Promoting Safe Sleep: The Role of Doulas in Black Communities.

BACKGROUND: Accidental suffocation and strangulation in bed continues to be a critical issue in Black communities, despite the widespread initiatives to promote safe sleep. Doulas are in an ideal position to promote safe sleep, particularly in hard-to-reach communities that are more distrusting of conventional medical providers. Little is known about their practices and perspectives for putting infants down to rest. This study informs this gap in the literature. PURPOSE: The purpose of this study was to explore doulas' perspectives and practices in the field of putting infants down to sleep. The researchers aimed to determine whether Black caregivers that work with doulas are likely to encounter safe sleep education. METHODS: The researchers used a descriptive approach to inquiry. They conducted three focus groups with a total of 17 Black doulas. The researchers independently and critically reviewed the transcriptions and observation notes from each group to identify codes. They then triangulated the results using Artificial Intelligence-driven tools. FINDINGS: The study found four themes: (1) Individualized Services, (2) Cultural Sensitivity, (3) Negotiating Safety, and (4) Safe Sleep Education. CONCLUSIONS: The study concluded doulas have a commitment to promoting safe sleep. The researchers found that doulas engage in practices that help caregivers to integrate safe sleep practices into their lifestyle and to adapt them to meet their needs. The researchers also documented a desire for more information and instruction on safe sleep among practicing doulas.

Out-of-hospital cardiac arrests in the young population; a 6-year review of the Irish out-of-hospital cardiac arrest register.

STUDY PURPOSE: Out-of-hospital cardiac arrests (OHCA) in the young population have only been examined in a limited number of regional studies. Hence, we sought to describe OHCA characteristics and predictors of survival to hospital discharge for the young Irish population. STUDY DESIGN: An observational analysis of the national Irish OHCA register for all OHCAs aged ≤35 years between January 2012 and December 2017 was performed. The young population was categorised into three age groups: ≤1 year, 1-15 years and 16-35 years. Multivariable logistic regression was used to determine the independent predictors of survival to hospital discharge. RESULTS: A total of 1295 OHCAs aged ≤35 years (26.9% female, median age 25 (IQR 17-31)) had resuscitation attempted. OHCAs in those aged ≥16 years (n=1005) were more likely to happen outside the home (38.5% vs 22.8%, p<0.001) and be of non-medical aetiology (59% vs 27.6%, p<0.001) compared with those aged <16 years (n=290). Asphyxiation, trauma and drug overdoses accounted for over 90% of the non-medical OHCAs for those 16-35 years. Overall survival to hospital discharge for the cohort was 5.1%; survival was non-significantly higher for those aged 16-35 years compared with those aged 1-15 years (6.0%, vs 2.8% p=0.93). Independent predictors of survival to hospital discharge included bystander witnessed OHCA, a shockable initial rhythm and a bystander defibrillation attempt. CONCLUSIONS: The high prevalence of non-medical OHCAs and the OHCA location need to be considered when developing OHCA care pathways and preventative strategies to reduce the burden of OHCAs in the young population.

Should Airbag Backpacks Be Standard Avalanche Safety Equipment?

Avalanche airbag backpacks have been shown to be effective at reducing avalanche mortality. However, they are yet to be considered standard avalanche safety equipment, which has long consisted of a transceiver, a shovel, and a probe. This is despite data showing that airbags reduce mortality by decreasing the likelihood of burial. In addition, airbags probably lessen trauma and possibly delay asphyxia. Moreover, the literature suggests airbags reduce mortality at a rate similar to transceivers. For those who work, volunteer, and recreate in avalanche terrain, airbags should be considered standard safety equipment. However, multiple barriers exist for universal adoption, including cost, size, weight, training burden, availability, risk tolerance, and lack of community support and recommendations from professional societies and associations.

Trends in Rates of Sudden Unexpected Infant Death (SUID): Hopes for Prevention.

