| 1. |
- Backes, Carl H., et al.
(författare)
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Management, treatment and ethical considerations in the care of mother-infant dyads at less than 25 weeks of gestations
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1
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Tidskriftsartikel (refereegranskat)abstract
- Infants born at less than 25 weeks of gestation represent a small fraction of all preterm births. Caring for these fragile patients is complex because of their significant risks of mortality and adverse outcomes. In the last decades, in view of decreased mortality without increased morbidity as reported from different centers, many clinicians are now more likely to consider providing intensive care treatment to infants born at less than 25 weeks of gestation. But in other settings, palliative care is still considered standard practice, particularly at 22 and 23 weeks of gestation.
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| 2. |
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| 3. |
- Backes, Carl, et al.
(författare)
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Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39:1, s. 39-47
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
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| 4. |
- Cristea, A. Ioana, et al.
(författare)
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Approaches to Interdisciplinary Care for Infants with Severe Bronchopulmonary Dysplasia: A Survey of the Bronchopulmonary Dysplasia Collaborative
- 2022
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Ingår i: American Journal of Perinatology. - : Georg Thieme Verlag KG. - 0735-1631 .- 1098-8785.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Bronchopulmonary dysplasia (BPD) remains the most common late morbidity for extremely premature infants. Care of infants with BPD requires a longitudinal approach from the neonatal intensive care unit to ambulatory care though interdisciplinary programs. Current approaches for the development of optimal programs vary among centers.Study design: We conducted a survey of 18 academic centers that are members of the BPD Collaborative, a consortium of institutions with an established interdisciplinary BPD program. We aimed to characterize the approach, composition, and current practices of the interdisciplinary teams in inpatient and outpatient domains.Results: Variations exist among centers, including composition of the interdisciplinary team, whether the team is the primary or consult service, timing of the first team assessment of the patient, frequency and nature of rounds during the hospitalization, and the timing of ambulatory visits postdischarge.Conclusion: Further studies to assess long-term outcomes are needed to optimize interdisciplinary care of infants with severe BPD.Key points: · Care of infants with BPD requires a longitudinal approach from the NICU to ambulatory care.. · Benefits of interdisciplinary care for children have been observed in other chronic conditions.. · Current approaches for the development of optimal interdisciplinary BPD programs vary among centers..
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| 5. |
- Diderholm, Barbro, 1965-, et al.
(författare)
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The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants
- 2022
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 14:4
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Tidskriftsartikel (refereegranskat)abstract
- The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22-26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 +/- 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 +/- 5 and 143 +/- 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.
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| 6. |
- Erdeve, Omer, et al.
(författare)
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An Update on Patent Ductus Arteriosus and What is Coming Next
- 2022
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Ingår i: TURKISH ARCHIVES OF PEDIATRICS. - : AVES Publishing Co.. - 2757-6256. ; 57:2, s. 118-131
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Forskningsöversikt (refereegranskat)abstract
- Patent ductus arteriosus is the most common cardiovascular condition in preterm infants. There is a significant uncertainty about when and how to close ductus arteriosus in preterm infants due to a high spontaneous closure rate even in very immature preterm infants. Diagnosis and management of patent ductus arteriosus remain a challenge for both neonatologists and pediatric cardiologists. Researchers have tried to define a balance between an expectant approach and active treatment in selected infants. This review aimed to focus on the pathophysiology and management of patent ductus arteriosus and to make suggestions about approaches that might eliminate the association of morbidities with patent ductus arteriosus.
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| 7. |
- Hoffsten, Alice, et al.
(författare)
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Early Postnatal Comprehensive Biomarkers Cannot Identify Extremely Preterm Infants at Risk of Developing Necrotizing Enterocolitis.
- 2021
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Ingår i: Frontiers in pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Necrotizing enterocolitis (NEC) is a fatal disease where current diagnostic tools are insufficient for preventing NEC. Early predictive biomarkers could be beneficial in identifying infants at high risk of developing NEC. Objective: To explore early biomarkers for predicting NEC in extremely preterm infants (EPIs). Methods: Blood samples were collected on day 2 (median 1.7; range 1.5-2.0) from 40 EPI (median 25 gestational weeks; range 22-27): 11 developed NEC and 29 did not (controls). In each infant, 189 inflammatory, oncological, and vascular proteomic biomarkers were quantified through Proximity Extension Assay. Biomarker expression and clinical data were compared between the NEC group and Controls. Based on biomarker differences, controls were sorted automatically into three subgroups (1, 2, and 3) by a two-dimensional hierarchical clustering analysis. Results: None of the biomarkers differed in expression between all controls and the NEC group. Two biomarkers were higher in Control 1, and 16 biomarkers were lower in Control group 2 compared with the NEC group. No biomarker distinguished Control 3 from the NEC group. Perinatal data were similar in the whole population. Conclusions: Early postnatal comprehensive biomarkers do not identify EPIs at risk of developing NEC in our study. Future studies of predictors of NEC should include sequential analysis of comprehensive proteomic markers in large cohorts.
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| 8. |
- Hoffsten, Alice, et al.
