High-flow nasal cannulae are associated with increased diaphragm activation compared with nasal continuous positive airway pressure in preterm infants.

AIM: High-flow nasal cannulae (HFNC) are increasingly used for respiratory management of preterm infants. However, their ability to provide support compared to nasal continuous positive airway pressure (CPAP) has been questioned. We compared the effect of HFNC versus nasal CPAP on diaphragm electrical activity (EAdi) in preterm infants. METHODS: Preterm infants ≤1500 g were randomised in a crossover design to receive 2 hours of either Infant Flow(®) CPAP (IF-CPAP) at 5-6 cmH2 O or HFNC with the flow rate adjusted to achieve an equivalent pharyngeal pressure. A feeding catheter with miniaturised sensors was inserted for continuous EAdi measurement. RESULTS: The study comprised ten infants. Physiologic parameters and oxygen requirements were not different between the two modes. However, seven infants demonstrated a higher EAdi peak and six showed a higher EAdi tonic on HFNC, even though the mean group data showed no difference between HFNC and IF-CPAP. Neural inspiratory time was significantly longer with HFNC than IF-CPAP (0.55 ± 0.11 versus 0.48 ± 0.06 seconds, p = 0.018). CONCLUSION: In this cohort of preterm infants, the majority exhibited greater diaphragm activation, as assessed by neural breathing patterns, when supported with HFNC than IF-CPAP, suggesting that nasal CPAP may provide more effective respiratory support.

Effect of clinical and histological chorioamnionitis on the outcome of preterm infants.

Chorioamnionitis contributes to neonatal and maternal morbidity and mortality. We aimed to evaluate of the impact of clinical and histological chorioamnionitis on mortality and morbidity of preterm infants. Maternal and neonatal data were collected in a retrospective cohort of preterm infants less than 30 weeks' gestation. Infants were divided into three groups: those born to mothers with clinical chorioamnionitis, histological chorioamnionitis, or no chorioamnionitis. Of 274 identified preterm infants, 33 infants were born to mothers with clinical chorioamnionitis, 95 to mothers with histological chorioamnionitis, and 146 to mothers with no chorioamnionitis. Data were available for 180 (78%) of the 230 survivors at 18 months corrected age. Infants in the study groups were similar in gestational age, birth weight, and sex distribution. Clinical and histological chorioamnionitis were not predictive of infant mortality, cerebral palsy, bronchopulmonary dysplasia, periventricular leukomalacia, or retinopathy of prematurity. Infants in the clinical chorioamnionitis group had significantly lower cognitive (88 ± 10), language (82 ± 12), and motor (89 ± 11) scores compared with infants in the histological chorioamnionitis group (101 ± 13, p < 0.01; 91 ± 13, p < 0.05; and 99 ± 13, p < 0.05, respectively) and to infants in the no chorioamnionitis group (99 ± 13, p < 0.01; 92 ± 15, p < 0.05; and 97 ± 13, p < 0.05, respectively). Clinical chorioamnionitis is associated with developmental delay in preterm infants despite adequate treatment.

Neonatal mythbusters: evaluating the evidence for and against pharmacologic and nonpharmacologic management of gastroesophageal reflux.

Gastroesophageal reflux (GER) is a challenging clinical entity that has often been associated with a number of negative clinical outcomes. The treatment of this condition lacks evidence and is often based on anecdotal beliefs and myths. This article will define GER and review the recommendations for the diagnosis of GER as well as review the evidence for both pharmacologic and nonpharmacologic treatment of GER.

Impact of feeding method on diaphragm electrical activity and central apnea in preterm infants (FEAdi study).

BACKGROUND: In preterm infants, it is unknown whether feeding affects neural breathing pattern. OBJECTIVES: By measuring the diaphragm electrical activity (Edi) waveform, we evaluated the effect of enteral feeding and compared the effects of feeding methods on neural breathing pattern and central apnea in very low birth weight preterm infants. METHODS: In a prospective, randomized, crossover study, ten non-ventilated preterm infants with birth weights<1250g and tolerating full feeds were randomized to either bolus feeding (BF) or slow infusion feeding (SF) over 90min, followed by crossover to the other method at the next feed. Edi was continuously measured by a feeding catheter with miniaturized sensors. Five 15-min epochs were chosen [Baseline (BL), first 15min and 90min after BF/SF started] for breath-by-breath analyses of neural breathing pattern, including Edi peak, Edi min (end-expiratory), neural inspiratory and expiratory times, neural respiratory rate, and central apnea. Primary outcome was change in Edi min with feed. Secondary outcomes include change in Edi peak, frequency and duration of central apnea with feeding. RESULTS: Although intrasubject coefficient of variation was not significantly different, individual responses to feeding and feeding method were variable. No significant difference in Edi timing, Edi min, Edi peak, or apnea was observed for the different epochs. CONCLUSIONS: In this study cohort, neural breathing pattern does not appear to be consistently affected by enteral feeding or the feeding method. Compared with BF, SF does not appear to reduce the number or duration of apneas.

Infantile myofibroma: a case report and review of the literature.

This article presents a case report of a 37-week gestational age (GA) female infant (CK) whose first ultrasound at 35 weeks' GA revealed polyhydramnios, fetal ascites, and a possible diaphragmatic hernia. At birth, CK had a grossly distended abdomen, prominent abdominal veins, hepatomegaly, bounding femoral pulses, and generalized edema. Initial imaging identified an absent ductus venosus, absent segment of the inferior vena cava (IVC), and prominent superior vena cava to the right atrium. A computed tomography (CT) scan showed a mass contiguous with the liver causing compression of the IVC. Biopsy confirmed infantile myofibromatosis (IM), an uncommon soft tissue neoplasm that may present at birth or in early infancy. Although rare, this neoplasm is the most common fibrous tumor of infancy. The case of CK was unusual because the solitary IM lesion was in an atypical location; a solitary lesion is not commonly found in the viscera, and solitary lesions are predominant in males. Although lesions are often benign, visceral involvement is associated with high mortality. The cause is unknown, although familial cases have been reported. This article describes the key features of IM, possible treatment options, nursing care, and prognosis for infants with the disease.

The relationship between feeding and necrotizing enterocolitis in very low birth weight infants.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NEC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NEC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NEC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NEC and examines studies of various feeding practices for their relationship to the development of NEC. It also highlights the potential benefits of breast milk in NEC prevention.