Infant deaths that occur unexpectedly during sleep have been attributed over generations to various explanations for this shocking and tragic loss of life. Historically, these deaths have been coded as caused by sudden infant death syndrome (SIDS), which defied prevention. This paper explores the evolution of understanding SIDS to the current use of the term sudden unexpected infant death (SUID) defined by the Centers for Disease Control as including three causes: SIDS, accidental strangulation and suffocation in bed (ASSB) and unknown. Data presented in this paper demonstrate that with enhanced death scene investigations there has been a shift over the past three decades in how SUIDs are coded. In 1990-4, nationally, 84 percent of post neonatal deaths were attributed to SIDS, 12 percent to unknown, and 3 percent to ASSB. Most current data (2014-18) show that 42 percent are now attributed to SIDS, 34 percent to unknown, and 25 percent to ASSB. While there has been stalled progress in the decrease of SUIDs, the diagnostic shift observed yields promise for the prevention of these deaths with public health measures that educate the public on the hazards of safe sleep for babies.

Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth.

OBJECTIVE: To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth. STUDY DESIGN: Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. RESULTS: Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. CONCLUSION: Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts.

Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep.

BACKGROUND: Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep. PURPOSE: Decrease the risk of overheating or suffocation by removing NICU infants' hats during sleep without increasing the relative risk of hypothermia during transition to an open crib. METHODS: Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib. FINDINGS: Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes. IMPLICATIONS FOR PRACTICE: Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants toan open crib in our NICU. By avoiding the use of hats in an open crib, it's possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment. IMPLICATIONS FOR RESEARCH: The removal of hats during sleep to promote infant health should be considered for all infants.

Reports of Injury Risks and Reasons for Choice of Sleep Environments for Infants and Toddlers.

OBJECTIVE: Compare mothers' reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices. METHODS: A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers' choices. RESULTS: Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because "There is no suffocation risk" (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because "I was concerned about suffocation risk." CONCLUSIONS FOR PRACTICE: Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers' use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers.

Molecular hydrogen alleviates asphyxia-induced neuronal cyclooxygenase-2 expression in newborn pigs.

Cyclooxygenase-2 (COX-2) has an established role in the pathogenesis of hypoxic-ischemic encephalopathy (HIE). In this study we sought to determine whether COX-2 was induced by asphyxia in newborn pigs, and whether neuronal COX-2 levels were affected by H2 treatment. Piglets were subjected to either 8 min of asphyxia or a more severe 20 min of asphyxia followed by H2 treatment (inhaling room air containing 2.1% H2 for 4 h). COX-2 immunohistochemistry was performed on brain samples from surviving piglets 24 h after asphyxia. The percentages of COX-2-immunopositive neurons were determined in cortical and subcortical areas. Only in piglets with more severe HIE, we observed significant, region-specific increases in neuronal COX-2 expression within the parietal and occipital cortices and in the CA3 hippocampal subfield. H2 treatment essentially prevented the increases in COX-2-immunopositive neurons. In the parietal cortex, the attenuation of COX-2 induction was associated with reduced 8'-hydroxy-2'-deoxyguanozine immunoreactivity and retained microglial ramifcation index, which are markers of oxidative stress and neuroinfiammation, respectively. This study demonstrates for the first time that asphyxia elevates neuronal COX-2 expression in a piglet HIE model. Neuronal COX-2 induction may play region-specific roles in brain lesion progression during HIE development, and inhibition of this response may contribute to the antioxidant/anti-infiammatory neuroprotective effects of H2 treatment.

The Interface Among Poverty, Air Mattress Industry Trends, Policy, and Infant Safety.

Infants can suffocate on air mattresses, even when the mattress is fully inflated. The interfacing issues of poverty, the bedbug epidemic, and changes in the design and marketing of air mattresses may be increasing consumer use of air mattresses as primary sleep environments and thus increasing the potential for infant death. Despite recent changes to improve air mattress safety labeling, the National Child Death Review Case Reporting System found that between 2004 and 2015 across 24 states, an air mattress was the incident sleep place for 108 infants whose deaths were either during sleep or in a sleep environment. At the same time, design components such as inflatable headboards and memory foam pillow tops potentially increase the hazard to infants, and marketing changes represent air mattresses as a preferred low-cost primary sleep environment. Analysis of current data surveillance systems, published position statements, and consumer materials from national organizations and federal agencies reveal opportunities for changing policy to better protect infants from this hazard.

Identification of Nonfatal Strangulation by 911 Dispatchers: Suggestions for Advances Toward Evidence-Based Prosecution.

