Publications by authors named "Charles Christoph Roehr"

51 Publications

Cerebral oxygenation and circulatory parameters during pressure-controlled vs volume-targeted mechanical ventilation in extremely preterm infants.

Adv Clin Exp Med 2020 Nov;29(11):1325-1329

Department of Neonatology, Poznan University of Medical Sciences, Poland.

Background: Respiratory distress syndrome (RDS) is the most common cause of respiratory failure of infants born prematurely with very low birth weight (VLBW). Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant.

Objectives: To assess the effect of volume-targeted compared to pressure-controlled mechanical ventilation (MV) on circulatory parameters and cerebral oxygenation StO2 in extremely preterm infants.

Material And Methods: This prospective, cross-over trial enrolled neonates born before 28 weeks of gestation. The patients were ventilated for 3 h in pressure-controlled assist-control (PC-AC) mode, followed by 3 h of volume-guarantee assist-control ventilation (VG-AC). Pulse oximetry (saturation (SpO2) and heart rate (HR)), near-infrared spectroscopy (NIRS), StO2, and electrical cardiometry (EC) were used in monitoring of the patients.

Results: Twenty preterm infants with a mean gestational age of 26 weeks were studied. The patients' mean postnatal age was 7.7 days. The SpO2 values and HR were comparable during PC-AC and VG-AC. The mean values of peak inspiratory pressure (PIP), mean airway pressure (MAP) and expiratory tidal volume (VTE) were lower, while the respiratory rate (RR) was higher during PC-VG. There were no significant differences in the mean values of StO2, but based on a comparison of the standard deviations (SD) the StO2 variability was significantly lower during VG-AC. The circulatory parameters were comparable.

Conclusions: The StO2 is more stable during VG than PC ventilation. These findings support the use of VG mode in premature infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17219/acem/128198DOI Listing
November 2020

Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis.

Arch Dis Child Fetal Neonatal Ed 2020 Sep 22. Epub 2020 Sep 22.

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK

Background: We investigated the impact of policy change in delivery room resuscitation from routine endotracheal (ET) suctioning of non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) to immediate non-invasive respiratory support.

Design: Single-centre cohort study. Prospective group (October 2016-September 2017)-non-vigorous neonates born through MSAF managed according to the current (2015) guidance of commencing respiratory support without prior suctioning. Retrospective group (August 2015-July 2016)-non-vigorous neonates born through MSAF who underwent routine ET suctioning.

Results: 1138 neonates born through MSAF were analysed. No differences in the incidence of meconium aspiration syndrome (MAS), requirement of mechanical ventilation, inhaled nitric oxide or surfactant therapy were found between groups. Less neonatal intensive care unit (NICU) admissions were necessary in the prospective cohort compared with the retrospective group (19.1% vs 55.6%, respectively; p<0.05).

Conclusion: The policy change towards not routinely suctioning non-vigorous neonates born through MSAF at birth was not associated with an increase in the local incidence of MAS and was associated with fewer NICU admissions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2020-319771DOI Listing
September 2020

Efficacy of noninvasive respiratory support modes for primary respiratory support in preterm neonates with respiratory distress syndrome: Systematic review and network meta-analysis.

Pediatr Pulmonol 2020 11 4;55(11):2940-2963. Epub 2020 Sep 4.

Department of Neonatology, Lady Hardinge Medical College, New Delhi, India.

Objectives: To compare the efficacy of different noninvasive respiratory support (NRS) modes for primary respiratory support of preterm infants with respiratory distress syndrome (RDS).

Design: Systematic review and network meta-analysis using the Bayesian random-effects approach. MEDLINE, EMBASE, and CENTRAL were searched.

Interventions: High flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), bilevel CPAP (BiPAP), noninvasive positive pressure ventilation (NIPPV).

Main Outcome Measures: Requirement of invasive mechanical ventilation (MV), any treatment failure.

