Mask versus Nasal Tube for Stabilization of Preterm Infants at Birth: Respiratory Function Measurements.

OBJECTIVE: To compare the nasal tube with face mask as interfaces for stabilization of very preterm infants at birth by using physiological measurements of leak, obstruction, and expired tidal volumes during positive pressure ventilation (PPV). STUDY DESIGN: In the delivery room, 43 infants <30 weeks gestation were allocated to receive respiratory support by nasal tube or face mask. Respiratory function, heart rate, and oxygen saturation were measured. Occurrence of obstruction, amount of leak, and tidal volumes were compared using a Mann-Whitney U test or a Fisher exact test. RESULTS: The first 5 minutes after initiation of PPV were analyzed (1566 inflations in the nasal tube group and 1896 inflations in the face mask group). Spontaneous breathing coincided with PPV in 32% of nasal tube and 34% of face mask inflations. During inflations, higher leak was observed using nasal tube compared with face mask (98% [33%-100%] vs 14 [0%-39%]; P < .0001). Obstruction occurred more often (8.2% vs 1.1%; P < .0001). Expired tidal volumes were significantly lower during inflations when using nasal tube compared with face mask (0.0 [0.0-3.1] vs 9.9 [5.5-12.8] mL/kg; P < .0001) and when spontaneous breathing coincided with PPV (4.4 [2.1-8.4] vs 9.6 [5.4-15.2] mL/kg; P < .0001) but were similar during breathing on continuous positive airway pressure (4.7 [2.8-6.9] vs 4.8 [2.7-7.9] mL/kg; P > 0.05). Heart rate was not significantly different between groups, but oxygen saturation was significantly lower in the nasal tube group the first 2 minutes after start of respiratory support. CONCLUSIONS: The use of a nasal tube led to large leak, more obstruction, and inadequate tidal volumes compared with face mask. TRIAL REGISTRATION: Trial registration Registered with the Dutch Trial Registry (NTR 2061) and the Australia and New Zealand Clinical Trials Register (ACTRN 12610000230055).

Early life growth and the development of preschool wheeze, independent from overweight: the LucKi Birth Cohort Study.

OBJECTIVE: To investigate whether birth weight and postnatal growth rates are independently related to the development of overweight and wheeze up to age 3 years. STUDY DESIGN: Children from the LucKi Birth Cohort Study with complete follow-up for repeated questionnaires (at age 0, 7, and 14 months and 3 years) and informed consent to use height and weight data (measured by trained personnel at age 0, 7, and 14 months and 2 and 3 years) were included (n = 566). Wheeze (parental-reported) and overweight (body mass index [BMI] >85th percentile) were regressed with generalized estimating equations on birth weight and relative growth rates (difference SDS for weight, height, and BMI). RESULTS: Higher birth weight and higher weight and BMI growth rates were associated with increased risk of overweight, but not of wheeze, up to age 3 years. Higher height growth rate was associated with lower risk of wheeze up to 3 years, independent of overweight (aOR, 0.65; 95% CI, 0.53-0.79). In time-lag models, wheeze was associated with subsequently reduced height growth up to age 14 months, but not vice versa. CONCLUSION: Only height growth rate, and not weight and BMI growth rate, is associated with preschool wheeze, independent of overweight. Children who wheeze demonstrate a subsequent reduction in height growth up to age 14 months, but not vice versa. Because height growth rate is not associated with overweight, preschool wheeze and overweight are not associated throughout early life growth.

Evaluating manual inflations and breathing during mask ventilation in preterm infants at birth.

