Publications by authors named "Arjan Te Pas"

206 Publications

Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping.

Pediatr Res 2022 Jan 7. Epub 2022 Jan 7.

Neonatal Research Group, Health Research Institute and University and Polytechnic Hospital La Fe, Valencia, Spain.

Blood oxygen in the fetus is substantially lower than in the newborn infant. In the minutes after birth, arterial oxygen saturation rises from around 50-60% to 90-95%. Initial respiratory efforts generate negative trans-thoracic pressures that drive liquid from the airways into the lung interstitium facilitating lung aeration, blood oxygenation, and pulmonary artery vasodilatation. Consequently, intra- (foramen ovale) and extra-cardiac (ductus arteriosus) shunting changes and the sequential circulation switches to a parallel pulmonary and systemic circulation. Delaying cord clamping preserves blood flow through the ascending vena cava, thus increasing right and left ventricular preload. Recently published reference ranges have suggested that delayed cord clamping positively influenced the fetal-to-neonatal transition. Oxygen saturation in babies with delayed cord clamping plateaus significantly earlier to values of 85-90% than in babies with immediate cord clamping. Delayed cord clamping may also contribute to fewer episodes of brady-or-tachycardia in the first minutes after birth, but data from randomized trials are awaited. IMPACT: Delaying cord clamping during fetal to neonatal transition contributes to a significantly earlier plateauing of oxygen saturation and fewer episodes of brady-and/or-tachycardia in the first minutes after birth. We provide updated information regarding the changes in SpO and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping. Nomograms in newborn infants with delayed cord clamping will provide valuable reference ranges to establish target SpO and HR in the first minutes after birth.
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http://dx.doi.org/10.1038/s41390-021-01805-yDOI Listing
January 2022

Comparing pulse rate measurement in newborns using conventional and dry-electrode ECG monitors.

Acta Paediatr 2022 Jan 4. Epub 2022 Jan 4.

Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands.

Aim: Heart rate (HR) is the most important parameter to evaluate newborns' clinical condition and to guide intervention during resuscitation at birth. The present study aims to compare the accuracy of NeoBeat dry-electrode ECG for HR measurement with conventional ECG and pulse oximetry (PO).

Methods: Newborns with a gestational age ≥ 32 weeks and/or birth weight ≥ 1.5 kg were included when HR evaluation was needed. HR was simultaneously measured for 10 minutes with NeoBeat, PO and conventional ECG.

Results: A total of 18 infants were included (median (IQR) gestational age 39 (36 - 39) weeks, birth weight 3150 (2288 - 3859) grams). Mean (SD) duration until NeoBeat obtained a reliable signal was 2.5 (9.0) s versus 58.5 (171.0) s for PO. Mean difference between NeoBeat and ECG was 1.74 bpm (LoA -4.987 - 8.459, correlation coefficient 0.98). Paired HR measurements over 30 s intervals revealed no significant difference between NeoBeat and ECG. The positive predictive value of a detected HR <100 bpm by NeoBeat compared to ECG was 54.84%, negative predictive value 99.99%, sensitivity 94.44%, specificity 99.99% and accuracy 99.85%.

Conclusion: HR measurement with NeoBeat dry-electrode ECG at birth is reliable and accurate.
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http://dx.doi.org/10.1111/apa.16242DOI Listing
January 2022

Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth.

Front Pediatr 2021 3;9:777614. Epub 2021 Dec 3.

Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands.

Preterm infants are commonly supported with 5-8 cmHO CPAP. However, animal studies demonstrate that high initial CPAP levels (12-15 cmHO) which are then reduced (termed physiological based (PB)-CPAP), improve lung aeration without adversely affecting cardiovascular function. We investigated the feasibility of PB-CPAP and the effect in preterm infants at birth. Preterm infants (24-30 weeks gestation) were randomized to PB-CPAP or 5-8 cmHO CPAP for the first 10 min after birth. PB-CPAP consisted of 15 cmHO CPAP that was decreased when infants were stabilized (heart rate ≥100 bpm, SpO ≥85%, FiO ≤ 0.4, spontaneous breathing) to 8 cmHO with steps of ~2/3 cmHO/min. Primary outcomes were feasibility and SpO in the first 5 min after birth. Secondary outcomes included physiological and breathing parameters and short-term neonatal outcomes. Planned enrollment was 42 infants. The trial was stopped after enrolling 31 infants due to a low inclusion rate and recent changes in the local resuscitation guideline that conflict with the study protocol. Measurements were available for analysis in 28 infants (PB-CPAP = 8, 5-8 cmHO = 20). Protocol deviations in the PB-CPAP group included one infant receiving 3 inflations with 15 cmHO PEEP and two infants in which CPAP levels were decreased faster than described in the study protocol. In the 5-8 cmHO CPAP group, three infants received 4, 10, and 12 cmHO CPAP. During evaluations, caregivers indicated that the current PB-CPAP protocol was difficult to execute. The SpO in the first 5 min after birth was not different [61 (49-70) vs. 64 (47-74), = 0.973]. However, infants receiving PB-CPAP achieved higher heart rates [121 (111-130) vs. 97 (82-119) bpm, = 0.016] and duration of mask ventilation was shorter [0:42 (0:34-2:22) vs. 2:58 (1:36-6:03) min, = 0.020]. Infants in the PB-CPAP group required 6:36 (5:49-11:03) min to stabilize, compared to 9:57 (6:58-15:06) min in the 5-8 cmH2O CPAP group ( = 0.256). There were no differences in short-term outcomes. Stabilization of preterm infants with PB-CPAP is feasible but tailoring CPAP appeared challenging. PB-CPAP did not lead to higher SpO but increased heart rate and shortened the duration of mask ventilation, which may reflect faster lung aeration.
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http://dx.doi.org/10.3389/fped.2021.777614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678466PMC
December 2021

Large Hemoglobin Differences at Birth in Monochorionic Twins with a Placental Chorangioma and Delayed Cord Clamping.

