Self-Massage Techniques for the Management of Pain and Mobility With Application to Resistance Training: A Brief Review.

ABSTRACT: MacLennan, M, Ramirez-Campillo, R, and Byrne, PJ. Self-massage techniques for the management of pain and mobility with application to resistance training: a brief review. J Strength Cond Res 37(11): 2314-2323, 2023-Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility, which contributes to abnormal muscle mechanics, reduced muscle length, and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power, which may lead to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function, and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs-associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain, including differing densities of foam rollers, roller massagers, tennis balls, and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SM device, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating foam rollers eliciting an increased reduction to pain perception, and tennis balls and soft massage balls were shown to be efficacious in targeting smaller affected areas.

Intra- and Inter-Day Reliability of Inertial Loads with Cluster Sets When Performed during a Quarter Squat on a Flywheel Device.

The aims of this study were to (i) estimate the intra- and inter-day reliability of mean concentric (CON) and eccentric (ECC) power at different inertial loads during a flywheel quarter-squat using a cluster set approach and (ii) to determine the acute effect of internal and external attentional focus on mean power when performing the flywheel quarter squat. Twelve collegiate field sport male athletes (age 22.4 ± 3.2 years, weight 81.4 ± 10.3 kg, height 1.81 ± 0.06 m) attended four cluster set testing sessions separated by 7 days. Sessions consisted of 4 sets of 15 repetitions using 4 inertial loads (0.025, 0.050, 0.075, and 0.100 kg·m2). A cluster block consisted of 5 repetitions, including "momentum repetitions" (4 × 5 + 5 + 5). Mean power (MP), CON power, ECC power, and ECC overload were recorded for both internal and external attentional focus groups. The external instructional group attained familiarization after two flywheel sessions (ES = 0.03-0.15) with little volatility between performance measures (CV% = 3.39-9.22). The internal instructional group showed large differences in MP output from session 2 to session 3 for all loads (ES = 0.59-1.25). In conclusion, the flywheel cluster set approach is a reliable training modality for maintaining MP output during all repetitions.

Effects of Plyometric Jump Training on the Reactive Strength Index in Healthy Individuals Across the Lifespan: A Systematic Review with Meta-analysis.

BACKGROUND: The reactive strength index (RSI) is meaningfully associated with independent markers of athletic (e.g., linear sprint speed) and neuromuscular performance [e.g., stretch-shortening cycle (SSC)]. Plyometric jump training (PJT) is particularly suitable to improve the RSI due to exercises performed in the SSC. However, no literature review has attempted to meta-analyse the large number of studies regarding the potential effects of PJT on the RSI in healthy individuals across the lifespan. OBJECTIVE: The aim of this systematic review with meta-analysis was to examine the effects of PJT on the RSI of healthy individuals across the lifespan compared with active/specific-active controls. METHODS: Three electronic databases (PubMed, Scopus, Web of Science) were searched up to May 2022. According to the PICOS approach, the eligibility criteria were: (1) healthy participants, (2) PJT interventions of ≥ 3 weeks, (3) active (e.g., athletes involved in standard training) and specific-active (e.g., individuals using heavy resistance training) control group(s), (4) a measure of jump-based RSI pre-post training, and (5) controlled studies with multi-groups in randomised and non-randomised designs. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias. The random-effects model was used to compute the meta-analyses, reporting Hedges' g effect sizes (ES) with 95% confidence intervals (95% CIs). Statistical significance was set at p ≤ 0.05. Subgroup analyses were performed (chronological age; PJT duration, frequency, number of sessions, total number of jumps; randomization). A meta-regression was conducted to verify if PJT frequency, duration, and total number of sessions predicted the effects of PJT on the RSI. Certainty or confidence in the body of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Potential adverse health effects derived from PJT were researched and reported. RESULTS: Sixty-one articles were meta-analysed, with a median PEDro score of 6.0, a low risk of bias and good methodological quality, comprising 2576 participants with an age range of 8.1-73.1 years (males, ~ 78%; aged under 18 years, ~ 60%); 42 studies included participants with a sport background (e.g., soccer, runners). The PJT duration ranged from 4 to 96 weeks, with one to three weekly exercise sessions. The RSI testing protocols involved the use of contact mats (n = 42) and force platforms (n = 19). Most studies reported RSI as mm/ms (n = 25 studies) from drop jump analysis (n = 47 studies). In general, PJT groups improved RSI compared to controls: ES = 0.54, 95% CI 0.46-0.62, p < 0.001. Training-induced RSI changes were greater (p = 0.023) for adults [i.e., age ≥ 18 years (group mean)] compared with youth. PJT was more effective with a duration of > 7 weeks versus ≤ 7 weeks, > 14 total PJT sessions versus ≤ 14 sessions, and three weekly sessions versus < three sessions (p = 0.027-0.060). Similar RSI improvements were noted after ≤ 1080 versus > 1080 total jumps, and for non-randomised versus randomised studies. Heterogeneity (I2) was low (0.0-22.2%) in nine analyses and moderate in three analyses (29.1-58.1%). According to the meta-regression, none of the analysed training variables explained the effects of PJT on RSI (p = 0.714-0.984, R2 = 0.0). The certainty of the evidence was moderate for the main analysis, and low-to-moderate across the moderator analyses. Most studies did not report soreness, pain, injury or related adverse effects related to PJT. CONCLUSIONS: The effects of PJT on the RSI were greater compared with active/specific-active controls, including traditional sport-specific training as well as alternative training interventions (e.g., high-load slow-speed resistance training). This conclusion is derived from 61 articles with low risk of bias (good methodological quality), low heterogeneity, and moderate certainty of evidence, comprising 2576 participants. PJT-related improvements on RSI were greater for adults versus youths, after > 7 training weeks versus ≤ 7 weeks, with > 14 total PJT versus ≤ 14 sessions, and with three versus < three weekly sessions.

