Associations between oxygen saturation Index and oxygenation index in neonates with congenital diaphragmatic hernia.

Objective: To explore the relationship between Oxygenation Index (OI) and Oxygen Saturation Index (OSI) among infants with Congenital Diaphragmatic Hernia (CDH), both within the first 24 h after birth and in extended observations in those who survived until their surgical intervention. Methods: Seven- years retrospective review of CDH cases at a single Level III neonatal intensive care unit. The correlations of various combinations of OI-OSI pairs were assessed using the Spearman's rho Correlation Coefficient. Additionally, during the initial 24 h, the correlations between admission (first), best (lowest), highest, and mean OI and OSI values were determined. The predictive ability of the first 24 h oxygen and oxygen saturation indices for mortality and other adverse outcomes were assessed using the Area Under the Curve (AUC) analysis. Results: Thirty-seven infants with CDH were included in the analysis. A strong correlation was observed between all pairs of OI/OSI (2,289) (Spearman's rho = 0.843), matched pairs of Postductal OI/OSI (1,232 pairs) (Spearman's rho = 0.835) and the unmatched pairs of Postductal OI and Preductal OSI (1,057 pairs) (Spearman's rho = 0.852). Using the regression equations for all pairs, matched and unmatched OI/OSI pairs, we deduced that for clinically pertinent OI thresholds of 10, 15, 20 and 40, the corresponding OSI values were 5, 8, 11, and 23, respectively. Furthermore, in the first 24 h, strong correlations were evident between OI/OSI: at admission (Spearman's rho = 0.783), best OI/OSI (Spearman's rho = 0.848), and highest OI/OSI (Spearman's rho = 0.921). The most robust correlation was observed between the mean OI/OSI with a Spearman's rho of 0.928. First (AUC = 0.849), best (AUC = 0.927), highest (AUC = 0.942) and mean day 1 OI (AUC = 0.946) were all predictive of mortality. Similarly, first (AUC = 1.00), best (AUC = 0.989), highest (AUC = 1.00) and the mean OSI in day 1 (AUC = 0.978) were all predictive of mortality. All of the OIs and OSIs in day 1 except for the admission OSI (AUC = 0.683) were predictive of pulmonary hypertension. Additionally, all of OI and OSI indices in the first 24-hour except for the best day 1 OI (AUC = 0.674) were predictive of the need for rescue HFOV. Conclusion: There were a strong correlation between the OI and OSI in infants with CDH. Oxygenation indices and OSI in the first 24 h were predictive of mortality and other adverse outcomes in infants with CDH.

Predictors for diabetes and hypertension among bus drivers and conductors in South India.

Bus drivers and conductors are facing various health hazards due to stressful working conditions. They are exposed to various occupational hazards which lead to deterioration of their health over a period of time. Therefore, it is of interest to evaluate the prevalence of diabetes and hypertension among bus drivers and conductors and to determine the factors associated with diabetes and hypertension. This cross-sectional study was done among 293 bus drivers and 157 conductors during March 2018 to December 2018 and the data was collected using a semi structured questionnaire after obtaining informed consent. Each individual was investigated for Blood sugar and Blood Pressure. Out of 450 study participants, about 6.9% were diabetic and 50.2% were hypertensive. Transport workers with single marital status, those who belong to rural areas and drivers were significant predictors for diabetes. Overweight was significantly associated with the Diabetes in negative direction. Marital status, years of experience and anxiety were significantly associated with hypertension. Hemoglobin level, total cholesterol level and blood urea level also emerged as predictors for Hypertension. Non-communicable diseases like diabetes and hypertension have surpassed the communicable diseases in affecting the health of people with distinct occupations like bus drivers and conductors.

Rectal and axillary admission temperature in preterm infants less than 32 weeks' gestation, a prospective study.