Research highlights the need for systematic law enforcement training on nonfatal strangulation in domestic violence situations to improve evidence-based prosecution of these violent felonies. However, most of this research focuses on the role of police officers in the safety response. Although often overlooked, this research examines the role of 911 dispatchers, who are many times the first person the victim calls for assistance. This study examines official domestic violence records, gathered through a partnership with a County Sheriff's agency, to determine whether domestic violence strangulation is being adequately identified and documented by first responders. This research highlights the need for considering 911 dispatchers as having a potentially critical role in a comprehensive response to domestic violence strangulation from initial screening to eventual prosecution.

Messaging Affects the Behavior of African American Parents with Regards to Soft Bedding in the Infant Sleep Environment: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the impact of specific health messages on the decisions of African American parents regarding soft bedding use, specifically related to the high degree of self-efficacy that African American parents have with regards to preventing infant suffocation vs low self-efficacy with regards to sudden infant death syndrome (SIDS) risk reduction. STUDY DESIGN: We conducted a randomized, controlled clinical trial of African American mothers of infants. The control group received standard messaging emphasizing safe sleep practices recommended by the American Academy of Pediatrics for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. RESULTS: Of 1194 mothers enrolled, 637 completed all interviews. The use of soft bedding both in the past week and last night declined with age (P < .001). Infants in the enhanced group had a lower rate of use of soft bedding in the past week (P = .006) and last night (P = .013). Mothers who received the enhanced message were more likely to state that they avoided soft bedding to protect their infant from suffocation. CONCLUSIONS: African American mothers who receive an enhanced message about SIDS risk reduction and suffocation prevention are less likely to use soft bedding in their infant's sleep environment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01361880.

From unwitnessed fatality to witnessed rescue: Nonpharmacologic interventions in sudden unexpected death in epilepsy.

Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP; postictal electroencephalography (EEG) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP, presumably by permitting intervention in the case of a life-threatening event. Resuscitative efforts were implemented promptly in near-SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions--including repositioning, oral suctioning, and oxygen administration--reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit (EMU), but have not been studied in outpatients. Cardiac pacemakers or cardioverter-defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic-clonic seizure-associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.

The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme.

AIM: Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths. METHODS: The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs). RESULTS: Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for Maori and in regions with the most intensive programmes. CONCLUSION: The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees.

Residual Confined Space Hazards...An Unintended Booby Trap!

Using elements of the new construction industry regulation for confined spaces in a general industry program will go a long way to save the lives of those who would otherwise fall victim to them.

Blood lactate level and meconium aspiration syndrome.

PURPOSE: Approximately 5% of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). Early recognition of infants at highest risk for the development of MAS and the prediction of disease severity are important for optimizing the clinical strategies for prevention and treatment. The aim of the present study was to identify the risk factors for MAS and to investigate the effect of blood lactate level on the development of MAS. METHODS: Between January 2011 and January 2012, data were recorded with regard to gender, mode of delivery, gestational week, birth weight, 5-min Apgar score, and need for resuscitation of the meconium-stained depressed infants who underwent tracheal aspiration. Moreover, the number of cases developing MAS, blood pH value, and lactate level in capillary blood gases obtained during the first hour after delivery, duration of oxygen supplementation, the number of cases receiving mechanical ventilation and surfactant therapy, duration of hospital stay, and outcomes of the infants were recorded. RESULTS: The number of live births during the study period was 17,202, and of them, 1,341 (7.8%) infants were born through MSAF. Of 195 infants who were meconium-stained depressed, 90 were girls and 105 were boys. Their mean gestational week was 39.37 ± 0.89 weeks and mean birth weight was 3,426 ± 634 g. Eighty-four of them were born through cesarean section (C/S), and 111 were born via normal spontaneous labor. For 40 infants, Apgar score at fifth minute was less than 6. In total, resuscitation was performed on 43 (22.9%) infants. Of the infants, 141 did not develop MAS and 54 developed MAS. While there were no significant differences between infants with and without MAS with regard to gender, delivery route, gestational week, and birth weight, a significant difference was observed regarding the Apgar score (p = 0.0001). The blood pH value in capillary blood gas analysis was less than 7.25 in 18 (28.5%) cases with MAS and four (3.2%) cases without MAS. There was no significant difference between infants with and without MAS with regard to blood pH levels (p = 0.031). The mean blood lactate level was 8.5± 3.4 mmol/L in the patients with MAS, and there was a significant difference between infants with and without MAS regarding blood lactate level (p = 0.0001). The mean duration of oxygen supplementation was 86.62 ± 66.52 and 44.36 ± 19.03 h in patients with MAS and without MAS, respectively. In total, 30 infants required mechanical ventilation (24 infants with MAS and 6 infants without MAS). In addition to mechanical ventilation, 16 infants with MAS were administered surfactant therapy. The mean duration of hospital stay of infants with MAS was significantly higher than infants without MAS (p = 0.0001). There was a correlation between blood lactate levels, blood pH value, and hospitalization duration (p < 0.05). All of the infants, except one patient, were discharged from the NICU. CONCLUSION: In addition to the blood pH value and 5-min Apgar score, increased blood lactate level may be a risk factor for the development of MAS in infants born with MSAF. This may aid in the early detection of MAS and, with appropriate measures taken sooner, reduce morbidity and mortality. Further studies are needed to elucidate the role of lactate level, which is an important indicator of hypoxia during the development of MAS.

