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New neonatal ventilation methods have developed over the recent past and now utilize new technological tools with the aim of decreasing induced lung injury while promoting growth of the developing neonatal lung. The previous methods of patient triggering were based on detecting patient's effort by either air flow or airway pressure differences. This limited the patient control to the initiation of the breath and was plagued by a delay in detecting this initial effort. Recently, neurally adjusted ventilatory assist (NAVA) has emerged as an innovative technology which gives the patient full control of timing and magnitude of the respiratory cycle. The patient-ventilator synchrony is improved because the diaphragmatic electromyogram controls the patient's own breathing as well as the ventilator. In addition to breath initiation; the neural control in NAVA improve synchrony in all phases of mechanical ventilation including breath magnitude, plateau and cycle-off or termination which are all important phases of patient ventilation synchrony. The experience in using NAVA as a tool for neonatal ventilation is still limited, especially in the extremely premature neonate, where little has been published regarding the indications, advantages and limitations of this new technology. NAVA offers other clinical and diagnostic innovations. With NAVA, traditional challenges imposed by airway leaks are easily managed. Additionally, NAVA works in concert with the diaphragm, encouraging its use, and minimizing its atrophy. It can also be a valuable tool in identifying true central apnea. A potential limitation of NAVA use in extremely premature neonates is related to the immaturity of respiratory drive and frequent apnea. Additionally, neonates under heavy sedation or neuromuscular blockade are not good candidates for NAVA. As NAVA is used on more neonatal patients, cumulative knowledge will enhance clinical practice, adding a valuable tool to the armament of neonatal care units. [ABSTRACT FROM AUTHOR]

Rare genetic syndromes, conditions with a global average prevalence of 40 cases/100,000 people, are associated with anatomical, physiological, and neurological anomalies that may affect different body districts, including the oral district. So far, no classification of oral abnormalities in rare genetic syndromes is present in the literature. The aim of this narrative review is to analyze literature on rare genetic syndromes affecting dento-oro-maxillofacial structures (teeth, maxillary bones, oral soft tissues, or mixed) and to propose a classification according to the detected oral abnormalities. In addition, five significant cases of rare genetic syndromes are presented. The Scale for the Assessment of Narrative Review Articles (SANRA) was followed for this review. From 674 papers obtained through PubMed search, 351 were selected. Sixty-two rare genetic syndromes involving oral manifestations were found and classified. The proposed classification aims to help the clinician to easily understand which dento-oro-maxillofacial findings might be expected in the presence of each rare genetic syndrome. This immediate framework may both help in the diagnosis of dento-oro-maxillofacial anomalies related to the underlying pathology as well as facilitate the drafting of treatment plans with the involvement of a multidisciplinary team.

Objectives: To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice., Design: Expert consensus recommendations with Delphi methodology., Setting: Latin American countries., Subjects: Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries., Interventions: Delphi methodology for expert consensus., Measurements and Main Results: The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement., Conclusions: This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Background: To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America., Methods: A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics., Results: Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses., Conclusions: Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.