The prediction of estimated cerebral perfusion pressure with trans-systolic time in preterm and term infants.

It is important to monitor cerebral perfusion in infants because hypo- and hyperperfusion can contribute to neurological injury. This study aimed to clarify the relationship between trans-systolic time (TST) and critical closing pressure (CrCP) or estimated cerebral perfusion pressure (CPPe) in neonates. Moreover, we aimed to determine the TST values in preterm and term infants with stable cerebral perfusion to clarify normative reference data. This multicentre prospective study included infants with arterial lines admitted to the neonatal intensive care units between December 2021 and August 2023. TST, CrCP, and CPPe were calculated using middle cerebral artery waveforms recorded using transcranial Doppler ultrasonography when clinicians collected arterial blood samples. Three hundred and sixty samples were obtained from 112 infants with a gestational age of 32 (interquartile range, 27-37) weeks and a birth weight of 1481 (956-2355) g. TST was positively correlated with CPPe (r = 0.60, p < 0.001), but not with CrCP (r = 0.08, p = 0.10). The normative reference values of TST in preterm and term infants without samples of hyper- or hypocapnia and/or hyper- or hypotension, which may affect cerebral perfusion, were as follows: ≤ 29 weeks, 0.12 (0.11-0.14) s; 30-36 weeks, 0.14 (0.12-0.15) s; and ≥ 37 weeks, 0.16 (0.14-0.17) s, respectively.  Conclusion: TST in neonates significantly correlated with CPPe, but not with CrCP. TST may be a good predictor of cerebral perfusion and potentially have wider clinical applications. What is Known: • Trans-systolic time (TST) is used in evaluating the effects of increased intracranial pressure on cerebral haemodynamics. However, little is known about the efficacy of TST in predicting neonatal cerebral perfusion pressure. What is New: • This study added evidence that TST correlated with estimated cerebral perfusion pressure, but not with critical closing pressure. Additionally, we showed the normative reference values of the TST in preterm and term infants.

Radiographic scores as a predictor of oxygenation index in very low-birthweight infants.

BACKGROUND: Very low birthweight infants (VLBWIs) often undergo chest radiographic examinations without standardization or objectivity. This study aimed to assess the association of two radiographic scores, the Brixia and radiographic assessment of lung edema (RALE), with oxygenation index (OI) in ventilated VLBWIs and to determine the optimal cutoff values to predict hypoxic respiratory severity. METHODS: VLBWIs who received invasive respiratory support with arterial lines between January 2010 and October 2023 were enrolled in this study (n = 144). The correlation between the Brixia or RALE scores and OI was investigated. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff points of the two radiographic scores for predicting OI values (OI ≥5, ≥10, and ≥15). RESULTS: The enrolled infants had a median gestational age of 27 weeks (interquartile range [IQR], 25-28 weeks) and a median birthweight of 855 g (IQR, 684-1003 g). Radiographic scoring methods correlated with the OI (Brixia score: r = 0.79, p < 0.001; RALE score: r = 0.72, p < 0.001). The optimal cutoff points for predicting OI values were as follows: Brixia score: OI ≥5, 10; OI ≥10, 13; OI ≥15, 15; RALE score: OI ≥5, 22; OI ≥10, 31; and OI ≥15, 40. CONCLUSIONS: Brixia and RALE scores are useful predictive markers of the oxygenation status in intubated VLBWIs with stable hemodynamics. These scores are easy to use and promising tools for clinicians to identify patients with a higher risk of hypoxic respiratory failure.

Central Hypercapnia in a Neonate With Parechovirus Infection.

Human parechovirus infections in newborns often affect the central nervous system. It is common in children after infancy for it to be a cause of the common cold or be asymptomatic, but an infection in infancy often causes a central nervous system infection. Herein, we present the case of a nine-day-old infant who developed hypercapnia without any involvement of respiratory lesions. She showed no hypoxia or circulatory abnormalities. A high-flow nasal cannula relieved hypercapnia and consequent respiratory acidosis, suggesting that the hypercapnia was due to central ventilation failure with central nervous system infection despite no abnormalities on brain magnetic resonance imaging. Accurate diagnosis and intervention of ventilatory failure, which is a central nervous system dysfunction, is important in hypercapnia associated with parechovirus infection.

Ventilated Infants Have Increased Dead Space and Lower Alveolar Tidal Volumes during the Early versus Recovery Phase of Respiratory Distress.

BACKGROUND: Few studies have reported the measurement of anatomical dead space (Vd,an) and alveolar tidal volume (VA) in ventilated neonates with respiratory distress. OBJECTIVE: The aim of this study was to determine the differences in Vd,an and VA in ventilated infants between the early and recovery phases of respiratory distress using volumetric -capnography (Vcap) based on ventilator graphics and capnograms. METHODS: This study enrolled twenty-five ventilated infants (mean birth weight, 2,220 ± 635 g; mean gestational age, 34.7 ± 3.3 weeks). We adjusted respiratory settings to maintain appropriate oxygenation and tidal volume (VT), and performed Vcap based on waveforms of ventilator graphics and capnograms. Vd,an and VAwere measured in infants with respiratory disorders, immediately after intubation (early phase) and subsequently when they were clinically stable (recovery phase). RESULTS: The early phase, with lower dynamic lung compliance, required a higher level of ventilator support, not positive end-expiratory pressure, than the recovery phase. There were significant differences between the early and recovery phases for Vd,an (mean difference in Vd,an/kg = 0.57 mL/kg; 95% confidence interval [CI], 0.38-0.77; mean difference in Vd,an/VT = 0.10; 95% CI, 0.07-0.14) and VA (mean difference in VA/kg = -0.60 mL/kg; 95% CI, -0.94 to -0.27; mean difference in VA/VT = -0.12; 95% CI, -0.15 to -0.09), despite no difference in VT. CONCLUSIONS: We evaluated changes in Vd,an and VA during mechanical ventilation using Vcap based on waveforms. The increase in Vd,an and decrease in VA suggested dilation of the airways and collapse of the alveoli in ventilated infants with low lung compliance.