques (see Fig). Conclusions: OEP can be used to assess lung volume changes and breathing pattern noninvasively in newborns supported by CPAP.