Objectives: The purpose of this research was to evaluate the differences between rectal and axillary temperature measurements in preterm infants who were born less than 32 weeks' gestation using digital thermometers upon their admission to the Neonatal Intensive Care Unit (NICU). Methods: Prospective, observational, single centre study. Rectal and axillary temperatures measurements were performed using a digital thermometer. The study examined various maternal and neonatal factors to describe the study group, including the use of prenatal corticosteroids, the occurrence of maternal diabetes and hypertension, a history of maternal prolonged rupture of membranes (PROM), maternal chorioamnionitis, the mode of delivery, along with the neonate's gender, birth weight, and gestational age. The Pearson correlation coefficient (R) was calculated to ascertain the linear relationship between the temperatures taken at the rectal and axillary sites. The concordance between the two sets of temperature data was analyzed using the Bland-Altman method. Results: Eighty infants with a mean gestational age of 28.4 weeks (SD = 2.9) and a mean birth weight of 1,229 g (SD = 456) were included in the study. The mean axillary temperature was 36.4 °C (SD = 0.7), which was lower than the mean rectal temperature of 36.6 °C (SD = 0.6) (p = 0.012). Rectal temperatures surpassed axillary measurements in 59% of instances, while the reverse was observed in 21% of cases. Rectal and axillary temperatures had a strong correlation (Pearson correlation coefficient of 0.915, p < 0.001). Bland-Altman plot showed a small mean difference of 0.1C between the two temperatures measurements but the limits of agreement were wide (+0.7 to -0.6 °C). For hypothermic infants, the mean difference between rectal and axillary temperatures was 0.27 °C, with a wide limit of agreement ranging from -0.5 °C to +1 °C. Conversely, for normothermic infants, the mean difference was smaller at 0.1 °C, with a narrower limit of agreement from -0.4 °C to +0.6 °C. Conclusions: While there is a good correlation between axillary and rectal temperatures, the wider limits of agreement indicate variability, particularly in hypothermic infants. For a more accurate assessment of core body temperature in hypothermic infants, clinicians should consider using rectal measurements to ensure effective thermal regulation and better clinical outcomes.

Use of High-Flow Nasal Cannulas in Saudi's Neonatal Level III Intensive Care Units: A Nationwide Questionnaire Study.

Objective. To describe heated humidified high-flow nasal cannulas (HHHFNC) utilization in level III neonatal intensive care units (NICUs) in Saudi Arabia. Methods. A prospective cross-sectional study using an electronic web-based questionnaire. The survey targeted level III NICUs hospitals using HHHFNCs, covering HHHFNC availability, protocols, patient characteristics, and indications. It also collected opinions on the benefits of HHHFNCs compared to nasal continuous positive airway pressure (nCPAP). Results. Out of 47 government-level III neonatal intensive care units, 35 (74%) responded to the survey. Among the included units, 46% had guidelines for HHHFNC use. Additionally, 51% reported using HHHFNC in infants of all gestational ages. The primary indication for HHHFNC use was weaning off nCPAP (34%), with 60% of the respondents noting its advantages for kangaroo care and breastfeeding. Conclusion. HHHFNC are increasingly prevalent in NICUs in Saudi Arabia. However, there remain no clear policies or guidelines regarding their use in preterm infants.

Retrospective Comparative Analysis of Neonatal Mortality and Morbidity in Preterm Singleton and Multiple Births -Single Center Experience.

Objective. To compare mortality and major neonatal morbidities between singleton preterm infants and preterm infants of multiple gestations born <33 weeks' gestation. Method. Case-control study of preterm multiples and singletons <33 weeks' born at King Abdul-Aziz Medical City Riyadh (KAMC-R) between January 2017 and December 2020. Out-born infants and infants with lethal congenital abnormalities were excluded from the study. Mortality and major neonatal morbidities including bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), sepsis and surgical necrotizing enterocolitis (NEC) were compared between preterm singletons and multiples. Results. A total of 803 preterm infants were included: 567 (70.6%) were singletons, 158 (19.6%) were twins and 36 (4.5%) infants were higher multiples. Adjusted mortality before hospital discharge was significantly higher among preterm infants of multiple gestations compared to preterm singletons (12.3% vs 7.9%; P = .003; AOR, 2.2; 95% CI, 1.3-3.7). Retinopathy of prematurity (ROP) needing treatment was significantly higher among preterm infants of multiple pregnancies compared to preterm singletons (11% vs 6.5%, P = .033, AOR 1.1, 95% CI, 1.04-2.99). In addition, the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks post menstrual age (PMA) (29.7% vs 20.5%; P = .003; AOR, 1.7; 95% CI, 1.2-2.5) and culture positive sepsis (24.2% vs 17.5%; P = .044; AOR, 1.5; 95% CI, 1.01-2.2) were significantly higher among preterm infants of multiple pregnancy. There were no differences in mortality and adverse neonatal outcomes between twins and higher multiples. Conclusion. Preterm infants of multiple gestations suffered higher mortality and neonatal morbidities compared to preterm singleton infants despite a higher utilization of maternal antenatal steroids and better antenatal care.