Results: A total of 35 studies including 4078 neonates were included. NIPPV was more effective in decreasing the requirement of MV than CPAP (risk ratios [95% credible interval]: 0.60 [0.44, 0.77]) and HFNC [0.66 (0.43, 0.97)]. Surface under the cumulative ranking curve (SUCRA) for NIPPV, BiPAP, HFNC, and CPAP were 0.95, 0.59, 0.32, and 0.13. For the outcome of treatment failure, both NIPPV and BiPAP were more efficacious compared to CPAP and HFNC (0.56 [0.44, 0.71] {NIPPV vs CPAP}, 0.69 [0.51, 0.93] {BiPAP vs CPAP}, 0.42 [0.30, 0.63] {NIPPV vs HFNC}, 0.53 [0.35, 0.81] {BiPAP vs HFNC}). The SUCRA for NIPPV, BiPAP, CPAP, and HFNC were 0.96, 0.70, 0.32, and 0.01. NIPPV was associated with a reduced risk of air leak compared to BiPAP and CPAP (0.36 [0.16, 0.73]; 0.54 [0.30, 0.87], respectively). NIPPV resulted in lesser incidence of bronchopulmonary dysplasia or mortality when compared to CPAP (0.74 [0.52, 0.98]). Nasal injury was lesser with HFNC compared to CPAP (0.15 [0.01, 0.60]).

Conclusions: Most effective primary mode of NRS in preterm neonates with RDS was NIPPV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.25011DOI Listing
November 2020

Experience and training in endotracheal intubation and laryngeal mask airway use in neonates: results of a national survey.

Arch Dis Child Fetal Neonatal Ed 2021 Mar 22;106(2):223-224. Epub 2020 Jun 22.

Newborn Services, John Radcliffe Hospital, Oxford, Oxfordshire, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2020-319118DOI Listing
March 2021

T-piece resuscitator or self-inflating bag during neonatal resuscitation: a scoping review.

Pediatr Res 2020 Jun 11. Epub 2020 Jun 11.

Department of Women's and Children's Health, University of Padova, Padova, Italy.

Background: To identify the evidence for administering positive pressure ventilation (PPV) to infants at birth by either T-piece resuscitator (TPR) or self-inflating bag (SIB), and to determine whether a full systematic review (SR) is warranted.

Methods: Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews, eligible studies included peer-reviewed human studies, prospectively or retrospectively comparing a TPR vs. SIB for administering PPV at birth. Databases searched were OVID Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials. Review Manager software was used for the data analysis.

Results: Following electronic literature search and review, data from four eligible studies (3 RCT and 1 observational study), enrolling a total of 2889 patients, were included. Studies differed regarding the investigated populations, reported outcomes and came from different geographical areas. In particular for preterm infants, use of TPR for providing PPV may improve survival, result in fewer intubations at birth and decrease the incidence of bronchopulmonary dysplasia.

Conclusions: This scoping review identified two new studies with substantive new evidence, pointing towards improved survival, decreased bronchopulmonary dysplasia and fewer intubations at birth, in particular among preterm infants treated with TPR. Full SR of the literature is advised.

Impact: This scoping review identified studies comparing TPR vs. SIB for respiratory support of newborn infants previously not included in the International Liaison Committee on Resuscitation (ILCOR) recommendations.Our review found substantive new evidence highlighting that device choice may impact the outcomes of compromised newborn infants'.This scoping review stipulates the need for full SR and updated meta-analysis of studies investigating supportive equipment for stabilizing infants at birth in order to inform ILCOR treatment recommendations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41390-020-1005-4DOI Listing
June 2020

A Comparison of UK Preterm Anthropometric Charts and INTERGROWTH-21st: Is It Time to Change Growth Charts?

Neonatology 2020 12;117(3):300-307. Epub 2020 May 12.

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.

Background: Current practice in the UK is to plot premature infant anthropometric measurements on Neonatal and Infant Close Monitoring (NICM) reference charts. These charts have several known limitations. The INTERGROWTH-21st Project has recently produced international ante- and postnatal growth standards. Exact knowledge of growth centiles allows clinicians to accurately assess infant nutritional requirements.

