Journal of perinatology : official journal of the California Perinatal Association
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To compare the utility of procalcitonin (PCT) vs C-reactive protein (CRP) as indicators of late-onset neonatal sepsis in very low birth weight (VLBW) infants. ⋯ PCT (0.5 ng/ml) is more sensitive than CRP in predicting late-onset sepsis in VLBW infants.
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Randomized Controlled Trial Clinical Trial
Effects of pressure support during an acute reduction of synchronized intermittent mandatory ventilation in preterm infants.
During weaning of synchronized intermittent mandatory rate in preterm infants, the spontaneous breaths must overcome the resistance of the endotracheal tube and the disease-induced respiratory loads. Pressure Support (PS) can be used as an adjunct to synchronized intermittent mandatory ventilation (SIMV) to partially unload the spontaneous breaths. ⋯ Assistance of the spontaneous breaths with pressure support maintained gas exchange. PS of 6 cm H(2)O prevented an increase in breathing effort during an acute 50% reduction in SIMV rate.
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Comparative Study
Foot pulse oximeter perfusion index correlates with calf muscle perfusion measured by near-infrared spectroscopy in healthy neonates.
In critically ill neonates, peripheral perfusion and oxygenation assessment may provide indirect information on the circulatory failure of vital organs during circulatory shock. The development of pulse oximetry has recently made it possible to calculate the perfusion index (PI), obtained from the ratio between the pulsatile and nonpulsatile signals of absorbed light. The main goals of this study were: (1) to study foot PI; and (2) to evaluate the relationship between foot PI, obtained continuously by pulse oximetry, and a number of variables, i.e. blood flow (BF), oxygen delivery (DO(2)), oxygen consumption (VO(2)), and fractional oxygen extraction (FOE), measured indirectly by near-infrared spectroscopy (NIRS) on the calf in 43 healthy term neonates (weight 3474.6 +/- 466.9 g; gestational age 39.1 +/- 1.4 weeks). ⋯ In the neonatal intensive care unit, continuously measuring foot PI by pulse oximetry seems clinically more feasible for peripheral perfusion monitoring than spot measurements of the calf BF and/or VO(2) by indirect NIRS.
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Randomized Controlled Trial Comparative Study Clinical Trial
Heat loss prevention for preterm infants in the delivery room.
Preterm infants are prone to hypothermia immediately following birth. Among other factors, excessive evaporative heat loss and the relatively cool ambient temperature of the delivery room may be important contributors. Most infants <29 weeks gestation had temperatures <36.4 degrees C on admission to our neonatal unit (NICU). Therefore we conducted a randomized, controlled trial to evaluate the effect of placing these infants in polyurethane bags in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the NICU. ⋯ Placing infants <29 weeks gestation in polyurethane bags in the delivery room reduced the occurrence of hypothermia and increased their NICU admission temperatures. Maintaining warmer delivery rooms helped but was insufficient in preventing hypothermia in most of these vulnerable patients without the adjunctive use of the polyurethane bags.
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Recognition that volume, not pressure, is the key factor in ventilator-induced lung injury and awareness of the association of hypocarbia and brain injury foster the desire to better control delivered tidal volume. Recently, microprocessor-based modifications of pressure-limited, time-cycled ventilators were developed to combine advantages of pressure-limited ventilation with the ability to deliver a more consistent tidal volume. ⋯ More consistent tidal volume, fewer excessively large breaths, lower peak pressure, less hypocarbia and lower levels of inflammatory cytokines have been documented. It remains to be seen if these short-term benefits will translate into shorter duration of ventilation or reduced incidence of chronic lung disease.