Assessing suboptimal health status in the Saudi population: Translation and validation of the SHSQ-25 questionnaire.

Background: Suboptimal Health Status (SHS) is realised as a vital feature for improving global health. However, the Arabian world does not have a validated instrument for screening SHS in their population. Therefore, the study aimed to evaluate the psychometric properties of Arabic-translated SHS (ASHSQ-25) in the Saudi Arabian population. Methods: We conducted a cross-sectional study among the conveniently sampled 1590 participants from the Saudi population (with a 97.4% response rate). The data was gathered through an online survey and then exported into SPSS and AMOS version 26.0 for analysis. Mann-Whitney and Kruskal-Wallis tests were used to identify the median difference between demographic groups. The one-tailed 90% upper limit of SHS scores was chosen as the cut-off criteria for SHS. Reliability and confirmatory analysis were performed for the psychometric evaluation of ASHSQ-25 in the Saudi Arabian context. Results: This study demonstrates that the ASHSQ-25 has good internal consistency, interclass correlation coefficient (ICC) = 0.92; 95% confidence interval (CI) = 0.91-0.93) and reliability (Cronbach's α = 0.92). The confirmatory factor analysis (CFA) results indicated a good fit of the databased on the CMIN/degrees of freedom (df) = 4.461, comparative fit index (CFI) = 0.94, Tucker Lewis index (TLI) = 0.93, and Root Mean Square Error of Approximation (RMSEA) = 0.05. The result factor loadings for each item were high (≥ 0.55), except for one item from the immune system subscale. The SHS cut-off point for ASHSQ-25 was 33, leading to a 23.7% prevalence of SHS. Conclusions: This study reveals that ASHSQ-25 has appropriate internal consistency and structural validity to assess SHS in an Arabic-speaking population; therefore, it is recommended.

Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center experience.

BACKGROUND: With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation. METHOD: This population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC. RESULTS: Three Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01-1.06], P < 0.01) after adjusting for confounding variables. CONCLUSION: The use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.

3D-DIoU: 3D Distance Intersection over Union for Multi-Object Tracking in Point Cloud.

Multi-object tracking (MOT) is a prominent and important study in point cloud processing and computer vision. The main objective of MOT is to predict full tracklets of several objects in point cloud. Occlusion and similar objects are two common problems that reduce the algorithm's performance throughout the tracking phase. The tracking performance of current MOT techniques, which adopt the 'tracking-by-detection' paradigm, is degrading, as evidenced by increasing numbers of identification (ID) switch and tracking drifts because it is difficult to perfectly predict the location of objects in complex scenes that are unable to track. Since the occluded object may have been visible in former frames, we manipulated the speed and location position of the object in the previous frames in order to guess where the occluded object might have been. In this paper, we employed a unique intersection over union (IoU) method in three-dimension (3D) planes, namely a distance IoU non-maximum suppression (DIoU-NMS) to accurately detect objects, and consequently we use 3D-DIoU for an object association process in order to increase tracking robustness and speed. By using a hybrid 3D DIoU-NMS and 3D-DIoU method, the tracking speed improved significantly. Experimental findings on the Waymo Open Dataset and nuScenes dataset, demonstrate that our multistage data association and tracking technique has clear benefits over previously developed algorithms in terms of tracking accuracy. In comparison with other 3D MOT tracking methods, our proposed approach demonstrates significant enhancement in tracking performances.

Admission temperature and neonatal outcomes - single-centre experience in Saudi Arabia.

