Neonatology
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Pulmonary hypertension and secondary cardiac dysfunction are important contributors of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). Milrinone, a phosphodiesterase-3 inhibitor, may be useful in this setting for its combined actions as a pulmonary vasodilator and to improve systolic and diastolic function. ⋯ Milrinone use was associated with an improvement in systolic and diastolic function in the RV, corresponding to an improvement in clinical status.
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Review Meta Analysis Comparative Study
Volume-targeted versus pressure-limited ventilation for preterm infants: a systematic review and meta-analysis.
The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume. ⋯ Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
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Review Meta Analysis
In search of the optimal oxygen saturation for extremely low birth weight infants: a systematic review and meta-analysis.
The optimal arterial oxygen saturation in the first weeks of life is unknown for immature newborn infants. ⋯ A low oxygen saturation approach reduces severe retinopathy of prematurity by 50%, i.e., from 20.9 to 9.5%, and bronchopulmonary dysplasia/lung problems by 25%, i.e., from 40.8 to 29.7%. Further randomized trials are needed to provide definite conclusions and to assess whether reducing oxygen saturation has an impact on mortality among very and extremely low birth weight infants.