Twin Res Hum Genet 2021 Dec 9:1-4. Epub 2021 Dec 9.

Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.

We report a case of a monochorionic diamniotic twin with an uncomplicated pregnancy, but with an unexpected large intertwin hemoglobin (Hb) difference at birth. Twin 1 was delivered vaginally and had an uneventful neonatal course. The umbilical cord of Twin 1 was clamped approximately 5 min after birth. After the birth of Twin 1, Twin 2 developed severe bradycardia and showed limited cardiac output on ultrasound, for which an emergency cesarean section was performed. A full blood count revealed an Hb of 20.1 g/dL for Twin 1 and 10.2 g/dL for Twin 2 (intertwin difference 9.9 g/dL). Reticulocyte counts were similar, 40‰ and 38‰, respectively. Placental examination revealed 10 vascular anastomoses, including one arterio-arterial anastomosis with a diameter of 1.4 mm. Additionally, a large chorangioma was present on the placental surface of Twin 2. There was no color difference on the maternal side of the placenta. Based on the reticulocyte count ratio and the placental characteristics, twin anemia polycythemia sequence was ruled out as the cause of the large intertwin Hb difference. In this report, we discuss the various potential causes that could explain the large intertwin Hb difference including the role of delayed cord clamping in Twin 1, and the role of a large chorangioma, which may have attracted blood from the fetal circulation of Twin 2.
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http://dx.doi.org/10.1017/thg.2021.46DOI Listing
December 2021

Sensory stimulation for apnoea mitigation in preterm infants.

Pediatr Res 2021 Nov 24. Epub 2021 Nov 24.

Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia.

Apnoea, a pause in respiration, is ubiquitous in preterm infants and are often associated with physiological instability, which may lead to longer-term adverse neurodevelopmental consequences. Despite current therapies aimed at reducing the apnoea burden, preterm infants continue to exhibit apnoeic events throughout their hospital admission. Bedside staff are frequently required to manually intervene with different forms of stimuli, with the aim of re-establishing respiratory cadence and minimizing the physiological impact of each apnoeic event. Such a reactive approach makes apnoea and its associated adverse consequences inevitable and places a heavy reliance on human intervention. Different approaches to improving apnoea management in preterm infants have been investigated, including the use of various sensory stimuli. Despite studies reporting sensory stimuli of various forms to have potential in reducing apnoea frequency, non-invasive intermittent positive pressure ventilation is the only automated stimulus currently used in the clinical setting for infants with persistent apnoeic events. We find that the development of automated closed-looped sensory stimulation systems for apnoea mitigation in preterm infants receiving non-invasive respiratory support is warranted, including the possibility of stimulation being applied preventatively, and in a multi-modal form. IMPACT: This review examines the effects of various forms of sensory stimulation on apnoea mitigation in preterm infants, namely localized tactile, generalized kinesthetic, airway pressure, auditory, and olfactory stimulations. Amongst the 31 studies reviewed, each form of sensory stimulation showed some positive effects, although the findings were not definitive and comparative studies were lacking. We find that the development of automated closed-loop sensory stimulation systems for apnoea mitigation is warranted, including the possibility of stimulation being applied preventatively, and in a multi-modal form.
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http://dx.doi.org/10.1038/s41390-021-01828-5DOI Listing
November 2021

Automation of oxygen titration in preterm infants: Current evidence and future challenges.

Early Hum Dev 2021 Nov 4;162:105462. Epub 2021 Sep 4.

School of Engineering, University of Tasmania, Hobart, Tasmania, Australia.

For the preterm infant with respiratory insufficiency requiring supplemental oxygen, tight control of oxygen saturation (SpO) is advocated, but difficult to achieve in practice. Automated control of oxygen delivery has emerged as a potential solution, with six control algorithms currently embedded in commercially-available respiratory support devices. To date, most clinical evaluations of these algorithms have been short-lived crossover studies, in which a benefit of automated over manual control of oxygen titration has been uniformly noted, along with a reduction in severe SpO deviations and need for manual FiO adjustments. A single non-randomised study has examined the effect of implementation of automated oxygen control with the CLiO algorithm as standard care for preterm infants; no clear benefits in relation to clinical outcomes were noted, although duration of mechanical ventilation was lessened. The results of randomised controlled trials are awaited. Beyond the gathering of evidence regarding a treatment effect, we contend that there is a need for a better understanding of the function of contemporary control algorithms under a range of clinical conditions, further exploration of techniques of adaptation to individualise algorithm performance, and a concerted effort to apply this technology in low resource settings in which the majority of preterm infants receive care. Attainment of these goals will be paramount in optimisation of oxygen therapy for preterm infants globally.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105462DOI Listing
November 2021

Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements.

J Pediatr 2021 12 25;239:150-154.e1. Epub 2021 Aug 25.

Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.

Objective: To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered noninvasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms.

Study Design: We analyzed RFM data from SAIL participants at 5 trial sites. We assessed tidal volumes, rates of airway obstruction, and mask leak among infants allocated to sustained inflations and IPPV, and we compared pulse rate and oxygen saturation measurements between treatment groups.

Results: Among 70 SAIL participants (36 sustained inflations, 34 IPPV) with RFM measurements, 40 (57%) were spontaneously breathing prior to the randomized intervention. The median expiratory tidal volume of sustained inflations administered was 5.3 mL/kg (IQR 1.1-9.2). Significant mask leak occurred in 15% and airway obstruction occurred during 17% of sustained inflations. Among 34 control infants, the median expiratory tidal volume of IPPV inflations was 4.3 mL/kg (IQR 1.3-6.6). Mask leak was present in 3%, and airway obstruction was present in 17% of IPPV inflations. There were no significant differences in pulse rate or oxygen saturation measurements between groups at any point during resuscitation.

