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How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope. Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure. What is Known: ⢠Neonatal intubation is a life-saving procedure that requires a skilled operator and may cause direct trauma to the tissues and precipitate adverse reactions. ⢠Intubation with a videolaryngoscope requires less force than with a direct laryngoscope, but how and when the forces are applied during the whole neonatal intubation procedure are currently unknown. What is New: ⢠Forces applied to the epiglottis during intubation can be divided into three sections: (i) an initial increase, (ii) a sort of plateau, and (iii) a decrease. ⢠The pattern of each section shows some differences in relation to the laryngoscope (direct or videolaryngoscope) that is used during the procedure.
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Intubação Intratraqueal , Laringoscópios , Recém-Nascido , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , ManequinsRESUMO
AIM: Apnoea of prematurity requires prompt intervention to prevent long-term adverse outcomes, but specific recommendations about the stimulation approach are lacking. Our study investigated the modalities of tactile stimulation for apnoea of prematurity in different settings. METHODS: In this multi-country observational prospective study, nurses and physicians of the neonatal intensive care units were asked to perform a tactile stimulation on a preterm neonatal manikin simulating an apnoea. Features of the stimulation (body location and hand movements) and source of learning (training course or clinical practice) were collected. RESULTS: Overall, 112 healthcare providers from five hospitals participated in the study. During the stimulation, the most frequent location were feet (72%) and back (61%), while the most frequent techniques were rubbing (64%) and massaging (43%). Stimulation modalities different among participants according to their hospitals and their source of learning of the stimulation procedures. CONCLUSION: There was a large heterogeneity in stimulation approaches adopted by healthcare providers to counteract apnoea in a simulated preterm infant. This finding may be partially explained by the lack of specific guidelines and was influenced by the source of learning for tactile stimulation.
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Apneia , Manequins , Humanos , Recém-Nascido , Estudos Prospectivos , Apneia/terapia , Recém-Nascido Prematuro , Estimulação Física/métodos , Tato , FemininoRESUMO
Laryngeal mask airway (LMA) may be considered by health caregivers of level I-II hospitals for neonatal resuscitation and stabilization before and during interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA during stabilization and transport in a large series of neonates. This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms, and hospital charts. In total, 64/3252 transferred neonates (2%) received positive pressure ventilation with an LMA, with increasing trend over time (p = 0.001). Most of these neonates were transferred after birth (97%), due to a respiratory or neurologic disease (95%). LMA was used before the transport (n = 60), during the transport (n = 1), or both (n = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the receiving center. CONCLUSION: In a large series of transferred neonates, LMA use during stabilization and transport was rare but increasing over time, and showed some heterogeneity among referring centers. In our series, LMA was safe and lifesaving in "cannot intubate, cannot oxygenate" situations. Future prospective, multicenter research may provide detailed insights on LMA use in neonates needing postnatal transport. WHAT IS KNOWN: ⢠A supraglottic airway device may be used as an alternative to face mask and endotracheal tube during neonatal resuscitation. ⢠The laryngeal mask may be considered by health caregivers of low-level hospitals with limited exposure on airway management, but literature provides little information on this aspect. WHAT IS NEW: ⢠In a large series of transferred neonates, laryngeal mask use was rare but increasing over time, and showed some heterogeneity among referring centers. ⢠The laryngeal mask was safe and lifesaving in "cannot intubate, cannot oxygenate" situations.