Objective: To compare target centile measurements between INTERGROWTH-21st and UK NICM growth charts for premature infants.

Method: Anthropometric measurements (weight and head circumference) of a convenience sample of neonates born between 24 and 32 weeks of gestation were analysed retrospectively. Measurements were collected across three time points and plotted on both the NICM and INTERGROWTH-21st growth charts. The respective centiles were compared and analysed by paired-sample t test, Wilcoxon rank test analysis, and multilevel mixed-effect linear regression models.

Results: Centiles for weight and head circumference measurements of 96 infants plotted on INTERGROWTH-21st charts were significantly greater than their corresponding UK charts at all three time points. For weight, the average difference between the two charts varied from 9.1 to 16.4 centiles. The difference between the two charts was greater for female than male infants by up to 6.9 centiles (95% CI 10.1-3.8).

Conclusion: Existing UK NICM reference charts are significantly different to the growth standards of INTERGROWTH-21st. The choice of which growth chart to adopt in the UK could have important consequences on premature infants' future adult health and therefore requires further prospective observational studies with larger data sets including length measurements and more comprehensive population characteristics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507024DOI Listing
May 2020

Neonatal Resuscitation Where the Mother Has a Suspected or Confirmed Novel Coronavirus (SARS-CoV-2) Infection: Suggestion for a Pragmatic Action Plan.

Neonatology 2020 24;117(2):133-140. Epub 2020 Apr 24.

Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy.

Coronavirus disease 2019 (COVID-19), caused by the novel SARS-CoV-2 virus, is rapidly spreading across the world. As the number of infections increases, those of infected pregnant women and children will rise as well. Controversy exists whether COVID-19 can be transmitted in utero and lead to disease in the newborn. As this chance cannot be ruled out, strict instructions for the management of mothers and newborn infants are mandatory. This perspective aims to be a practical support tool for the planning of delivery and neonatal resuscitation of infants born by mothers with suspected or confirmed COVID-19 infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251577PMC
August 2020

Caffeine in preterm infants: where are we in 2020?

ERJ Open Res 2020 Jan 2;6(1). Epub 2020 Mar 2.

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

The incidence of preterm birth is increasing, leading to a growing population with potential long-term pulmonary complications. Apnoea of prematurity (AOP) is one of the major challenges when treating preterm infants; it can lead to respiratory failure and the need for mechanical ventilation. Ventilating preterm infants can be associated with severe negative pulmonary and extrapulmonary outcomes, such as bronchopulmonary dysplasia (BPD), severe neurological impairment and death. Therefore, international guidelines favour non-invasive respiratory support. Strategies to improve the success rate of non-invasive ventilation in preterm infants include pharmacological treatment of AOP. Among the different pharmacological options, caffeine citrate is the current drug of choice. Caffeine is effective in reducing AOP and mechanical ventilation and enhances extubation success; it decreases the risk of BPD; and is associated with improved cognitive outcome at 2 years of age, and pulmonary function up to 11 years of age. The commonly prescribed dose (20 mg·kg loading dose, 5-10 mg·kg per day maintenance dose) is considered safe and effective. However, to date there is no commonly agreed standardised protocol on the optimal dosing and timing of caffeine therapy. Furthermore, despite the wide pharmacological safety profile of caffeine, the role of therapeutic drug monitoring in caffeine-treated preterm infants is still debated. This state-of-the-art review summarises the current knowledge of caff-eine therapy in preterm infants and highlights some of the unresolved questions of AOP. We speculate that with increased understanding of caffeine and its metabolism, a more refined respiratory management of preterm infants is feasible, leading to an overall improvement in patient outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00330-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049734PMC
January 2020

Use of Intraosseous Needles in Neonates: A Systematic Review.

Neonatology 2019 28;116(4):305-314. Epub 2019 Oct 28.

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.

