Non-invasive forced oscillometry to quantify respiratory mechanics in term neonates.

BACKGROUND: To determine normative data by forced oscillation technique (FOT) in non-sedated normal term neonates and test the hypothesis that infants with transient tachypnea of the newborn (TTN) have higher resistance (R) and lower reactance (X) on day 1. METHODS: Healthy term infants (n = 138) and infants with TTN (n = 17) were evaluated on postnatal days 1 through 3 (NCT03346343). FOT was measured with a mask using a TremoFlo C-100 Airwave System™. R, X, and area under the reactance curve (AX) were measured at prime frequencies 7-41 Hz for 8 s. RESULTS: In all, 86% of control infants had adequate measurements (coherence >0.8, CV < 0.25) on day 1. Infants with TTN had higher resistance at 13 Hz (TTN 32.5 cm H2O·s/L [95% CI 25.5-39.4]; controls 23.8 cm H2O·s/L [95% CI 22.2 to 25.3], P = 0.007) and lower reactance from 17 to 37 Hz (TTN -35.1 to -10.5; controls -26.3 to -6.1, P < 0.05). In healthy controls, lung mechanics were unchanged from days 1 to 3. In TTN, lung mechanics normalized on days 2 and 3. CONCLUSIONS: FOT is feasible in neonates and distinguishes normal control infants from those with TTN on postnatal day 1. Oscillometry offers a non-invasive, longitudinal technique to assess lung mechanics in newborns.

Contribution of food additives to sodium and phosphorus content of diets rich in processed foods.

OBJECTIVE: Phosphorus-based food additives increase the total phosphorus content of processed foods. However, the extent to which these additives augment total phosphorus intake per day is unclear. DESIGN AND METHODS: To examine the contribution of phosphorus-based food additives to the total phosphorus content of processed foods, separate 4-day menus for a low-additive and additive-enhanced diet were developed using Nutrition Data System for Research (NDSR) software. The low-additive diet was designed to conform to U.S. Department of Agriculture guidelines for energy and phosphorus intake (∼2,000 kcal/day and 900 mg of phosphorus per day), and it contained minimally processed foods. The additive-enhanced diet contained the same food items as the low-additive diet except that highly processed foods were substituted for minimally processed foods. Food items from both diets were collected, blended, and sent for measurement of energy and nutrient intake. RESULTS: The low-additive and additive-enhanced diet provided approximately 2,200 kcal, 700 mg of calcium, and 3,000 mg of potassium per day on average. Measured sodium and phosphorus content standardized per 100 mg of food was higher each day of the additive-enhanced diet as compared with the low-additive diet. When averaged over the 4 menu days, the measured phosphorus and sodium contents of the additive-enhanced diet were 606 ± 125 and 1,329 ± 642 mg higher than the low-additive diet, respectively, representing a 60% increase in total phosphorus and sodium content on average. When comparing the measured values of the additive-enhanced diet to NDSR-estimated values, there were no statistically significant differences in measured versus estimated phosphorus contents. CONCLUSION: Phosphorus and sodium additives in processed foods can substantially augment phosphorus and sodium intake, even in relatively healthy diets. Current dietary software may provide reasonable estimates of the phosphorus content in processed foods.

Prevention of severe brain injury in very preterm neonates: A quality improvement initiative.

OBJECTIVE: To determine the impact of neuroprotection interventions bundle on the incidence of severe brain injury or early death (intraventricular hemorrhage grade 3/4 or death by 7 days or ventriculomegaly or cystic periventricular leukomalacia on 1-month head ultrasound, primary composite outcome) in very preterm (270/7 to ≤ 296/7 weeks gestational age) infants. STUDY DESIGN: Prospective quality improvement initiative, from April 2017-September 2019, with neuroprotection interventions bundle including cerebral NIRS, TcCO2, and HeRO monitoring-based management algorithm, indomethacin prophylaxis, protocolized bicarbonate and inotropes use, noise reduction, and neutral positioning. RESULT: There was a decrease in the incidence of the primary composite outcome in the intervention period on unadjusted (N = 11/99, pre-intervention to N = 0/127, intervention period, p < 0.001) and adjusted analysis (adjusted for birthweight and Apgar score <5 at 5 min, aOR = 0.042, 95% CI = 0.003-0.670, p = 0.024). CONCLUSIONS: Neuroprotection interventions bundle was associated with significant decrease in severe brain injury or early death in very preterm infants.