(författare)
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Paneth cell proteins DEFA6 and GUCA2A as tissue markers in necrotizing enterocolitis
- 2023
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Ingår i: European Journal of Pediatrics. - : Springer Nature. - 0340-6199 .- 1432-1076. ; 182:6, s. 2775-2784
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies suggest that Paneth cells are involved in NEC development. Defensin alpha 6 (DEFA6) and guanylate cyclase activator 2A (GUCA2A) are selective protein markers of Paneth cells. The objective was to explore DEFA6 and GUCA2A expression in intestinal tissue samples from newborn infants with and without NEC. Tissue samples from histologically intact intestine were analyzed from 70 infants: 43 underwent bowel resection due to NEC and 27 controls were operated due to conditions such as intestinal atresia, dysmotility, aganglionosis, pseudo-obstruction or volvulus. Each tissue sample was immunohistochemically stained for DEFA6 and GUCA2A. Semi-automated digital image analysis was performed to determine protein expression. Clinical data and protein expressions were compared between the groups. DEFA6 expression was lower in the NEC group (p = 0.006). Low DEFA6 correlated with risk of developing NEC in a logistic regression analysis, independently of gestational age and birth weight (OR 0.843 [CI 0.732–0.971]; p = 0.018). GUCA2A expression did not differ between the two groups.Conclusion: Lower expression of DEFA6 together with intact GUCA2A expression indicates that NEC patients have well-defined Paneth cells but diminished defensin activity. Our results suggest that DEFA6 could be used as a biomarker for NEC.What is Known:• Previous studies of defensin activity in NEC have been inconsistent, showing that defensin levels may be increased or diminished in NEC. GUCA2A has to our knowledge never been studied in NEC.What is New:• This study benchmarks two specific Paneth cell markers (DEFA6 and GUCA2A) and their activity in individuals with and without NEC.• The key finding is that the NEC group had a lower DEFA6 expression compared to the Controls, while the expression of GUCA2A did not differ between the groups.
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| 9. |
- Hoffsten, Alice, et al.
(författare)
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The value of autopsy in preterm infants at a Swedish tertiary neonatal intensive care unit 2002-2018
- 2021
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Reliable data on causes of death (COD) in preterm infants are needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born <37 weeks' gestational age (n=278) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002-2018), and assessed changes in COD between two periods (period 1:2002-2009 vs. period 2:2011-2018; 2010 excluded due to centralized care and seasonal variation in COD). Autopsy was performed in 73% of all cases and was more than twice as high compared to national infant autopsy rates (33%). Autopsy revised or confirmed a suspected preliminary COD in 34.9% of the cases (23.6% and 11.3%, respectively). Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs. 26%). The autopsy rate did not change between the two study periods (75% vs. 71%). We conclude that autopsy determined the final COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.
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| 10. |
- Kielt, Matthew, et al.
(författare)
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Classifying multicenter approaches to invasive mechanical ventilation for infants with bronchopulmonary dysplasia using hierarchical clustering analysis
- 2023
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Ingår i: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 58:8, s. 2323-2332
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionEvidence-based ventilation strategies for infants with severe bronchopulmonary dysplasia (BPD) remain unknown. Determining whether contemporary ventilation approaches cluster as specific BPD strategies may better characterize care and enhance the design of clinical trials. The objective of this study was to test the hypothesis that unsupervised, multifactorial clustering analysis of point prevalence ventilator setting data would classify a discrete number of physiology-based approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD.MethodsWe performed a secondary analysis of a multicenter point prevalence study of infants with severe BPD treated with invasive mechanical ventilation. We clustered the cohort by mean airway pressure (MAP), positive end expiratory pressure (PEEP), set respiratory rate, and inspiratory time (Ti) using Ward's hierarchical clustering analysis (HCA).ResultsSeventy-eight patients with severe BPD were included from 14 centers. HCA classified three discrete clusters as determined by an agglomerative coefficient of 0.97. Cluster stability was relatively strong as determined by Jaccard coefficient means of 0.79, 0.85, and 0.77 for clusters 1, 2, and 3, respectively. The median PEEP, MAP, rate, Ti, and PIP differed significantly between clusters for each comparison by Kruskall–Wallis testing (p < 0.0001).ConclusionsIn this study, unsupervised clustering analysis of ventilator setting data identified three discrete approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD. Prospective trials are needed to determine whether these approaches to mechanical ventilation are associated with specific severe BPD clinical phenotypes and differentially modify respiratory outcomes.
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| 11. |
- Lewis, Tamorah R., et al.
(författare)
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Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia
- 2022
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Ingår i: JAMA pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 176:9, s. 852-859
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities.Objective: To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD.Design, setting, and participants: This multicenter cohort study included preterm infants enrolled in the BPD Collaborative registry from January 1, 2015, to July 19, 2021, involving 8 BPD Collaborative centers located in the US. Included patients were born at less than 32 weeks' gestation, had a diagnosis of severe BPD as defined by the 2001 National Institutes of Health Consensus Criteria, and were born to Black or White mothers.Exposures: Maternal race: Black vs White.Main outcomes and measures: Death and length of hospital stay.Results: Among 834 registry infants (median [IQR] gestational age, 25 [24-27] weeks; 492 male infants [59%]) meeting inclusion criteria, the majority were born to White mothers (558 [67%]). Death was observed infrequently in the study cohort (32 [4%]), but Black maternal race was associated with an increased odds of death (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) after adjusting for center. Black maternal race was also significantly associated with length of hospital stay (adjusted between-group difference, 10 days; 95% CI, 3-17 days).Conclusions and relevance: In a multicenter severe BPD cohort, study results suggest that infants born to Black mothers had increased likelihood of death and increased length of hospital stay compared with infants born to White mothers. Prospective studies are needed to define the sociodemographic mechanisms underlying disparate health outcomes for Black infants with severe BPD.
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| 12. |
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| 13. |
- Markasz, Laszlo, et al.
