Neonatology
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Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. ⋯ Pulse oximetry showed increased bias and decreased accuracy and precision during CPR in a model of neonatal cardiac arrest. We recommend further studies to clarify the exact mechanisms of these false readings to improve reliability of pulse oximetry during the marked desaturation and hypoperfusion found during CPR.
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The lower margin amplitude (LMA) of the amplitude-integrated electroencephalogram (aEEG) is suppressed in neonates during deep sedation, a feature that is attributed to the bispectral index (BIS) in adults. ⋯ We found a light-to-moderate correlation between BIS and LMA in our study cohort and a good correlation in the subgroup with high signal quality.
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We have previously shown that nasal pressure support ventilation (nPSV) can lead to an active inspiratory laryngeal narrowing in lambs. This, in turn, can limit lung ventilation and divert air into the digestive system, with potentially deleterious consequences. On the other hand, nasal high-frequency oscillatory ventilation (nHFOV) is particularly attractive in newborns, especially since, unlike nPSV, it does not require synchronization with the patient's inspiratory efforts. ⋯ nHFOV does not induce glottal constrictor muscle EMG in nonsedated newborn lambs, in contrast to nPSV. This may be an additional advantage of nHFOV relative to nPSV.
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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.