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Importance A sustained inflation (SI) provided at birth might reduce bronchopulmonary dysplasia (BPD). Objective This study aims to examine whether an SI-guided exhaled carbon dioxide (ECO 2 ) compared with positive pressure ventilation (PPV) alone at birth decreases BPD. Design Randomised controlled trial. Infants were randomly allocated to either SI (SI group) or PPV (PPV group). Participants Participants of this study include infants between 23 +0 and 32 +6 weeks gestation with a need for PPV at birth. Intervention Infants randomised into the SI group received an initial SI with a peak inflation pressure (PIP) of 24 cmH 2 O over 20 s. The second SI was guided by the amount of ECO 2 . If ECO 2 was ≤20 mm Hg, a further SI of 20 s was delivered. If ECO 2 was >20 mm Hg the second SI was 10 s. Infants randomised into the PPV group received mask PPV with an initial PIP of 24 cmH 2 O. Primary outcomes Reduction in BPD defined as the need for respiratory support or supplemental oxygen at corrected gestational age of 36 weeks. Results SI (n=76) and PPV (n=86) group had similar rates of BPD (23% vs 33%, p=0.090, not statistically significant). The duration of mechanical ventilation was significantly reduced with SI versus PPV (63 (10–246) hours versus 204 (17–562) hours, respectively (p=0.045)). No short-term harmful effects were identified from two SI lasting up to 40 s (eg, pneumothorax, intraventricular haemorrhage or patent ductus arteriosus). Conclusion Preterm infants 2 to guide length of SI is feasible. Trial registration number NCT01739114; Results.

Background: Despite being an experimental therapy in preterm neonates, inhaled nitric oxide (iNO) is used as a rescue therapy when high-frequency oscillatory ventilation (HFOV) and other conventional therapies fail. Objective: We aimed to determine the outcomes of very-low-birth-weight (VLBW) neonates with hypoxemic respiratory failure (HRF) who had received iNO after maximal conventional therapies. Methods: We retrospectively reviewed preterm neonates (Results: During the study period, 1,168 eligible preterm neonates were admitted; 155 (13%) had HRF treated with HFOV, of whom 47 (30%) received iNO. The baseline characteristics between the 24 survivors and 23 nonsurvivors were not different. Survivors had a greater decrease in oxygenation index than nonsurvivors (61 vs. 33%) after 6 h of iNO (p = 0.003). The causes of death were refractory hypoxemia (8), multi-organ failure (7), treatment withdrawal (6), and others (2). During the NICU stay, 23 survivors (96%) developed complications. At 18-24 months, 7 (29%) had significant disabilities. Conclusions: Of the VLBW neonates with severe HRF rescued by HFOV and iNO, many survived without neurodevelopmental disability at early childhood, despite multiple short-term complications. Further research is necessary to understand the clinical course and risk factors of adverse outcomes and to improve the management care of these critically ill neonates.

A sustained inflation (SI) provided at birth might reduce bronchopulmonary dysplasia (BPD).This study aims to examine whether an SI-guided exhaled carbon dioxide (ECORandomised controlled trial. Infants were randomly allocated to either SI (SI group) or PPV (PPV group).Participants of this study include infants between 23Infants randomised into the SI group received an initial SI with a peak inflation pressure (PIP) of 24 cmHReduction in BPD defined as the need for respiratory support or supplemental oxygen at corrected gestational age of 36 weeks.SI (n=76) and PPV (n=86) group had similar rates of BPD (23% vs 33%, p=0.090, not statistically significant). The duration of mechanical ventilation was significantly reduced with SI versus PPV (63 (10-246) hours versus 204 (17-562) hours, respectively (p=0.045)). No short-term harmful effects were identified from two SI lasting up to 40 s (eg, pneumothorax, intraventricular haemorrhage or patent ductus arteriosus).Preterm infants33 weeks gestation receiving SI at birth had lower duration of mechanical ventilation and similar incidence of BPD compared with PPV. Using ECONCT01739114; Results.