(författare)
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CD44 and RHAMM expression patterns in the human developing lung
- 2021
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Ingår i: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 89, s. 134-142
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Tidskriftsartikel (refereegranskat)abstract
- Background: The hyaluronan (HA) receptors CD44 and RHAMM (CD168) are involved in cellular proliferation, differentiation, and motility. As previously investigated, HA and RHAMM expression in human neonatal lungs correlates to gestational age (GA) and air content.Methods: CD44 immunofluorescence was analyzed in postmortem lung samples from infants (n=93;22-41GA) by digital image analysis together with clinical data, including RHAMM expression, lung air and HA content by hierarchical clustering.Results: Five groups were defined according to RHAMM/CD44 expression, GA, and postnatal age (PNA): extremely-to-very preterm (EVP;22-31GA; Groups 1-2), moderately preterm-to-term (MPT;31-41GA; Groups 3-4) and mixed preterm-to-term (27-40GA; Group 5). CD44 correlated linearly with RHAMM in MPT (r=0.600;p<0.004). In EVP, high CD44 and low RHAMM corresponded with high PNA and lung air content independently of HA and GA (Group 1 vs 2;p<0.05 respectively). In MPT, high and low CD44 corresponded with low and high RHAMM independently of GA, HA and lung air content (Group 3 vs 4;p<0.001). No correlation between CD44 and GA/PNA at death was observed. Conclusions: A linear correlation between CD44 and RHAMM expression occurs during the late saccular phase of lung development at birth, whereas postnatal influences on CD44 and RHAMM expression in extremely-to-very preterm infants cannot be excluded.
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| 14. |
- Markasz, Laszlo, et al.
(författare)
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Cluster Analysis of Early Postnatal Biochemical Markers May Predict Development of Retinopathy of Prematurity
- 2020
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Ingår i: Translational Vision Science & Technology. - : Association for Research in Vision and Ophthalmology (ARVO). - 2164-2591. ; 9:13
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Growth factors and inflammatory and angiogenetic proteins are involved in the development of retinopathy of prematurity (ROP). However, no early biochemical markers are in clinical use to predict ROP. By performing cluster analysis of multiple biomarkers, we aimed to determine patient groups with high and low risk for developing ROP.Methods: In total, 202 protein markers in plasma were quantified by proximity extension assay from 35 extremely preterm infants on day 2 of life. Infants were sorted in groups by automated two-dimensional hierarchical clustering of all biomarkers. ROP was classified as stages I to III with or without surgical treatment. Predictive biomarkers were evaluated by analysis of variance and detected differences by two-sided paired t-test with Bonferroni corrections for multiple comparisons.Results: Differences in 39 biochemical markers divided infants without ROP into two control groups (control 1, n = 7; control 2, n = 5; P < 0.05). Sixty-six biochemical markers defined differences between the control groups (n = 13) and all ROP infants (n = 23; P < 0.05). PARK7, VIM, MPO, CD69, and NEMO were markedly increased in control 1 compared to all ROP infants (P < 0.001). Lower TNFRSF4 and higher HER2 and GAL appeared in infants with ROP as compared to control 1 and/or 2 (P < 0.05, respectively).Conclusions: Our data suggest that early elevated levels of PARK7, VIM, MPO, CD69, and NEMO may be associated with lower risk of developing ROP. Lower levels of TNFRSF4 with higher levels of HER2 and GAL may predict ROP development.Translational Relevance: Cluster analysis of early postnatal biomarkers may help to identify infants with low or high risk of developing ROP.
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| 15. |
- Markasz, Laszlo, et al.
(författare)
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Collagen type IV alpha 1 chain (COL4A1) expression in the developing human lung
- 2024
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Ingår i: BMC Pulmonary Medicine. - : Springer Nature. - 1471-2466. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCollagen type IV alpha 1 chain (COL4A1) in the basement membrane is an important component during lung development, as suggested from animal models where COL4A1 has been shown to regulate alveolarization and angiogenesis. Less is known about its role in human lung development. Our aim was to study COL4A1 expression in preterm infants with different lung maturational and clinical features.MethodsCOL4A1 expression in 115 lung samples from newborn infants (21-41 weeks' gestational age; 0-228 days' postnatal age [PNA]) was studied by immunohistochemistry combined with digital image analysis. Cluster analysis was performed to find subgroups according to immunohistologic and clinical data.ResultsPatients were automatically categorized into 4 Groups depending on their COL4A1 expression. Expression of COL4A1 was mainly extracellular in Group 1, low in Group 2, intracellular in Group 3, and both extra- and intracellular in Group 4. Intracellular/extracellular ratio of COL4A1 expression related to PNA showed a distinctive postnatal maturational pattern on days 1-7, where intracellular expression of COL4A1 was overrepresented in extremely preterm infants.ConclusionsCOL4A1 expression seems to be highly dynamic during the postnatal life due to a possible rapid remodeling of the basement membrane. Intracellular accumulation of COL4A1 in the lungs of extremely premature infants occurs more frequently between 1 and 7 postnatal days than during the first 24 hours. In view of the lung arrest described in extremely preterm infants, the pathological and/or developmental role of postnatally increased intracellular COL4A1 as marker for basement membrane turnover, needs to be further investigated.
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| 16. |
- Markasz, Laszlo, et al.
