Neonatology
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Review Meta Analysis Comparative Study
Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis.
The issue of whether 21% O(2) is more effective than 100% O(2) for resuscitation of newborn infants remains controversial. ⋯ There is a significant reduction in the risk of neonatal mortality and a trend towards a reduction in the risk of severe hypoxic ischemic encephalopathy in newborns resuscitated with 21% O(2).
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Historical Article
History of neonatal resuscitation. Part 1: Artificial ventilation.
The construction of manual ventilators by Hunter, Chaussier, and Gorcy seemed to set the stage for artificial ventilation of the neonate at the end of the 18th century. When Leroy d'Etiolles recognized pneumothorax as a complication of ventilation in 1828, the Paris Academy of Science advised against positive pressure ventilation. Indirect techniques like that of Silvester or the Schultze swingings gained widespread acceptance and prevailed until the First World War. Modern ventilators were developed following the poliomyelitis epidemics in the 20th century.
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Review Meta Analysis
A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants.
The optimal timing of clamping the umbilical cord in preterm infants at birth is the subject of continuing debate. ⋯ The procedure of a delayed cord clamping time of at least 30 s is safe to use and does not compromise the preterm infant in the initial post-partum adaptation phase.
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Nasal continuous positive airway pressure (nCPAP) is an effective treatment of respiratory distress syndrome. Due to long-standing experience of early nCPAP as the primary respiratory support option in preterm infants, this approach is sometimes labeled 'the Scandinavian Model'. Mechanical ventilation is potentially harmful to the immature lungs and cohort studies have demonstrated that centers using more CPAP and less mechanical ventilation have reduced rates of bronchopulmonary dysplasia. ⋯ Surfactant is essential in the treatment of respiratory distress syndrome and has generally been reserved for infants on mechanical ventilation. With the development of INSURE (INtubation SURfactant Extubation), in which surfactant is administered during a brief intubation followed by immediate extubation, surfactant therapy can be given during nCPAP treatment further reducing need for mechanical ventilation. In this review the history, current knowledge and techniques of CPAP and surfactant are discussed.
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We review information about how the preterm lung can be injured with the initiation of mechanical ventilation at birth. Although multiple variables such as pressure, tidal volume, positive end expiratory pressure, and the gas used for ventilation may contribute to the injury, the relative contribution of each is not known. ⋯ A model for gas inflation of the fluid-filled lung may explain why even low tidal volumes may injure the preterm lung, and why the injury may initially occur to the small airways. Ventilation strategies that minimize injury need to be developed.