Minerva pediatrica
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Randomized Controlled Trial Comparative Study
[Procedural pain perception of preterm newborn in neonatal intensive care unit: assessment and non-pharmacological approaches].
The aim of this study was to evaluate the reaction to the procedural pain of preterm newborn and to demonstrate the different effectiveness of the two analgesic and not pharmacological techniques of recent clinical acquisition, the use of glucose solution and the sensorial saturation, in order to identify an optimal strategy for the prevention and pain treatment. ⋯ The use of "care" techniques (in our case sensorial saturation) ameliorates the quality of life in NICU and reduces the pain threshold perceived by newborn, reducing therefore the exposition to the pain stimulus and the possibility that some consequences due to an inadequate pain treatment in neonatal age could develop.
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Neonatal pulmonary hypertension refractory to high frequency ventilation (HFOV) and inhaled nitric oxide (iNO) is an occasional occurrence. We report a full-term neonate with severe pulmonary hypertension unresponsive to the treatment with HFOV and iNO, later associated with prostacyclin, who rapidly improved after the addition of vecuronium, a neuromuscular blocker.
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The aims of this paper are: to examine the physiological rationale for noninvasive respiratory support (NRS) in children with acute respiratory failure (ARF); to review clinical available data and to give some practical recommendations to its safe application. NRS is the delivery of ventilatory support without the need of an invasive airway. Two types of NRS are commonly used in the pediatric population: non-invasive continuous positive airway pressure (nCPAP) and non-invasive positive pressure ventilation (nPPV). ⋯ However, two randomized studies have been recently published suggesting that nPPV ameliorates clinical signs and gas exchange while reducing the need for endotracheal intubation. Moreover, nCPAP and heliox may improve clinical scores and CO2 washout in infants with severe bronchiolitis, without major complications. Data from non controlled studies show that NRS unloads the respiratory muscles and that the helmet can be a valid alternative to facial and/or nasal mask when nCPAP is administered to children in the early stage of ARF.
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Over the most recent 10 years there have been no significant further improvements in survival or morbidity rates of preterm infants, mostly the extremely-low-gestational-age-neonates (ELGANs, defined as less than or equal to 28 weeks' gestation). The incidence of some of the major morbidities associated with extreme prematurity, such as BPD, could potentially be affected by management in the first minutes of life; it may be necessary to apply the principles of care that occur in the neonatal intensive care unit in the delivery room to achieve a further improvements in short and long-term outcome of these neonates. ⋯ Therefore, it may be useful to incorporate an intensive care environment into the delivery room to enhance survival rates and reduce morbidity of the extremely preterm infants. New approaches in the first minutes of life using more gentle parameters of intervention are being studied but further evidence is needed to improve resuscitation procedures in these newborns.