Conclusion: Expiratory tidal volumes of sustained inflations and IPPV inflations administered in the SAIL trial were highly variable in both treatment arms. Vital sign values were similar between groups throughout resuscitation. Sustained inflation as operationalized in the SAIL trial was not superior to IPPV to promote lung aeration after birth in this study subgroup.

Trial Registration: Clinicaltrials.gov: NCT02139800.
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http://dx.doi.org/10.1016/j.jpeds.2021.08.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8604776PMC
December 2021

Video-based reflection on neonatal interventions during COVID-19 using eye-tracking glasses: an observational study.

Arch Dis Child Fetal Neonatal Ed 2021 Aug 19. Epub 2021 Aug 19.

Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.

Objective: The aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic.

Design: Observational prospective single-centre study.

Setting: Neonatal intensive care unit at the Leiden University Medical Center.

Participants: All local neonatal healthcare providers.

Intervention: There were two groups of participants: proceduralists, who wore eye-tracking glasses during procedures, and observers who later watched the procedures as part of a video-based reflection.

Main Outcome Measures: The primary outcome was the feasibility of, and the proceduralists and observers' experience with, the point-of-view eye-tracking videos as an additional tool for bedside teaching and video-based reflection.

Results: We conducted 12 point-of-view recordings on 10 different patients (median gestational age of 30.9±3.5 weeks and weight of 1764 g) undergoing neonatal intubation (n=5), minimally invasive surfactant therapy (n=5) and umbilical line insertion (n=2). We conducted nine video-based observations with a total of 88 observers. The use of point-of-view recordings was perceived as feasible. Observers further reported the point-of-view recordings to be an educational benefit for them and a potentially instructional tool during COVID-19.

Conclusion: We proved the practicability of eye-tracking glasses for point-of-view recordings of neonatal procedures and videos for observation, educational sessions and logistics considerations, especially with the COVID-19 pandemic distancing measures reducing bedside teaching opportunities.
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http://dx.doi.org/10.1136/archdischild-2021-321806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384497PMC
August 2021

Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes.

Crit Care Med 2021 12;49(12):2003-2016

Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.

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http://dx.doi.org/10.1097/CCM.0000000000005251DOI Listing
December 2021

Increased end-expiratory pressures improve lung function in near-term newborn rabbits with elevated airway liquid volume at birth.

J Appl Physiol (1985) 2021 09 5;131(3):997-1008. Epub 2021 Aug 5.

School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia.

Approximately 53% of near-term newborns admitted to intensive care experience respiratory distress. These newborns are commonly delivered by cesarean section and have elevated airway liquid volumes at birth, which can cause respiratory morbidity. We investigated the effect of providing respiratory support with a positive end-expiratory pressure (PEEP) of 8 cmHO on lung function in newborn rabbit kittens with elevated airway liquid volumes at birth. Near-term rabbits (30 days; term = 32 days) with airway liquid volumes that corresponded to vaginal delivery (∼7 mL/kg, control, = 11) or cesarean section [∼37 mL/kg; elevated liquid (EL), = 11] were mechanically ventilated (tidal volume = 8 mL/kg). The PEEP was changed after lung aeration from 0 to 8 to 0 cmHO (control, = 6; EL, = 6), and in a separate group of kittens, PEEP was changed after lung aeration from 8 to 0 to 8 cmHO (control, = 5; EL, = 5). Lung function (ventilator parameters, compliance, lung gas volumes, and distribution of gas within the lung) was evaluated using plethysmography and synchrotron-based phase-contrast X-ray imaging. EL kittens initially receiving 0 cmHO PEEP had reduced functional residual capacities and lung compliance, requiring higher inflation pressures to aerate the lung compared with control kittens. Commencing ventilation with 8 cmHO PEEP mitigated the adverse effects of EL, increasing lung compliance, functional residual capacity, and the uniformity and distribution of lung aeration, but did not normalize aeration of the distal airways. Respiratory support with PEEP supports lung function in near-term newborn rabbits with elevated airway liquid volumes at birth who are at a greater risk of suffering respiratory distress. Term babies born by cesarean section have elevated airway liquid volumes, which predisposes them to respiratory distress. Treatments targeting molecular mechanisms to clear lung liquid are ineffective for term newborn respiratory distress. We showed that respiratory support with an end-expiratory pressure supports lung function in near-term rabbits with elevated airway liquid volumes at birth. This study provides further physiological understanding of lung function in newborns with elevated airway liquid volumes at risk of respiratory distress.
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http://dx.doi.org/10.1152/japplphysiol.00918.2020DOI Listing
September 2021

Ductal Flow Ratio as Measure of Transition in Preterm Infants After Birth: A Pilot Study.

Front Pediatr 2021 19;9:668744. Epub 2021 Jul 19.

Division of Paediatric Cardiology, Department of Paediatrics, Leiden University Medical Centre, Leiden, Netherlands.

