The use of cardiotonic drugs in neonates

There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU

Resuscitation of term and near-term newborns in low-resourced settings : Studies of positive end-expiratory pressure and expired CO2 during bag-mask ventilation at birth

Background: An estimated 0.7 million newborns die due to perinatal asphyxia each year, most are born at or near term. The major burden of preventable newborn deaths occur in low-resourced settings. A self-inflating bag is the most used and available equipment to save newborn lives globally. To aerate the lungs is key to survival. Expired CO2 (ECO2) may be an indicator for lung aeration, and positive end-expiratory pressure (PEEP) may facilitate aeration of the lungs. Research aiming to improve ventilation in term and near-term newborns using a self-inflating bag is needed. Aims: To investigate interpretation of ECO2 measured during bag-mask ventilation in the immediate newborn period, and assess whether this can be used as a marker for lung aeration, effective ventilation technique and prognosis. To study the effects of PEEP during bag-mask ventilation at or near term. Methods: Two observational studies and one randomized clinical trial were performed at Haydom Lutheran Hospital in Tanzania. Data were collected using direct observation, side-stream CO2-monitoring, respiratory function monitoring and dry-electrode ECG. In the randomized trial, newborns in need of ventilation were assigned in blocks based on weeks to receive ventilations by self-inflating bag with or without a PEEP-valve. Results: ECO2 during bag-mask ventilation at birth was significantly associated with both ventilation factors and clinical factors. Tidal volumes of 10-14 ml/kg and a low ventilation frequency of around 30 inflations/minute were associated with the fastest rise and highest levels of ECO2. ECO2 increased before heart rate, and measured levels of ECO2 during resuscitation could, similar to heart rate, predict 24-hours survival. Adding a PEEP-valve to the self-inflating bag did not improve heart rate, ECO2 or outcomes in term and near-term newborns despite delivery of an adequate PEEP. Conclusions: ECO2 may be seen as a combined marker for lung aeration, airway patency and pulmonary circulation at birth. Tidal volumes of 10-14 ml/kg and ventilation frequencies of around 30 inflations/minute may be favorable to achieve a fast lung aeration. We found no clinical benefit of adding a PEEP-valve during bag-mask ventilation at birth in term and near-term newborns, and our study does not support routine use

Congenital TrainHeart: development of a fully 3D printed simulator for hands-on surgical training

RIASSUNTO Introduzione: Con la crescente aspettativa di un perfetto outcome per i pazienti sottoposti a interventi di cardiochirurgia, risulta fondamentale sviluppare e utilizzare nuove modalità per la formazione dei giovani chirurghi. Tuttavia, ad oggi, l’organizzazione di corsi di simulazione risulta dispendioso sia in termini di risorse economiche che di personale. Proprio per questo, il crescente interesse collettivo verso la stampa 3D ha permesso di sviluppare nuove tecnologie che possono essere efficacemente utilizzate nell’ambito della simulazione cardiochirurgica. Obiettivo dello studio: Questa tesi descrive lo sviluppo di un simulatore a basso costo stampato in 3D che può essere utilizzato sia nell’ambito delle cardiopatie congenite che di quelle acquisite Materiali e metodi: Il simulatore è stato sviluppato in modo tale da simulare posizione, visuale ed esposizione del cuore all’interno del torace in diversi approcci chirurgici. Tutte le componenti del simulatore sono state progettate tramite un software di modellazione 3D e stampati con stampante 3D a stereolitografia. I modellini da inserire all’interno dello stesso simulatore sono stati a loro volta sviluppati o tramite l’utilizzo dello stesso software o sfruttando tecniche di ricostruzione 3D a partenza da immagini TC o RMN. Risultati: Il simulatore si compone di una struttura che simula la cavità toracica con una apertura ellittica nella parte superiore atta a simulare una sternotomia mediana. Il simulatore può essere fissato ad un treppiede permettendo aggiustamenti per quanto concerne l’altezza, nonché movimenti di inclinazione e rotazione. In aggiunta, sono state realizzate quattro cover che permettono di modificare l’apertura sulla parte superiore del simulatore, al fine di simulare accessi di tipo mininvasivo. I modellini sono stati invece stampati con una resina elastica che, date le sue caratteristiche, può essere tagliata e suturata. Conclusioni: Il nuovo simulatore stampabile in 3D che è stato sviluppato potrebbe rappresentare uno strumento estremamente valido per le simulazioni cardiochirurgiche ad alta fedeltà e per il planning personalizzato di una procedura.Background: With the growing expectation of a perfect outcome for patients undergoing cardiac surgery, it is now imperative to find alternative surgical training methods for residents and fellows. However, surgical simulation usually requires a fair amount of funds and manpower to establish a reliable program. For this reason, the increasing interest in the 3D printing field allowed the development of new technologies that found immediate application in surgical simulation. Aim of the study: This thesis illustrates the development of a low-cost 3D printed simulator for congenital and acquired cardiac surgery. Materials and methods: A simulator was designed to replicate position, view, and exposure of the heart within the chest wall using different approaches (median sternotomy, mini-sternotomy, subaxillary, and posterior mini-thoracotomy). All components were designed using a 3D modeling software and printed using a stereolithography 3D printer. All models that come with the simulator were designed using the same CAD software used for the chest simulator or using 3D reconstruction software for CT or MRI scans. Results: The simulator consists of a chest wall cavity with an oval opening on the top simulating a median sternotomy. The simulator can be attached to a tripod, allowing for height adjustments and pitch-and-roll movements. In addition, five different covers were designed to modify the opening, thus allowing to replicate minimally-invasive surgical approaches. The fully printed design made it possible to significantly reduce the cost of the entire product. All models are printed with a special elastic resin which makes it possible to cut and suture all structures. Conclusion: A novel low-cost fully 3D printed simulator was developed. This may represent a valid tool for high fidelity simulation programs in congenital and acquired cardiac surgery in addition to a patient-specific surgical planning

The role of simulation in neonatal and pediatric training and research

From a pediatric perspective, the two main types of simulation-based research are: studies that assess the efficacy of simulation as a training methodology and studies where simulation is used as an investigative methodology. Aim of the study. Overall, the aim of the research activity is to inquire the use of simulation as investigative methodology in pediatric and neonatal settings. Study design: Previously, we investigated the current use of simulation in pediatric fellowships in Italy in order to understand the state of the art and the expectations of pediatric residents with regard to simulationbased training and research. Furthermore, we developed suitable simulated scenarios for pediatric training and research. As second step, we evaluated technical (TS) and non-technical (NTS) skills in a sample of Italian pediatric residents using a neonatal resuscitation scenario; Finally, we aimed to evaluate the accuracy of NeoTapAS in reliably determining HR from auscultation in a high-fidelity simulated newborn resuscitation scenario. Results and future perspectives: Firstly, we highlighted that an extremely high percentage of pediatric italian residents spent less than 5 hours/year in simulation-based education. Secondly, the mean compliance to last ILCOR recommendations about neonatal resuscitation was 59 % and a very low compliance (< 30%) was observed for a number of important technical items. Finally, NeoTapAS showed a good accuracy in estimating HR and it could be an important resource for neonatologists in delivery room resuscitation As future perspective, we designed a new simulation-based multi-center research (\u201cSimarrest \u201d) in collaboration with University of Padua in order to identify gaps about in-hospital pediatric cardiac arrest management in a standardized setting

Polish recommendations for diagnosis and therapy of paediatric stroke

Stroke remains one of the greatest health challenges worldwide, due to a high mortality rate and, despite great progress in its treatment, the significant disability that it causes. Studies conducted around the world show that the diagnosis of stroke in children is often significantly delayed. Paediatric ischaemic arterial stroke (PAIS) is not only a problem that varies greatly in frequency compared to the adult population, it is also completely different in terms of its risk factors, clinical course and outcome. The main reason for the lack of a rapid diagnosis of PAIS is a lack of access to neuroimaging under general anaesthesia. The insufficient knowledge regarding PAIS in society as a whole is also of great importance. Parents and carers of children should always bear in mind that paediatric age is not a factor that excludes a diagnosis of stroke. The aim of this article was to develop recommendations for the management of children with acute neurological symptoms suspected of ischaemic stroke and further treatment after confirmation of the ischaemic aetiology of the problem. These recommendations are based on current global recommendations for the management of children with stroke, but our goal was also to match them as closely as possible to the needs and technical diagnostic and therapeutic possibilities encountered in Poland. Due to the multifactorial problem of stroke in children, not only paediatric neurologists but also a neurologist, a paediatric cardiologist, a paediatric haematologist and a radiologist took part in the preparation of these recommendations

Clinical Application of Three-dimensional Printing and Extended Reality in Congenital Heart Disease

This PhD study investigates the clinical role of the two emerging techniques, which are 3D printing and virtual reality, to improve the visualisation and surgical planning of congenital heart disease. This research findings show that both of these technologies can enhance the users’ perception on the spatial relationship of the heart structures and defects, and therefore improving the management of congenital heart disease

UWOMJ Volume 83, No 1, Winter 2014

Schulich School of Medicine & Dentistry Rural and Remote Medicine Cover of issue reads Winter 2014 - Inside Table of Contents page reads Spring 2014https://ir.lib.uwo.ca/uwomj/1067/thumbnail.jp

Simulation in neonatal resuscitation

Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a "New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment." This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy "used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner." Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term "Train to win" is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially "game day." In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we "train to win.