Neonatology
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Bedside chest radiographs used for the confirmation of diagnosis of pneumothorax in the neonatal intensive care unit (NICU) are routinely obtained in the supine position. However, pneumothoraces may not appear in the classically described forms on these radiographs, resulting in a delayed diagnosis. ⋯ The present study shows that the recognition of these signs would assist the physician in identifying occult pneumothorax earlier in its course. Physicians dealing with critically ill infants should ensure that they can recognize these radiological signs.
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Initiation of empiric antibiotic treatment for possible early-onset sepsis is recommended for late preterm and term neonates with respiratory distress. There is no evidence base to this approach. ⋯ This study suggests that empiric postnatal antibiotic treatment may not be warranted for late preterm and term infants with TTN in the absence of specific infectious risk factors.
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Ventilatory pressures should target the range between the upper and lower inflection point of the pressure volume curve in order to avoid atelecto- and volutrauma. During high-frequency oscillatory ventilation (HFOV), this range is difficult to determine. Quadrant impedance measurement (QIM) has recently been shown to allow accurate and precise measurement of lung volume changes during conventional mechanical ventilation. ⋯ QIM could be used for continuous monitoring of thoracic impedance and determination of the pressure-RI curve during HFOV. The method could prove to be a promising bedside method for the monitoring of lung recruitment during HFOV in the future.
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Untreated exposure to pain in preterm neonates might damage the vulnerable premature brain and alter development. Pain treatment is limited because analgesic agents may also have adverse neurodevelopmental consequences in newborns. ⋯ Severe inflammatory pain and pain caused by repetitive injections in neonatal rats may cause major changes in the developing brain during the first week of life. Morphine may only protect the newborn brain against these changes in specific situations.