Ultrasound Assessment of Larynx and Trachea in the Neonatal Period, Examination Standard with Predictive Values-Study Protocol.

Diseases of the larynx and trachea are a heterogenous group of disorders. Their diagnosis frequently requires invasive methods. Ultrasound is a non-invasive, repeatable and safe diagnostic method, which has recently, thanks to the development of technology, provided for very accurate imaging of even small structures, as well as their assessment on dynamic examination. Ultrasound examination of the larynx and trachea will be performed in 2022-2023 in a group of randomly selected 300 stable neonates born between 32 and 42 weeks of gestation. The results of this study will be presented after data collection in accordance with the adopted methodology. To date, this will be the first study to describe the ultrasound anatomy of the larynx and trachea and to establish reference ranges for the size of individual structures of the larynx and trachea in the neonatal population. We expect that our study will contribute to the further development of this part of ultrasonography and will reduce the number of invasive procedures performed in the diagnostics of these organs in the future. This manuscript is a study protocol registered at ClinicalTrials.gov (Identifier NCT05636410) and approved by the Bioethics Committee of the Medical University of Warsaw (KB 65/A2022).

Use of the expanded Apgar score for the assessment of intraventricular and intraparenchymal haemorrhage risk in neonates.

OBJECTIVES: Preterm birth is a key factor contributing to haemorrhage incidence in neonates. This study focused on defining relevant parameters for the assessment of intraventricular and intraparenchymal haemorrhage risks in neonates. MATERIAL AND METHODS: Chi-square automatic interaction detection was used to analyse the Apgar score (AS), the Apgar max score, and the course of resuscitation documented according to the expanded AS in 696 infants born between 2009 and 2011 in the Neonatal and Intensive Care Department of the Medical University of Warsaw. RESULTS: Gestational age was the most relevant discriminating variable for the prediction of intraventricular III degree and intraparenchymal haemorrhage incidences. Infants born before the 31st week of pregnancy made up 80% of the intraventricular or intraparenchymal haemorrhage cases. Additionally, a fraction of inspired oxygen > 0.8 at ten minutes after birth was a better discriminating variable in the youngest neonates than an Apgar max score ≤ 5, identifying 31.6% and 20.6% of infants with intraventricular and intraparenchymal haemorrhage, respectively. CONCLUSIONS: Consideration of the oxygen concentration supplied during resuscitation significantly improves the prognosis of intraventricular and intraparenchymal haemorrhages in preemies compared to the use of the classical AS.

Doppler tissue imaging assessment of myocardial velocities and atrioventricular time intervals in term newborn infants during the neonatal period.

BACKGROUND: In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation as well as the presence of concurrent diseases. AIM: To evaluate the changes in values of systolic and diastolic LV and RV function using pulse tissue Doppler imaging (TDI) in 20 healthy term newborn infants from birth to the 28th day of life. METHODS: Ventricular peak myocardial velocities were recorded during early diastole (Em wave), atrial contraction (Am wave), and systole (Sm wave). TDI derived atrioventricular (AV) intervals were measured as the period from atrial contraction (Am) to isovolumic contraction (IV), from Am to ventricular systole (Sm), from Sm to the following Am, and from IV to the following Am. The first measurements were taken as soon as possible after birth, the second on the third day, and the final one on the 28th day of life. RESULTS: The diastolic myocardial velocities recorded in the RV were higher than those in the LV. Statistically significant differences were observed for time intervals in the RV: Am-IV and Am-Sm (day 1-3), p < 0.02; IV-Am (day 1-28), p < 0.005; Sm-Am (day 1-28), p < 0.01. Statistically significant differences for time intervals were also evident in the LV: Am-IV (day 1-28), p < 0.05; and for Sm-Am (day 1-28), p < 0.01. Mean isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) intervals remained stable for all measurements recorded in the RV. However, a statistically significant difference was evident for both ICT and IRT intervals in the LV between days 1 and 28 of life (p < 0.01). CONCLUSIONS: 1. Cardiac TDI is feasible in the neonate. 2. In neonates, the diastolic and systolic function recorded in the RV was better than that in the LV. This may reflect the 'persistent' foetal status of this ventricle in the first day of life. 3. The differences observed in conduction times also reflect the haemodynamic changes which occur in the circulatory system of the neonate in the first month of life. 4. Further investigation of a larger population of neonates throughout the whole neonatal period is indicated.