Background: Discrepancies between pulse oximetry saturation (SpO2) and arterial saturation (SaO2) at low blood oxygenation values have been previously reported with significant variations among instruments and studies. Whether pulse oximeters that attenuate motion artifact are less prone to such discrepancies is not well known. Objective: To prospectively assess the agreement of the Masimo V4 pulse oximeter within the critical 85–95% SpO2 target range. Patients and Methods: For all consecutive babies with gestational age 2 was measured continuously and SaO2 analyzed on an as-needed basis. Bland-Altman techniques provided estimates of the difference (D = SaO2 – SpO2), standard deviation (SD), and 95% limits of agreement (D ± 2*SD). Results: There were 1,032 measurements (114 babies) with SpO2 between 85 and 95%. The 95% limits of agreement were –2.0 ± 5.8, –2.4 ± 9.2, and –1.9 ± 5.3 in the SpO2 categories 85–95, 85–89, and 91–95%, respectively. For the SpO2 categories 85–89% and 91–95%, only 52% (53/101) and 59% (523/886) of SpO2 values, respectively, corresponded to the analogous SaO2 categories. In the 85–89% SpO2 category, SaO2 was lower than 85% in 39 of the 101 (39%) measurements. Conclusion: SaO2 was lower on average than SpO2 with an increased bias at lower saturation. The –2.4 ± 9.2 95% limits of agreement for SaO2 – SpO2 in the 85–89% SpO2 category suggest that SpO2 and SaO2 are not interchangeable and intermittent SaO2 assessments are warranted when the targeted SpO2 is within this range.

Background: Infants with extremely low birth weight uniformly develop anemia of prematurity and frequently require red blood cell transfusions (RBCTs). Although RBCT is widely practiced, the indications remain controversial in the absence of conclusive data on the long-term effects of RBCT. Objectives: To summarize the current equipoise and to outline the study protocol of the ‘Effects of Transfusion Thresholds on Neurocognitive Outcome of extremely low birth-weight infants (ETTNO)’ study. Methods: Review of the literature and design of a large pragmatic randomized controlled trial of restrictive versus liberal RBCT guidelines enrolling 920 infants with birth weights of 400–999 g with long-term neurodevelopmental follow-up. Results and Conclusions: The results of ETTNO will provide definite data about the efficacy and safety of restrictive versus liberal RBCT guidelines in very preterm infants.

Apnea of prematurity (AOP) is frequently managed with nasal continuous positive airway pressure (NCPAP). Nasal cannula (NC) are used at low flows (Objective. To determine the NC flow required to generate PDP equal to that provided by NCPAP at 6 cm H2O and to assess the effectiveness of HFNC as compared NCPAP in the management of AOP.Method. Forty premature infants, gestation 28.7 ± 0.4 weeks (mean ± standard error of mean), postconceptual age at study 30.3 ± 0.6 weeks, birth weight 1256 ± 66 g, study weight 1260 ± 63 g who were being managed with conventional NCPAP for at least 24 hours for clinically significant apnea of prematurity, were enrolled in a trial of ventilator-generated conventional NCPAP versus infant NC at flows of up to 2.5 L/min. End expiratory esophageal pressure was measured on NCPAP and on NC, and the gas flow on NC was adjusted to generate an end expiratory esophageal pressure equal to that measured on NCPAP. Two 6-hour periods were continuously recorded and the data were stored on computer.Results. The flow required to generate a comparable PDP with NC varied with the infant's weight and was represented by the equation: flow (L/min) = 0.92 + 0.68x, x = weight in kg,R = 0.72. There was no difference in the frequency and duration of apnea, bradycardia or desaturation per recording between the 2 systems.Conclusion. NC at flows of 1 to 2.5 L/min can deliver PDP in premature neonates. HFNC is as effective as NCPAP in the management of AOP.

Background and aims If infants fail to initiate spontaneous breathing after birth, international guidelines recommend positive pressure ventilation (PPV). However, mask PPV remains challenging with leakage occurring commonly. Despite a variety of available facemasks, none has been systemically studied in newborn infants. We aimed to determine if using a Fisher and Paykel (FP) round facemask would reduce mask leak compared to using a Laerdal round facemask during mask PPV in preterm infants. Methods From April to September 2013, at the Royal Alexandra Hospital, newborn infants. Results Fifty-eight preterm infants (n = 29 in each group) were enrolled; mean±SD gestation 28 ± 3 weeks; birth weight 1210 ± 448 g, 30(52%) male, 39(67%) born by caesarean section. Apgar scores at 1 and 5 min were 5 ± 3 and 7 ± 2, respectively. Infants randomised to the FP facemask and Laerdal facemask had similar mask leak (37 ± 17% vs. 33 ± 12%, respectively, p = 0.30) and tidal volume (7.3 ± 3.0 mL/kg vs. 6.9 ± 2.7 mL/kg, p = 0.73) during PPV. There were no significant differences in ventilation rate, inflation time or airway pressures between groups. Conclusions The use of either facemask during PPV in the delivery room yields similar mask leak.

Continuous Positive Airway Pressure (CPAP) in the Treatment of Apnea of Prematurity: A Comparison of Two CPAP Delivery Systems