Archives of disease in childhood. Fetal and neonatal edition
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Arch. Dis. Child. Fetal Neonatal Ed. · May 2016
ReviewA review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns.
Provision of chest compressions (CCs) and/or medications in the delivery room is associated with poor outcomes. Based on the physiology of perinatal asphyxia, we aimed to provide an overview of current recommendations and explore potential determinants of effective neonatal cardiopulmonary resuscitation (CPR): balancing ventilations and CC, CC rate, depth, full chest recoil, CC technique and adrenaline. ⋯ Successful CPR requires the delivery of high-quality CC, encompassing optimal (A) C:V ratio (B) rate, (C) depth, (D) chest recoil between CC, (E) technique and (F) adrenaline dosage. More animal studies with high translational value and randomised clinical trials are needed.
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Arch. Dis. Child. Fetal Neonatal Ed. · May 2016
Multicenter Study Observational StudyA propensity-matched cohort study of vancomycin-associated nephrotoxicity in neonates.
The incidence of nephrotoxicity among vancomycin-treated neonates has been reported to range from 2% to 20%. These widely varying estimates have led to confusion and controversy regarding the safety of vancomycin among neonates. ⋯ These results corroborate several earlier reports and much anecdotal evidence describing the infrequent occurrence of nephrotoxicity in neonates receiving concomitant vancomycin and gentamicin.
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Arch. Dis. Child. Fetal Neonatal Ed. · May 2016
The effects of non-invasive respiratory support on oropharyngeal temperature and humidity: a neonatal manikin study.
Heating and humidification of inspired gases is routine during neonatal non-invasive respiratory support. However, little is known about the temperature and humidity delivered to the upper airway. The International Standards Organization (ISO) specifies that for all patients with an artificial airway humidifiers should deliver ≥33 g/m(3) absolute humidity (AH). We assessed the oropharyngeal temperature and humidity during different non-invasive support modes in a neonatal manikin study. ⋯ Different non-invasive devices deliver inspiratory gases of variable temperature and humidity. Most AH levels were above the ISO recommendation; however, with some HF and variable flow CPAP devices at higher gas flow this was not achieved. Clinicians should be aware of differences in the efficacy of heating and humidification when choosing modes of non-invasive respiratory support.
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Arch. Dis. Child. Fetal Neonatal Ed. · Mar 2016
ReviewCuffed endotracheal tubes for neonates and young infants: a comprehensive review.
Traditionally, uncuffed endotracheal tubes (ETTs) have been used for artificial ventilation of infants and children. More recently, newer designed high-volume low-pressure (HVLP) cuffed ETTs are being used with increasing frequency in infants from birth. Considering that many paediatric anaesthetists and intensivists are already using cuffed ETTs in infants >3 kg from birth, should neonatologists be doing the same? This review examines the reasons behind the traditional use of uncuffed ETTs and the problems associated with their use; newer HVLP cuffed ETTs and what they can potentially offer neonates; and reviews evidence from studies comparing the use of cuffed and uncuffed ETTs in neonates and small infants.