(författare)
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The receptor for hyaluronan-mediated motility (RHAMM) expression in neonatal bronchiolar epithelium correlates negatively with lung air content
- 2018
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 127, s. 58-68
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The receptor for hyaluronan-mediated motility (RHAMM) may have an important role in lung development. The aim of this study was to examine the expression of hyaluronan (HA) content and RHAMM during postnatal lung development by analyzing human lung specimens from ventilated newborn infants with a variety of lung diseases at different gestational and postnatal ages.Materials and methods: Ninety four patient samples were evaluated. RHAMM expression was studied by immunohistochemistry combined with digital image analysis. Cluster analysis was performed to find subgroups according to immuno-histological and clinical data. We present a computerized method that describes the air content of the lung by determining the fraction of the parenchyma-covered area in lung sections. HA content was estimated by radiometric assay.Results: The patients could be sorted into groups by hierarchical clustering. Five of six groups showed individual patterns according to RHAMM expression and HA content. Negative correlation was observed between air content and RHAMM expression in the bronchiolar epithelium irrespective of clustered groups. Lung hypoplasia appeared in two distinctive groups, with significant differences in lung development and RHAMM expression.Conclusions: RHAMM expression may show dynamic changes during pathological processes in the neonatal lung. The distribution of RHAMM in the lung tissue is heterogeneous with a predominance to the bronchiolar epithelium. We found a negative correlation between lung air content and RHAMM expression in bronchiolar epithelium.
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| 17. |
- McKinney, Robin L., et al.
(författare)
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Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia
- 2021
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Ingår i: American Journal of Perinatology. - : Georg Thieme Verlag KG. - 0735-1631 .- 1098-8785. ; 38, s. E162-E166
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes.Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA).Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge.Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.
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| 18. |
- McKinney, R. L., et al.
(författare)
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Novel forms of ventilation in neonates : Neurally adjusted ventilatory assist and proportional assist ventilation
- 2024
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 48:2
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Forskningsöversikt (refereegranskat)abstract
- Patient-triggered modes of ventilation are currently the standard of practice in the care of term and preterm infants. Maintaining spontaneous breathing during mechanical ventilation promotes earlier weaning and possibly reduces ventilator-induced diaphragmatic dysfunction. A further development of assisted ventilation provides support in proportion to the respiratory effort and enables the patient to have full control of their ventilatory cycle. In this paper we will review the literature on two of these modes of ventilation: neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV), propose future studies and suggest clinical applications of these modes.
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| 19. |
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| 20. |
- Munsters, Josanne, 1986-, et al.
(författare)
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Skin conductance measurement as a selective and continuous pain assessment method during eye examinations for retinopathy of prematurity
- 2023
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Ingår i: Global Pediatrics. - : Elsevier. - 2667-0097. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAssessing and managing pain in newborns is important for normal development and reduction of morbidity.AimTo assess whether skin conductance measurements (SCM) can be used as an objective method for measuring procedural pain during screening for retinopathy of prematurity (ROP) in preterm infants and to identify painful components of the examination.Methods65 separate SCM were performed in 33 infants born at <32 weeks gestational age (wGA) eligible for ROP screening (median 26+4 wGA, range 23+3 to 31+3; median weeks postmenstrual age 37+2, range 31+0 to 49+6). SCM was measured before, during and after eye examination (fundoscopy and/or wide-field digital retinal imaging [WFDRI]), and compared to changes in heart rate (HR), pulse oximetry saturation (SpO2) and behavioral state measured with the Neonatal Pain, Agitation and Sedation Scale (N-PASS).ResultsA major increase of SCM could be seen during both fundoscopy and WFDRI (p<0.01, respectively). No correlation was found between SCM and wGA. N-PASS changed significantly during ROP examination (p<0.01). While N-PASS could only distinguish painful response from baseline during fundoscopy and WFDRI, SCM detected responses during each stage of the investigations i.e. the application of mydriatics, fundoscopy, anesthetic drops, speculum and WFDRI. HR increased only during digital retinal imaging (p = 0.049), while SpO2 decreased only during fundoscopy (p = 0.042).ConclusionSCM may be used as a continuous and objective method to evaluate pain and its intensity during screening for ROP, enabling the separation of the different painful components of the investigation. Selecting and grading the different painful stages improves the possibility to assess and continue to improve pain management more specifically in these patients.
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| 21. |
- Norman, Mikael, et al.
(författare)
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Respiratory support of infants born at 22-24 weeks of gestational age
- 2022
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Ingår i: Seminars in Fetal & Neonatal Medicine. - : Elsevier. - 1744-165X .- 1878-0946. ; 27:2
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Forskningsöversikt (refereegranskat)abstract
- Lung immaturity and acute respiratory failure are the major problems in the care of extremely preterm infants. Most infants with gestational age (GA) 22-24 weeks will need mechanical ventilation and many will depend on some type of respiratory support, invasive and non-invasive for extended periods. There is ongoing gap in knowledge regarding optimal respiratory support and applying strategies that are effective in more mature populations is not easy or even suitable because lung maturation differs in smaller infants. Better strategies on how to avoid lung damage and to promote growth and development of the immature lung are warranted since increased survival is accompanied by increasing rates of bronchopulmonary dysplasia and concerns over long-standing reductions in lung function.This review focuses on some aspects of respiratory care of infants born at 22-24 weeks of GA.
