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1.
J Pediatr ; 265: 113842, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37995929

RESUMEN

Maternal, placental, and neonatal factors were compared between infants born at ≤29 weeks of gestational age with admission hyperthermia (>37.5○C) and euthermia (36.5-37.5○C). Admission hyperthermia was associated with longer duration of face-mask positive-pressure ventilation and infant's temperature ≥37.5○C in the delivery room. Infants born preterm with admission hyperthermia had greater odds of developing necrotizing enterocolitis and neurodevelopmental impairment.


Asunto(s)
Enterocolitis Necrotizante , Hipertermia Inducida , Lactante , Recién Nacido , Humanos , Embarazo , Femenino , Recien Nacido Prematuro , Placenta , Edad Gestacional , Factores de Riesgo
2.
Pediatr Res ; 95(6): 1603-1610, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38097721

RESUMEN

BACKGROUND: Respiratory care protocol including less invasive ssurfactant administration (LISA) in ≤29 weeks' gestational age (GA) infants introduced in October 2018. METHODS: Retrospective study of infants admitted on continuous positive airway pressure (CPAP) October 2018 to December 2021. Maternal and neonatal variables were compared between infants managed on CPAP with and without LISA. Infants who received LISA and subsequently required mechanical ventilation (MV) within 72 h of life (HOL) [LISA failure (LF)] were compared with those who required no MV [LISA success (LS)]. RESULTS: 249 infants were admitted on CPAP, 5 were intubated prior to LISA, 143 required LISA and 101 remained on CPAP without surfactant. Of those receiving LISA, 108 were LS and 35 were LF. Compared to LS, LF infants were of lower GA and birth weight, required higher fractional inspired oxygen (FiO2), and CPAP level at birth, admission, one HOL, and an hour after LISA. Moreover, LF infants had higher mortality and morbidity. Together GA ≤ 25 weeks' and FiO2 ≥ 0.3 an hour after LISA best predicted LF. CONCLUSIONS: Over 80% of infants admitted on CPAP avoided MV within 72 HOL. Early predictors of LF provide targets for future interventions to decrease need for MV in preterm infants. IMPACT: Less invasive surfactant administration (LISA) decreases the need for mechanical ventilation (MV) and improves outcomes. However, some infants require MV within 72 h of life (HOL) despite LISA (LISA failure). Over 80% of ≤29 weeks' gestational age (GA) infants can be successfully managed on CPAP with or without surfactant in the first 72 HOL. A combination of factors including ≤25 weeks' GA and fraction of inspired oxygen ≥0.3 an hour after LISA predict LISA failure. Evaluation of a noninvasive respiratory support strategy including LISA provides targets for intervention to decrease need for MV in preterm infants.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Edad Gestacional , Recien Nacido Prematuro , Surfactantes Pulmonares , Síndrome de Dificultad Respiratoria del Recién Nacido , Humanos , Recién Nacido , Estudios Retrospectivos , Surfactantes Pulmonares/administración & dosificación , Surfactantes Pulmonares/uso terapéutico , Femenino , Masculino , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Respiración Artificial , Resultado del Tratamiento
3.
Pediatrics ; 143(2)2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30602545

RESUMEN

BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks' gestation. METHODS: Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre-quality improvement cohort (QIC) (January 2014-September 2015) were compared with post-QIC (October 2015-December 2016). RESULTS: Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS: Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.


Asunto(s)
Salas de Parto/normas , Recien Nacido Prematuro/fisiología , Mejoramiento de la Calidad/normas , Resucitación/normas , Adulto , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/terapia , Estudios de Cohortes , Salas de Parto/tendencias , Femenino , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/terapia , Masculino , Embarazo , Mejoramiento de la Calidad/tendencias , Resucitación/métodos , Resucitación/tendencias , Estudios Retrospectivos
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