Background: The use of intraosseous (IO) access during resuscitation is widely accepted and promoted in paediatric medicine but features less prominently in neonatal training. Whilst umbilical venous catheterization (UVC) is a reliable method of delivering emergency drugs and fluids, it is not always achievable in a timely manner. IO access warrants exploration as an alternative.

Aim: Conduct a systematic review of existing literature to examine the evidence for efficacy and safety of IO devices in neonatal patients, from birth to discharge.

Method: A search of PubMed, Ovid, Medline, and Embase was carried out. Abstracts were screened for relevance to focus on neonatal-specific literature and studies which carried out separate analyses for neonates (infants <28 days of age or resident on a neonatal unit).

Results: One case series and 12 case reports describe IO device insertion into 41 neonates, delivering a variety of drugs, including adrenaline (epinephrine) and volume resuscitation. Complications range from none to severe. Cadaveric studies show that despite a small margin for error, IO devices can be correctly sited in neonates. Simulation studies suggest that IO devices may be faster and easier to site than UVC, even in experienced hands.

Conclusion: IO access should be available on neonatal units and considered for early use in neonates where other access routes have failed. Appropriate training should be available to staff in addition to existing life support and UVC training. Further studies are required to assess the optimal device, position, and whether medication can be delivered IO as effectively as by UVC. If IO devices provide a faster method of delivering adrenaline effectively than UVC, this may lead to changes in neonatal resuscitation practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000502212DOI Listing
June 2020

Surfactant Administration via Thin Catheter: A Practical Guide.

Neonatology 2019 28;116(3):211-226. Epub 2019 Aug 28.

Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.

Exogenous surfactant replacement is the most effective evidence-based therapy for respiratory distress syndrome in preterm infants. The mode of administration has evolved in the last decade towards less invasive techniques that aim to effectively provide an adequate dose of surfactant, while allowing spontaneous respiration to continue, and with the support of continuous positive airway pressure. Surfactant delivery via aerosolisation, pharyngeal instillation, and laryngeal mask are being actively pursued in research, but have not yet been adopted to any significant degree in clinical practice. Surfactant administration via thin catheter, on the other hand, is becoming more widely used in neonatal intensive care units worldwide and is now an acknowledged alternative to the standard mode of surfactant delivery. Different devices, including nasogastric tubes, vascular catheters, and purpose-built surfactant instillation catheters are used. We present here a contemporary review of surfactant administration via thin catheter, in a practical guide format that reflects the individual and collective scientific opinions of the clinicians who participated in formulating the guide.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000502610DOI Listing
June 2020

Is waveform capnography reliable in neonates?

Arch Dis Child 2019 Jul;104(7):711-715

Department of Paediatrics, University of Oxford, Oxford, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2018-316577DOI Listing
July 2019

Initial Oxygen Use for Preterm Newborn Resuscitation: A Systematic Review With Meta-analysis.

Pediatrics 2019 01;143(1)

Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and.

: media-1vid110.1542/5839981895001PEDS-VA_2018-1828 CONTEXT: The International Liaison Committee on Resuscitation prioritized to review the initial fraction of inspired oxygen (Fio) during the resuscitation of preterm newborns.

Objectives: This systematic review and meta-analysis provides the scientific summary of initial Fio in preterm newborns (<35 weeks' gestation) who receive respiratory support at birth.

Data Sources: Medline, Embase, Evidence-Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018.

Study Selection: Studies were selected by pairs of independent reviewers in 2 stages with a Cohen's κ of 0.8 and 1.0.

Data Extraction: Pairs of independent reviewers extracted data, appraised the risk of bias (RoB), and assessed Grading of Recommendations Assessment, Development and Evaluation certainty.

Results: Ten randomized controlled studies and 4 cohort studies included 5697 patients. There are no statistically significant benefits of or harms from starting with lower compared with higher Fio in short-term mortality ( = 968; risk ratio = 0.83 [95% confidence interval 0.50 to 1.37]), long-term mortality, neurodevelopmental impairment, or other key preterm morbidities. A sensitivity analysis in which 1 study with a high RoB was excluded failed to reveal a reduction in mortality with initial low Fio ( = 681; risk ratio = 0.63 [95% confidence interval 0.38 to 1.03]).

