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| 2. |
- Arwehed, Sofia, et al.
(författare)
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Nordic survey showed wide variation in discharge practices for very preterm infants
- 2023
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227.
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Tidskriftsartikel (refereegranskat)abstract
- AimWe aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units.MethodsMedical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments.ResultsWe received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay.ConclusionDischarge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.
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| 3. |
- Domellöf, Magnus, 1963-, et al.
(författare)
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The Swedish Approach to Management of Extreme Prematurity at the Borderline of Viability : A Historical and Ethical Perspective
- 2018
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Ingår i: Pediatrics. - 0031-4005 .- 1098-4275. ; 142, s. S533-S538
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has a long tradition of being at the forefront of the management of extremely preterm infants. In this article, we explore the historical background, ethical discussions, and evidence from national surveys combined with data from quality registers that form the background of the current Swedish guidelines for the care of extremely preterm infants. The current Swedish national guidelines suggest providing active care for preterm infants from 23 weeks' gestation and considering active care from 22 weeks' gestation. The survival of infants in gestational weeks 22 and 23 has increased and now exceed 50% and 60%, respectively; importantly, the Swedish proactive approach to care at the border of viability has not resulted in an increased proportion of functional impairment among survivors.
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| 4. |
- Donaldsson, Snorri, et al.
(författare)
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Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks Gestational Age The CORSAD Randomized Clinical Trial
- 2021
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Ingår i: JAMA pediatrics. - : AMER MEDICAL ASSOC. - 2168-6203 .- 2168-6211. ; 175:9, s. 911-918
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Establishing stable breathing is a key event for preterm infants after birth. Delivery of pressure-stable continuous positive airway pressure and avoiding face mask use could be of importance in the delivery room. OBJECTIVE To determine whether using a new respiratory support system with low imposed work of breathing and short binasal prongs decreases delivery room intubations or death compared with a standard T-piece system with a face mask. DESIGN, SETTING, AND PARTICIPANTS In this unblinded randomized clinical trial, mothers threatening preterm delivery before week 28 of gestation were screened. A total of 365 mothers were enrolled, and 250 infants were randomized before birth and 246 liveborn infants were treated. The trial was conducted in 7 neonatal intensive care units in 5 European countries from March 2016 to May 2020. The follow-up period was 72 hours after intervention. INTERVENTIONS Infants were randomized to either the new respiratory support system with short binasal prongs (n = 124 infants) or the standard T-piece system with face mask (n = 122 infants). The intervention was providing continuous positive airway pressure for 10 to 30 minutes and positive pressure ventilation, if needed, with the randomized system. Main Outcomes and Measures The primary outcome was delivery room intubation or death within 30 minutes of birth. Secondary outcomes included respiratory and safety variables. RESULTS Of 246 liveborn infants treated, the mean (SD) gestational age was 25.9 (1.3) weeks, and 127 (51.6%) were female. A total of 41 infants (33.1%) receiving the new respiratory support system were intubated or died in the delivery room compared with 55 infants (45.1%) receiving standard care. The adjusted odds ratio was statistically significant after adjusting for stratification variables (adjusted odds ratio, 0.53; 95% CI, 0.30-0.94; P = .03). No significant differences were seen in secondary outcomes or safety variables. CONCLUSIONS AND RELEVANCE In this study, using the new respiratory support system reduced delivery room intubation in extremely preterm infants. Stabilizing preterm infants with a system that has low imposed work of breathing and binasal prongs as interface is safe and feasible.
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| 5. |
- Drevhammar, Thomas, et al.
(författare)
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Comparison of Nasal Continuous Positive Airway Pressure Delivered by Seven Ventilators Using Simulated Neonatal Breathing
- 2013
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 14:4, s. E196-E201
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Nasal continuous positive airway pressure (NCPAP) is an established treatment for respiratory distress in neonates. Most modern ventilators are able to provide NCPAP. There have been no large studies examining the properties of NCPAP delivered by ventilators. The aim of this study was to compare pressure stability and imposed work of breathing (iWOB) for NCPAP delivered by ventilators using simulated neonatal breathing. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: Neonatal breathing was simulated using a mechanical lung simulator. Seven ventilators were tested at different CPAP levels using two breath profiles. Pressure stability and iWOB were determined. Results from three ventilators revealed that they provided a slight pressure support. For these ventilators, iWOB could not be calculated. There were large differences in pressure stability and iWOB between the tested ventilators. For simulations using the 3.4-kg breath profile, the pressure swings around the mean pressure were more than five times greater, and iWOB more than four times higher, for the system with the highest measured values compared with the system with the lowest. Overall, the Fabian ventilator was the most pressure stable system. Evita XL and SERVO-i were found more pressure stable than Fabian in some simulations. The results for iWOB were in accordance with pressure stability for systems that allowed determination of this variable. Conclusions: Some of the tested ventilators unexpectedly provided a minor degree of pressure support. In terms of pressure stability, we have not found any advantages of ventilators as a group compared with Bubble CPAP, Neopuff, and variable flow generators that were tested in our previous study. The variation between individual systems is great within both categories. The clinical importance of these findings needs further investigation.