Flywheel Romanian Deadlift: Intra- and Inter-Day Kinetic and Kinematic Reliability of Four Inertial Loads Using Cluster Sets.

The primary aim of this study was to investigate the intra- and inter-day reliability of flywheel cluster set training in concentric power (CON), eccentric power (ECC), and ECC overload during the Romanian deadlift exercise (RDL). A secondary aim was to assess the acute effect of internal and external attentional focus instructions on mean power when performing the flywheel RDL. Fourteen collegiate male field sport athletes (age, 23.3 ± 3.7 years; mass, 80.8 ± 9.9 kg; height, 1.79 ± 0.06 m) were randomized into internal (n = 7) or external (n = 7) attentional focus groups and attended four testing sessions, with a between-session separation of 7 days. Sessions consisted of four cluster sets of fifteen repetitions "excluding momentum repetitions" (4 × (5 + 5 + 5)) using a specific inertial load (0.025, 0.050, 0.075, and 0.100 kg·m-2) for a given set in a randomized ascending or descending order. Cluster sets were separated by a 45 s intra-set rest period. Both instructional focus groups attained familiarization, although the time taken to achieve familiarization (outcome stability) differed between groups. The external instructional group attained familiarization post-session 2 (Cohen's d (ES), ES = 0.11-0.65) with little volatility between performance measures (CV% = 4.61-9.59). Additionally, the internal group reported inconsistencies among all inertial loads, reporting large differences in MP in the 0.100 kg·m-2 inertial load from day 2 to day 3 (ES = 1.22) and both 0.050 kg·m2 (p = 0.010) and 0.075 kg·m-2 (p = 0.016) between day 3 and day 4. The flywheel RDL cluster set approach is a reliable training modality for maintaining mean power output during cluster set repetitions.

Short-Term Effects of "Composite" Training on Strength, Jump, and Sprint Performance in Hurling Players.