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PURPOSE: In adult mannequins, videolaryngoscopy improves glottic visualization with lower force applied to upper airway tissues and reduced task workload compared with direct laryngoscopy. This trial compared oropharyngeal applied forces and subjective workload during direct vs indirect (video) laryngoscopy in a neonatal mannequin. METHODS: We conducted a randomized crossover trial of intubation with direct laryngoscopy, straight blade videolaryngoscopy, and hyperangulated videolaryngoscopy in a neonatal mannequin. Thirty neonatal/pediatric/anesthesiology consultants and residents participated. The primary outcome measure was the maximum peak force applied during intubation. Secondary outcome measures included the average peak force applied during intubation, time needed to intubate, and subjective workload. RESULTS: Direct laryngoscopy median forces on the epiglottis were 8.2 N maximum peak and 6.8 N average peak. Straight blade videolaryngoscopy median forces were 4.7 N maximum peak and 3.6 N average peak. Hyperangulated videolaryngoscopy median forces were 2.8 N maximum peak and 2.1 N average peak. The differences were significant between direct laryngoscopy and straight blade videolaryngoscopy, and between direct laryngoscopy and hyperangulated videolaryngoscopy. Significant differences were also found in the top 10th percentile forces on the epiglottis and palate, but not in the median forces on the palate. Time to intubation and subjective workload were comparable with videolaryngoscopy vs direct laryngoscopy. CONCLUSIONS: The lower force applied during videolaryngoscopy in a neonatal mannequin model suggests a possible benefit in reducing potential patient harm during intubation, but the clinical implications require assessment in future studies. REGISTRATION: ClinicalTrials.gov (NCT05197868); registered 20 January 2022.
RéSUMé: OBJECTIF: Sur les mannequins adultes, la vidéolaryngoscopie améliore la visualisation glottique avec une force plus faible appliquée aux tissus des voies aériennes supérieures et une charge de travail réduite par rapport à la laryngoscopie directe. Cette étude a comparé les forces appliquées sur la zone oropharyngée et la charge de travail subjective au cours d'une laryngoscopie directe vs indirecte (vidéolaryngoscopie) sur un mannequin néonatal. MéTHODE: Nous avons réalisé une étude randomisée croisée d'intubation par laryngoscopie directe, vidéolaryngoscopie à lame droite et vidéolaryngoscopie avec lame hyperangulée sur un mannequin néonatal. Trente spécialistes diplômés et résidents en néonatologie, en pédiatrie et en anesthésiologie y ont participé. Le critère d'évaluation principal était le pic de force maximal obtenu pendant l'intubation. Les critères d'évaluation secondaires comprenaient la force maximale moyenne appliquée pendant l'intubation, le temps nécessaire pour intuber et la charge de travail subjective. RéSULTATS: Les forces médianes appliquées sur l'épiglotte lors de la laryngoscopie directe étaient de 8,2 N pour le pic maximum et de 6,8 N pour le pic moyen. Les forces médianes appliquées lors de la vidéolaryngoscopie à lame droite étaient de 4,7 N pour le pic maximum et de 3,6 N pour le pic moyen. Les forces médianes appliquées lors de la vidéolaryngoscopie avec lame hyperangulée étaient de 2,8 N pour le pic maximum et de 2,1 N pour le pic moyen. Les différences étaient significatives entre la laryngoscopie directe et la vidéolaryngoscopie à lame droite, et entre la laryngoscopie directe et la vidéolaryngoscopie avec lame hyperangulée. Des différences significatives ont également été observées dans le 10e percentile supérieur des forces sur l'épiglotte et le palais, mais pas dans les forces médianes sur le palais. Le délai d'intubation et la charge de travail subjective étaient comparables entre la vidéolaryngoscopie et la laryngoscopie directe. CONCLUSION: La force plus faible appliquée lors de la vidéolaryngoscopie dans un modèle de mannequin néonatal suggère un avantage possible de réduction des lésions potentielles pour le patient pendant l'intubation, mais les implications cliniques doivent être évaluées dans des études futures. ENREGISTREMENT DE L'éTUDE: ClinicalTrials.gov (NCT05197868); enregistré le 20 janvier 2022.
