High Flow Nasal Cannulae versus Nasal Continuous Positive Airway Pressure in Neonates with Respiratory Distress Syndrome Managed with INSURE Method: A Randomized Clinical Trial.

BACKGROUND: In recent years, various noninvasive respiratory support (NRS) of ventilation has been provided more in neonates. The aim of this study was to compare the effect of HFNC with NCPAP in post-extubation of preterm infants with RDS after INSURE method (intubation, surfactant, extubation). METHODS: A total of 54 preterm infants with RDS (respiratory distress syndrome) were enrolled in this study. Using a randomized sequence, they were assigned into two groups after INSURE method. The first group received HFNC while the second group received NCPAP for respiratory support after extubation. A comparison was made between these two groups by the rate of reintubation, air leak syndrome, duration of oxygen therapy, hospitalization, the rate of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and mortality. Data were analyzed by using the SPSS version 18 software. The statistical analyses included Student's t-test for continuous data and compared proportions using Chi-squared test and Fisher's exact test for categorical data. RESULT: The rate of reintubation was higher in the HFNC compared with the NCPAP group. The rate of either IVH or ROP had no significant differences between the two groups. In addition, duration of oxygen requirement and hospitalization were not statistically different. There was no case of BPD or mortality among these patients. CONCLUSION: This study showed that preterm infants with RDS could manage post-extubation after INSURE method with either NCPAP or HFNC. However, in this single-center study, the rate of reintubation was higher in the HFNC group while further multicenter study might be assigned. Trial Registration Number: IRCT201201228800N1.

Intractable neonatal seizures: an unusual presentation of congenital hypothyroidism.

Congenital hypothyroidism is the most common treatable cause of mental retardation. We report an unusual case of congenital hypothyroidism presenting as intractable seizures in an infant delivered to a mother known to have autoimmune hypothyroidism and who was noncompliant with therapy. To our knowledge, this rare presentation of congenital hypothyroidism has not been reported previously.

Periodic breathing and oxygen saturation in preterm infants at discharge.

OBJECTIVE: Periodic breathing (PB) is a common respiratory pattern in preterm infants. Our aim was to determine the influence of PB on the pattern of oxygenation in preterm infants with significant PB at discharge from hospital. STUDY DESIGN: Overnight 12-hour recordings of arterial O(2) saturation (SpO(2)), impedance breathing movement, nasal thermistor signals for airflow, and heart rate were performed in all preterm infants < or = 34 weeks' gestational age at birth, prior to hospital discharge. Infants had recovered from their neonatal complications and were not receiving methylxanthines or supplemental oxygen. Data from 28 infants who had significant PB (> or = 5% of quiet time artifact free) were further analyzed. Gestational age at birth was (median, range) 32 (27-34) weeks, and gestational age at recording was 35 (33-37) weeks. RESULTS: The baseline SpO(2) was 98% (92-100%). During PB, all infants had episodes when SpO(2) fell > or = 5%, and all except one had episodes when SpO(2) was < 90%. Sixty episodes of prolonged desaturation (SpO(2) < or = 80% for >/ or = 4 seconds) were recorded in 10 infants: 31 occurred during PB, 16 during hypopnea, 10 during apnea, and 3 occurred in the absence of these breathing patterns. During PB, nine infants (32%) had 1 to 13 episodes of prolonged desaturation, lasting 9 (4-76) seconds. CONCLUSION: We conclude that PB is a common cause of prolonged desaturation in preterm infants at discharge.

Apparent life-threatening events in neonatal period: clinical manifestations and diagnostic challenges in a pediatric referral center.

OBJECTIVE: Apparent Life-Threatening Events (ALTEs) is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE in a year. METHODS: In this prospective observational study, all of the neonates with episode of ALTE who were admitted to the Children's Medical Center (CMC) in Tehran, from June 15(th) 2010 to May 14(th) 2011 were enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings were recorded in a checklist and all followed up 3 to 6 months after discharge. FINDINGS: During the study period 18 neonates were admitted due to ALTE episode(s) with mean age of 15±13 days. Nine (50%) neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in 12 (67%) and apnea in 8 (44%) patients. In 10 (56%) the event lasted less than one minute, 13 (72%) were awake, 17 (95%) in supine position and 13 (72%) on their parent's lap. Primary antagonistic impression on admission was sepsis in 11 (61%) and concomitant seizure in 5 (28%). The most common final diagnosis according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4 (22%) and aspiration 9 (50%). ALTE recurred in none of the neonates during follow up. CONCLUSION: The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE. Although most of these attacks regress spontaneously, more attention should be paid for the underlying diseases.

Effects of prenatal exposure to cigarette smoke on use of xanthine and pneumogram evaluation at discharge in premature infants.

OBJECTIVE: Prenatal exposure to cigarette smoke is associated with an increased risk of sudden infant death syndrome and possible rate increase of obstructive apnea in full-term infants but unknown in premature infants. Therefore, the objective was to study the effect of prenatal exposure to cigarette smoke on the use of methylxanthines and discharge pneumograms in premature infants. METHODS: Preterm infants [gestational age (GA) ≤34 weeks] born between January 1997 and September 2007 were studied. A four-channel pneumogram was performed at discharge. Relevant clinical data were collected from the infant's records. Infants with prenatal exposure to cigarette smoke were compared with infants not exposed (controls). RESULTS: A total of 1656 infants were studied: 263 infants {birth weight (BW) (mean ± SD) 1682 ± 566 g, GA 31.0 ± 2.8 weeks} exposed to prenatal cigarette smoke and 1393 infants (BW 1638 ± 575 g, GA 31.1 ± 2.7 weeks) not exposed. Baseline patient characteristics were similar between the two groups. When comparing the smoking versus control groups, there was no significant difference in the infants for the following: xanthine therapy and abnormal pneumograms; presence of central, obstructed or mixed apnea and home discharge on monitors, oxygen and xanthines. CONCLUSIONS: Prenatal exposure to cigarette smoke was not associated with increased use of xanthines or abnormal pneumogram in premature infants.