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- Stoecklin, B, et al.
(author)
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Simplified bedside assessment of pulmonary gas exchange in very preterm infants at 36 weeks' postmenstrual age
- 2021
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In: Thorax. - : BMJ. - 1468-3296 .- 0040-6376. ; 76:7, s. 689-695
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Journal article (peer-reviewed)abstract
- We aimed to develop and validate a prediction table for a simplified measure of rightward shift of the fetal oxyhaemoglobin saturation (SpO2) versus inspired oxygen pressure (PIO2) curve as an objective marker of lung disease severity in very preterm infants, independent of unit altitude or oxygen prescribing policies.MethodsVery preterm infants (n=219) had an oxygen reduction test at median (IQR) test age of 354 (345–360) weeks’ postmenstrual age (PMA). Shift was derived from at least three paired SpO2 versus PIO2 measurements using a computer algorithm, using the fetal oxyhaemoglobin dissociation curve as the reference. Linear regression of resultant shift values enabled construction of a table to predict shift using a single paired SpO2 versus PIO2 measurement, validated subsequently in a separate infant cohort using Bland-Altman analysis. Receiver operating curve analysis provided threshold values equating to a clinical diagnosis of mild bronchopulmonary dysplasia (BPD) or moderate to severe BPD.ResultsThe median (IQR) age of 63 infants in the validation cohort was 360 (356–362) weeks’ PMA. Mean difference (95% CI) between predicted and measured shift was 2.1 (−0.8% to 4.9%) with wide limits of agreement (−20.7% to 24.8%). Predicted shift >10.1 kPa identified mild BPD with 71% sensitivity and 88% specificity while values>13.0 kPa identified moderate to severe BPD with 81% sensitivity and 100% specificity.DiscussionShift predicted from a single paired SpO2 versus PIO2 measurement using our validated table enables objective bedside screening of lung disease severity in very preterm infant cohorts at 36 weeks’ PMA.
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- Alikhani, Vesta Seyed, 1982, et al.
(author)
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Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review
- 2023
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In: Acta Paediatrica. - 0803-5253. ; 112:12, s. 2468-2477
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Journal article (peer-reviewed)abstract
- AimThis scoping review identified studies on approaches to intact cord resuscitation and/or stabilisation (ICR/S) for neonates delivered by Caesarean section (C-section).MethodsA systematic literature search was carried out using the PubMed, Web of Science, Scopus, Cochrane and CINAHL databases to identify papers published in English from inception to 14 November 2022.ResultsWe assessed 2613 studies and included 18 from 10 countries, covering 1-125 C-sections: the United States, the United Kingdom, Australia, India, Italy, China, France, The Netherlands, New Zealand and Taiwan. The papers were published from 2014 to 2023, and the majority were randomised controlled trials and observational studies. Different platforms, equipment and staff positions in relation to the operating table were described. Options for resuscitation and stabilisation included different bedding and trolley approaches, and maintaining aseptic conditions was mainly addressed by the neonatal team scrubbing in. Hypothermia was prevented by using warm surfaces, polythene bags and radiant heaters. Equipment was kept easily accessible by mounting it on a trolley or a separate mobile pole.ConclusionWe could not reach definitive conclusions on the optimal method for performing ICR/S during a C-section, due to study variations. However, a number of equipment and management options appeared to be feasible approaches.
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