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Laringoscópios , Laringoscopia , Humanos , Recém-Nascido , Estudos Cross-Over , Intubação Intratraqueal , Manequins , Gravação em VídeoRESUMO
AIM: Less invasive surfactant administration is becoming increasingly popular, but health-care providers may experience some difficulties in achieving the correct positioning of the catheter in the trachea. We compared catheters with marked versus unmarked tips in terms of correct depth positioning in the trachea, total time, number of attempts and participant's opinion on using the device in a manikin model. METHODS: A randomised controlled crossover trial of surfactant administration with less invasive surfactant administration catheters with marked versus unmarked tip in a preterm infant manikin. Fifty tertiary hospital consultants and paediatric residents with previous experience in surfactant administration participated. The primary outcome measure was the positioning of the device at the correct depth in the trachea. The secondary outcome measures were the total time and the number of attempts for positioning the device in the trachea, and participant's opinion on using the device. RESULTS: Correct depth in the trachea was achieved by 38 (76%) and 28 (56%) participants using the catheters with marked and unmarked tip, respectively (P = 0.04). Median time of device positioning (P = 0.08) and number of attempts (P = 0.13) were not statistically different between the two catheters. Participants found the catheter with the marked tip easier to use (P = 0.007), especially concerning the insertion in the trachea (P = 0.04) and the positioning at the correct depth (P = 0.004). CONCLUSIONS: In a preterm manikin model, the marked tip catheter offered a higher chance of achieving the correct depth of the device in the trachea and was favoured by the participants.
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Surfactantes Pulmonares , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Recém-Nascido , Criança , Tensoativos , Recém-Nascido Prematuro , Manequins , Catéteres , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológicoRESUMO
BACKGROUND: Thrombotic events are severe, often under-diagnosed, complications occurring in newborn infants during their hospital stay. Currently, there is no consensus regarding the optimal treatment scheme for thrombolysis in neonates. OBSERVATIONS: We present the case of a newborn suffering from a life-threatening thrombosis. Diagnosis was suggested by a gradual increase of C-reactive protein, with repeatedly normal procalcitonin. Thrombosis was successfully and safely treated with a long scheme of 21 days of urokinase, supported by vascular ultrasound and d-dimer trend. CONCLUSIONS: Laboratory and ultrasound results may help in adjusting the duration of the thrombolytic treatment, allowing for longer therapeutic schemes that could optimize treatment success. In addition, our case may suggest a possible combined role of C-reactive protein and procalcitonin as an early diagnostic aid in neonatal thrombosis.
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Trombose , Ativador de Plasminogênio Tipo Uroquinase , Proteína C-Reativa , Objetivos , Humanos , Lactente , Recém-Nascido , Pró-Calcitonina , Terapia Trombolítica/métodos , Trombose/etiologia , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13 s, 95% confidence interval 8 to 18 s; p < 0.0001) and neonatologists (mean difference 12 s, 95% confidence interval 8 to 16 s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference - 1 s, 95% confidence interval - 7 to 6 s; p = 0.85).Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer-but not clinically relevant-time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted.Registration: clinicaltrial.gov NCT04076189. What is Known: ⢠Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial. ⢠Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown. What is New: ⢠Performing immediate ventilation without intubation was associated with shorter-but not clinically relevant-time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model. ⢠Further studies in a clinical setting are warranted.
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Manequins , Síndrome de Aspiração de Mecônio , Criança , Estudos Cross-Over , Humanos , Recém-Nascido , Intubação Intratraqueal , Mecônio , Respiração com Pressão Positiva , SucçãoRESUMO
Water use efficiency in agriculture can be improved by implementing advisory systems that support on-farm irrigation scheduling, with reliable forecasts of the actual crop water requirements, where crop evapotranspiration (ETc) is the main component. The development of such advisory systems is highly dependent upon the availability of timely updated crop canopy parameters and weather forecasts several days in advance, at low operational costs. This study presents a methodology for forecasting ETc, based on crop parameters retrieved from multispectral images, data from ground weather sensors, and air temperature forecasts. Crop multispectral images are freely provided by recent satellite missions, with high spatial and temporal resolutions. Meteorological services broadcast air temperature forecasts with lead times of several days, at no subscription costs, and with high accuracy. The performance of the proposed methodology was applied at 18 sites of the Campania region in Italy, by exploiting the data of intensive field campaigns in the years 2014-2015. ETc measurements were forecast with a median bias of 0.2 mm, and a median root mean square error (RMSE) of 0.75 mm at the first day of forecast. At the 5th day of accumulated forecast, the median bias and RMSE become 1 mm and 2.75 mm, respectively. The forecast performances were proved to be as accurate and as precise as those provided with a complete set of forecasted weather variables.
