American journal of perinatology
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Comparative Study
Type and timing of ventilation in the first postnatal week is associated with bronchopulmonary dysplasia/death.
The type and timing of respiratory support in the first week affecting bronchopulmonary dysplasia (BPD)/death have not been evaluated. We compared outcomes of premature infants on nasal intermittent positive pressure ventilation (NIPPV) or nasal continuous positive airway pressure (NCPAP) to those on endotracheal tube (ETT). We retrospectively reviewed data (1/2004 to 6/2009) of infants ≤ 30 weeks' gestational age (GA) who received NIPPV in the first postnatal week. ⋯ Infants on ETT (N = 97) during 1 to 3 days were more likely to have BPD/death compared with those on NIPPV (N = 38): 67% versus 47% (P = 0.035). Infants on ETT (N = 30) during 4 to 7 days were more likely to have BPD/death compared with those extubated to NIPPV (N = 36): 87 versus 53% (P = 0.003). Extubation to NIPPV or NCPAP in the first postnatal week is associated with decreased probability of BPD/death.
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Comparative Study
Computerized physician order entry reduces medication turnaround time of labor induction agents.
We sought to determine whether computerized physician order entry (CPOE) improves the induction agent turnaround time on the labor and delivery unit (L&D) compared with paper-based order entry (PBOE). We conducted a retrospective study of singleton, term pregnancies admitted to L&D for induction of labor. Outcomes of women who delivered 3 months before or 3 months after universal CPOE implementation were compared including induction agent turnaround time. ⋯ There were no differences in cesarean section rate or length of hospital stay. After controlling for time of day of induction, induction agent, and type of order entry, CPOE continued to significantly decrease the induction agent turnaround time by 25 minutes ( P = 0.042). CPOE improved the process of induction of labor and efficiency of care of pregnant women.
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We hypothesized that because the view of the glottis is better with videolaryngoscopes, successful intubation in neonates would be accomplished in a shorter time with the GlideScope (®) (Verathon, Inc., Bothell, WA) videolaryngoscope (GVL). Forty-five students of the University of Athens, inexperienced in both techniques, participated in the study (21 medical students and 24 nursing students, crossover randomized study). Following a brief educational session, each participant practiced and attempted intubation on a neonatal manikin using conventional laryngoscope and GVL, as many times as required to secure the airway. ⋯ There was no difference regarding the time required for the successful intubation between medical and nursing students, using the conventional laryngoscope or the GVL. The number of attempts to successful intubation with either device did not differ. The time required for intubation with the GVL was longer, and this is probably due to a design flaw.
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Randomized Controlled Trial
Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study.
We sought to determine the efficacy and safety of tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). We performed a randomized, double-blind, placebo-controlled study of 660 women who underwent elective CS. The patients were randomly selected to receive an intravenous infusion of either TA (1 g/10 mL in 20 mL of 5% glucose; N = 330) or 30 mL 5% glucose prior to surgery. ⋯ TA significantly reduced bleeding during CS, the percentage of patients with blood loss >1000 mL, and the need for additional uterotonic agents. Furthermore, the incidence of thromboembolic events did not increase. Our results suggest that TA can be used safely and effectively to reduce CS bleeding.
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Review Case Reports
Unilateral lung intubation for pulmonary air leak syndrome in neonates: a case series and a review of the literature.
Air leak syndrome represents a common set of complications of ventilated premature neonates and includes pneumothorax, pneumomediastinum, pulmonary interstitial emphysema, and pneumatocele. Unilateral intubation is an infrequently utilized treatment option. ⋯ In view of our experience and the review of the literature, we suggest that unilateral intubation is an efficient and relatively safe therapy in cases of neonatal air leak syndrome. It is also suggested that appropriate treatment duration should be at least 48 hours.