Limitations: The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low for all outcomes due to RoB, inconsistency, and imprecision.

Conclusions: The ideal initial Fio for preterm newborns is still unknown, although the majority of newborns ≤32 weeks' gestation will require oxygen supplementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2018-1828DOI Listing
January 2019

Room Air for Initiating Term Newborn Resuscitation: A Systematic Review With Meta-analysis.

Pediatrics 2019 01;143(1)

Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and.

: media-1vid110.1542/5839981898001PEDS-VA_2018-1825 CONTEXT: The International Liaison Committee on Resuscitation prioritized to rigorously review the initial fraction of inspired oxygen (Fio) during resuscitation of newborns.

Objective: This systematic review and meta-analysis provides the scientific summary of initial Fio in term and late preterm newborns (≥35 weeks' gestation) who receive respiratory support at birth.

Data Sources: Medline, Embase, Evidence Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018.

Study Selection: Studies were selected by pairs of independent reviewers in 2 stages, with a Cohen's κ of 0.8 and 1.0.

Data Extraction: Pairs of independent reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence.

Results: Five randomized controlled trials (RCTs) and 5 quasi RCTs included 2164 patients. Room air (Fio 0.21) was associated with a statistically significant benefit in short-term mortality compared with 100% oxygen (Fio 1.0) (7 RCTs; = 1469; risk ratio [RR] = 0.73; 95% confidence interval [CI]: 0.57 to 0.94). No significant differences were observed in neurodevelopmental impairment (2 RCTs; = 360; RR = 1.41; 95% CI: 0.77 to 2.60) or hypoxic-ischemic encephalopathy (5 RCTs; = 1315; RR = 0.89; 95% CI: 0.68 to 1.18).

Limitations: The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was low for short-term mortality and hypoxic-ischemic encephalopathy and very low for neurodevelopmental impairment.

Conclusions: Room air has a 27% relative reduction in short-term mortality compared with Fio 1.0 for initiating neonatal resuscitation ≥35 weeks' gestation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2018-1825DOI Listing
January 2019

Randomised cross-over study of automated oxygen control for preterm infants receiving nasal high flow.

Arch Dis Child Fetal Neonatal Ed 2019 Jul 21;104(4):F366-F371. Epub 2018 Nov 21.

Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Objective: To evaluate a prototype automated controller (IntellO) of the inspired fraction of oxygen (FiO) in maintaining a target range of oxygen saturation (SpO) in preterm babies receiving nasal high flow (HF) via the Vapotherm Precision Flow.

Design: Prospective two-centre order-randomised cross-over study.

Setting: Neonatal intensive care units.

Patients: Preterm infants receiving HF with FiO ≥25%.

Intervention: Automated versus manual control of FiO to maintain a target SpO range of 90%-95% (or 90%-100% if FiO=21%).

Main Outcome Measures: The primary outcome measure was per cent of time spent within target SpO range. Secondary outcomes included the overall proportion and durations of SpO within specified hyperoxic and hypoxic ranges and the number of in-range episodes per hour.

Results: Data were analysed from 30 preterm infants with median (IQR) gestation at birth of 26 (24-27) weeks, study age of 29 (18-53) days and study weight 1080 (959-1443) g. The target SpO range was achieved 80% of the time on automated (IntellO) control (IQR 70%-87%) compared with 49% under manual control (IQR 40%-57%; p<0.0001). There were fewer episodes of SpO below 80% lasting at least 60 s under automated control (0 (IQR 0-1.25)) compared with manual control (5 (IQR 2.75-14)). There were no differences in the number of episodes per hour of SpO above 98% (4.5 (IQR 1.8-8.5) vs 5.5 (IQR 1.9-14); p=0.572) between the study arms.

