Neonatology
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It would be advantageous for the treatment of neonatal respiratory distress syndrome if effective amounts of surfactant could be delivered by nebulization. ⋯ Using this nebulizer, the lung depositions of porcine surfactant were 45% via endotracheal tube and 14% via nasal-continuous positive airway pressure (prongs). These figures might be physiologically relevant, but still have to be confirmed in efficacy studies.
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Randomized Controlled Trial
Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain?
Traditionally, 10 years ago, children born preterm often routinely received morphine, especially during mechanical ventilation. Studies in neonatal rats, whose stage of brain development roughly corresponds to that of children born preterm, found negative long-term effects after pain and opioid exposure. ⋯ Although prematurity, opioid exposure and neonatal pain were significantly associated with brain volume, no major associations with neuropsychological functioning or thermal sensitivity were detected. Our findings suggest that morphine administration during neonatal life does not affect neurocognitive performance or thermal sensitivity during childhood in children born preterm without brain damage during early life. Future studies with larger sample sizes are needed to confirm these findings.
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Therapeutic hypothermia for hypoxic ischaemic encephalopathy (HIE) has been proved effective. Standard equipment is expensive, while ice packs used in low resource settings are labour intensive and associated with wider temperature fluctuations. ⋯ PCM provides a low cost and effective method to maintain therapeutic hypothermia. However, careful monitoring is required during induction and the rewarming phase to avoid hypothermia outside the therapeutic range.
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Observational Study
Reference Ranges for Cerebral Tissue Oxygen Saturation Index in Term Neonates during Immediate Neonatal Transition after Birth.
Non-invasive monitoring of the brain with near-infrared spectroscopy (NIRS) during immediate transition after birth is of growing interest. ⋯ The present observational study adds the reference ranges and centile charts of cTOI measured with the NIRO 200NX and cFTOE calculated out of cTOI and SpO2 in neonates during the immediate neonatal transition. Centiles for each instrument will be necessary for future clinical application, since the differences between cTOI and cerebral regional tissue oxygen saturation measured with INVOS 5100C change with increasing regional oxygenation.
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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.