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AIM: To evaluate any geographical variations in practice and adherence to international guidelines for early delivery room management of extremely low birthweight (ELBW) infants in the North, Centre and South of Italy. METHODS: A questionnaire was sent to all 107 directors of Italian level III centres between April and August 2012. RESULTS: There was a 92% (n = 98) response rate. A polyethylene bag/wrap was used by 54 centres (55.1%), with the highest rate in Northern Italy (77.5%) and the lowest rate in Southern (37.7%) areas. In Northern regions, one centre (2.5%) said it used oxygen concentrations >40% to initiate positive pressure ventilation in ELBW infants. These proportions were higher in the Central (14.3%) and Southern (16.2%) areas. A T-piece device for positive pressure ventilation was more frequently available in the Northern (95%) units than in those in the Central (66.7%) and Southern (69.4%) regions. A median of 13% (IQR: 5%-30%) of ELBW infants received chest compressions at birth in Italy: 5%, 18% and 22% in Northern, Central and Southern units, respectively. CONCLUSION: In Italy, delivery room management of ELBW infants showed marked geographical variations. Implementation of national training programmes could increase adherence to the guidelines and reduce such discordance.
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Salas de Parto/estatística & dados numéricos , Gerenciamento Clínico , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Respiração Artificial/estatística & dados numéricos , Ressuscitação/estatística & dados numéricos , Salas de Parto/organização & administração , Salas de Parto/normas , Geografia , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Itália , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Respiração Artificial/métodos , Respiração Artificial/normas , Ressuscitação/métodos , Ressuscitação/normas , Inquéritos e Questionários , Análise de SobrevidaRESUMO
We describe a previously unreported case of immature teratoma originating from the tela chorioidea of the third ventricle diagnosed during labor at term of pregnancy. Postnatal MR imaging and pediatric neurosurgery with postnatal outcome at 6 months of age are reported.
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Neoplasias do Ventrículo Cerebral/diagnóstico , Teratoma/diagnóstico , Terceiro Ventrículo/patologia , Adulto , Feminino , Humanos , Lactente , GravidezRESUMO
BACKGROUND: We compared surfactant administration with a rigid versus soft catheter in a manikin simulating an extremely preterm infant. METHODS: Randomized controlled crossover (AB/BA) trial. Fifty tertiary hospital consultants and pediatric residents. The primary outcome was the time of device positioning. The secondary outcomes were the success of the first attempt, the number of attempts, and the participant's opinion. RESULTS: Median time of device positioning was 19 s (interquartile range [IQR]: 15-25) with rigid catheter and 40 s (IQR: 28-66) with soft catheter (p < 0.0001). Success at first attempt was 92% with rigid catheter and 74% with soft catheter (p = 0.01). Median number of attempts was 1 (IQR: 1-1) with rigid catheter and 1 (IQR: 1-2) with soft catheter (p = 0.009). Participants found the rigid catheter easier to use (p < 0.0001). CONCLUSIONS: In a preterm manikin model, using a rigid catheter for less invasive surfactant administration was quicker and easier to use than a soft catheter.
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Surfactantes Pulmonares , Tensoativos , Lactente , Humanos , Recém-Nascido , Criança , Manequins , Intubação Intratraqueal , Lactente Extremamente Prematuro , CatéteresRESUMO
BACKGROUND: Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants' perceptions of the educational experience. METHODS: Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. RESULTS: 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. CONCLUSIONS: Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions.
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Neonatal resuscitation remains a hot topic for pediatricians and neonatologists worldwide [...].
