Laryngeal Mask Airway for Surfactant Administration Versus Standard Treatment Methods in Preterm Neonates with Respiratory Distress Syndrome: A Systematic Review and Meta-analysis.

OBJECTIVE: Laryngeal mask airway (LMA) has emerged as an alternative surfactant delivery method. The effectiveness of this method for the delivery of surfactant is uncertain. A meta-analysis of randomized control trials (RCTs) comparing LMA with standard methods of surfactant delivery for the outcomes of surfactant dose repetition, oxygen requirement, mechanical ventilation, intubation, mortality, bronchopulmonary dysplasia (BPD), and pneumothorax. STUDY DESIGN: Systematic review and meta-analysis of RCTs. Homogeneity between studies was analyzed by using I2 statistics. Risk ratio or mean difference of outcomes was assessed from random effects models. Subgroup analyses were conducted when necessary. Data sources are as follows: Ovid Medline, Embase, and the Cochrane Central Register of Controlled trials from inception till December 2018, bibliographies of identified reviews and trial registries for ongoing studies. RCTs comparing short-term respiratory outcomes in neonates with respiratory distress syndrome who were administered surfactant through an LMA versus standard method of care. RESULTS: Six RCTs were identified, enrolling a total of 357 infants. Administering surfactant via LMA was associated with decreased FiO2 requirement (mean difference = 1.82 (95% confidence interval [CI]: -6.01-9.66), decreased intubation (risk ratio [RR] = 0.17; 95% CI: 0.05-0.57), and decreased mechanical ventilation (RR = 0.44; 95% CI: 0.31-0.61). There were no significant differences between groups for death, BPD, or pneumothorax. CONCLUSION: LMA might be an effective alternative method of surfactant delivery; however, further high-quality RCTs with larger sample size and including extreme preterm infants are needed to establish LMA as an alternative technique for surfactant delivery. KEY POINTS: · Pulmonary surfactants reduce mortality and pulmonary air leaks in newborns with respiratory distress syndrome.. · Preterm lungs are at risk of volutrauma by mechanical ventilation; laryngoscopy is still traumatic.. · Surfactant administration via LMA to avoid mechanical ventilation and intubation might be feasible..

Rehearsal simulation for antenatal consults.

BACKGROUND: Rehearsal simulations are patient-specific case- matched tasks performed immediately prior to the actual task, with the objective of improving performance. OBJECTIVE: How does rehearsal simulation for antenatal consults impact how residents learn to engage in difficult conversations with families? STUDY DESIGN: Residents in the NICU performed case-matched video recorded rehearsal simulations, followed by actual antenatal consults. The purpose of antenatal consults is to prepare parents expecting a complication with their baby before birth. Questionnaires assessed changes in resident confidence and self-assessment of communication skills. Residents were interviewed for qualitative data to explore the overall impact of rehearsal simulation on their learning and performance. RESULTS: Thirteen residents participated. Rehearsal simulation improved confidence with a more organized approach of medical content and better communication techniques, allowing for a shift of focus from a checklist approach to building rapport and displaying empathy. CONCLUSIONS: While rehearsal simulation did not prepare residents for unexpected parent responses, trainees' increased confidence with medical content organization and communication techniques created space for reflection-in-action and compassionate approaches.

CONTEXTE: Les simulations préparatoires correspondent à des cas spécifiques de patients et elles sont effectuées immédiatement avant l'intervention réelle, dans le but d'améliorer la performance. OBJECTIF: Comment la simulation préparatoire pratiquée avant une consultation prénatale influence-t-elle la manière dont les résidents apprennent à engager une conversation difficile avec les familles? MÉTHODES: Les résidents de l'unité de soins intensifs néonatals ont effectué des simulations préparatoires adaptées à la situation clinique à venir, qui ont été filmées. Ils ont par la suite effectué les consultations prénatales réelles. L'objet des consultations prénatales est de préparer les parents lorsque des complications sont anticipées, et ce avant la naissance de leur bébé. Nous avons évalué les changements au niveau de la confiance des résidents et l'autoévaluation par ces derniers de leurs compétences en communication par le biais de questionnaires. Les résidents ont participé à une entrevue, qui a fourni les données qualitatives afin d'explorer l'impact global de la simulation sur leur apprentissage et leur performance. RÉSULTATS: Treize résidents ont participé à l'étude. La simulation préparatoire a rehaussé leur confiance en eux, car elle les a aidés à adopter une approche plus organisée du contenu médical et de meilleures techniques de communication, permettant de passer d'une approche par « cases à cocher ¼ à une approche basée sur l'établissement d'un lien avec les parents et à la manifestation d'empathie. CONCLUSIONS: Bien que la simulation préparatoire n'ait pas préparé les résidents aux réactions inattendues des parents, la confiance accrue des stagiaires en leur capacité à organiser le contenu médical et en leurs techniques de communication a laissé place à la réflexion dans l'action et aux approches compatissantes.

Development and implementation of a novel online breastfeeding support resource: the Maternal Virtual Infant Nutrition Support Clinic.