Cardiovascular changes during the transition from intra- to extrauterine life, alters the pressure gradient across the ductus arteriosus (DA). DA flow ratio (R-L/L-R) has been suggested to reflect the infant's transitional status and could potentially predict neonatal outcomes after preterm birth. Determine whether DA flow ratio correlates with oxygenation parameters in preterm infants at 1 h after birth. Echocardiography was performed in preterm infants born <32 weeks gestational age (GA), as part of an ancillary study. DA flow was measured at 1 h after birth. DA flow ratio was correlated with FiO, SpO, and SpO/FiO (SF) ratio. The DA flow ratio of infants receiving physiological-based cord clamping (PBCC) or time-based cord clamping (TBCC) were compared. Measurements from 16 infants were analysed (median [IQR] GA 29 [27-30] weeks; birthweight 1,176 [951-1,409] grams). R-L DA shunting was 16 [17-27] ml/kg/min and L-R was 110 [81-124] ml/kg/min. The DA flow ratio was 0.18 [0.11-0.28], SpO 94 [93-96]%, FiO was 23 [21-28]% and SF ratio 4.1 [3.3-4.5]. There was a moderate correlation between DA flow ratio and SpO [correlation coefficient (CC) -0.415; = 0.110], FiO (CC 0.384; = 0.142) and SF ratio (CC -0.356; = 0.175). There were no differences in DA flow measurements between infants where PBBC or TBCC was performed. In this pilot study we observed a non-significant positive correlation between DA flow ratio at 1 h after birth and oxygenation parameters in preterm infants.
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http://dx.doi.org/10.3389/fped.2021.668744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326397PMC
July 2021

A multi-centre randomised controlled trial of respiratory function monitoring during stabilisation of very preterm infants at birth.

Resuscitation 2021 10 22;167:317-325. Epub 2021 Jul 22.

Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address:

Aim: To determine whether the use of a respiratory function monitor (RFM) during PPV of extremely preterm infants at birth, compared with no RFM, leads to an increase in percentage of inflations with an expiratory tidal volume (Vte) within a predefined target range.

Methods: Unmasked, randomised clinical trial conducted October 2013 - May 2019 in 7 neonatal intensive care units in 6 countries. Very preterm infants (24-27 weeks of gestation) receiving PPV at birth were randomised to have a RFM screen visible or not. The primary outcome was the median proportion of inflations during manual PPV (face mask or intubated) within the target range (Vte 4-8 mL/kg). There were 42 other prespecified monitor measurements and clinical outcomes.

Results: Among 288 infants randomised (median (IQR) gestational age 26 (25-27) weeks), a total number of 51,352 inflations were analysed. The median (IQR) percentage of inflations within the target range in the RFM visible group was 30.0 (18.0-42.2)% vs 30.2 (14.8-43.1)% in the RFM non-visible group (p = 0.721). There were no differences in other respiratory function measurements, oxygen saturation, heart rate or FiO. There were no differences in clinical outcomes, except for the incidence of intraventricular haemorrhage (all grades) and/or cystic periventricular leukomalacia (visible RFM: 26.7% vs non-visible RFM: 39.0%; RR 0.71 (0.68-0.97); p = 0.028).

Conclusion: In very preterm infants receiving PPV at birth, the use of a RFM, compared to no RFM as guidance for tidal volume delivery, did not increase the percentage of inflations in a predefined target range.

Trial Registration: Dutch Trial Register NTR4104, clinicaltrials.gov NCT03256578.
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http://dx.doi.org/10.1016/j.resuscitation.2021.07.012DOI Listing
October 2021

Higher CPAP levels improve functional residual capacity at birth in preterm rabbits.

Pediatr Res 2021 Jul 22. Epub 2021 Jul 22.

The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.

Background: Preterm infants are commonly supported with 4-8 cm HO continuous positive airway pressures (CPAP), although higher CPAP levels may improve functional residual capacity (FRC).

Methods: Preterm rabbits delivered at 29/32 days (~26-28 weeks human) gestation received 0, 5, 8, 12, 15 cm HO of CPAP or variable CPAP of 15 to 5 or 15 to 8 cm HO (decreasing ~2 cm HO/min) for up to 10 min after birth.

Results: FRC was lower in the 0 (6.8 (1.0-11.2) mL/kg) and 5 (10.1 (1.1-16.8) mL/kg) compared to the 15 (18.8 (10.9-22.4) mL/kg) cm HO groups (p = 0.003). Fewer kittens achieved FRC > 15 mL/kg in the 0 (20%), compared to 8 (36%), 12 (60%) and 15 (73%) cm HO groups (p = 0.008). While breathing rates were not different (p = 0.096), apnoea tended to occur more often with CPAP < 8 cm HO (p = 0.185). CPAP belly and lung bulging rates were similar whereas pneumothoraces were rare. Lowering CPAP from 15 to 5, but not 15 to 8 cm HO, decreased FRC and breathing rates.

Conclusion: In all, 15 cm HO of CPAP improved lung aeration and reduced apnoea, but did not increase the risk of lung over-expansion, pneumothorax or CPAP belly immediately after birth. FRC and breathing rates were maintained when CPAP was decreased to 8 cm HO.

Impact: Although preterm infants are commonly supported with 4-8 cm HO CPAP at birth, preclinical studies have shown that higher PEEP levels improve lung aeration. In this study, CPAP levels of 15 cm HO improved lung aeration and reduced apnoea in preterm rabbit kittens immediately after birth. In all, 15 cm HO CPAP did not increase the risk of lung over-expansion (indicated by bulging between the ribs), pneumothorax, or CPAP belly. These results can be used when designing future studies on CPAP strategies for preterm infants in the delivery room.
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http://dx.doi.org/10.1038/s41390-021-01647-8DOI Listing
July 2021

Effect of maternal oxytocin on umbilical venous and arterial blood flows during physiological-based cord clamping in preterm lambs.

PLoS One 2021 17;16(6):e0253306. Epub 2021 Jun 17.

The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.

Background: Delayed umbilical cord clamping (UCC) after birth is thought to cause placental to infant blood transfusion, but the mechanisms are unknown. It has been suggested that uterine contractions force blood out of the placenta and into the infant during delayed cord clamping. We have investigated the effect of uterine contractions, induced by maternal oxytocin administration, on umbilical artery (UA) and venous (UV) blood flows before and after ventilation onset to determine whether uterine contractions cause placental transfusion in preterm lambs.