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OBJECTIVE: We aimed to compare time of device positioning, success of procedure and operator's opinion with LISA vs. INSURE in a manikin simulating an extremely low birthweight infant. METHODS: A randomized controlled crossover (AB/BA) trial of surfactant administration with LISA vs. INSURE in a preterm manikin. Forty-two tertiary hospital consultants and pediatric residents with previous experience with LISA and INSURE participated. The primary outcome measure was the time of device positioning. The secondary outcome measures were: success of the first attempt, number of attempts, correct depth, and participant's opinion on difficulty in using the device. RESULTS: Median time of device positioning was shorter with LISA vs. INSURE (median difference -8 s, 95% confidence interval -16 to -1 s; p = .04). Success at first attempt was 35/40 with LISA (83%) and 31/40 with INSURE (74%) (p = .42). Median number of attempts was 1 (IQR 1-1) with LISA and 1 (IQR 1-2) with INSURE (p = .08). Correct depth was achieved in 30/40 with LISA (71%) and 37/40 with INSURE (88%) (p = .12). Participants found LISA easier to insert in the trachea (p = .002) but INSURE easier to place at the correct depth (p = .008). Handling the device (p = .43), visualizing the glottis (p = .17) and overall difficulty in using the device (p = .13) were not statistically different. CONCLUSIONS: In a preterm manikin model, positioning a thin catheter (LISA) was quicker and easier than a tracheal tube (INSURE), but the magnitude of the difference was unlikely to be clinically relevant and the tracheal tube was easier to place at the correct depth. REGISTRATION: clinicaltrial.gov NCT04944108.
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Recém-Nascido Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Recém-Nascido , Humanos , Criança , Manequins , Intubação Intratraqueal/métodos , Respiração Artificial/métodosRESUMO
Background: Thermal management of the newborn at birth remains an actual challenge. This systematic review aimed to summarize current evidence on the use of thermal servo-controlled systems during stabilization of preterm and VLBW infants immediately at birth. Methods: A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database through December 2021. PRISMA guidelines were followed. Risk of bias was appraised using Cochrane RoB2 and Risk Of Bias In Non-Randomized Studies of Interventions (ROBIN-I) tools, and certainty of evidence using GRADE framework. Results: One randomized controlled trial and one observational study were included. Some aspects precluded the feasibility of a meaningful meta-analysis; hence, a qualitative review was conducted. Risk of bias was low in the trial and serious in the observational study. In the trial, the servo-controlled system did not affect normothermia (36.5-37.5°C) but was associated with increased mild hypothermia (from 22.2 to 32.9%). In the observational study, normothermia (36-38°C) increased after the introduction of the servo-controlled system and the extension to larger VLBW infants. Conclusion: Overall, this review found very limited information on the use of thermal servo-controlled systems during stabilization of preterm and VLBW infants immediately at birth. Further research is needed to investigate the opportunity of including such approach in the neonatal thermal management in delivery room. Registration: PROSPERO (CRD42022309323).
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BACKGROUND: The neonatal period is the most vulnerable time in terms of a child's survival, with mortality during this period accounting for approximately half of the deaths before the age of 5 years. The Neonatal Essential Survival Technology (NEST) project is a program aiming to reduce mortality by improving the quality of neonatal care in sub-Saharan Africa. This study presents the evaluation of the first phase of the NEST intervention program at Saint Camille Hospital Ouagadougou (HOSCO), Burkina Faso, in terms of the reduction in neonatal mortality. METHODS: This is a retrospective analysis, based on "pre-intervention" data collected in 2015, and "post-intervention" data collected in 2018, including all infants admitted to the neonatal unit of HOSCO. The intervention period (2016 and 2017) comprised a structured quality improvement process conducted by a multidisciplinary working group that focused on improving infrastructure, equipment, training and use of clinical protocols, team working within the neonatal unit and with other hospital departments, and communication with referring healthcare facilities. Mortality data were compared pre- vs. post-intervention using a logistic regression model. RESULTS: The analysis included 1427 infants in the pre-intervention period, and 819 post-intervention. In both time periods, more than 75% of admissions were infants with low birth weight, and nearly 50% were very low birth weight. Post-intervention, while there was a decrease in overall admission, the proportion of multiple births increased from 20% to 24% (p = .01). The overall mortality rate was 44.9% (641/1427) pre-intervention, and 42.2% (346/819) post-intervention (OR 0.90, 95% confidence interval (CI) 0.76-1.07; p = .23). Adjusting for clinically relevant factors, the intervention was not associated with a change in overall mortality (OR 1.39, 95% CI 0.91-2.12; p = .13), but was associated with a reduced likelihood of mortality in outborn infants compared to inborn infants (OR 0.57, 95% CI 0.36-0.92; p = .02). CONCLUSIONS: The first phase of the NEST quality improvement program was associated with a decrease in mortality in outborn infants admitted to the neonatal unit at HOSCO. Long-term assessment is expected to provide a more comprehensive evaluation of the program in a low-income setting.