ABSTRACT: Byrne, PJ, Moody, JA, Cooper, S-M, Farrell, E, and Kinsella, S. Short-term effects of "composite training" on strength, jump, and sprint performance in hurling players. J Strength Cond Res 36(8): 2253-2261, 2022-The purpose of this study was to compare the short-term effects of "composite" training to sprint training on strength, jump, and sprint acceleration performance in hurling players. A randomized counterbalanced group design with baseline test, pretest and post-test measures was used. Twenty-five hurling players volunteered to participate and 21 completed the study. Subjects were divided into a "composite" (COMP group, n = 10) or a sprint training (SPRINT group, n = 11) group. Both groups trained twice per week for 7 weeks with the SPRINT group performing 6 repetitions of 20 m sprints and the COMP group completing 6 repetitions (1 repetition = 3 bounce drop jumps [BDJs] with a 20 m sprint after 15 seconds recovery). Significant differences existed pretraining to post-training for the COMP group for BDJ contact time (-7.25%; p = 0.05) and countermovement jump (CMJ) variables (height: 7.43%, p = 0.006; force: 5.24%, p = 0.05; power: 15.11%, p = 0.001). No significant differences were found between groups at baseline and for group by time interactions. Significant improvements were observed pretraining to post-training in both groups for the following: absolute 3 repetition maximum (3RM) back squat strength (12.73-17.62%, p = 0.01), 5 m (5.74-9.49%, p = 0.006-0.04), 10 m (4.27-5.59%, p = 0.007-0.02), and 20 m (3.35-3.98%, p = 0.003-0.01). In conclusion, "composite" training is effective in enhancing fast stretch-shortening cycle efficiency inducing CMJ force and power augmentation. However, "composite" and sprint training are effective training approaches for enhancing maximal strength and sprint performance in a time efficient manner in hurling players.

Cross-Sectional Study of the Physical Fitness and Anthropometric Profiles of Adolescent Hurling, Camogie, and Gaelic Football Players.

ABSTRACT: Byrne, LM, Byrne, PJ, Byrne, EK, Byrne, AP, and Coyle, C. Cross-sectional study of the physical fitness and anthropometric profiles of adolescent hurling, camogie, and Gaelic football players. J Strength Cond Res 36(12): 3422-3431, 2022-The primary aim of this study was to identify the physical fitness profile of Irish adolescents playing hurling, camogie, and Gaelic football according to age and gender. To establish relationships between the physical fitness tests and anthropometry for these male and female adolescents. This cross-sectional study design included 311 adolescents between age of 13-18 years. Subjects completed a physical fitness test battery of 9 tests which included the following: height, body mass, modified sit and reach (SR), seated medicine ball throw (MBT), countermovement jump (CMJ), standing long jump (SLJ), 15-m sprint, 505 agility, and a 6-minute modified Cooper test (m-CT). Female subjects scored significantly higher in the SR than males, and older adolescents scored significantly higher than younger adolescents ( p < 0.05). In the remaining fitness tests (MBT, SLJ, CMJ, 15-m sprint, agility, and m-CT), males outperformed females, males had greater anthropometry scores than females, and older adolescents outperformed and had higher changes in anthropometry than younger counterparts ( p < 0.05). Normative data for gender and age-specific percentile values (5th, 10th, 25th, 50th, 75th, 90 th , and 95th) for these tests in these adolescent players are provided. These data are useful for clubs, parents, coaches, clinicians, and secondary schools in monitoring adolescents and to provide training programs that develop athletic performance.

Change of Direction Ability as a Sensitive Marker of Adaptation to Different Training Configurations, and Different Populations: Results from Four Experiments.

This article includes four separate experiments. In the first experiment male beach handball players (n = 24) were randomly assigned to regular training (n = 12) or plyometric and sprint training (n = 12). In the second experiment, male players were assigned to a handball practice only (n = 12), a plyometric training (n = 12), or an eccentric-overload (e.g., versa-pulley machine) training group (n = 12). In the third experiment, participants were assigned to padel training (n = 12) or specific on-court neuromuscular technical actions (n = 12). In the fourth experiment, females between 50-59 years (n = 25), 60-64 years (n = 25), and 65-70 years (n = 25) completed 10 weeks of bench stepping training involving jumps, and were compared to age-matched controls (n = 45). The COD ability was assessed with the 10-m COD ability test (experiments one and two), the COD ability test with 90º and 180º turns (third experiment), and with the timed-up-and-go test (fourth experiment). In experiment one, greater COD improvement was noted in the experimental group compared to the control group (p < 0.05). In experiment two, both intervention groups similarly improved COD when compared to the control group (p < 0.05). In experiment three, although no significant group-time interactions were observed for COD, the experimental group improved all COD measures pre-post-training (p < 0.05), with a larger effect size for COD with 180° turn to the right compared to the control group (effect size = 0.8 vs. 0.3). In experiment four, the three training groups improved COD ability compared to the control group (p < 0.05). In conclusion, COD is a sensitive marker of adaptation to different training configurations in these diverse groups.

Training Load Monitoring Considerations for Female Gaelic Team Sports: From Theory to Practice.

Athlete monitoring enables sports science practitioners to collect information to determine how athletes respond to training loads (TL) and the demands of competition. To date, recommendations for females are often adapted from their male counterparts. There is currently limited information available on TL monitoring in female Gaelic team sports in Ireland. The collection and analysis of female athlete monitoring data can provide valuable information to support the development of female team sports. Athletic monitoring can also support practitioners to help minimize risk of excessive TL and optimize potential athletic performance. The aims of this narrative review are to provide: (i) an overview of TL athlete monitoring in female team sports, (ii) a discussion of the potential metrics and tools used to monitor external TL and internal TL, (iii) the advantages and disadvantages of TL modalities for use in Gaelic team sports, and (iv) practical considerations on how to monitor TL to aid in the determination of meaningful change with female Gaelic team sports athletes.

Acute Effects of "Composite" Training on Neuromuscular and Fast Stretch-Shortening Cycle Drop Jump Performance in Hurling Players.

ABSTRACT: Byrne, PJ, Moody, JA, Cooper, SM, and Kinsella, S. Acute effects of "composite" training on neuromuscular and fast stretch-shortening cycle drop jump performance in hurling players. J Strength Cond Res 35(12): 3474-3481, 2021-"Composite" training is a term developed by the authors and defined as the combination of a plyometric exercise with an explosive activity such as a sprint run, performed as a "combined repetition"/session. The purposes of this study were to investigate the acute effect of a "composite" training session on neuromuscular and fast stretch-shortening cycle bounce drop jumps (BDJs) in hurling players' immediately, after session, and after 7 days of recovery. Eight hurling players first completed a drop jump test to identify individual BDJ drop height, followed 72 hours later with a single "composite" training session. Three repetition maximum (3RM) back squat strength, BDJ, countermovement jump (CMJ), and sprint performance testing were performed 10 minutes before and immediately after session and 7 days after session. An analysis of variance reported a significant decrease in CMJ measures (height, velocity, and eccentric rate of force development) and sprint performance from presession to postsession (p ≤ 0.05). Moreover, a significant increase was evident for CMJ performance (height and power), sprint performance (5 and 20 m), 3RM back squat strength, and BDJ performance (reactive strength index and height) from postsession to post-7-day recovery (p ≤ 0.05). Pairwise comparisons indicated that absolute and relative 3RM strength significantly increased from presession to post-7 days (absolute 3RM: p = 0.0001; relative 3RM: p = 0.01). The findings indicate that "composite" training results in an immediate decline in CMJ measures after session possibly due to acute muscle fatigue, and supercompensation augments maximum lower-limb strength after 7 days of recovery.

Potentiating Response to Drop-Jump Protocols on Sprint Acceleration: Drop-Jump Volume and Intrarepetition Recovery Duration.

Byrne, PJ, Moody, JA, Cooper, SM, Callanan, D, and Kinsella, S. Potentiating response to drop-jump protocols on sprint acceleration: drop-jump volume and intrarepetition recovery duration. J Strength Cond Res 34(3): 717-727, 2020-The purpose of this study was to investigate the postactivation potentiation response first to bounce drop jump (BDJ) volume; second, BDJ intrarepetition recovery duration and recovery duration between BDJs and 20-meter (including 5- and 10-m split times) sprint performance. The study was undertaken in 2 parts, the first part compared different volumes of BDJs and the second part compared different BDJ intrarepetition recovery periods. The effect of recovery periods between the BDJs and the subsequent 20-m sprints was examined in both parts 1 and 2 (15 seconds, 4, 8, and 12 minutes). Fourteen (mean ± SD: age = 20.83 ± 1.26 years; height = 1.77 ± 0.04 m; and mass = 74.89 ± 6.07 kg) (part 1) and 15 (mean ± SD: age = 20.64 ± 1.00 years; height = 1.78 ± 0.06 m; and mass = 75.67 ± 6.28 kg) (part 2) male collegiate and club hurling players volunteered to participate. A randomized cross-over design was used to compare BDJ volumes (1, 2, and 3 sets of 3 repetitions) and BDJ intrarepetition recovery time (15 vs. 60 seconds) after a warm-up followed by 2 baseline 20-m sprints. The results in part 1 reported a significant improvement in 5- and 10-m sprint time for 1 set of 3 BDJs between baseline and 4 minutes (5 m: -2.34%, p = 0.04, effect size [ES] = -0.043; 10 m: -1.42%, p = 0.03, ES = -0.35), and baseline and 12 minutes (5 m: -3.33%, p = 0.03, ES = -0.57; 10 m: -2.13%, p = 0.01, ES = -0.52). Part 2 reported a significant improvement in 5-m sprint time between baseline and 15 seconds (5 m: -3.38%, p = 0.01, ES = -0.83; 10 m: -2.07%, p = 0.02, ES = -0.58) after the BDJs. The findings support the use of 1 set of 3 BDJs using a 15-second intrarepetition recovery period to maximize 5-, 10-, and 20-m sprint performance after 15 seconds of recovery after the final BDJ in hurling players. The acute response to this BDJ protocol proves to be time efficient and effective in acutely improving sprint acceleration.

