Search

Zachary A Vesoulis,1 Danielle P Sharp,2 Natasha Lalos,1 Devon P Swofford,1 Valerie Y Chock2 1Department of Pediatrics, Washington University, St. Louis, MO, USA; 2Department of Pediatrics, Stanford University, Palo Alto, CA, USACorrespondence: Zachary A Vesoulis, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110, USA, Tel +1 314-454-6148, Email vesoulis_z@wustl.eduAbstract: Conventional clinical practice in the neonatal intensive care unit (NICU) often fails to actively monitor the brain, relying on reactive strategies and imprecise risk indicators. The introduction of Near-Infrared Spectroscopy (NIRS) enhances current approaches to brain monitoring, offering non-invasive, real-time, continuous, and tissue-specific measures of oxygen saturation. NIRS leverages the physics of light to provide a comprehensive evaluation of oxygen delivery and consumption. This review covers the principles of NIRS, normative values for cerebral oximetry, and its applications in various clinical scenarios. Current clinical applications of NIRS span diverse areas, including intraventricular hemorrhage, white matter injury, anemia, congenital heart disease, and hypoxic-ischemic encephalopathy (HIE). NIRS demonstrates its potential in predicting and preventing adverse outcomes, particularly in optimizing cerebral oxygenation during cardiac surgery and guiding respiratory support in neonates. Key highlights of this review include the role of NIRS for the detection of cerebral hypoxia, even when other monitors do not show signs of clinical deterioration, a discussion of new methods for quantifying cerebral autoregulation and the connection to brain injury, and the potential utility NIRS monitoring offers for critically ill infants, such as those with congenital heart disease. The comprehensive insights provided by NIRS, if translated effectively into clinical practice, have the potential to improve the care and outcomes of neonates in the NICU.Keywords: NIRS, neonatal, brain injury, intraventricular hemorrhage, white matter injury, hypoxic ischemic encephalopathy, seizures, congenital heart disease

Background: Interpretation of coagulation testing in neonates currently relies on reference intervals (RIs) defined from older patient cohorts. Direct RI studies are difficult, but indirect estimation may allow us to infer normative neonatal distributions from routinely collected clinical data., Objective: Assess the utility of indirect reference interval methods in estimating coagulation reference intervals in critically ill neonates., Methods: We analyzed first-in-life coagulation testing results from all patients admitted to a level IV neonatal intensive care unit between January 1, 2018, and January 1, 2024. Results obtained after transfusion of any blood product were excluded. Indirect RIs were estimated across gestational age groups using refineR and compared with currently reported intervals for patients less than 1 year of age., Results: Prothrombin times (PTs) and international normalized ratios (INRs) were available for 1128 neonates, while activated partial thromboplastin times (APTTs) were available for 790 neonates. The indirect RI was 10 to 25 seconds in preterm, 10 to 22 seconds in term, and 10 to 24 seconds in all neonates for PT; 0.7 to 2.1 in preterm, 0.8 to 1.8 in term, and 0.8 to 1.9 in all neonates for INR; and 25 to 68 seconds in preterm, 25 to 58 seconds in term, and 25 to 62 seconds in all neonates for APTT. Compared with our current intervals, the indirect RIs would flag 58% fewer PT, 43% fewer INR, and 17% fewer APTT results as abnormal., Conclusion: Indirectly estimated RIs in neonates admitted to intensive care show substantial divergence from current, first-year-of-life RIs, leading to an abundance of abnormal flags. The associations between these flags and provider behavior, transfusion practice, or clinical outcomes are areas of future exploration., Competing Interests: Declaration of competing interests The authors have no competing interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Pulse oximetry is commonly used in Neonatology, however recent adult data suggest racial disparity in accuracy, with overestimation of oxygen saturation for Black patients., Study Design: Black and White infants <32 weeks gestation underwent simultaneous arterial blood gas and pulse oximetry measurement. Error by race was examined using mean bias, A rms , Bland-Altman, and linear/non-linear analysis., Results: A total of 294 infants (124 Black, 170 White) were identified with mean GA of 25.8 ± 2.1 weeks and mean BW of 845 ± 265 grams, yielding 4387 SaO 2 -SpO 2 datapoints. SpO 2 overestimation, measured by mean bias, was 2.4-fold greater for Black infants and resulted in greater occult hypoxemia (SpO 2  > 90% when SaO 2  < 85%; 9.2% vs. 7.7% of samples). Sensitivity and specificity for detection of true hypoxemia were similar between groups (39 vs. 38%; 81 vs. 78%)., Conclusion: There is a modest but consistent difference in SpO 2 error between Black and White infants, with increased incidence of occult hypoxemia in Black infants., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Ventilator-associated tracheobronchitis (VAT) is an infection commonly affecting mechanically ventilated intubated patients. Several studies suggest that VAT is associated with increased duration of mechanical ventilation (MV) and length of intensive care unit (ICU) stay, and a presumptive increase in healthcare costs. Uncertainties remain, however, regarding the cost/benefit balance of VAT treatment. The aim of this narrative review is to discuss the two fundamental and inter-related dilemmas regarding VAT, i.e., (i) how to diagnose VAT? and (ii) should we treat VAT? If yes, should we treat all cases or only selected ones? How should we treat in terms of antibiotic choice, route, treatment duration?