Objective: This study aimed to investigate the association between admission hypothermia (AH), neonatal mortality and major neonatal morbidities in preterm infants <33 weeks' gestation. An additional aim of the study was to examine changes in the prevalence of admission hypothermia after the initiation of a thermoregulation quality improvement (QI) project. Method: This is a retrospective cohort study of preterm infants < 33 weeks' gestation born at King AbdulAziz Medical City Riyadh (KAMC-R) between January 2017 to December 2020. Results: Eight-hundred infants were born during the study period. Four hundred and one infants (50.1%) had an admission temperature of <36.5 °C and a further 399 (49.9%) had an admission temperature of >36.5 °C. The mortality before discharge was 15.7% in infants with AH compared to 4.8% among those with an admission temperature above 36.5 °C. This remained statistically significant after adjustments for gestational age and maternal PET status on a multivariate analysis (P = .001, OR 2.7,95%CI 1.5-4.7). The need for mechanical ventilation (P = .005) and incidence of surgical NEC (P = .030) were significantly different between the two temperature groups. Mean (SD) admission temperature increased from 36.3 °C to 36.6 °C following the thermoregulation intervention program (P <.001). Admission temperature <36 °C is associated with higher mortality in the first week (P = .001, OR 3.3,95% CI (1.7-6.6)) and increased incidence of cystic PVL (P = .04, OR 2.1, CI (1.03-4.3)). Conclusion: Preterm infants with AH suffered higher mortality and greater neonatal morbidities.

Assessing the Level of Awareness of COVID-19 and Prevalence of General Anxiety Disorder among the Hail Community, Kingdom of Saudi Arabia.

BACKGROUND: The COVID-19 pandemic has caused a major public health problem around the world. Therefore, the aim of the study was to assess the awareness and prevalence of General Anxiety Disorder (GAD) with regard to COVID-19 among the Hail community, in the Kingdom of Saudi Arabia, in order to help health authorities to effectively control the pandemic. METHODS: A cross-sectional online survey was completed by 412 participants living in Hail, Saudi Arabia. The questionnaire assessed demographic characteristics, knowledge, attitudes, and practices for the prevention of COVID-19, as well as psychological feelings in terms of GAD as an impact of the COVID-19 pandemic. RESULTS: The study found that most of the respondents demonstrated good knowledge, attitudes, and practice for COVID-19 prevention. The elderly and employed demonstrated significant positive attitudes and practices (p < 0.05). Participants with a positive attitude were almost two and a half times (OR = 2.4; 95% CI: 1.54-3.99) more likely to have good practices. Additionally, the rural respondents were less likely (OR = 0.45; 95% CI: 0.21-0.96) to have a positive attitude. Married participants were more than one and a half (OR = 1.60; 95% CI: 1.04-2.44) times more likely to have a positive attitude. The prevalence of GAD was 21.8% and was significantly increased among participants with inadequate knowledge (OR = 2.01; 95% CI: 1.25-3.22), females (OR = 1.92; 95% CI: 1.19-3.09), individuals with chronic diseases (OR = 1.71; 95% CI: 1.02-2.86), and non-Saudi participants (OR = 2.44; 95% CI: 1.02-5.85). CONCLUSIONS: Ensuring a sufficient combination of relatively good levels of knowledge, positive attitudes, and desired practices serves as a good approach to preventing the spread of COVID-19. However, the increased prevalence of GAD requires the attention of policymakers. Therefore, a great emphasis should be placed on health awareness campaigns, with a focus on misconceptions and the provision of counseling.

Organized crime in the fisheries sector threatens a sustainable ocean economy.

The threat of criminal activity in the fisheries sector has concerned the international community for a number of years. In more recent times, the presence of organized crime in fisheries has come to the fore. In 2008, the United Nations General Assembly asked all states to contribute to increasing our understanding the connection between illegal fishing and transnational organized crime at sea. Policy-makers, researchers and members of civil society are increasing their knowledge of the dynamics and destructiveness of the blue shadow economy and the role of organized crime within this economy. Anecdotal, scientific and example-based evidence of the various manifestations of organized crime in fisheries, its widespread adverse impacts on economies, societies and the environment globally and its potential security consequences is now publicly available. Here we present the current state of knowledge on organized crime in the fisheries sector. We show how the many facets of organized crime in this sector, including fraud, drug trafficking and forced labour, hinder progress towards the development of a sustainable ocean economy. With reference to worldwide promising practices, we highlight practical opportunities for action to address the problem. We emphasize the need for a shared understanding of the challenge and for the implementation of intelligence-led, skills-based cooperative law enforcement action at a global level and a community-based approach for targeting organized crime in the supply chain of organized criminal networks at a local level, facilitated by legislative frameworks and increased transparency.