Methods And Findings: At ~128 days of gestation, UA and UV blood flows, pulmonary arterial blood flow (PBF) and carotid arterial (CA) pressures and blood flows were measured in three groups of fetal sheep during delayed UCC; maternal oxytocin following mifepristone, mifepristone alone, and saline controls. Each successive uterine contraction significantly (p<0.05) decreased UV (26.2±6.0 to 14.1±4.5 mL.min-1.kg-1) and UA (41.2±6.3 to 20.7 ± 4.0 mL.min-1.kg-1) flows and increased CA pressure and flow (47.1±3.4 to 52.8±3.5 mmHg and 29.4±2.6 to 37.3±3.4 mL.min-1.kg-1). These flows and pressures were partially restored between contractions, but did not return to pre-oxytocin administration levels. Ventilation onset during DCC increased the effects of uterine contractions on UA and UV flows, with retrograde UA flow (away from the placenta) commonly occurring during diastole.

Conclusions: We found no evidence that amplification of uterine contractions with oxytocin increase placental transfusion during DCC. Instead they decreased both UA and UV flow and caused a net loss of blood from the lamb. Uterine contractions did, however, have significant cardiovascular effects and reduced systemic and cerebral oxygenation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253306PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211207PMC
November 2021

Comparison of two devices for automated oxygen control in preterm infants: a randomised crossover trial.

Arch Dis Child Fetal Neonatal Ed 2022 Jan 10;107(1):20-25. Epub 2021 Jun 10.

Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.

Objective: To compare the effect of two different automated oxygen control devices on target range (TR) time and occurrence of hypoxaemic and hyperoxaemic episodes.

Design: Randomised cross-over study.

Setting: Tertiary level neonatal unit in the Netherlands.

Patients: Preterm infants (n=15) born between 24+0 and 29+6 days of gestation, receiving invasive or non-invasive respiratory support with oxygen saturation (SpO) TR of 91%-95%. Median gestational age 26 weeks and 4 days (IQR 25 weeks 3 days-27 weeks 6 days) and postnatal age 19 (IQR 17-24) days.

Interventions: Inspired oxygen concentration was titrated by the OxyGenie controller (SLE6000 ventilator) and the CLiO controller (AVEA ventilator) for 24 hours each, in a random sequence, with the respiratory support mode kept constant.

Main Outcome Measures: Time spent within set SpO TR (91%-95% with supplemental oxygen and 91%-100% without supplemental oxygen).

Results: Time spent within the SpO TR was higher during OxyGenie control (80.2 (72.6-82.4)% vs 68.5 (56.7-79.3)%, p<0.005). Less time was spent above TR while in supplemental oxygen (6.3 (5.1-9.9)% vs 15.9 (11.5-30.7)%, p<0.005) but more time spent below TR during OxyGenie control (14.7 (11.8%-17.2%) vs 9.3 (8.2-12.6)%, p<0.05). There was no significant difference in time with SpO <80% (0.5 (0.1-1.0)% vs 0.2 (0.1-0.4)%, p=0.061). Long-lasting SpO deviations occurred less frequently during OxyGenie control.

Conclusions: The OxyGenie control algorithm was more effective in keeping the oxygen saturation within TR and preventing hyperoxaemia and equally effective in preventing hypoxaemia (SpO <80%), although at the cost of a small increase in mild hypoxaemia.

Trial Registry Number: NCT03877198.
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http://dx.doi.org/10.1136/archdischild-2020-321387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685610PMC
January 2022

Effect of breathing on venous return during delayed cord clamping: an observational study.

Arch Dis Child Fetal Neonatal Ed 2022 Jan 9;107(1):65-69. Epub 2021 Jun 9.

Neonatology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands.

Objective: To investigate the effect of spontaneous breathing on venous return in term infants during delayed cord clamping at birth.

Methods: Echocardiographic ultrasound recordings were obtained directly after birth in healthy term-born infants. A subcostal view was used to obtain an optimal view of the inferior vena cava (IVC) entering the right atrium, including both the ductus venosus (DV) and the hepatic vein (HV). Colour Doppler was used to assess flow direction and flow velocity. Recordings continued until the umbilical cord was clamped and were stored in digital format for offline analyses.

Results: Ultrasound recordings were obtained in 15 infants, with a median (IQR) gestational age of 39.6 (39.0-40.9) weeks and a birth weight of 3560 (3195-4205) g. Flow was observed to be antegrade in the DV and HV in 98% and 82% of inspirations, respectively, with flow velocity increasing in 74% of inspirations. Retrograde flow in the DV was observed sporadically and only occurred during expiration. Collapse of the IVC occurred during 58% of inspirations and all occurred caudal to the DV inlet (100%).

Conclusion: Spontaneous breathing was associated with collapse of the IVC and increased antegrade DV and HV flow velocity during inspiration. Therefore, inspiration appears to preferentially direct blood flow from the DV into the right atrium. This indicates that inspiration could be a factor driving placental transfusion in infants.
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http://dx.doi.org/10.1136/archdischild-2020-321431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685611PMC
January 2022

[Newborn resuscitation and support of transition of infants at birth].

Notf Rett Med 2021 Jun 2:1-47. Epub 2021 Jun 2.

James Cook University Hospital, Middlesbrough, Großbritannien.

The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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http://dx.doi.org/10.1007/s10049-021-00894-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170636PMC
June 2021

European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth.

Resuscitation 2021 04 24;161:291-326. Epub 2021 Mar 24.

James Cook University Hospital, Middlesbrough, UK.

The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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http://dx.doi.org/10.1016/j.resuscitation.2021.02.014DOI Listing
April 2021

The Effect of Initial Oxygen Exposure on Diaphragm Activity in Preterm Infants at Birth.

Front Pediatr 2021 9;9:640491. Epub 2021 Feb 9.

Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.

The initial FiO that should be used for the stabilization of preterm infants in the delivery room (DR) is still a matter of debate as both hypoxia and hyperoxia should be prevented. A recent randomized controlled trial showed that preterm infants [gestational age (GA) < 30 weeks] stabilized with an initial high FiO (1.0) had a significantly higher breathing effort than infants stabilized with a low FiO (0.3). As the diaphragm is the main respiratory muscle in these infants, we aimed to describe the effects of the initial FiO on diaphragm activity. In a subgroup of infants from the original bi-center randomized controlled trial diaphragm activity was measured with transcutaneous electromyography of the diaphragm (dEMG), using three skin electrodes that were placed directly after birth. Diaphragm activity was compared in the first 5 min after birth. From the dEMG respiratory waveform several outcome measures were determined for comparison of the groups: average peak- and tonic inspiratory activity (dEMG and dEMG, respectively), inspiratory amplitude (dEMG), area under the curve (dEMG) and the respiratory rate (RR). Thirty-one infants were included in this subgroup, of which 29 could be analyzed [ = 15 (median GA 28.4 weeks) and = 14 (median GA 27.9 weeks) for the 100 and 30% oxygen group, respectively]. Tonic diaphragm activity was significantly higher in the high FiO-group (4.3 ± 2.1 μV vs. 2.9 ± 1.1 μV; = 0.047). The other dEMG-parameters (dEMG, dEMG, dEMG) showed consistently higher values in the high FiO group, but did not reach statistical significance. Average RR showed similar values in both groups (34 ± 9 vs. 32 ± 10 breaths/min for the high and low oxygen group, respectively). Preterm infants stabilized with an initial high FiO showed significantly more tonic diaphragm activity and an overall trend toward a higher level of diaphragm activity than those stabilized with an initial low FiO. These results confirm that a high initial FiO after birth stimulates breathing effort, which can be objectified with dEMG.
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http://dx.doi.org/10.3389/fped.2021.640491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899995PMC
February 2021

Neonatal resuscitation research: closing the gap.

Pediatr Res 2021 Dec 24;90(6):1117-1119. Epub 2021 Feb 24.

The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1038/s41390-021-01403-yDOI Listing
December 2021

Persistent pulmonary hypertension in neonates with perinatal asphyxia and therapeutic hypothermia: a frequent and perilous combination.

J Matern Fetal Neonatal Med 2021 Feb 21:1-7. Epub 2021 Feb 21.

Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.

Objectives: (1) To investigate whether neonates with perinatal asphyxia and therapeutic hypothermia more often developed PPHN compared to a control group with perinatal asphyxia not treated with hypothermia; (2) To identify risk factors for severe PPHN during hypothermia and evaluate short-term outcome.

Methods: This single-center retrospective cohort study included (near-)term neonates with perinatal asphyxia admitted between 2004 and 2016. Neonates with perinatal asphyxia and hypothermia were compared to a historical control group without hypothermia. Primary outcome was PPHN, defined as severe hypoxemia requiring mechanical ventilation and inhaled nitric oxide, confirmed by echocardiography. Short-term adverse outcome was defined as mortality within one month and/or severe brain injury on MRI.

Results: Incidence of PPHN was 23% (26/114) in the hypothermia group and 11% (8/70) in controls. In multivariate analysis, PPHN was 2.5 times more common among neonates with hypothermia. Neonates developing PPHN during hypothermia often had higher fraction of inspired oxygen at baseline. PPHN was not associated with a higher risk of severe brain injury. However, early mortality was higher and three infants died due to severe refractory PPHN during hypothermia.

Conclusions: In this study PPHN occurred more often since the introduction of therapeutic hypothermia. This was usually reversible and did not lead to overall increased adverse outcome. However, in individual cases with PPHN deterioration occurred rapidly. In such cases the benefits of hypothermia should be weighed against the risk of a complicated, fatal course.
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http://dx.doi.org/10.1080/14767058.2021.1873941DOI Listing
February 2021

Respiratory distress syndrome and bronchopulmonary dysplasia after fetal growth restriction: Lessons from a natural experiment in identical twins.

EClinicalMedicine 2021 Feb 29;32:100725. Epub 2021 Jan 29.

Neonatology, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.

Background: Fetal growth restriction (FGR) is thought to negatively affect lung development resulting in increased respiratory morbidity. However, research performed in singletons is often limited by a certain level of bias caused by individual differences in genetic constitution, obstetrical and maternal factors.

Methods: Respiratory morbidity was compared between the smaller and the larger twin in monochorionic twins with selective fetal growth restriction (sFGR), defined as a birth weight discordance ≥ 20%, born in our center between 2010 and 2019 in this retrospective study. Respiratory distress syndrome (RDS) was diagnosed based on the clinical picture of a neonate with respiratory failure requiring mechanical ventilation and/or surfactant, confirmed by a chest X-ray. Bronchopulmonary dysplasia (BPD) was diagnosed when the neonate required treatment with >21% oxygen for at least 28 days.

Findings: Median gestational age at birth for the 94 included pregnancies was 32.4 (IQR 30.4-34.3) weeks. Within-pair analyses showed that the prevalence of RDS was lower in the smaller twin compared to the larger twin, 19.1% (18/94) vs 34.0% (32/94), respectively ( = 0.004). The odds of RDS for the larger twin was doubled (OR 2.1 (CI95% 1.3-3.5). In contrast, the rate of BPD in the smaller twin was higher as opposed to the larger twin, 16.7% (15/90) vs 6.7% (6/89), respectively ( = 0.008), with a more than doubled odds (OR 2.5 (CI95% 1.3-4.9)).

Interpretation: Despite being genetically identical, sFGR twins have different respiratory outcomes. Adverse growth condition in the smaller twin is associated with a reduced odds of RDS at birth but a more than doubled odds of BPD, reflecting the pathophysiologic adverse effect of growth restriction on lung development.