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Mortalidade Infantil , Melhoria de Qualidade , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Hospitais , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Estudos RetrospectivosRESUMO
Rising air pollution levels in South Asia will have worldwide environmental consequences. Transport of pollutants from the densely populated regions of India, Pakistan, China, and Nepal to the Himalayas may lead to substantial radiative forcing in South Asia with potential effects on the monsoon circulation and, hence, on regional climate and hydrological cycles, as well as to dramatic impacts on glacier retreat. An improved description of particulate sources is needed to constrain the simulation of future regional climate changes. Here, the first evidence of very frequent new particle formation events occurring up to high altitudes is presented. A 16-month record of aerosol size distribution from the Nepal Climate Observatory at Pyramid (Nepal, 5,079 m above sea level), the highest atmospheric research station, is shown. Aerosol concentrations are driven by intense ultrafine particle events occurring on >35% of the days at the interface between clean tropospheric air and the more polluted air rising from the valleys. During a pilot study, we observed a significant increase of ion cluster concentrations with the onset of new particle formation events. The ion clusters rapidly grew to a 10-nm size within a few hours, confirming, thus, that in situ nucleation takes place up to high altitudes. The initiation of the new particle events coincides with the shift from free tropospheric downslope winds to thermal upslope winds from the valley in the morning hours. The new particle formation events represent a very significant additional source of particles possibly injected into the free troposphere by thermal winds.
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Poluentes Atmosféricos , Altitude , Íons , Nanopartículas , Aerossóis , Movimentos do Ar , Atmosfera , Nepal , Material ParticuladoRESUMO
BACKGROUND: In late preterm infants born in nontertiary hospitals, the occurrence of respiratory distress syndrome requires postnatal transport. This study aimed to investigate the impact of the timing of surfactant administration in late preterm infants needing postnatal transport. METHODS: This is a retrospective study evaluating surfactant administration in late preterm infants during emergency transports by the Eastern Veneto Neonatal Emergency Transport Service between January 2005 and December 2019. The outcome measures included short-term clinical complications, stabilization time, oxygen concentration, duration of mechanical ventilation and noninvasive respiratory support, length of hospital stay, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis. RESULTS: Surfactant was administered to 155/303 neonates (51.1%) at 3 different time points: at a referring hospital (50 neonates), when the transport team arrived (25 neonates), or at a referral hospital (80 neonates). Stabilization time was longer in neonates receiving surfactant by the transport team (adjusted mean difference 17 min, 95% confidence interval, 4-29 min; p = 0.01). Decrease in oxygen concentrations during the transport was larger in neonates receiving surfactant at a referring hospital (adjusted mean difference -11%, 95% confidence interval, -15 to -3%; p = 0.01). The other outcome measures were not statistically different according to the timing of surfactant administration. CONCLUSIONS: In late preterm infants with respiratory distress needing postnatal transfer, stabilization time was longer when the first surfactant was administered by the transport team, but such delay did not affect safety and clinical outcomes.
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Surfactantes Pulmonares , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Estudos Retrospectivos , TensoativosRESUMO
Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome.