Trends in respiratory management of transferred very preterm infants in the last two decades.

BACKGROUND: Among infants needing urgent transfer after birth, very preterm infants are a high-risk sub-group requiring special attention. This study aimed to assess trends in early respiratory management in a large series of very preterm infants undergoing postnatal transfer. METHODS: Trends in patient characteristics and early respiratory management were assessed in 798 very preterm infants who were transferred by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Trends were analyzed using joinpoint regression analysis and summarized as annual percentage changes (APCs). RESULTS: Proportion of neonates with birth weight less than 1 kg decreased from 33% to 16% (APC -3.82%). Use of nasal-continuous-positive-airway pressure increased (at call: APC 15.39%; during transfer: APC 15.60%), while use of self-inflating bag (at call: APC -12.09%), oxygen therapy (at call: APC -13.00%; during transfer: APC -23.77%) and mechanical ventilation (at call: APC -2.71%; during transfer: APC -2.99%) decreased. Use of oxygen concentrations at 21% increased (at call: APC 6.26%; during transfer: APC 7.14%), while oxygen concentrations above 40% decreased (at call: APC -5.73%; at transfer APC -8.89%). Surfactant administration at call increased (APC 3%-10%), while surfactant administration when arriving at referring hospital remained around 7-11% (APC 2.55%). CONCLUSION: Relevant trends toward "gentle" approaches in early respiratory management of very preterm infants undergoing postnatal transfer occurred during the last twenty years. In addition, the proportion of transferred extremely low birth weight infants halved. Clinicians and stakeholders should consider such information when allocating assets to both hospitals and transfer services and planning regional perinatal programs.

Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing?

OBJECTIVE: To evaluate the impact of the laryngeal mask airway (LMA) on neonatal resuscitation policy. DESIGN: We analyzed retrospectively the records of neonates requiring positive pressure ventilation (PPV) at birth before (1996) and after (2000) the introduction of the LMA into our delivery suites. In addition, the outcome of neonates treated with the LMA was compared with that of neonates matched for gestational age and mode of delivery who were resuscitated using a face mask. RESULTS: During the year 2000, 95 out of 380 (25%) resuscitated neonates were treated with the LMA. The LMA was effective in 94 out of 95 (99%) of these infants. Over the same period, the percentage of neonates receiving tracheal intubation (TI) at birth (34%) was significantly reduced compared with the figure for 1996 (67%). There were no reported complications associated with the use of the LMA. Seventy-four out of the 95 neonates treated with the LMA were considered suitable for matching for gestational age and mode of delivery with 74 neonates treated with a face mask. No differences were found between the two groups for birth weight, Apgar scores, need for tracheal intubation, need for admission to the Neonatal Intensive Care Unit (NICU), primary diagnosis at discharge and primary outcomes. The LMA provided effective ventilation in four neonates in whom the face mask failed. CONCLUSIONS: The LMA is changing neonatal resuscitation practice in our Institution. Our data suggest that it is a safe and useful alternative method for respiratory support in neonates requiring PPV at birth, which merits further study.

Asymmetric dimethylarginine in ELBW newborns exposed to chorioamnionitis.

We measured circulating ADMA concentrations in a group of very premature newborns at birth and during the first week of life. ADMA levels resulted significantly higher in infants born to mothers with histologic chorioamnionitis than in infants delivered for other maternal or fetal indications, both at birth and through the first week of life. We speculate that ADMA might be involved in the complex biological events associated with fetal exposure to chorioamnionitis.

Effects of ibuprofen and indomethacin on urinary antidiuretic hormone excretion in preterm infants treated for patent ductus arteriosus.

OBJECTIVE: To compare the effects of intravenous ibuprofen and indomethacin for treatment of patent ductus arteriosus (PDA) on urinary antidiuretic hormone (ADH) excretion, as a cause of oliguria. STUDY DESIGN: Forty-four respiratory distress syndrome prematures (

Changes in skin temperature of hyperbilirubinemic newborns under phototherapy: conventional versus fiberoptic device.

The purpose of this study is to determine the changes in skin temperature of hyperbilirubinemic term newborns under conventional and fiberoptic phototherapy. The study included a group of 41 hyperbilirubinemic, but otherwise healthy, term infants, all of appropriate size for gestational age. The study was devised to include two separate groups: group 1 of 21 infants (51.2%) received conventional phototherapy, and group 2 of 20 infants (48.8%) received fiberoptic phototherapy. In both groups the surface temperature on the forehead, abdomen, left leg and back was calculated by infrared radiation thermometer (Cyclops Compac 3, Minolta, Land, England). A "Photo-Therapie 800 Heraeus" unit (Drager, Lübeck, Germany) was used for conventional phototherapy (CPT). A "Biliblanket PT system" (Ohmeda, Louisville, KY) was used for fiberoptic phototherapy (FO-PT). In our study we did not find significant differences of skin temperature in the four areas examined in the two groups prior to phototherapy. During conventional phototherapy, mean values of skin temperature were found to be significantly higher than those found before phototherapy. During fibreoptic phototherapy no statistically significant temperature differences were found on the forehead, abdomen, leg, and back before and during phototherapy. Furthermore, a statistically significant increase in skin temperature was found during phototherapy on the forehead, abdomen, leg, and back in patients of group 1 with respect to patients of group 2. We demonstrated that fibreoptic phototherapy, in contrast to conventional phototherapy, does not induce a significant increase in skin temperature.