Prediction of extubation success using the diaphragmatic electromyograph results in ventilated neonates.

Objectives Extubation failure is common in infants and associated with complications. Methods A prospective study was undertaken of preterm and term born infants. Diaphragm electromyogram (EMG) was measured transcutaneously for 15-60 min prior to extubation. The EMG results were related to tidal volume (Tve) to calculate the neuroventilatory efficiency (NVE). Receiver operating characteristic curves (ROC) were constructed and areas under the ROCs (AUROC) calculated. Results Seventy-two infants, median gestational age 28 (range 23-42) weeks were included; 15 (21%) failed extubation. Infants successfully extubated were more mature at birth (p=0.001), of greater corrected gestational age (CGA) at extubation (p<0.001) and heavier birth weight (p=0.005) than those who failed extubation. The amplitude and area under the curve of the diaphragm EMG were not significantly different between those who were and were not successfully extubated. Those successfully extubated required a significantly lower inspired oxygen and had higher expiratory tidal volumes (Tve) and NVE. The CGA and Tve had AUROCs of 0.83. A CGA of >29.6 weeks had the highest combined sensitivity (86%) and specificity (80%) in predicting extubation success. Conclusions Although NVE differed significantly between those who did and did not successfully extubate, CGA was the best predictor of extubation success.

Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy.

OBJECTIVES: To determine the incidence, trends, maternal and neonatal risk factors of severe intraventricular hemorrhage (IVH) among infants born 24-32 weeks and/or < 1500 g, and to evaluate the impact of changing of hospital policies and unit clinical practice on the IVH incidence. STUDY DESIGN: Retrospective chart review of preterm infants with a gestational age (GA) of 24-326 weeks and/or weight of < 1500 g born at King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia, from 2016 to 2018. Multivariate logistic regression model was constructed to determine the probability of developing severe IVH and identify associations with maternal and neonatal risk factors. RESULTS: Among 640 infants, the overall incidence of severe IVH was 6.4% (41 infants), and its rate decreased significantly, from 9.4% in 2016 to 4.5% and 5% in 2017 and 2018 (p = 0.044). Multivariate analysis revealed that caesarian section delivery decreased the risk of severe IVH in GA group 24-27 weeks (p = 0.045). Furthermore use of inotropes (p = 0.0004) and surfactant (p = 0.0003) increased the risk of severe IVH. Despite increasing use of inotropes (p = 0.024), surfactant therapy (p = 0.034), and need for delivery room intubation (p = 0.015), there was a significant reduction in the incidence of severe IVH following the change in unit clinical practice and hospital policy (p = 0.007). CONCLUSION: Cesarean section was associated with decreased all grades of IVH and severe IVH, while use of inotropes was associated with increased severe IVH. The changes in hospital and unit policy were correlated with decreased IVH during the study period.

Vitamin C administration attenuated artemether induced hepatic injury in rats / La aAdministración de vitamina C atenúa la lesión hepática inducida por artemeter en ratas

This research was designed to investigate the potential protective effect of vitamin C supplementation against hepatocyte ultrastructural alterations induced by artemether (antimalarial drug) administration. Twenty-four adult male albino rats were used in this study and were divided into four groups (n=6). Group I served as a control and rats in group II administrated artemether (4 mg/kg B.W) orally for three consecutive days. Group III administered artemether plus a low dose of vitamin C (2.86 mg/kg/l water) while group IV received artemether plusa high dose of vitamin C (8.56 mg/kg). At the end of the experimental period (14 days), the harvested liver tissues were examined by transmission electron microscopy (TEM), and blood samples were assayed for biomarkers of liver injury and oxidative stress. Artemether significantly (p<0.05) augmented biomarkers of liver injury such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and oxidative stress such as superoxide dismutase (SOD), Glutathione Peroxidase (GPX), and caused degeneration and damage of the rough endoplasmic reticulum and disrupted mitochondria. The blood sinusoids were also damaged with distortion of their canaliculi. Administration of vitamin C showed improvement of liver biomarkers, and liver parenchyma, especially in a high dose of vitamin C.We concludes that vitamin C is a partial protective agent against artemether-induced liver injury.