Exclusive breastfeeding is the optimal method of infant feeding for the first 6 months of life for both term and preterm infants. This recommendation is based on indisputable evidence that breastfeeding offers numerous infant and maternal health benefits. Several trials have shown the beneficial effect of peer and/or professional support on the duration of any breastfeeding up to 6 months. Although many well-established programs exist that provide this support in-person or via telephone, the Internet is a relatively new means to deliver breastfeeding help. Yet, mothers have a vast presence online and a clear desire to seek healthcare information on the Internet. The availability and accessibility of interactive communication technologies via the internet provide the opportunity for developing new methods of healthcare delivery. Our project uses information technology to deliver an innovative and cost-effective way to support breastfeeding mothers. Our new online breastfeeding support clinic has the potential to improve access to specialized professional breastfeeding support in combination with interactive peer support. This new online clinic can be readily implemented to all regions in Canada with reliable Internet access, with the potential to significantly impact the health of all Canadian infants and their families.

The effect of bundle branch block on heart function and cardiac output in premature infant.

It is well known that hyperkalemia may cause arrhythmia, right bundle branch block, and cardiac conduction block. These dysrhythmias have the potential to affect cardiac function. We present a premature newborn with hyperkalemia and right bundle branch block causing left ventricular dyssynchrony with mitral regurgitation, which led to decreased pump function.

Reducing falls among geriatric rehabilitation patients: a controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of an intervention programme to reduce falls among geriatric rehabilitation patients. DESIGN: Pre/post-test design with independent pre-test and matched post-test samples. SETTING: Inpatient geriatric wards in a rehabilitation hospital. PARTICIPANTS: Seventy-six matched pairs (n = 152) of geriatric rehabilitation patients from one control and one intervention ward participated in the study, and 36 nursing staff surveys were completed. INTERVENTION: The intervention programme was developed based on interviews and systematic reviews. Educational materials were distributed to patients and families, and preventive measures were implemented. MAIN OUTCOME MEASURES: The rates of falls before and after the intervention both within and between the wards were compared, and surveys were completed. RESULTS: The matched patients presented no significant differences on age, gender or medical conditions. The falls rates, proportion of fallers and length of stay was higher among those in the control ward (P< 0.043). The percentage of fallers and the rate of falls/1000 patient days were lower on the intervention ward after implementation: odds ratio (95% confidence interval) = -2.9 (-6.6, -1.2) and -1.8 (-6.0, 0.5). Thirty of 36 respondents considered the tool to be helpful and beneficial for use on other wards. CONCLUSION: The intervention programme was effective in reducing falls among geriatric rehabilitation patients.

Risks and suggestions to prevent falls in geriatric rehabilitation: a participatory approach.

OBJECTIVE: The objective of this study was to establish the rates and to gather information from patients, staff and family members on risks and potential measures to prevent patient falls on geriatric rehabilitation units in a hospital. METHODS: The falls recorded in the geriatric rehabilitation units between January 2006 and December 2008 were reviewed to establish their rates (falls/1000 patient days) and locations. Twenty-eight interviews with ten patients, twelve staff and six family members were conducted in one of the units. The identified risks and suggestions were organised using the International Classification of Functioning, Disability and Health (ICF) areas--body function and structure, activity and participation, personal and environmental factors. RESULTS: The rates of falls (mean ± SD) on the two units evaluated were 7 ± 4 and 8 ± 4. The several risks and potential interventions to prevent falls that emerged from the 28 interviews were presented on figures and tables including examples of the participant quotes. CONCLUSIONS: The findings highlight the complexity of the problem and the value of the approach used to increase our understanding of the issues considering the perspectives of patients, staff and family members. The results are being used to construct context-specific interventions to reduce the rates of falls.

Paroxetine toxicity in a newborn after in utero exposure: clinical symptoms correlate with serum levels.

There are several case reports and case series that have examined the acute effects of selective serotonin reuptake inhibitors (SSRIs) on the newborn. There is considerable controversy whether the reported symptoms represent withdrawal from the SSRI or toxicity caused by the SSRI. A case of an infant who was exposed to paroxetine during pregnancy is presented. This case supports the notion of serotonin toxicity and is believed to be the first report that substantiates clinical symptoms with serum levels of the offending SSRI.

Vitamin A activation of transforming growth factor-beta1 enhances porcine ileum wound healing in vitro.

Treatment with transforming growth factor-beta(1) (TGF-beta(1)) has been shown to be effective in accelerating skin wound healing. Another approach to gain the beneficial effects of TGF-beta(1) on wound healing could be the activation of tissue stores of latent TGF-beta(1) with agents such as vitamin A. The aims of this study were to determine whether 1) vitamin A is effective in enhancing intestinal wound healing in vitro and 2) activation of TGF-beta(1) is increased during wound healing with vitamin A treatment. We used the intraluminal chemical induction model of necrotizing enterocolitis (NEC), which was adapted to the 1-wk-old piglet. Injured (NEC) and noninjured full-thickness ileum explants harvested from the piglets were cultured for 24 and 48 h in serum-free medium supplemented with all-trans retinol (ATR; 0, 2, 5, and 10 microM). All concentrations of ATR improved recovery of normal ileal wall cytoarchitecture of NEC explants, with maximal recovery observed with 2 microM ATR after 24 h of culture. Further recovery after 48 h was observed with 5 and 10 microM ATR but did not achieve the degree of healing observed with 2 microM ATR. There were no observable adverse effects of ATR on noninjured ileal explant morphology. Active TGF-beta(1) was identified only in the NEC explants incubated with ATR. The results of this study demonstrate that administration of vitamin A accelerates recovery of normal intestinal wall cytoarchitecture of injured ileum in vitro, without adversely affecting noninjured ileum. The increased activation of latent TGF-beta(1) may, in part, be responsible for the accelerated healing of injured ileum observed with vitamin A administration.