Journal of perinatology : official journal of the California Perinatal Association
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Randomized Controlled Trial Comparative Study
A crossover analysis of mandatory minute ventilation compared to synchronized intermittent mandatory ventilation in neonates.
Mandatory minute ventilation (MMV) is a novel ventilator mode that combines synchronized intermittent mandatory ventilation (SIMV) breaths with pressure-supported spontaneous breaths to maintain a desired minute volume. The SIMV rate is automatically adjusted to maintain minute ventilation. ⋯ Neonates with an intact respiratory drive can be successfully managed with MMV without an increase in etCO(2). While this mode generates similar PIP and PEEP, the decrease in mechanical breaths and the mean airway pressure generated with MMV may reduce the risk of some of the long-term complications associated with mechanical ventilation.
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Randomized Controlled Trial Comparative Study
Effect of volume guarantee combined with assist/control vs synchronized intermittent mandatory ventilation.
To compare the effect of combining assist/control with volume-guarantee (AC+VG) vs synchronized intermittent mandatory ventilation with VG (SIMV+VG) on tidal volume (V(T)), peak inspiratory pressure (PIP), mean airway pressure (MAP), respiratory rate, heart rate, oxygen saturation (SpO(2)), and minute volume (MV) in preterm infants. ⋯ SIMV+VG is associated with higher work of breathing indicated by tachycardia, tachypnea and lower SpO(2) compared to AC+VG. VG appears to be more effective when combined with AC than with SIMV.
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Hypothermia incurred during delivery room resuscitation continues to cause morbidity in infants <29 weeks gestation. Three recent trials have shown that wrapping such infants instead of drying prevents heat loss, resulting in higher infant temperatures at Newborn Intensive Care Unit (NICU) admission. ⋯ "In all" was added -This implies 20% of all NICU's changed practice, 20% of level III NICUs responding have changed delivery room resuscitation practices rapidly in response to new evidence. No "gold" standard exists nationally and there is considerable variation in practice. Neonatal resuscitation guidelines for premature infants should include recommendations regarding choice occlusive wrap and application techniques.
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This case series reports an acute episode of hypoxemia and systemic hypotension in seven infants under 1 kg, taking place several hours or days after birth, after a period of stability and in the absence of significant lung disease. These patients were growth-restricted at birth and had a history of chronic fetal hypoxia and oligohydramnios. Pulmonary hypertension and right ventricular dysfunction were found by echocadiography. ⋯ The timing of symptoms seemed related to ductus arteriosus closure or constriction. Oxygenation and right ventricular function improvement occurred within a few days under ventilatory and inotropic support, while milrinone was administered in five cases. In conclusion, pulmonary hypertension is a rare but significant cause of hypoxemia in preterm infants, and pulmonary vasodilator therapy should be considered in the presence of right ventricular dysfunction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices.
To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants. ⋯ The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.