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| 22. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants
- 2021
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Ingår i: Frontiers in Pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment.Objective: Our aim was to assess differences in clinical characteristics and outcomes between surgically treated and matched non-surgically treated PDA in extremely pre-term infants.Methods: All extremely pre-term infants born 2010-2016 with surgically treated PDA (Ligated group; n = 44) were compared to non-surgically treated infants (Control group; n = 44) matched for gestational age (+/-1 week) and time of birth (+/-1 month). Perinatal parameters, echocardiographic variables, details of pharmacological PDA treatment, morbidity, and mortality were assessed.Result: Mean GA and birthweight were similar between the Ligated group (24(+5) +/- 1(+3) weeks and 668 +/- 170 g) and the Control group (24(+5) +/- 1(+3) weeks and 704 +/- 166 g; p = 1.000 and p = 0.319, respectively). Infants in the Ligated group had larger ductal diameters prior to pharmacological treatment, and lack of diameter decrease and PDA closure after treatment (p = 0.022, p = 0.043 and 0.006, respectively). Transfusions, post-natal steroids and invasive respiratory support were more common in the Ligated group. Except for a higher incidence of severe bronchopulmonary dysplasia (BPD) in the Ligated group there were no other differences in outcomes or mortality between the groups.Conclusion: Early large ductal diameter and reduced responsiveness to pharmacological treatment predicted the need for future surgical ligation in this matched cohort study of extremely pre-term infants where the effect of GA and differences in treatment strategies were excluded. Besides an increased incidence of severe BPD in the Ligated group, no other differences in morbidity or mortality were detected.
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| 23. |
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| 24. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Early haemodynamically significant patent ductus arteriosus does not predict future persistence in extremely preterm infants
- 2019
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 108:9, s. 1590-1956
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Tidskriftsartikel (refereegranskat)abstract
- AimWe assessed whether early haemodynamically significant patent ductus arteriosus (hsPDA) predicted persistent patent ductus arteriosus (PDA) in extremely preterm infants.MethodsThis prospective observational study of 60 infants born at 22–27 weeks of gestational age (GA) without any major congenital anomalies or heart defects was conducted at Uppsala University Children's Hospital from November 2012 to May 2015. Respiratory and systemic circulatory parameters were continuously recorded, and echocardiographic examinations performed daily during the first three days of life. Pharmacological treatment was initiated if hsPDA was found on days two to seven. Persistent PDA was diagnosed if hsPDA remained after pharmacological treatment or pharmacological treatment was contraindicated.ResultsThe infants (56% male) had a median GA of 25 + 2 weeks and 50% received pharmacological treatment. PDA was persistent in 30% and ultimately closed or insignificant in 70%. hsPDA on days two to seven was not associated with future persistent PDA (p = 1.000). Mechanical ventilation (p = 0.025), high mean airway pressure (p = 0.020) and low ductal maximal flow velocity (Vmax) (p = 0.024) on day two were associated with future persistent PDA.ConclusionEarly hsPDA did not predict persistent PDA, but the early need for assisted ventilation and low ductal Vmax were associated with future persistent PDA in these extremely preterm infants.
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| 25. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Exploration of potential biochemical markers for persistence of patent ductus arteriosus in preterm infants at 22–27 weeks’ gestation
- 2019
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 86, s. 333-338
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEarly identification of infants at risk for complications from patent ductus arteriosus (PDA) may improve treatment outcomes. The aim of this study was to identify biochemical markers associated with persistence of PDA, and with failure of pharmacological treatment for PDA, in extremely preterm infants.MethodsInfants born at 22–27 weeks’ gestation were included in this prospective study. Blood samples were collected on the second day of life. Fourteen biochemical markers associated with factors that may affect PDA closure were analyzed and related to persistent PDA and to the response of pharmacological treatment with ibuprofen.ResultsHigh levels of B-type natriuretic peptide, interleukin-6, -8, -10, and -12, growth differentiation factor 15 and monocyte chemotactic protein 1 were associated with persistent PDA, as were low levels of platelet-derived growth factor. High levels of erythropoietin were associated with both persistent PDA and failure to close PDA within 24 h of the last dose of ibuprofen.ConclusionsHigh levels of inflammatory markers were associated with the persistence of PDA. High levels of erythropoietin were associated with both the persistence of PDA and failure to respond to pharmacological treatment.
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| 26. |
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| 27. |
- Rieger-Fackeldey, Esther, et al.
(författare)
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Pulmonary stretch receptor activity during partial liquid ventilation with different pressure waveforms
- 2020
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Ingår i: Respiratory Physiology & Neurobiology. - : Elsevier BV. - 1569-9048 .- 1878-1519. ; 276
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the present study was to investigate pulmonary stretch receptor activity (PSR) under different peak inspiratory pressures (PIPs) and inspiratory pressure waveforms during partial liquid (PLV) and gas ventilation (GV).METHODS: PSR instantaneous impulse frequency (PSRfimp) was recorded from single fibers in the vagal nerve during PLV and GV in young cats. PIPs were set at 1.2/1.8/2.2/2.7 kPa, and square and sinusoidal pressure waveforms were applied.RESULTS: PSRfimp at the start of inspiration increased with increasing PIPs, and was steeper and higher with square than with sinusoidal waveforms (p < 0.05). Total number of impulses, peak and mean PSRfimp were lower during PLV than GV at the lowest and highest PIPs (p < 0.025). Time to peak PSRfimp was shorter with square than with sinusoidal waveforms at all pressures and ventilations (p < 0.005). Irrespective of waveform, lower PIPs yielded lower ventilation during PLV.CONCLUSION: As assessed by PSRfimp, increased PIPs do not expose the lungs to more stretching during PLV than during GV, with only minor differences between square and sinusoidal waveforms.
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| 28. |
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| 29. |
- Sindelar, Richard, Docent, 1964-, et al.