Funding: The Dutch Heart Foundation (2017T075).
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http://dx.doi.org/10.1016/j.eclinm.2021.100725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851769PMC
February 2021

High-CPAP Does Not Impede Cardiovascular Changes at Birth in Preterm Sheep.

Front Pediatr 2020 22;8:584138. Epub 2021 Jan 22.

The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.

Continuous positive airway pressures (CPAP) used to assist preterm infants at birth are limited to 4-8 cmHO due to concerns that high-CPAP may cause pulmonary overexpansion and adversely affect the cardiovascular system. We investigated the effects of high-CPAP on pulmonary (PBF) and cerebral (CBF) blood flows and jugular vein pressure (JVP) after birth in preterm lambs. Preterm lambs instrumented with flow probes and catheters were delivered at 133/146 days gestation. Lambs received low-CPAP (LCPAP: 5 cmHO), high-CPAP (HCPAP: 15 cmHO) or dynamic HCPAP (15 decreasing to 8 cmHO at ~2 cmHO/min) for up to 30 min after birth. Mean PBF was lower in the LCPAP [median (Q1-Q3); 202 (48-277) mL/min, = 0.002] compared to HCPAP [315 (221-365) mL/min] and dynamic HCPAP [327 (269-376) mL/min] lambs. CBF was similar in LCPAP [65 (37-78) mL/min], HCPAP [73 (41-106) mL/min], and dynamic HCPAP [66 (52-81) mL/min, = 0.174] lambs. JVP was similar at CPAPs of 5 [8.0 (5.1-12.4) mmHg], 8 [9.4 (5.3-13.4) mmHg], and 15 cmHO [8.6 (6.9-10.5) mmHg, = 0.909]. Heart rate was lower in the LCPAP [134 (101-174) bpm; = 0.028] compared to the HCPAP [173 (139-205)] and dynamic HCPAP [188 (161-207) bpm] groups. Ventilation or additional caffeine was required in 5/6 LCPAP, 1/6 HCPAP, and 5/7 dynamic HCPAP lambs ( = 0.082), whereas 3/6 LCPAP, but no HCPAP lambs required intubation ( = 0.041), and 1/6 LCPAP, but no HCPAP lambs developed a pneumothorax ( = 0.632). High-CPAP did not impede the increase in PBF at birth and supported preterm lambs without affecting CBF and JVP.
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http://dx.doi.org/10.3389/fped.2020.584138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862825PMC
January 2021

Reviewing recordings of neonatal resuscitation with parents.

Arch Dis Child Fetal Neonatal Ed 2021 Jul 29;106(4):346-351. Epub 2021 Jan 29.

Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.

Background: Recording of neonatal resuscitation, including video and respiratory parameters, was implemented for research and quality purposes at the neonatal intensive care unit (NICU) of the Leiden University Medical Center, and parents were offered to review the recording of their infant together with a neonatal care provider. We aimed to provide insight in parental experiences with reviewing the recording of the neonatal resuscitation of their premature infant.

Methods: This study combined participant observations during parental review of recordings with retrospective qualitative interviews with parents.

Results: Parental review of recordings of neonatal resuscitation was observed on 20 occasions, reviewing recordings of 31 children (12 singletons, 8 twins and 1 triplet), of whom 4 died during admission. Median (range) gestational age at birth was 27+5 (24+5-30+3) weeks. Subsequently, 25 parents (13 mothers and 12 fathers) were interviewed.Parents reported many positive experiences, with special emphasis on the value for getting hold of the start of their infant's life and coping with the trauma of neonatal resuscitation. Reviewing recordings of neonatal resuscitation frequently resulted in appreciation for the child, the father and the medical team. Timing and set-up of the review contributed to positive experiences. Parents considered screenshots/copies of the recording of the resuscitation of their infant as valuable keepsakes of their NICU story and reported that having the screenshots/video comforted them, especially when their child died during admission.

Conclusion: Parents consider reviewing recordings of neonatal resuscitation as valuable. These positive parental experiences could allay concerns about sharing recordings of neonatal resuscitation with parents.
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http://dx.doi.org/10.1136/archdischild-2020-320059DOI Listing
July 2021

Cardiorespiratory monitoring in the delivery room using transcutaneous electromyography.

Arch Dis Child Fetal Neonatal Ed 2021 Jul 19;106(4):352-356. Epub 2020 Nov 19.

Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, North-Holland, Netherlands.

Objective: To assess feasibility of transcutaneous electromyography of the diaphragm (dEMG) as a monitoring tool for vital signs and diaphragm activity in the delivery room (DR).

Design: Prospective observational study.

Setting: Delivery room.

Patients: Newborn infants requiring respiratory stabilisation after birth.

Interventions: In addition to pulse oximetry (PO) and ECG, dEMG was measured with skin electrodes for 30 min after birth.

Outcome Measures: We assessed signal quality of dEMG and ECG recording, agreement between heart rate (HR) measured by dEMG and ECG or PO, time between sensor application and first HR read-out and agreement between respiratory rate (RR) measured with dEMG and ECG, compared with airway flow. Furthermore, we analysed peak, tonic and amplitude diaphragmatic activity from the dEMG-based respiratory waveform.

Results: Thirty-three infants (gestational age: 31.7±2.8 weeks, birth weight: 1525±661 g) were included.18%±14% and 22%±21% of dEMG and ECG data showed poor quality, respectively. Monitoring HR with dEMG was fast (median 10 (IQR 10-11) s) and accurate (intraclass correlation coefficient (ICC) 0.92 and 0.82 compared with ECG and PO, respectively). RR monitoring with dEMG showed moderate (ICC 0.49) and ECG low (ICC 0.25) agreement with airway flow. Diaphragm activity started high with a decreasing trend in the first 15 min and subsequent stabilisation.