Esta investigación fue diseñada para investigar el posible efecto protector de la vitamina C contra las alteraciones ultraestructurales de los hepatocitos, inducidas por la administración de arteméter (medicamento antipalúdico). En el estudio se utilizaron 24 ratas albinas macho adultas y se dividieron en cuatro grupos (n = 6). El grupo I fue designado como control y las ratas en el grupo II se adminstró Arteméter (4 mg / kg de peso corporal) por vía oral durante tres días consecutivos. En el grupo III se administró arteméter, además de una dosis baja de vitamina C (2,86 mg / kg / l de agua) mientras que el grupo IV recibió arteméter más una dosis alta de vitamina C (8,56 mg / kg). Al final del período experimental (14 días), los tejidos hepáticos recolectados se examinaron por microscopía electrónica de transmisión (MET), y las muestras de sangre se analizaron en busca de biomarcadores de daño hepático y estrés oxidativo. El arteméter aumentó significativamente (p <0,05) los biomarcadores de daño hepático como alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y estrés oxidativo como superóxido dismutasa (SOD), glutatión peroxidasa (GPX) y causó degeneración y daño de la retículo endoplásmico rugoso y mitocondrias alteradas. Los sinusoides sanguíneos también fueron dañados con la distorsión de sus canalículos. La administración de vitamina C mostró una mejoría de los biomarcadores hepáticos y el parénquima hepático, especialmente en una dosis alta de vitamina C. Concluimos que la vitamina C es un agente protector parcial contra la lesión hepática inducida por arteméter.

Outcomes of infants with congenital diaphragmatic hernia by side of defect in the FETO era.

PURPOSE: To compare the outcomes of infants with a right (RCDH) versus a left-sided (LCDH) congenital diaphragmatic hernia (CDH) and whether these differed according to whether the infants had undergone fetoscopic tracheal occlusion (FETO). METHODS: Demographics, the type of surgical repair, preoperative and postoperative courses and respiratory, gastrointestinal, surgical and skeletal morbidities at follow-up were compared between infants with a RCDH or LCDH. A sub-analysis was undertaken in those who had undergone FETO. RESULTS: During the study period, there were 167 infants with a LCDH and 24 with a RCDH; 106 underwent FETO (15 RCDH). Overall, the need for inhaled nitric oxide (p = 0.036) was higher in the RCDH group and, at follow-up, infants with RCDH were more likely to have a hernia recurrence (p = 0.043), pectus deformity (p = 0.019), scoliosis (p = 0.029) and suffer chronic respiratory morbidity (p = 0.001). There were, however, no significant differences in short term or long term outcomes (hernia recurrence (p = 0.237), pectus deformity (p = 0.322), scoliosis (p = 0.0174) or chronic respiratory morbidity (p = 0.326)) between infants with a right or left sided CDH who had undergone FETO. CONCLUSION: Overall, infants with a RCDH compared to those with a LCDH had greater long-term morbidity, but not if they had undergone FETO.

Prediction of prolonged ventilator dependence in preterm infants.

Volutrauma is an important factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Our aims were to identify risk factors in the first 24 h for prolonged ventilator dependence and assess volume delivery and carbon dioxide levels in infants with evolving BPD. A retrospective study was undertaken of 41 infants born at less than 32 weeks of gestational age (GA). A higher tidal volume, minute volume and resistance and a lower GA, birth weight and compliance were associated with a significantly higher risk of ventilator dependence at 28 days. The strongest relationships were with birth weight (area under the receiver operating characteristic curve, AUROC = 0.771) and GA (AUROC = 0.813). Tidal volume remained significantly higher after adjusting for GA in those who remained ventilator dependent at 28 days. The 18 who remained ventilator dependent at 28 days had increased mean carbon dioxide (PCO2) levels with increasing age from a mean of 41 mmHg in the first 24 h to 65 mmHg at 28 days PMA (p < 0.001). The increase in PCO2 occurred despite increases in peak inflation pressures (p < 0.001), tidal volumes (p = 0.002) and minute volumes (p < 0.001).Conclusion: These results suggest that initial volutrauma may contribute to the development of chronic ventilator dependence. What is Known: • In prematurely born infants, excessive tidal volumes are important in the pathogenesis of bronchopulmonary dysplasia (BPD), but a tidal volume that is too low will increase the risk of atelectasis, work of breathing and energy expenditure. What is New: • A high tidal volume in the first 24 h was associated with an increased risk of ventilator dependence at 28 days, which remained significant after adjusting for gestational age. Carbon dioxide levels significantly increased over the first month despite increased pressures and volumes in those who remained ventilator dependent.