(författare)
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Established severe BPD: is there a way out? Change of ventilatory paradigms
- 2021
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Ingår i: Pediatric Research. - : Springer Nature. - 0031-3998 .- 1530-0447. ; 90:6, s. 1139-1146
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Tidskriftsartikel (refereegranskat)abstract
- Improved survival of extremely preterm newborn infants has increased the number of infants at risk for developingbronchopulmonary dysplasia (BPD). Despite efforts to prevent BPD, many of these infants still develop severe BPD (sBPD) andrequire long-term invasive mechanical ventilation. The focus of research and clinical management has been on the prevention ofBPD, which has had only modest success. On the other hand, research on the management of the established sBPD patient hasreceived minimal attention even though this condition poses large economic and health problems with extensive morbidities andlate mortality. Patients with sBPD, however, have been shown to respond to treatments focused not only on ventilatory strategiesbut also on multidisciplinary approaches where neurodevelopmental support, growth promoting strategies, and aggressivetreatment of pulmonary hypertension improve their long-term outcomes. In this review we will try to present a physiology-basedventilatory strategy for established sBPD, emphasizing a possible paradigm shift from acute efforts to wean infants at all costs to amore chronic approach of stabilizing the infant. This chronic approach, herein referred to as chronic phase ventilation, aims atallowing active patient engagement, reducing air trapping, and improving ventilation-perfusion matching, while providingsufficient support to optimize late outcomes.
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| 30. |
- Sindelar, Richard, Docent, 1964-, et al.
(författare)
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Kapitel 2. Andningsstörningar hos nyfödda
- 2019. - 8
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Ingår i: Akut pediatrik. - Stockholm : Liber. - 9789147114276 ; , s. 23-37
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 31. |
- Sindelar, Richard, Docent, 1964-, et al.
(författare)
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Proportional assist and neurally adjusted ventilation : Clinical knowledge and future trials in newborn infants
- 2021
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Ingår i: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 56:7, s. 1841-1849
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Forskningsöversikt (refereegranskat)abstract
- Different types of patient triggered ventilator modes have become the mainstay of ventilation in term and preterm newborn infants. Maintaining spontaneous breathing has allowed for earlier weaning and the additive effects of respiratory efforts combined with pre-set mechanical inflations have reduced mean airway pressures, both of which are important components in trying to avoid lung injury and promote normal lung development. New sophisticated modes of assisted ventilation have been developed during the last decades where the control of ventilator support is turned over to the patient. The ventilator detects the respiratory effort and adjusts ventilatory assistance proportionally to each phase of the respiratory cycle, thus enabling the patient to have full control of the start, the duration and the amount of ventilatory assistance. In this paper we will review the literature on the ventilatory modes of proportional assist ventilation and neurally adjusted ventilatory assistance, examine the different ways the signals are analyzed, propose future studies, and suggest ways to apply these modes in the clinical environment.
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| 32. |
- Sindelar, Richard, Docent, 1964-, et al.
(författare)
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Respiratory Management for Extremely Premature Infants born at 22 to 23 weeks of Gestation in Proactive Centers in Sweden, Japan, and USA
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1, s. 151540-
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Tidskriftsartikel (refereegranskat)abstract
- Survival of preterm newborn infants have increased steadily since the introduction of surfactanttreatment and antenatal steroids. In the absence of randomized controlled trials onventilatory strategies in extremely preterm infants, we present ventilatory strategiesapplied during the initial phase and the continued ventilatory care as applied in three centerswith proactive prenatal and postnatal management and well documented good outcomesin terms of mortality and morbidity in this cohort of infants.
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| 33. |
- Söderström, Fanny, et al.
(författare)
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Active versus restrictive ligation strategy for patent ductus arteriosus : A retrospective two-center study of extremely preterm infants born between 22 + 0 and 25 + 6 weeks of gestational age
- 2024
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Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable.AimsTo investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA.Study designRetrospective, two-center, cohort study.SubjectsInfants born at 22+0–25+6 weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220).Main outcome measuresSurvival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).ResultsSurgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub-group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort.ConclusionEarlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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| 34. |
- Söderström, Fanny, et al.
(författare)
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Active versus restrictive ligation strategy for patent ductus arteriosus - A retrospective two-center study of extremely preterm infants born between 22+0 and 25+6 weeks of gestational age
- 2024
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Ingår i: EARLY HUMAN DEVELOPMENT. - : Elsevier. - 0378-3782 .- 1872-6232. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. Aims: To investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. Study design: Retrospective, two-center, cohort study. Subjects: Infants born at 22(+0)-25(+6) weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). Main outcome measures: Survival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Results: Surgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub -group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. Conclusion: Earlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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| 35. |
- Söderström, Fanny, et al.
(författare)
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Early extubation is associated with shorter duration of mechanical ventilation and lower incidence of bronchopulmonary dysplasia
- 2021
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Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 163
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Respiratory care of extremely preterm infants remains a challenge. The majority require invasive mechanical ventilation (MV), which is a contributing factor in developing bronchopulmonary dysplasia (BPD). It is important to keep MV to a minimum but there have been concerns that attempting extubation too early increases the risk for atelectasis, re-intubation, and further lung trauma. The aim of this study was to compare two different approaches to extubation. Methods: Single-center, retrospective cohort study including infants born at 22 + 0-25 + 6 weeks during 2005-2009 and 2011-2015, before and after implementing guidelines recommending delayed extubation. Primary outcomes were BPD, duration of MV and length of hospital stay. Results: Eighty-eight infants in the early era and 102 infants in the late era were included. Infants in the first period were younger at first extubation attempt, and a higher number of infants were extubated within 24 h, 72 h, and one week after birth. The number of infants re-intubated and postnatal age at re-intubation did not differ between the groups. The incidence of severe BPD was 28% in the early period compared to 48% in the later (p < 0.01). Infants in the late period had longer duration of MV (17 vs 27 days, p < 0.01) but similar length of hospital stay (118 vs 123, p = 0.21). Conclusion: After implementing guidelines recommending delayed extubation, the incidence of severe BPD was higher and the duration of MV was longer. This supports the strategy to attempt extubation early even in extremely preterm infants.
