Neonatology
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Observational Study
Influence of gestational age on dead space and alveolar ventilation in preterm infants ventilated with volume guarantee.
Ventilated preterm infant lungs are vulnerable to overdistension and underinflation. The optimal ventilator-delivered tidal volume (VT) in these infants is unknown and may depend on the extent of alveolarisation at birth. ⋯ VD,app rather than anatomical VD is the major factor influencing increased VD,MM/VT at a younger GA. A volume guarantee setting of 4-5 ml/kg in the Dräger Babylog® 8000 plus ventilator may be inappropriate as a universal target across the GA range of 23-32 weeks. Differences between measured and set VT and the dependence of this difference on GA require further investigation.
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The oxygenation index (OI = mean airway pressure, MAP × FiO2 × 100 : PaO2) is used to assess the severity of hypoxic respiratory failure (HRF) and persistent pulmonary hypertension of the newborn (PPHN). An indwelling arterial line or arterial punctures are necessary to obtain PaO2 for the calculation of OI. Oxygenation can be continuously and noninvasively assessed using pulse oximetry. The use of the oxygen saturation index (OSI = MAP × FiO2 × 100 : SpO2) can be an alternate method of assessing the severity of HRF. ⋯ OSI correlates significantly with OI in infants with HRF. This noninvasive measure may be used to assess the severity of HRF and PPHN in neonates without arterial access.
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Classifying the severity of bronchopulmonary dysplasia (BPD) by continuous numerical variables would facilitate follow-up of disease progression and quantified analysis of disease determinants. ⋯ Severity of pulmonary oxygenation impairment in BPD can be quantified at the cot-side by non-invasive measurement of shunt, shift and VA/Q. Low GA at birth, low weight at birth and at the time of study and impaired weight gain are significantly associated with the severity of oxygen-exchange impairment in infants with BPD.
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Case Reports
Diagnosis of Hemidiaphragmatic Paresis in a Preterm Infant with Transcutaneous Electromyography: A Case Report.
Transcutaneous electromyography of the diaphragm (dEMG) is a noninvasive and easy applicable tool to measure the electrical activity of the diaphragm. dEMG monitoring has recently been introduced in the neonatal intensive care unit as a novel cardiorespiratory monitor providing direct information on diaphragmatic breathing activity. We report a preterm infant with suspected paresis of the right diaphragm measured with transcutaneous dEMG, which showed a clear reduction in the electrical activity of the right-sided diaphragm. In conclusion, dEMG provides valuable information on regional diaphragmatic activity, which can assist the clinician in diagnosing hemidiaphragmatic paresis.
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Episodes of hypoxemia and bradycardia frequently occur with apnea of prematurity in preterm infants. Little is known about the impact of different event types on the brain. ⋯ Isolated bradycardias had the lowest impact on cerebral desaturation, and combined events had the highest. Most infants preserved cerebral oxygenation >60% during events.