Conclusions: The IntellO automated oxygen controller maintained patients in the target SpO range significantly better than manual adjustments in preterm babies receiving HF.

Trial Registration Number: NCT02074774.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2018-315342DOI Listing
July 2019

National surveys of UK and Italian neonatal units highlighted significant differences in the use of non-invasive respiratory support.

Acta Paediatr 2019 05 13;108(5):865-869. Epub 2018 Nov 13.

Newborn Services, John Radcliffe Hospital, Oxford, UK.

Aim: This study compared how non-invasive respiratory support (NRS) was provided in neonatal units in Italy and the UK.

Methods: An NRS questionnaire was sent to tertiary neonatal centres, identified by national societies, from November 2015 to May 2016.

Results: Responses were received from 49/57 (86%) UK units and 103/115 (90%) Italian units. NRS was started in the delivery room by 61% of UK units and 85% of Italian units. In neonatal intensive care units, 33% of UK units used nasal high-flow therapy (HFT) as primary support, compared to 3% in Italy. Nasal continuous positive airway pressure (CPAP) was used in 57% of UK units and 90% of Italian units. The commonest starting flow rate on nasal HFT for term and preterm infants was 6 L/min in the UK, while Italian units mainly used this flow for term infants. In the UK, 67% of units decreased nasal HFT by 1 L/min per day. In Italy, infants on nasal CPAP were weaned by 1 cm H O per day in 39% of units.

Conclusion: The way that NRS was managed for very preterm infants differed between the UK and Italy, reflecting a lack of evidence on optimal NRS and the use of local protocols.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.14611DOI Listing
May 2019

Navigating a Mid-Level Gap in Neonatal Resuscitation.

Neonatology 2018 22;114(4):362-363. Epub 2018 Aug 22.

Department of Woman's and Child's Health, University of Padova, Padova, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000491689DOI Listing
June 2019

Education, training, and accreditation of Neonatologist Performed Echocardiography in Europe-framework for practice.

Pediatr Res 2018 07;84(Suppl 1):13-17

Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands.

There is a growing interest worldwide in using echocardiography in the neonatal unit to act as a complement to the clinical assessment of the hemodynamic status of premature and term infants. However, there is a wide variation in how this tool is implemented across many jurisdictions, the level of expertise, including the oversight of this practice. Over the last 5 years, three major expert consensus statements have been published to provide guidance to neonatologists performing echocardiography, with all recommending a structured training program and clinical governance system for quality assurance. Neonatal practice in Europe is very heterogeneous and the proximity of neonatal units to pediatric cardiology centers varies significantly. Currently, there is no overarching governance structure for training and accreditation in Europe. In this paper, we provide a brief description of the current training recommendations across several jurisdictions including Europe, North America, and Australia and describe the steps required to achieve a sustainable governance structure with the responsibility to provide accreditation to neonatologist performed echocardiography in Europe.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41390-018-0078-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257220PMC
July 2018

WITHDRAWN: Techniques to ascertain correct endotracheal tube placement in neonates.

Cochrane Database Syst Rev 2018 07 5;7:CD010221. Epub 2018 Jul 5.

Department of Pediatrics, Division of Neonatology, University of Alberta, Royal Alexandra Hospital, Rm. 418 CSC, 10240 Kingsway Ave, Edmonton, AB, Canada, T5H 3V9.

Background: The success rate of correct endotracheal tube (ETT) placement for junior medical staff is less than 50% and accidental oesophageal intubation is common. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes including hypoxaemia, death, pneumothorax and right upper lobe collapse.ETT position can be confirmed using chest radiography, but this is often delayed; hence, a number of rapid point-of-care methods to confirm correct tube placement have been developed. Current neonatal resuscitation guidelines advise that correct ETT placement should be confirmed by the observation of clinical signs and the detection of exhaled carbon dioxide (CO). Even though these devices are frequently used in the delivery room to assess tube placement, they can display false-negative results. Recently, newer techniques to assess correct tube placement have emerged (e.g. respiratory function monitor), which have been claimed to be superior in the assessment of tube placement.

Objectives: To assess various techniques for the identification of correct ETT placement after oral or nasal intubation in newborn infants in either the delivery room or neonatal intensive care unit compared with chest radiography.

Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2012, Issue 4), MEDLINE (January 1996 to June 2014), EMBASE (January 1980 to Juen 2014) and CINAHL (January 1982 to June 2014). We searched clinical trials registers and the abstracts of the Society for Pediatric Research and the European Society for Pediatric Research from 2004 to 2014. We did not apply any language restrictions.

Selection Criteria: We planned to include randomised and quasi-randomised controlled trials and cluster trials that compared chest radiography with clinical signs, respiratory function monitors, exhaled CO detectors or ultrasound for the assessment of correct ETT placement either in the delivery room or the neonatal intensive care unit.

Data Collection And Analysis: Two review authors independently evaluated the search results against the selection criteria. We did not perform data extraction and 'Risk of bias' assessments because we identified no studies that met our inclusion criteria.

Main Results: We did not identify any studies meeting the criteria for inclusion in this review.

Authors' Conclusions: There is insufficient evidence to determine the most effective technique for the assessment of correct ETT placement either in the delivery room or the neonatal intensive care unit. Randomised clinical trials comparing either of these techniques with chest radiography are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD010221.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513417PMC
July 2018

When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings.

Neonatology 2018 25;114(2):112-123. Epub 2018 May 25.

Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden.

Background: Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care.

Objectives: The aim is to close a significant gap in neonatal care provision in LRS by establishing consensus on a protocol that would guide MSF field teams in their practice of more advanced NR.

Methods: An independent committee of international experts was formed and met regularly from June 2016 to agree on the content and design of a new NR algorithm.

Results: Consensus was reached on a novel, mid-level NR algorithm in April 2017. The algorithm was accepted for use by MSF Operational Center Paris.

Conclusion: This paper contributes to the literature on decision-making in the development of cognitive aids. The authors also highlight how critical gaps in healthcare delivery in LRS can be addressed, even when there is limited evidence to guide the process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000486705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159832PMC
September 2019

The Laryngeal Mask Airway and Its Use in Neonatal Resuscitation: A Critical Review of Where We Are in 2017/2018.

Neonatology 2018 13;113(2):152-161. Epub 2017 Dec 13.

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Headley Way, Oxford, UK.

Studies using videotape recordings and respiratory function monitoring have shown that both face mask (FM) application and endotracheal tube (ETT) placement represent a challenge for resuscitators. Hence, there is a strong need for devices that can largely be used independently of individual operator training levels, in order to ensure more reliable support in time-critical situations, such as neonatal resuscitation. The laryngeal mask airway device (LMA) has evolved as a potentially very valuable tool. We conducted a systematic review of studies evaluating the use of the LMA in neonatal resuscitation. An electronic literature search of large medical databases was performed to identify relevant publications on the use of an LMA during neonatal delivery room (DR) resuscitation. Following a rigorous systematic review, we identified a total of 7 randomized controlled trials with results indicating that initial respiratory management of newborn infants with an LMA is feasible for a defined subgroup of infants, but the evidence is still insufficient to recommend the LMA instead of FM ventilation in the DR. There is, in particular, a dearth of evidence of the use of LMA in neonates born before 34 weeks' gestational age or weighing <1,500 g at birth. There were no reports on significant complications following the use of LMA; however, evidence is still limited regarding short- and long-term outcomes. We conclude that the limited currently available evidence suggests that the use of the LMA is a feasible and safe alternative to mask ventilation of late preterm and term infants in the DR. The potential use of LMA resuscitation, in particular for low-gestation and low-birth-weight infants, needs further study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000481979DOI Listing
September 2019

Ingeborg Syllm-Rapoport (1912-2017): An Exemplary Life for Children and Paediatrics.

Neonatology 2017 15;112(4):384-386. Epub 2017 Sep 15.

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Ingeborg Syllm-Rapoport, the first Chair in neonatology in Europe, passed away on March 23. Her biography illustrates how medical and scientific work has been influenced by social, ideological, and economic frames and boundaries in the 20th century. Regarded as a "Half-Jew" by the Nazi racist laws, she was denied her medical doctorate. She went to the USA, where she trained in paediatrics and met her husband, the biochemist Samuel Mitja Rapoport. During the "McCarthy Era" both were persecuted as communists. They returned to Europe and became two of the most influential figures at the Charité Hospital in East Berlin. She had to wait until 2015 to finally undergo the doctoral examination at the age of 102 years, making her the oldest person in history to receive a doctorate. We describe Syllm-Rapoport's life and the challenges she had to face living in several countries under different political systems in the 20th century.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000479860DOI Listing
July 2018

Reply.

J Pediatr 2017 06 3;185:254. Epub 2017 Mar 3.

University of Oxford Oxford, United Kingdom.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2017.02.031DOI Listing
June 2017

Key paediatric messages from the 2016 European Respiratory Society International Congress.

ERJ Open Res 2017 Jan 17;3(1). Epub 2017 Jan 17.

Dept of Paediatrics, Sapienza University of Rome, Rome, Italy.

In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00127-2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279069PMC
January 2017

One Step Further Toward Defining the Optimal Respiratory Care Package for Neonates: Interventions to Successfully Extubate Preterm Infants.

JAMA Pediatr 2017 02;171(2):120-121

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom3Department of Neonatology, Charité University Medical Center Berlin, Berlin, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamapediatrics.2016.3271DOI Listing
February 2017

Two variations of congenital epulis.

Arch Dis Child Fetal Neonatal Ed 2016 Sep 8;101(5):F432. Epub 2016 Jun 8.

Newborn Care Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK Department of Neonatology, Charité University Medical Center Berlin, Berlin, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2015-310312DOI Listing
September 2016

Ventilation-Induced Brain Injury in Preterm Neonates: A Review of Potential Therapies.

Neonatology 2016 23;110(2):155-62. Epub 2016 Apr 23.

The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Vic., UK.

Mechanical ventilation is a risk factor for cerebral inflammation and brain injury in preterm neonates. The risk increases proportionally with the intensity of treatment. Recent studies have shown that cerebral inflammation and injury can be initiated in the delivery room. At present, initiation of intermittent positive pressure ventilation (IPPV) in the delivery room is one of the least controlled interventions a preterm infant will likely face. Varying pressures and volumes administered shortly after birth are sufficient to trigger pathways of ventilation-induced lung and brain injury. The pathways involved in ventilation-induced brain injury include a complex inflammatory cascade and haemodynamic instability, both of which have an impact on the brain. However, regardless of the strategy employed to deliver IPPV, any ventilation has the potential to have an impact on the immature brain. This is particularly important given that preterm infants are already at a high risk for brain injury simply due to immaturity. This highlights the importance of improving the initial respiratory support in the delivery room. We review the mechanisms of ventilation-induced brain injury and discuss the need for, and the most likely, current therapeutic agents to protect the preterm brain. These include therapies already employed clinically, such as maternal glucocorticoid therapy and allopurinol, as well as other agents, such as erythropoietin, human amnion epithelial cells and melatonin, already showing promise in preclinical studies. Their mechanisms of action are discussed, highlighting their potential for use immediately after birth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000444918DOI Listing
November 2017

European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth.

Resuscitation 2015 Oct 15;95:249-63. Epub 2015 Oct 15.

Division of Neonatology, Medical University Graz, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.resuscitation.2015.07.029DOI Listing
October 2015

Changing the paradigm from resuscitation to physiological support.

Paediatr Respir Rev 2015 Jun 24;16(3):141-2. Epub 2015 Feb 24.

Department of Neonatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prrv.2015.02.003DOI Listing
June 2015