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| 36. |
- Söderström, Fanny, et al.
(författare)
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Reduced rate of retinopathy of prematurity after implementing lower oxygen saturation targets.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39, s. 409-414
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate an implementation of lower oxygen saturation targets with retinopathy of prematurity (ROP) as primary outcome, in infants at the lowest extreme of prematurity.Study design: Retrospective cohort including infants born at 22-25 weeks of gestation in 2005-2015 (n = 325), comparing high (87-93%) and low (85-90%) targets; infants transferred early were excluded from the main analysis to avoid bias.Results: Overall survival was 76% in high saturation era, and 69% in low saturation era (p = .17). Treatment-requiring ROP was less common in low saturation group (14% vs 28%, p < .05) with the most prominent difference in the most immature infants. Including deceased infants in the analysis, necrotizing enterocolitis was more frequent in low saturation era (21% vs 10%, p < .05).Conclusions: Implementing lower saturation targets resulted in a halved incidence of treatment-requiring ROP; the most immature infants seem to benefit the most. An association between lower oxygenation and necrotizing enterocolitis cannot be excluded.
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| 37. |
- Thernström Blomqvist, Ylva, 1974-, et al.
(författare)
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Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy
- 2020
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Ingår i: Advances in Neonatal Care. - 1536-0903 .- 1536-0911. ; 20:6, s. 495-498
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Tidskriftsartikel (refereegranskat)abstract
- Background: Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated.Purpose: To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support.Methods: Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator. Cerebral and systemic regional oxygen saturation (rSao2), pulse oximetry (Spo2), heart rate (HR), and body temperature were recorded, and the fractional tissue oxygen extraction (fTOE) was calculated.Results: A total of 16 periods of SSC (mean duration 3 hours 30 minutes) were evaluated, 9 during nasal continuous positive airway pressure and 7 during mechanical ventilation. Cerebral rSao2 was 68% ± 4% (SE) and 69% ± 4% during incubator care and SSC, respectively (P = .56). Somatic rSao2 was 64% ± 4% during incubator care and 66% ± 4% during SSC (P = .54). Also, fTOE, HR, and Spo2 was similar during the 2 modes of care. Body temperature increased during SSC (P < .01).Implications for Practice: The present study reveals no differences in cerebral and somatic tissue oxygenation between periods of SSC and care in the incubator. The findings indicate that SSC supports physiological stability also during management of very preterm infants receiving respiratory support.Implications for Research: Further studies directed to further optimize SSC performance should enable its safe implementation at gradually lower gestational and postnatal ages.
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| 38. |
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| 39. |
- Tsolakis, Nikolaos, et al.
(författare)
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Strategy of changing from tracheostomy and non‐invasive mechanical ventilation to diaphragm pacing in children with congenital central hypoventilation syndrome
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:6, s. 1245-1247
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Tidskriftsartikel (refereegranskat)abstract
- Congenital central hypoventilation syndrome (CCHS) is a rare disorder that affects central control of breathing and paediatric treatment varies worldwide. One approach is diaphragm pacing (DP), by phrenic nerve stimulation or direct diaphragm muscle stimulation, with or without a tracheostomy. In Sweden, non-invasive ventilation (NIV) has been the first-line ventilator support for patients with CCHS. However, disadvantages such as midface hypoplasia and unintentional leakage have required assessment over time. DP implants are provided at the National Reference Center for Diaphragm Pacing at Uppsala University Hospital, Sweden, at 3-4 years of age, when the upper airways have become more stable. Some international centres wait until children are older. Our aim was to evaluate switching patients with CCHS from mechanical ventilation, namely tracheostomy or NIV, to DP.
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| 40. |
- van Kaam, Anton H., et al.
(författare)
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Modes and strategies for providing conventional mechanical ventilation in neonates
- 2021
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Ingår i: Pediatric Research. - : Springer Nature. - 0031-3998 .- 1530-0447. ; 90:5, s. 957-962
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Forskningsöversikt (refereegranskat)abstract
- Neonatal respiratory failure is a common and serious clinical problem which in a considerable proportion of infants requires invasive mechanical ventilation. The basic goal of mechanical ventilation is to restore lung function while limiting ventilator-induced lung injury, which is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD). Over the last decades, new conventional mechanical ventilation (CMV) modalities have been introduced in clinical practice, aiming to assist clinicians in providing lung protective ventilation strategies. These modalities use more sophisticated techniques to improve patient-ventilator interaction and transfer control of ventilation from the operator to the patient. Knowledge on how these new modalities work and how they interact with lung physiology is essential for optimal and safe use. In this review, we will discuss some important basic lung physiological aspects for applying CMV, the basic principles of the old and new CMV modalities, and the evidence to support their use in daily clinical practice.
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| 41. |
- Veneroni, Chiara, et al.
(författare)
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Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns
- 2019
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Ingår i: Pediatric Research. - : Springer Nature. - 0031-3998 .- 1530-0447. ; 85:3, s. 312-317
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency.METHODS: Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated.RESULTS: Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1–155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development.CONCLUSIONS: FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.
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| 42. |
- Wallström, Linda, 1973-, et al.