Isocitrate supplementation promotes breathing generation, gasping, and autoresuscitation in neonatal mice.

Breathing is a vital function generated and controlled by a brainstem neural network, which is able to adjust its function to fit different metabolic demands. For instance, the pre-Bötzinger complex (preBötC) can respond to low oxygen availability (hypoxia) by an initial increase in rhythm frequency followed by a decrease in respiratory efforts that leads to gasping generation. Gasping is essential for autoresuscitation, which has motivated studies of the cellular mechanisms involved in these processes. Hypoxia has different effects on enzymes that participate in the Krebs cycle. In particular, aconitase is downregulated, whereas isocitrate dehydrogenase is unaffected or upregulated under hypoxic conditions. We hypothesized that the application of isocitrate, the product of aconitase and the substrate of isocitrate dehydrogenase as well as an alternative metabolic substrate, might enhance breathing and render it more resistant to hypoxic insult. We tested the effects of isocitrate applied on brainstem slices containing the preBötC as well as its central effects in vivo using plethysmography. Our results show that isocitrate increases the frequency of fictive eupnea and fictive gasping produced by the preBötC in vitro. Moreover, isocitrate increases the amplitude of ventilation in vivo in normoxia, increases ventilation during gasping, and favors autoresuscitation when animals were subjected to asphyxiation. In conclusion, we have found that isocitrate improves ventilation under both normoxic and hypoxic conditions through a mechanism that involves the preBötC and possibly other respiratory neural networks. Thus, isocitrate would be useful to avoid the failure of gasping generation and autoresuscitation in pathological conditions.

The need for a comprehensive approach to managing confined space entry: summary of the literature and recommendations for next steps.

Despite all the regulatory and standard-setting efforts that have been made in North America, judging from the most recent statistics many fatal incidents related to work in confined spaces still occur. In Canada, fatal incidents in the province of Quebec reveal failures in and absence of the identification and preparation of work situations in confined spaces and in risk management. In this study, we performed a literature review consisting of 77 documents on existing hazards and risk assessment for confined spaces. Moreover, we formulated proposals regarding the design of specific and improved tools for assessing such risks. We found that atmospheric hazards monopolized attention in the literature on confined spaces, while risk estimation specific to confined space interventions received little practical coverage overall, apart from atmospheric hazards. The parameters used to establish classes or groupings of confined spaces in existing tools were imprecise. The development of a risk analysis process that is (i) more systematic and based on the concepts recognized in risk management standards, (ii) multidisciplinary, and (iii) adapted to the specific characteristics of confined spaces is therefore needed. Such a process will better support managers and occupational health and safety (OH&S) personnel in their efforts to prioritize and reduce risks. Suggestions on such a risk analysis tool and categorization of interventions in confined spaces are proposed in this article. Lastly, risk analysis tools adapted to confined space interventions are needed to ensure the inherently safe design of these spaces.

Exposure of unsuspecting workers to deadly atmospheres in below-ground confined spaces and investigation of related whole-air sample composition using adsorption gas chromatography.

