Neonatology
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Lung ultrasound (LUS) is a promising technique for the diagnosis of neonatal respiratory diseases. Preliminary data has shown a good sensitivity and specificity of LUS in the diagnosis of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). ⋯ LUS showed high sensitivity and specificity in diagnosing RDS and TTN.
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Clinical Trial
Low-flow oxygen for positive pressure ventilation of preterm infants in the delivery room.
The recent newborn resuscitation guidelines have recommended that a pulse oximeter and oxygen blender be used to keep oxygen saturation (SpO2) within the target range. However, an oxygen blender and compressed air are not generally available in delivery rooms. ⋯ Low-flow oxygen for PPV via an SIB used in this study should be sufficient for providing oxygen in resuscitation of preterm infants as long as adequate ventilation is evident. This technique is simple and could be useful in a resource-limited setting.
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Evidence-based medicine has been embraced wholeheartedly, and rightly so, as the best approach for reducing clinical uncertainty and ensuring that patients receive treatment and care that are efficacious (i.e. they work) and effective (i.e. they work in real life). High-quality evidence comes from high-quality clinical research. It would hence be reasonable to assume that these two would form a closely integrated partnership. ⋯ For neonatal medicine, this would reduce the risk of 'injurious misconception', where trial entry is inappropriately rejected by parents because of an exaggerated and disproportionate perception of risk [4] that is brought on or magnified by the burden of making decisions at this difficult and stressful time. Randomization to treatments that fall within accepted practice and are considered standard-of-care involves no research-related risks to participants, and as trial data can increasingly be extracted from electronic clinical records [5], the costs and burden of data collection placed upon clinical teams will be minimized and, ultimately, the resolution of uncertainties about treatment can be hastened. It should also be noted that this approach fulfils the four cardinal principles of research ethics, namely: autonomy, justice, beneficence and nonmaleficence as well as upholding the responsibility of all doctors to strive to reduce uncertainty in the care they provide to their patients [6].
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To study whether new pharmacological and nonpharmacological guidelines lowered numbers of painful procedures in neonates and changed the amount and frequency of analgesic therapy as compared to the results of our previous study in 2001. ⋯ The mean number of painful procedures per NICU patient per day declined. Nonpharmacological pain- or stress-reducing strategies like NIDCAP and sucrose were fully embedded in our pain management. As further reduction of the number of painful procedures is unlikely, we should apply more nonpharmacological interventions and explore newer pharmacological agents.
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Gases for respiratory support at birth are typically 'cold and dry', which may increase the risk of hypothermia and lung injury. ⋯ Rapid gas conditioning for newborn stabilisation is feasible using the experimental set-up, ≥20 ml H2O and a flow of 10 l/min. The circuit could be used immediately once switched on. Without power, conditioning is quickly lost. Investigation of the clinical effects of gas conditioning is warranted.