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This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26–27, 2018 at the Radcliffe Institute at Harvard University. The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. We describe the diagnostic shift away from SIDS and the practical issues contributing to it. The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers. SIDS was reframed as unexplained sudden death in infancy or SIDS/MH11 to emphasize that either term signifies the lack of explanation following a rigorous investigation. A distinct category for children over the age of 1 was recommended (MH12). Definitions and exclusions were provided for the alternative categories of accidental asphyxia and undetermined. As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. The conclusions will be submitted to the World Health Organization for inclusion in the upcoming ICD-11. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EAdi), a measure of neural respiratory drive and inspiratory load, may be a useful predictor of extubation success in preterm neonates. The objective of this work was to investigate whether peak EAdi could distinguish successful versus failed extubation in mechanically ventilated preterm infants. METHODS: We examined peak EAdi as a predictor of extubation outcome in a convenience sample of 21 preterm infants with respiratory distress syndrome requiring mechanical ventilation. Infants were ventilated with a VN500 ventilator using volume guarantee mode and extubated per unit protocol. Peak EAdi was continuously measured with an EAdi catheter in the esophagus to obtain data at 1-min intervals for 24 h before extubation. The primary outcome was extubation success, defined as not requiring re-intubation for at least 72 h. RESULTS: Twenty one premature infants with respiratory distress syndrome included in the study had a mean ± SD) gestational age of 28 ± 2.6 weeks and mean birthweight of 1,208 ± 611 g. The first extubation attempt occurred at a median age of 1 d (interquartile range 1-2 d). One third of the infants failed the first extubation attempt. Infants with failed extubations were significantly smaller (mean ± SD birthweight 788 ± 266 g versus 1,417 ± 632 g) and of lower gestational age (mean ± SD 26 ± 1.9 weeks versus 29 ± 2.6 weeks) compared with those with successful extubation. Mean peak EAdi before extubation did not differ between the 2 groups. CONCLUSIONS: This small study suggests that the pre-extubation peak EAdi does not predict extubation success. (ClinicalTrials.gov registration NCT02144363.) [ABSTRACT FROM AUTHOR]

Objective: To compare the level of continuous positive airway pressure (CPAP) delivered by the RAM cannula system (Neotech, Valencia, CA) with that delivered by a traditional CPAP nasal delivery interface (Hudson prongs; Hudson-RCI, Temecula, CA) in preterm infants with respiratory distress., Methods: This was a crossover intervention study in a convenience sample of preterm infants with respiratory distress requiring treatment with CPAP. We measured the mean intraoral (pharyngeal) pressure, which approximates the applied CPAP level, using both the RAM cannula and Hudson prongs. The primary outcome was a comparison of the differences between the set CPAP levels and the measured intraoral pressures of both delivery systems., Results: We analyzed data from 12 preterm infants with mean (standard deviation) birth weight of 1,225 (405) g and gestational age of 28.4 (2.1) weeks at a median postnatal age of 10 days. The mean difference (95% confidence interval) between the set CPAP level and measured intraoral pressure was -2.45 cm H 2 O (-3.36, -1.55) with the RAM cannula and +0.40 cm H 2 O (-0.30, 1.12) with Hudson prongs, p  = 0.0002., Conclusion: For given set CPAP pressure level in preterm infants, the RAM cannula system consistently delivers lower pharyngeal pressure (effective CPAP) levels than Hudson prongs., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)