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| 6. |
- Drevhammar, Thomas, et al.
(författare)
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Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing
- 2012
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 13:2, s. E113-E119
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Continuous positive airway pressure is an established treatment for respiratory distress in neonates. Continuous positive airway pressure has been applied to infants using an array of devices. The aim of this experimental study was to investigate the characteristics of seven continuous positive airway pressure systems using simulated breath profiles from newborns. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: In vitro simulation of spontaneous neonatal breathing was achieved with a mechanical lung model. Simulation included two breath profiles, three levels of continuous positive airway pressure with and without short binasal prongs and different levels of constant leak. Pressure stability and imposed work of breathing were determined. Seven continuous positive airway pressure systems were tested. There were large differences in pressure stability and imposed work of breathing between tested continuous positive airway pressure systems. Neopuff and Medijet had the highest pressure instability and imposed work of breathing. Benveniste, Hamilton Universal (Arabella), and Bubble continuous positive airway pressure showed intermediate results. AirLife and Infant Flow had the lowest pressure instability and imposed work of breathing. AirLife and Infant Flow showed the least decrease in delivered pressure when challenged with constant leak. Conclusion: The seven tested continuous positive airway pressure systems showed large variations in pressure stability and imposed work of breathing. They also showed large differences in how well they maintain continuous positive airway pressure when exposed to leak. For most systems, imposed work of breathing increased with increasing continuous positive airway pressure level. The clinical importance of the difference in pressure stability is uncertain. Our results may facilitate the design of clinical studies examining the effect of pressure stability on outcome.
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| 7. |
- Drevhammar, Thomas, et al.
(författare)
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Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP : An Experimental Pilot Study
- 2015
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Ingår i: Respiratory care. - : Daedalus Enterprises. - 0020-1324 .- 1943-3654. ; 60:7, s. 1000-1006
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nasal CPAP is the most common respiratory support for neonates. Several factors are considered important for effective treatment, including leaks at the patient interface and the delivery of pressure-stable CPAP. Investigations of pressure stability during leaks should include both the change in the mean delivered CPAP and the pressure variation during each breath. The aim of this study was to examine the response of ventilators delivering nasal CPAP when challenged with leaks at the patient interface. METHODS: Seven ventilators providing nasal CPAP at 4 cmH(2)O were challenged with leaks during simulated neonatal breathing. Leak was applied for 15 consecutive breaths at a constant level (1-4 L/min). RESULTS: The 2 aspects of pressure stability were evaluated by measuring the mean delivered CPAP and the amplitude of pressure swings before, during, and after leaks. The ability to maintain the delivered CPAP and the amplitude of pressure swings varied greatly among the 7 ventilators before, during, and after leaks. Four of the ventilators tested have built-in leak compensation. CONCLUSIONS: There was no simple relationship between maintaining delivered CPAP during leaks and providing CPAP with low pressure swing amplitude. Maintaining the delivered CPAP and providing this without pressure swings are 2 separate aspects of pressure stability, and investigations concerning the clinical importance of pressure stability should address both aspects. This study also shows that compensation for leaks does not necessarily provide pressure-stable CPAP.
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| 8. |
- Erlandsson, Kerstin, 1961-, et al.