Conclusion: Monitoring vital signs with dEMG in the DR is feasible and fast. Diaphragm activity can be detected and described with dEMG, making dEMG promising for future DR studies.
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http://dx.doi.org/10.1136/archdischild-2020-319535DOI Listing
July 2021

Optimizing oxygenation of the preterm infant directly at birth: focus of future studies.

J Pediatr 2021 02 13;229:309. Epub 2020 Nov 13.

Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.

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http://dx.doi.org/10.1016/j.jpeds.2020.11.017DOI Listing
February 2021

Physiologic-Based Cord Clamping Maintains Core Temperature vs. Immediate Cord Clamping in Near-Term Lambs.

Front Pediatr 2020 23;8:584983. Epub 2020 Oct 23.

The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.

Physiologic-based cord clamping (PBCC) involves deferring umbilical cord clamping until after lung aeration. It is unclear if infant is at risk of becoming hypothermic during PBCC. To test if PBCC would maintain core temperature more effectively than immediate cord clamping (ICC). At 0.93 gestation, fetal lambs were surgically exteriorized and instrumented from pregnant ewes under general anesthesia. Prior to the start of the experiment, lambs were thoroughly dried, placed on hot water bottles, and core temperature was continuously monitored using a rectal thermometer. PBCC lambs ( = 21), received intermittent positive pressure ventilation (iPPV) for ≥5 min prior to umbilical cord clamping. In ICC lambs ( = 23), iPPV commenced within 60 s after umbilical cord clamping. iPPV was provided with heated/humidified gas. Lambs were moved under a radiant warmer after umbilical cord clamping. Additional warmth was provided using a plastic overlay, hairdryer, and extra water bottles, as needed. Two-way mixed and repeated measures one-way ANOVAs were used to compare temperature changes between and within a single group, respectively, over time. Basal fetal parameters including core temperature were similar between groups. ICC lambs had a significant reduction in temperature compared to PBCC lambs ( < 0.001), evident by 1 min ( = 0.002). ICC lambs decreased temperature by 0.51°C (± 0.42) and 0.79°C (± 0.55) at 5 and 10 min respectively ( < 0.001). In PBCC lambs, temperature did not significantly change before or after umbilical cord clamping ( = 0.4 and = 0.3, respectively). PBCC stabilized core temperature at delivery better than ICC in term lambs. Hypothermia may not be a significant risk during PBCC.
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http://dx.doi.org/10.3389/fped.2020.584983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644840PMC
October 2020

Improving Newborn Respiratory Outcomes With a Sustained Inflation: A Systematic Narrative Review of Factors Regulating Outcome in Animal and Clinical Studies.

Front Pediatr 2020 29;8:516698. Epub 2020 Oct 29.

The Ritchie Centre Hudson Institute of Medical Research, Melbourne, VIC, Australia.

Respiratory support is critically important for survival of newborns who fail to breathe spontaneously at birth. Although there is no internationally accepted definition of a sustained inflation (SI), it has commonly been defined as a positive pressure inflation designed to establish functional residual capacity and applied over a longer time period than normally used in standard respiratory support (SRS). Outcomes vary distinctly between studies and to date there has been no comprehensive investigation of differences in SI approach and study outcome in both pre-clinical and clinical studies. A systematic literature search was performed and, after screening, identified 17 animal studies and 17 clinical studies evaluating use of a SI in newborns compared to SRS during neonatal resuscitation. Study demographics including gestational age, SI parameters (length, repetitions, pressure, method of delivery) and study outcomes were compared. Animal studies provide mechanistic understanding of a SI on the physiology underpinning the cardiorespiratory transition at birth. In clinical studies, there is considerable difference in study quality, delivery of SIs (number, pressure, length) and timing of primary outcome evaluation which limits direct comparison between studies. The largest difference is method of delivery, where the role of a SI has been observed in intubated animals, as the inflation pressure is directly applied to the lung, bypassing the obstructed upper airway in an apnoeic state. This highlights a potential limitation in clinical use of a SI applied non-invasively. Further research is required to identify if a SI may have greater benefits in subpopulations of newborns.
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http://dx.doi.org/10.3389/fped.2020.516698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658322PMC
October 2020

Comparing the effect of two different interfaces on breathing of preterm infants at birth: A matched-pairs analysis.

Resuscitation 2020 12 17;157:60-66. Epub 2020 Oct 17.

Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands.

Objective: Applying a face mask could provoke a trigeminocardiac reflex. We compared the effect of applying bi-nasal prongs with a face mask on breathing and heart rate of preterm infants at birth.

Methods: In a retrospective matched-pairs study of infants <32 weeks of gestation, the use of bi-nasal prongs for respiratory support at birth was compared to the use of a face mask. Infants who were initially breathing at birth and subsequently received respiratory support were matched for gestational age (±4 days), birth weight (±300 g), general anaesthesia and gender. Breathing, heart rate and other parameters were collected before and after interface application and in the first 5 min thereafter.

Results: In total, 130 infants were included (n = 65 bi-nasal prongs, n = 65 face mask) with a median (IQR) gestational age of 27 (25-28) vs 26 (25-28) weeks. The proportion of infants who stopped breathing after applying the interface was not different between the groups (bi-nasal prongs 43/65 (66%) vs face mask 46/65 (71%), p = 0.70). Positive pressure ventilation was given more often when bi-nasal prongs were used (55/65 (85%) vs 40/65 (62%), p < 0.001). Heart rate (101 (75-145) vs 110 (68-149) bpm, p = 0.496) and oxygen saturation (59% (48-87) vs 56% (35-84), p = 0.178) were similar in the first 5 min after an interface was applied in the infants who stopped breathing.

Conclusion: Apnoea and bradycardia occurred often after applying either bi-nasal prongs or a face mask on the face for respiratory support in preterm infants at birth.
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http://dx.doi.org/10.1016/j.resuscitation.2020.10.004DOI Listing
December 2020
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