OBJECTIVE: To investigate inflations (initial sustained inflations and consecutive inflations) and breathing during mask ventilation in preterm infants at birth. STUDY DESIGN: Resuscitation of infants <32 weeks' gestation receiving mask ventilation at birth were recorded. Recorded waveforms were divided into inflations (sustained and consecutive inflations), breaths in between inflations, breaths coinciding with an inflation, and breaths on continuous positive airway pressure (during evaluation moments in between and after ventilation) and expiratory tidal volume (V(Te)) was compared. Inflations were analyzed for leak, low V(Te) (<2.5 mL/kg), high V(Te) (>15 mL/kg in sustained inflations, >10 mL/kg in consecutive inflations), and airway obstruction. RESULTS: In 27 infants, we analyzed 1643 inflations, 110 breaths in between inflations, 133 breaths coinciding with an inflation, and 1676 breaths on continuous positive airway pressure. A large mask leak frequently resulted in low V(Te). Breathing during positive pressure ventilation occurred in 24 of 27 infants (89%). Median (IQR) V(Te) of inflations, breaths in between inflations, and breaths coinciding with an inflation were 0.8 mL/kg (0.0-5.6 mL/kg), 2.8 mL/kg (0.7-4.6 mL/kg), and 3.9 mL/kg (0.0-7.7 mL/kg) during sustained inflations and 3.7 mL/kg (1.4-6.7 mL/kg), 3.3 mL/kg (2.1-6.6 mL/kg), and 4.6 mL/kg (2.1-7.8 mL/kg) during consecutive inflations, respectively. The V(Te) of breaths were significantly lower than the V(Te) of inflations or breaths coinciding with an inflation. CONCLUSIONS: We often observed large leak and low V(Te), especially during sustained inflations. Most preterm infants breathe when receiving mask ventilation and this probably contributed to the stabilization of the infants after birth.

Intergenerational family solidarity: value differences between immigrant groups and generations.

Although immigrants may be more dependent on their immediate family for support, they may also experience a wider generation-gap in values regarding intergenerational solidarity, because of processes of acculturation. Based on large scale survey data (N = 2,028), differences between first and second generation immigrants in values regarding intergenerational solidarity were examined among family members in the Netherlands with an immigration background from Turkey, Morocco, Suriname, and The Dutch Antilles. Using a multilevel analytic approach, effects of family and individual characteristics on values regarding intergenerational solidarity were tested, considering the perspectives of two generations. It was found that immigrants with Moroccan and Turkish backgrounds scored higher on values with respect to intergenerational family solidarity than immigrants stemming from Suriname and The Antilles. First generation immigrants placed higher values on family solidarity compared to second generation immigrants. Additionally, religious denomination was a significant predictor of higher values with respect to intergenerational family solidarity. Immigration and acculturation may create great strains in migrant families. Policies to support the fabric of intergenerational solidarity should consider ethnic and religious background and immigration history.

Neonatal outcome in twin-to-twin transfusion syndrome treated with fetoscopic laser occlusion of vascular anastomoses.

OBJECTIVE: To determine neonatal mortality and morbidity rates in monochorionic twins with chronic twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser occlusion of vascular anastomoses. STUDY DESIGN: In a prospective study of monochorionic twins delivered at our center between June 2002 and December 2004, neonatal outcome was assessed in 40 monochorionic twin pairs with TTTS treated with laser compared with 46 monochorionic twin pairs without TTTS. RESULTS: The neonatal mortality rate in the TTTS and no-TTTS group was 8% (6/76) and 3% (3/90), respectively. The rate of severe cerebral lesions on ultrasound scanning in the TTTS and no-TTTS group was 14% (10/72) and 6% (5/82), respectively. The incidence of adverse neonatal outcome (neonatal death, major neonatal morbidity, or severe cerebral lesions) in the TTTS and no-TTTS group was, respectively, 26% (20/76) and 13% (12/90) (RR = 1.97, 95% CI = 1.03 to 3.77). CONCLUSIONS: Although perinatal outcome in TTTS has improved after laser therapy, neonatal mortality and morbidity rates remain high. Relative risk for adverse neonatal outcome is increased 2-fold in TTTS treated with laser relative to monochorionic twins without TTTS.

Interruption of malaria transmission by chloroquinized salt in Guyana, with observations on a chloroquine-resistant strain of Plasmodium falciparum

Malaria and its local vector, Anopheles darlingi, were eradicated from the coastlands and near interior of Guyana by DDT house-spraying in 1945-51. In the remote interior, where 10 percent of the population live, only partial control could be achieved, owing to the semi-silvatic habits of A. darlingi and the considerable movement of the sparce population; low malaria endemicity persisted in these areas with occasional localized outbreaks. In the south-west the problem was further complicated by the presence of malaria across the frontier. During the years 1961-65, the use of chloroquinized salt was made compulsory over an area of some 109,000 km(sq), covering a population of 48,500. Satisfactory results were obtained over 84 percent of this area within 6 months of the start of the campaign; only four cases of malaria were seen in four years. In the south-west, however, an initally favourable trend was reversed in 1962 with the introduction of a chloroquine-resistant strain of Plasmodium falciparum from Brazil. The situation was brought under control by house-spraying with DDT and interruption of transmission is expected. (AU)