Hazardous atmospheres in confined spaces may be obvious when a source of air contamination or oxygen (O2) deficiency is recognized. Such is often the case in general industry settings, especially with work processes which create hazardous atmospheres that may be anticipated. Hazards present in active sewers are also well recognized; but the possibility that O2 deficiency or high airborne contaminant concentrations may exist in new construction sewers or storm drains has been repeatedly ignored with deadly results. Low O2 and high carbon dioxide (CO2) concentrations may exist in new construction manholes that have not yet been connected to an active sewer or drain system, and these concentrations have been shown to vary over time. A recent incident is described where workers repeatedly entered such a confined space without incident, but subsequent entry resulted in a fatality and a near-miss for a co-worker rescuer. Additional cases are discussed, with an emphasis placed on elevated CO2 concentrations as a causative factor. A description is provided for the adsorptive gas chromatography whole-air analysis methodology used to quantitatively determine atmospheric conditions present at this type of fatality site or others after an incident, and for the gas chromatography-mass spectrometry method used to provide confirmation of analyte identity with high certainty. Many types of confined spaces may be encountered in addition to the underground varieties discussed, and many possible atmospheric hazards are possible. The definitive whole-air analysis approach described here may be of use and should be considered to investigate many confined space fatality and near-miss cases, and to better understand the causes of dangerous atmosphere conditions that may arise in confined spaces.

Fetal asphyctic preconditioning modulates the acute cytokine response thereby protecting against perinatal asphyxia in neonatal rats.

BACKGROUND: Perinatal asphyxia (PA) is a major cause of brain damage and neurodevelopmental impairment in infants. Recent investigations have shown that experimental sublethal fetal asphyxia (FA preconditioning) protects against a subsequent more severe asphyctic insult at birth. The molecular mechanisms of this protection have, however, not been elucidated. Evidence implicates that inflammatory cytokines play a protective role in the induction of ischemic tolerance in the adult brain. Accordingly, we hypothesize that FA preconditioning leads to changes in the fetal cytokine response, thereby protecting the newborn against a subsequent asphyctic insult. METHODS: In rats, FA preconditioning was induced at embryonic day 17 by clamping the uterine vasculature for 30 min. At term birth, global PA was induced by placing the uterine horns, containing the pups, in a saline bath for 19 min. We assessed, at different time points after FA and PA, mRNA and protein expression of several cytokines and related receptor mRNA levels in total hemispheres of fetal and neonatal brains. Additionally, we measured pSTAT3/STAT3 levels to investigate cellular responses to these cytokines. RESULTS: Prenatally, FA induced acute downregulation in IL-1ß, TNF-α and IL-10 mRNA levels. At 96 h post FA, IL-6 mRNA and IL-10 protein expression were increased in FA brains compared with controls. Two hours after birth, all proinflammatory cytokines and pSTAT3/STAT3 levels decreased in pups that experienced FA and/or PA. Interestingly, IL-10 and IL-6 mRNA levels increased after PA. When pups were FA preconditioned, however, IL-10 and IL-6 mRNA levels were comparable to those in controls. CONCLUSIONS: FA leads to prenatal changes in the neuroinflammatory response. This modulation of the cytokine response probably results in the protective inflammatory phenotype seen when combining FA and PA and may have significant implications for preventing post-asphyctic perinatal encephalopathy.

Methods of administering superimposed high-frequency jet ventilation and the associated risk for aspiration in a model of tracheal bleeding.

BACKGROUND: To determine the suitability of different superimposed high-frequency jet ventilation (SHFJV) application methods during tracheal bleeding. OBJECTIVE: To determine the effect of SHFJV on the aspiration of blood during tracheal bleeding. METHODS: A test lung was ventilated using SHFJV via a rigid endoscope, a jet laryngoscope and a 4-lumen jet catheter. Packed red blood cells (PRBCs) were injected into the artificial trachea caudally to the rigid endoscope and jet laryngoscope ventilation, and both caudally and cranially during ventilation via the 4-lumen jet catheter, and the migration of PRBCs during ventilation was studied using continuous video recording. RESULTS: Migration of blood into the lower respiratory tract did not occur during SHFJV via the rigid endoscope and jet laryngoscope and via the 4-lumen jet catheter with the bleeding caudal to ventilation source. If the bleeding was cranial to the 4-lumen jet catheter ventilation, migration of blood into the lower respiratory tract was seen when reflux of blood reached the entrainment area. From this area, blood is transported within the jet stream into the lower respiratory tract. CONCLUSIONS: SHFJV protects the lower respiratory tract from blood aspiration in case of tracheal bleeding. During SHFJV via the 4-lumen jet catheter, aspiration of blood only occurs if bleeding is localized cranial to the 4-lumen jet catheter ventilation. In case of heavy tracheal bleeding, the jet sources should be positioned cranial to the site of bleeding.