Effects of Myofascial Trigger Point Release on Power and Force Production in the Lower Limb Kinetic Chain.

Devereux, F, O'Rourke, B, Byrne, PJ, Byrne, D, and Kinsella, S. Effects of myofascial trigger point release on power and force production in the lower limb kinetic chain. J Strength Cond Res 33(9): 2453-2463, 2019-The purpose of this study was to first investigate the effects of treating latent myofascial trigger points (MTrPs) in the lower limb kinetic chain with respect to performance during sporting actions, as opposed to the traditional goal of pain management with active MTrPs. The second aim was to investigate the effects of dry needling (DN) on performance parameters over time to establish treatment timeframe guidelines before performance. Forty male athletes were assigned to 4 groups; rectus femoris DN (group 1), medial gastrocnemius DN (group 2), rectus femoris and medial gastrocnemius DN (group 3), and no DN (group 4). Subjects completed 6 sessions; familiarization, baseline, immediately after DN, 48, 72, and 96 hours after intervention. Subjects performed squat jumps at 5 incremental loads and were recorded using the My Jump app (iOS) for jump height, power output, optimal force, and optimal velocity. A between-within subject's analysis of variance was used for statistical analysis. Results showed a significant increase in jump height in group 2 (gastrocnemius muscle only) from immediately after to 48 hours after intervention (p = 0.01); however, no other statistical significance was observed. From 48 hours onward, a trend for improved performance was observed, with jump height, power, and velocity showing trivial increases. This study found improved jump performance from immediately after to 48 hours post-DN of the gastrocnemius muscle only. This study suggests a likely immediate decrease in jump performance after DN, with levels increasing above baseline between 48 and 96 hours, which may have clinical significance.

Interday Reliability of the Reactive Strength Index and Optimal Drop Height.

Byrne, DJ, Browne, DT, Byrne, PJ, and Richardson, N. Interday reliability of the reactive strength index and optimal drop height. J Strength Cond Res 31(3): 721-726, 2017-The purpose of this study was to investigate the interday reliability of the reactive strength index (RSI) and optimal drop height (ODH) identification from multiple drop heights. Nineteen male trained hurling players (23.1 ± 2.9 years, 83.1 ± 15.5 kg, and 182.5 ± 4.89 cm) completed 2 maximal depth jumps from 4 incremental drop heights (30, 40, 50, and 60 cm), over 2 separate testing sessions 48 hours apart. The RSI and ODH were analyzed for reliability using intraclass correlation coefficient (ICC) and coefficient of variation (CV). The RSI and ODH both demonstrated good reliability with ICC ≥0.80 (0.87 and 0.81) and CV ≤10% (4.2 and 2.98), respectively. The results of this study support the use of an incremental depth jump protocol to find the RSI and ODH in trained hurlers. It is recommended that the incremental depth jump protocol be used when assessing an athlete's reactive strength, as it allows a reactive strength profile, maximum RSI, and an ODH to be determined, all of which can provide vital information when determining an athletes training intensity and load.

Acute potentiating effect of depth jumps on sprint performance.

