Journal of neonatal-perinatal medicine
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J Neonatal Perinatal Med · Jan 2016
Use of naloxone to minimize extubation failure after premedication for INSURE procedure in preterm neonates.
A new guideline for the early respiratory management of preterm infants that included early nCPAP and INSURE was recently introduced in our NICU. This case series describes the clinical courses of a group of preterm infants managed according to this guideline, and reports the rates of successful extubation within 30 minutes of surfactant administration with and without the use of naloxone and adverse events encountered. ⋯ Naloxone can be effective in reversing the respiratory depressive effect of analgesic premedication and in turn facilitates expeditious extubation in some preterm infants intubated for INSURE procedure.
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J Neonatal Perinatal Med · Jan 2015
Hyperglycemia is associated with poor outcome in newborn infants undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy.
Therapeutic hypothermia (TH) improves survival and neurodevelopmental outcome in neonatal hypoxic ischemic encephalopathy (HIE). Both, hypoglycemia and hyperglycemia are common in infants with HIE. The relationship between hypoglycemia and hyperglycemia, and immediate outcome has not been well described. ⋯ Hyperglycemia on the first day portends poor outcome in newborn infants undergoing TH for HIE.
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J Neonatal Perinatal Med · Jan 2015
Early extubation attempts reduce length of stay in extremely preterm infants even if re-intubation is necessary.
Prolonged mechanical ventilation in the extremely premature infant is associated with the development of bronchopulmonary dysplasia (BPD). Clinically, the decision to extubate the extremely low birth weight (ELBW) infant can be difficult. There is continued debate regarding whether it is better for an ELBW infant to remain on the ventilator or to extubate to nasal constant positive airway pressure (nCPAP). It has also been argued that repeated intubations may be detrimental to ELBW infants. We tested the hypothesis that earlier extubation attempts would decrease length of hospital stay and BPD. ⋯ In our cohort of extremely premature infants, the earlier the first extubation attempt the sooner the patient was discharged home and the less likely to develop BPD. Our study suggests that extubation should not be delayed in extremely premature infants due to fears of need for re-intubation.
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J Neonatal Perinatal Med · Jan 2015
Monitoring mesenteric tissue oxygenation with near-infrared spectroscopy during packed red blood cell transfusion in preterm infants.
To monitor altered mesenteric tissue oxygen saturation (StO2) before and after blood transfusion. ⋯ There are several plausible mechanisms that may explain the relationship between necrotizing enterocolitis and PRBC transfusion; however, mesenteric tissue oxygen saturation changes did not clearly show that ischemia or re-perfusion injury to be one of the potential mechanisms.
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J Neonatal Perinatal Med · Jan 2015
Effects of intermittent hypoxia and hyperoxia on angiogenesis and lung development in newborn mice.
Premature birth disrupts hypoxia driven microvascular development that directs alveolar and lung growth. Changes in oxygen exposure after birth can perturb the regulation of angiogenesis leading to bronchopulmonary dysplasia (BPD). We studied the effects of intermittent hypoxia or hyperoxia on HIF and angiogenic gene expression and lung development in newborn mice. ⋯ Downregulation of HIF and angiogenic gene expression with associated changes in lung histology following intermittent hypoxia-hyperoxia is likely an important contributing factor in the development of BPD.