Impact of the shift to neonatal noninvasive ventilation in Poland: a population study.

OBJECTIVE: This study was undertaken to document the real impact of a directed shift in the standard of neonatal practice to a pervasive use of noninvasive respiratory support. DESIGN: Before-after observational study. SETTING: All 18 neonatal ICUs in the capital region of Poland. PATIENTS: Every infant admitted to a neonatal ICU who received respiratory pressure support over a 7-year period of interest (12-month transition to the new noninvasive standard and 36 months before and after). INTERVENTION: Education as to the benefits of noninvasive respiratory support and widespread availability of Infant Flow noninvasive ventilation systems. MEASUREMENTS AND MAIN RESULTS: Five thousand five hundred fifty-one infants required respiratory support in this period. Of these, 14% were less than 28 weeks estimated gestational age, 33% between 28 and 32 weeks, 31% between 33 and 36 weeks, and 22% more than 36 weeks. The use of noninvasive support, as the first form of respiratory support, increased by 19% (p < 0.001). The use of noninvasive support, for weaning following extubation, increased by 32% (p = 0.06). The increased use in weaning was the most pronounced in infants younger than or equal to 32 weeks estimated gestational age (p < 0.001). There were two prospective primary endpoints, mortality and bad outcome among survivors younger than or equal to 32 weeks estimated gestational age. Mortality decreased from 11% to 7%, and the difference remained statistically significant after controlling for baseline factors (p < 0.001). The reduced mortality was more apparent in infants younger than or equal to 32 weeks estimated gestational age. In infants younger than or equal to 32 weeks estimated gestational age, bad outcome in survivors (grade III bronchopulmonary dyplasia and retinopathy of prematurity requiring laser treatment) did not increase (p = 0.669) after controlling for significant baseline variables. CONCLUSIONS: We believe that the adoption of an approach emphasizing noninvasive ventilation in Poland resulted in decreased mortality without an increase in significant pulmonary or retinal morbidity.

Factors affecting outcomes in very low birth weight infants treated electively with nasal continuous positive airway pressure.

OBJECTIVE: Although interest in nasal continuous positive airway pressure (nCPAP) to avoid intubation is increasing, there is limited data regarding patient selection and outcome. We sought to determine the baseline parameters associated with failure. STUDY DESIGN: In all, 938 cases of elective nCPAP use were extracted from our registry. Two primary end points, Treatment Failure (need for intubation) and Bad Outcome (death, need for respiratory support at 40 weeks post conceptual age, grade 4 intraventricular hemorrhage or periventricular leucomalacia), and 12 potentially predictive baseline parameters were prospectively defined and evaluated using logistic regression. RESULT: Intubation occurred in 31%, and Bad Outcome occurred in 11%. Besides estimated gestational age (EGA), only a few variables were significant predictors in the multivariate models: Intubation (PaO(2)/FiO(2)<150 or pH< 7.25) and Bad Outcome (FiO(2), low weight for EGA). The relative risk doubled between infants of 34 and 26 weeks EGA and increased by about 50% for those meeting the other criteria. CONCLUSION: We hope these findings will help those using elective nCPAP to refine their practice and those considering its use in establishing reasonable guidelines, as well as be useful for designing clinical research.

Spondylothoracic dysostosis associated with diaphragmatic hernia and camptodactyly.

We present a case of a female newborn with a combination of congenital diaphragmatic hernia, skeletal defects, craniofacial dysmorphism, dextrocardia and persistent ductus arteriosus, and normal female karyotype. History of family and pregnancy-labour were non-contributory. The findings in the present patient are most compatible with the diagnosis of a spondylothoracic dysostosis with a set of uncommon anomalies.

[On carnitine requirements in full term and low birth weight neonates]. / W sprawie gospodarki karnityna u noworodków donoszonych i z mala masa ciala.

The concentration of total carnitine in the blood serum of 15 newborns between days 5-21 of life was determined. The concentration of carnitine in low-birth-weight newborns is decreased in comparison with normal weight newborns; this deficiency may increase as a consequence of lack of carnitine provided with food or concomitant infection. The authors suggest that supplementation with carnitine be provided to this group of patients so as to prevent possible metabolic and clinical consequences.

[Polycythemia]. / Policytemia.

On the basis of own material, the authors discuss the epidemiology, clinical picture, and results of treatment of newborns with polycythaemia. An analysis shows that the blood hyperviscosity syndrome is an underestimated cause of many pathological signs in newborns.

[Myasthenia gravis in newborn infants--pathological mechanism, clinical symptomatology and therapeutic procedures]. / Myasthenia gravis u noworodków--patomechanizm, symptomatologia kliniczna, postepowanie lecznicze.

Modern views on the pathological mechanism, clinical symptoms and therapeutic management of neonatal myasthenia gravis are reviewed on the basis of literature reports and own experiences. Particular attention is given to intensive medical care in this condition.

[Therapeutic management of acute febrile states in children]. / Postepowanie lecznicze w ostrym stanie goraczkowym u dzieci.

Long-lasting body temperature over 41 degrees C may constitute a death risk without regard to its cause. Such high fever is associated with functional and organic changes in many organs. The management includes, apart from early diagnosis and causative treatment, also emergency symptomatic therapy with continuous monitoring of the basic vital functions. Treatment undertaken for reducing high body temperature must take into account all elements of thermoregulation. With normally functioning hypothalamic thermoregulation physical methods of cooling are effective. In case of impaired heat transference to the surface of the body drugs dilating the cutaneous vascular bed are helpful. Many pharmacological agents decrease effectively body temperature through a central mechanism, they have, however, numerous side effects.