(författare)
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Early volume targeted ventilation in preterm infants born at 22-25 weeks of gestational age
- 2021
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Ingår i: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 56:5, s. 1000-1007
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEarly hypocapnia in preterm infants is associated with intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). Volume targeted ventilation (VTV) has been shown to reduce hypocapnia in preterm infants. Less is known of VTV in infants born at <26 weeks gestational age (GA).ObjectivesOur aim was to investigate the short- and long-term effects of early VTV as compared to pressure limited ventilation (PLV) in extremely preterm infants on the incidence of hypocapnia, days on ventilatory support, IVH, and BPD.Study DesignA retrospective observational study of 104 infants born at 22–25 weeks GA (mean ± SD; 24+0 ± 1+1 GA; birth weight 619 ± 146 g), ventilated with either VTV (n = 44) or PLV (n = 60) on their first day of life. Ventilatory data and blood gases were collected at admission and every fourth hour during the first day of life, together with perinatal characteristics and outcomes.ResultsPeak inflation pressure (PIP) was lower in the VTV-group than in the PLV-group during the first 20 h of life (p < .05), without any difference in respiratory rate or FiO2. Incidence of hypocapnia (PaCO2 < 4.5 kPa) was lower with VTV than PLV during the first day of life (32% vs. 62%; p < .01). Infants in the VTV-group were more frequently extubated at 24 h (30% vs. 13%; p < .05). IVH Grade ≥3, BPD, and time on mechanical ventilation did not differ between the groups.ConclusionsVTV is safe to apply in infants born at <26 GA and was observed to result in a lower incidence of hypocapnia compared to infants ventilated by PLV, without any differences in outcomes.
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| 43. |
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| 44. |
- Wallström, Linda, 1973-
(författare)
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Optimizing mechanical ventilation in extremely preterm infants
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extremely low gestational age newborns (ELGANs) i.e. infants born before 28 weeks of gestational age (GA), require respiratory support during their hospital stay, and a majority needs mechanical ventilation (MV) at some time point. The duration of mechanical ventilation is related to morbidity and mortality, and respiratory support needs to be approached with the aim of minimizing both short and long term effects.In this thesis the overall aim was to explore lung mechanics and the effect of different ventilatory settings and modes during MV in ELGANs.In Paper I and II, bedside forced oscillation technique (FOT) was combined with a positive end-expiratory pressure (PEEP)-titration trial. In Paper I, FOT measurements on day 1 showed dependence of reactance (Xrs) on PEEP. FOT-parameters correlated with days on MV, and together with radiography and GA predicted respiratory outcomes. In Paper II, FOT was studied on day 1, 3 and 7, and Xrs was used to find the optimal lung recruiting PEEP. The optimal PEEP was lower than the clinically set PEEP, and especially during the first day of life. Xrs indicated that the lung was easily over extended with small increases in PEEP.In Paper III, we compared retrospectively early application of volume targeted ventilation (VTV) to pressure limited ventilation (PLV) in infants born at 22+0-25+6 weeks GA. Infants that received VTV had lower peak inflation pressures, less frequent hypocapnia and were earlier extubated to CPAP compared to infants receiving PLV.In Paper IV, we investigated the respiratory activity in animals by measurements of phrenic nerve activity (PNA), and in infants by measuring electrical activity of the diaphragm (EAdi) during the transition from PLV to proportional assist ventilation (PAV), a proportionally adjusted ventilatory mode. PNA and EAdi increased during PAV as compared to PLV with similar tidal volumes, thus promoting increased respiratory activity and weaning. In conclusion, we found that FOT was feasible bedside in ELGANs and FOT-parameters were correlated to PEEP and respiratory outcomes; VTV was safely applied during the first day of life; increased breathing activity during PAV suggests this to be a suitable mode in weaning from MV to non-invasive ventilation, when optimized support is needed during this transition.
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| 45. |
- Wallström, Linda, 1973-, et al.
(författare)
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Respiratory activity in the transition from assist control to proportional assist ventilation or CPAP in cats and preterm infants.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Phrenic nerve activity (PNA) has been studied in animal models to evaluate respiratory activity during different ventilatory modes and lung conditions. Bedside measurements of esophageal circumferential electrical activity of the diaphragm (EAdi) allows us to interpret the respiratory activity in relation to the applied ventilatory support. During proportional assist ventilation (PAV) the applied airway pressure is proportional to the breathing effort, allowing the patient to control amplitude and timing of tidal breathing.Objective: To study respiratory activity, measured as PNA and EAdi, in the transition from assist control ventilation (A/C) to PAV in a study comparing cats and premature infants. Our hypothesis was that PAV is associated with increased respiratory activity compared to A/C whereby weaning might be promoted.Methods: Intubated study objects (five cats and three infants) were exposed to A/C and PAV (60-70% elastic unloading) with interposed periods of CPAP and fixed end-expiratory pressures (cats: 2 cm H20; infants: 5-6 cm H20). Respiratory activity was assessed by PNA in cats and Edi in infants.Results: Higher PNA amplitudes were observed in cats during PAV than during A/C (0.41±0.13 vs 0.22±0.06AU; p=0.03). Higher maximum EAdi were detected in infants during PAV than during A/C (10.0±2.5µV vs 5.1±1.2 µ V; p<0.01). Similar tidal volumes and respiratory rates were observed with PAV and A/C in both cats and infants, but at markedly lower peak pressures during PAV (4.42±0.62 vs 7.01±0.52 cmH2O, p<0.001; 20.3±1.8 vs 23.4±1.3cm H2O, p<0.01).Conclusion: PAV stimulates higher respiratory activity than A/C in both cats and infants with reciprocally increased PNA and EAdi, suggesting that PAV might be an optimal mode of weaning from A/C to CPAP.
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