Prediction of Mortality in Newborn Infants With Severe Congenital Diaphragmatic Hernia Using the Chest Radiographic Thoracic Area.

OBJECTIVES: To evaluate whether the preoperative chest radiographic thoracic area in newborn infants with congenital diaphragmatic hernia was related to the length of mechanical ventilation and the total length of stay and whether chest radiographic thoracic area predicted survival to discharge from neonatal care. DESIGN: Retrospective observational cohort study. SETTING: Tertiary neonatal unit at King's College Hospital National Health Service Foundation Trust, London, United Kingdom. PATIENTS: Newborn infants admitted with congenital diaphragmatic hernia at King's College Hospital in a 10-year period (2007-2017). INTERVENTIONS: The chest radiographic thoracic area was assessed by free hand tracing of the perimeter of the thoracic area as outlined by the diaphragm and the rib cage and excluded the mediastinal structures and abdominal contents in the thorax and calculated using the Sectra PACS software (Sectra AB, Linköping, Sweden). MEASUREMENTS AND MAIN RESULTS: Eighty-four infants with congenital diaphragmatic hernia (70 left-sided) were included with a median (interquartile range) gestation of 36 weeks (34-39 wk). Fifty-four (64%) survived to discharge from neonatal care. In the infants who survived the chest radiographic thoracic area was not related to the length of mechanical ventilation (r = 0.136; p = 0.328) or the total duration of stay (r = 0.095; p = 0.495). The median (interquartile range) chest radiographic thoracic area was higher in infants who survived (1,780 mm [1,446-2,148 mm]) compared with in the deceased infants (1,000 mm [663-1,449 mm]) after correcting for confounders (adjusted p = 0.01). Using receiver operator characteristics analysis, the chest radiographic thoracic area predicted survival to discharge from neonatal care with an area under the curve of 0.826. A chest radiographic thoracic area higher than 1,299 mm predicted survival to discharge with 85% sensitivity and 73% specificity. CONCLUSIONS: The chest radiograph in infants with severe congenital diaphragmatic hernia can predict survival from neonatal care with high sensitivity and moderate specificity.

Sustained inflations during delivery suite stabilisation in prematurely-born infants - A randomised trial.

BACKGROUND: Sustained inflations at initial stabilisation in the delivery suite may reduce the need for intubation and result in a shorter duration of initial ventilation, but have not been compared to routine UK practice. AIMS: To compare the early efficacy of sustained inflation during stabilisation after delivery to UK practice. STUDY DESIGN: A randomised trial was performed of a fifteen second sustained inflation compared to five inflations lasting 2 to 3 s, each intervention could be repeated once if no chest rise was apparent. Respiratory function monitoring was undertaken. SUBJECTS: Infants born prior to 34 weeks of gestation. OUTCOME MEASURES: The minute volume and maximum end-tidal carbon dioxide level in the first minute after the interventions, the time to the first spontaneous breath after the beginning of stabilisation and the duration of ventilation in the first 48 h. RESULTS: There were no significant differences in the minute volume or maximum end tidal carbon dioxide level between the groups. Infants in the sustained inflation group made a respiratory effort sooner (median 3.5 (range 0.2-59) versus median 12.8 (range 0.4-119) s, p = 0.001). The sustained inflation group were ventilated for a shorter duration in the first 48 h (median 17 (range 0-48) versus median 32.5 (range 0-48) h, p = 0.025). CONCLUSIONS: A sustained inflation of 15 s compared to five two to three second inflations during initial stabilisation was associated with a shorter duration of mechanical ventilation in the first 48 h after birth.

Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia.

AIMS: To compare the mean oxygenation index on day1 (MOId1) with the best OI on day1 (BOId1) in predicting 30-day mortality in congenital diaphragmatic hernia (CDH). In addition, to determine whether serial OIs in the first 48 h after birth and preoperative OI (PreOp-OI), were associated with optimal timing of surgery, ventilation requirement and hospital stay in infants with CDH. METHODS: The medical records of infants with antenatally diagnosed CDH during 2009-2015 were retrospectively reviewed. Receiver operator characteristic curves were constructed to identify MOId1 and BOId1 cutoff levels to predict 30-day mortality. In those who underwent surgery, the mean OI on each of the first two days (MOId1, MOId2) and PreOp-OI were correlated using Spearman (rs) with the age at surgery, the duration of ventilation and length of stay. Statistical significance was P < 0.05* and < 0.001**. RESULTS: Survivors (n = 44) and nonsurvivors (n = 24) were comparable in gestational age, birth weight and defect laterality. Nonsurvivors had higher median BOId1 (15.4 vs 2.9; P < 0.01) and MOId1 (48 vs 7.5; p < 0.01) than survivors. Mortality was best predicted by two cutoffs [BOId1 > 6 (sensitivity 92%, specificity 89%); and MOId1 > 17 (sensitivity 96%, specificity 96%)]. Forty-four infants underwent surgery at a median postnatal age of five (range 2-19) days. MOId1 and MOId2 both correlated significantly with the age at surgery (rs = 0.4**, rs 0.5**) but not ventilation period and length of stay. PreOp-OI correlated significantly with age at surgery, duration of ventilation and length of stay (rs = 0.32*, rs = 0.47**, rs = 0.37*). A PreOp-OI <3 was predictive of optimal timing for surgery with improved duration of ventilation (8 vs 22, P = 0.001) and length of stay (26 vs 47, P = 0.004). However, 11/44 (25%) patients would not achieve a PreOp-OI < 3 by day 7+ of life and might still require surgery, one of them died. CONCLUSION: Both MOId1 and BOId1 are highly predictive of mortality in CDH. Oxygenation indices in the first 48 h poorly predicted the timing of surgery. PreOp-OI <3 may be a cutoff for optimal timing for surgery in infants for CDH repair. TYPE OF STUDY: Prognostic Study. LEVEL OF EVIDENCE: Level III.

Volume targeting levels and work of breathing in infants with evolving or established bronchopulmonary dysplasia.

OBJECTIVES: To assess the work of breathing at different levels of volume targeting in prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD). DESIGN: Randomised crossover study. SETTING: Tertiary neonatal intensive care unit. PATIENTS: Eighteen infants born at <32 weeks gestation who remained ventilated at or beyond 1 week after birth, that is, they had evolving or established BPD. INTERVENTIONS: Infants received ventilation at volume targeting levels of 4, 5, 6 and 7 mL/kg each for 20 minutes, the levels were delivered in random order. Baseline ventilation (without volume targeting) was delivered for 20 minutes between each epoch of volume-targeting. MAIN OUTCOME MEASURES: Pressure-time product of the diaphragm (PTPdi), a measure of the work of breathing, at different levels of volume targeting. RESULTS: The 18 infants had a median gestational age of 26 (range 24-30) weeks and were studied at a median of 18 (range 7-60) days. The mean PTPdi was higher at 4 mL/kg than at baseline, 5 mL/kg, 6 mL/kg and 7 mL/kg (all P≤0.001). The mean PTPdi was higher at 5 mL/kg than at 6 mL/kg (P=0.008) and 7 mL/kg (P<0.001) and higher at 6 mL/kg than 7 mL/kg (P=0.003). Only at 7 mL/kg was the PTPdi significantly lower than at baseline (P=0.001). CONCLUSIONS: Only a tidal volume target of 7 mL/kg reduced the work of breathing below the baseline and may be more appropriate for infants with evolving or established BPD who remained ventilator dependent at or beyond 7 days of age.