Neonatology
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Closed endotracheal suction interferes with mechanical ventilation received by infants, but the change to ventilation may be different when ventilator modes that target expired tidal volume (VT(e)) are used. ⋯ Closed endotracheal suction interferes with ventilator function in volume-targeted mode, with substantially negative intratracheal pressure during suction, and the potential for high airway pressures and tidal volumes following the procedure. These effects should be considered and pressure limits set appropriately whenever using volume-targeted ventilation.
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When 30 s of initial positive pressure ventilation fails to stabilize the heart rate (HR) of newborns in the delivery room, the International Liaison Committee on Resuscitation guidelines recommend initiation of cardiac compressions. However, it may take longer than 30 s to establish effective pulmonary gas exchange. Whether a longer period of initial ventilation to reverse asphyxia would result in less need for cardiac compressions is unknown. ⋯ Although an additional 30 s to ensure effective ventilation does not impair the speed or success in achieving ROSC, delaying circulatory support for as long as 1.5 min of initial ventilation may be harmful.
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Comparative Study
Sustained inflations: comparing three neonatal resuscitation devices.
Some national resuscitation guidelines advocate using sustained initial inflations (2-3 s) for babies requiring resuscitation. Inflation times ≥10 s have been used for preterm infants. ⋯ The T-piece provided consistent PIP during a single 10 s sustained inflation with less variation in pressure compared with the flow-inflating bag. Sustained inflations >3 s were difficult to achieve with a self-inflating bag.
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Cardiovascular drugs play a major role in the pre- and postoperative care in neonates with congenital heart disease. Management strategies aim to optimise contractility, improve diastolic function, maintain adequate preload, and reduce afterload. Levosimendan, a novel inodilator agent, enhances myocardial contractility and causes peripheral and coronary vasodilation. ⋯ Levosimendan improves cerebral and systemic perfusion and oxygenation in critically ill infants suffering from LCOS.