The purpose of this investigation was to determine whether the addition of 3 depth jumps to a dynamic warm-up (DYNDJ) protocol would significantly improve 20-m sprint performance when compared with a cardiovascular (C) warm-up protocol or a dynamic (DYN) stretching protocol alone. The first part of the study identified optimal drop height for all subjects using the maximum jump height method. The identified optimal drop heights were later used during the DYNDJ protocol. The second part compared the 3 warm-up protocols above to determine their effect on 20-m sprint performance. Twenty-nine subjects (age, 20.8 ± 4.4 years; weight, 82.6 ± 9.9 kg; height, 180.3 ± 6.2 cm) performed 3 protocols of a C protocol, a DYN protocol, and a DYNDJ protocol in a randomized order. A 20-m sprint was performed 1 minute after the completion of each of the 3 protocols. Results displayed significant differences between each of the 3 protocols. A significant improvement (p = 0.001) of 2.2% was obtained in sprint time between the C protocol (3.300 ± 0.105 seconds) and the DYN protocol (3.227 ± 0.116 seconds), a further significant improvement of 5.01% was attained between the C and the DYNDJ protocols (3.300 ± 0.10 vs. 3.132 ± 0.120 seconds; p = 0.001). In addition, a significant improvement (p = 0.001) of 2.93% was observed between the DYN protocol (3.227 ± 0.116 seconds) and the DYNDJ protocol (3.132 ± 0.116 seconds). The data from this study advocate the use of DYNDJ protocol as a means of significantly improving 20-m sprint performance 1 minute after the DYNDJ protocol.

A comparison of methods used to identify 'optimal' drop height for early phase adaptations in depth jump training.

The purpose of this study was to compare 2 methods of identifying an appropriate drop height for bounce depth jump (DJ) training, which aimed to improve reactive strength and countermovement jump (CMJ) performance. The maximum jump height (MJH) method was compared to the reactive strength index (RSI) method. The first part of the study identified each participant's drop height for both methods and determined the extent to which both methods differed. The subsequent part of the study used an 8-week bounce DJ training program to compare the effectiveness of the MJH and RSI methods. Twenty-two male participants volunteered. There was a significant difference between the MJH and the RSI methods in the optimal drop height they identified (median = 0.40 and 0.30 m, respectively), with 19 participants exhibiting a difference of 0.10 m or more. These 19 participants were assigned to 1 of 3 training groups: a control, an MJH method, and an RSI method group. The results demonstrated a significant increase in pre to posttraining in reactive strength (MJH: 27.3 +/- 18.7%, p = 0.025; RSI: 11.8 +/- 10.1%, p = 0.019) and CMJ performance (MJH: 9.9 +/- 5.2%, p = 0.009; RSI: 9.2 +/- 4.8%, p = 0.006) in both the MJH and RSI groups, respectively, with no change in the control group. The study concluded that either method can be used to identify the optimal drop height in bounce DJ training to increase CMJ performance, but the MJH method should be used to improve reactive strength.

Informed consent and hypoplastic left heart syndrome.

UNLABELLED: We present an ethical analysis from the perspective of shared decision-making and informed consent of a change in clinical management of infants born with hypoplastic left heart syndrome (HLHS). We reported a change in treatment of HLHS at the University of Alberta away from comfort care to life-saving surgery (LST) between 1987 and 1998. In a second review (1996-2001), 49/62 infants received LST, with 81% survival from the NICU and 58% at 35 mo. Eleven infants died preoperatively of non-cardiac conditions and two received elective comfort care. Sixteen infants had 18-mo Bayley Mental Development Index, mean score 84+/-19, but five scored <70. Although we continue to present the comfort care option to parents, since 2001 LST use for HLHS at our center is almost universal despite serious complications. CONCLUSION: We conclude that these findings are inconsistent with an open, shared decision-making model of informed consent and we suggest that comfort care should remain an ethically valid choice until the rate of serious long-term complications of LST decreases.

Cardiopulmonary resuscitation and epinephrine infusion in extremely low birth weight infants in the neonatal intensive care unit.

BACKGROUND: Survival of extremely low birth weight (ELBW) infants has improved significantly; however, the aggressiveness of treatment in these infants remains controversial. Critical appraisal of the benefits of cardiopulmonary resuscitation (CPR) and intravenous epinephrine infusion (IV EPI) has not been studied in this population. OBJECTIVE: To determine if either CPR or continuous IV EPI in NICU is of benefit for surviving in a selected population of infants weighing 1.0 mcg/kg/hour intravenously died. CONCLUSIONS: In view of the poor survival after either CPR or high-dose IV EPI in infants