(författare)
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Do caregiving models after caesarean birth influence the infant's breathing adaptation and crying? A pilote study
- 2008
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Ingår i: Journal of Children's and Young People's Nursing. - : MA Healthcare. - 1753-1594 .- 2052-2886. ; 2:1, s. 7-12
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Tidskriftsartikel (refereegranskat)abstract
- Cesarean birth is a mode of delivery that often minimizes the mothers’ possibility to handle her term baby skin-to-skin while the father takes care of the baby for part, or all, of the first hours. No attention has, as far as we know, been given to different caregiving models and their eventual effects on the adaptation of breathing for the term infant born by elective cesarean. Previous publications on breathing patterns in newborn infants have mostly been conducted on premature infants in kangaroo care. The aim of this pilot study was to compare the effects of two caregiving models on the adaptation of breathing and infant crying after elective cesarean section, in term infants during the first hours after birth. Term infants born by elective cesarean were held skin-to-skin on their father’s chest or cared for in a cot during the mother’s post-operative observation stay. Thirteen father-infant pairs participated in a pilot sub-study with a randomized control trial design. Data were collected both by respiratory inductance plethysmography (RIP) and by tape-recorded crying time. The data raises important questions about the effects on breathing adaptation in relation to caregiving models. The infants in the skin-to-skin group showed significantly higher inspiratory and expiratory air flows, larger breath volume (all p<0.001) and minute ventilation, compared with the cot group. The infants in the skin-to-skin group cried less than the infants in the cot group (p<0.001). A caregiving model where fathers hold their infants skin-to-skin in an upright position on their chest has a positive impact on the infants’ respiratory adaptation and reduced infant crying. Larger studies of caregiving models after elective cesarean birth on the adaptation of breathing need to be conducted.
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| 9. |
- Heiring, Christian, et al.
(författare)
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Survey shows large differences between the Nordic countries in the use of less invasive surfactant administration
- 2017
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Ingår i: Acta Paediatrica, International Journal of Paediatrics. - : Wiley. - 0803-5253 .- 1651-2227. ; 106:3, s. 382-386
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Less invasive surfactant administration (LISA), namely surfactant instillation through a thin catheter in the trachea during spontaneous breathing, is increasingly used for premature infants. We surveyed the use of this technique in the Nordic countries in autumn 2015. Methods: A link to a web-based survey of surfactant administration methods was emailed to the directors of all neonatal units in the Nordic Region, apart from Finland, where only the five university-based departments were invited. Results: Of the 73 units (85%) who responded, 23 (32%) said that they used LISA. The country rates were Iceland 100%, Norway 82%, Finland 60%, Denmark, including Faroe Island and Greenland, 11% and Sweden 9%. LISA was used in 62% of level three units, but only 14% of level two units and most commonly in babies with a gestational age of at least 26 weeks. Premedication was always or sometimes used by 78%. The main reasons for not using LISA were lack of familiarity with the technique (61%), no perceived benefit over other methods (22%) and concerns about patient discomfort (26%). Conclusion: Less invasive surfactant administration was used in 32% of Nordic neonatal units, most commonly in level three units. Premedication was used more often than previously reported.
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| 10. |
- Jónsson, Baldvin
(författare)
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Chronic lung disease of prematurity : a study of selected causative factors and preventive measures
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic lung disease of prematurity (CLD) is the most common chronic lung disorder in infants. With the increase in survival of preterm infants in recent years, many immature infants are surviving with CLD. Care of preterm babies with CLD is a major clinical problem in neonatal intensive care. We studied the population of very-low-birth-weight infants (n = 687) in Stockholm County from 1988-1993 to evaluate the use of nasal continuous airway pressure (NCPAP) and mechanical ventilation, and the effects on respiratory morbidity, including the incidence of CLD. We found that infants with gestational ages > 26 weeks can often be cared for at level II neonatal units without mechanical ventilation by using early NCPAP. On the other hand, infants with a gestational age of < 26 weeks need transfer to level III neonatal units, since they will often need mechanical ventilation. Failure of NCPAP is related to the presence of respiratory distress syndrome. CLD increased with decreasing gestational age in mechanically ventilated infants. The incidence of Ureaplasma urealyticum colonization and relationship to CLD was investigated in two studies (n = 93 and 155). Colonization with Ureaplasma urealyticum was inversely related to gestational age and only seen in infants < 30 weeks gestation. Colonization is significantly related to vaginal delivery, prolonged rupture of membranes and chorioamnionitis in the mother. Colonized infants developed CLD more frequently, but immaturity was the strongest determinant for this outcome. Oxygen requirement at 36 weeks postconceptual age was most strongly related to the presence of chorioamnionitis in the mother, and sepsis and/or persisting ductus arteriosus after the first week of life. Erythromycin treatment reduced colonization, but not time with supplemental oxygen. Cytokine levels in relation to CLD development were examined in two studies (n = 38 and 69). Levels of proinflammatory cytokines were elevated in tracheobronchial aspirate fluid during the first days of life in preterm infants who developed CLD. Production of downregulatory cytokines was irregular or absent in preterm infants who developed CLD, while levels of cytokines leading to the development of fibrosis remained elevated. An imbalance in the pulmonary cytokine network may contribute to the development of CLD. We studied the effects of an inhaled steroid (budesonide) in 30 infants at high risk for development of CLD. Inhaled budesonide decreased the need for mechanical ventilation similar to intravenous dexamethasone, but without significant side effects.
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