Investigating the Impact of Isolation During COVID-19 on Family Functioning – An Australian Snapshot

This study explored possible changes in family functioning from the perspective of parents during the COVID-19 pandemic. Thirty-four parents/guardians of children under 18 years completed a semi-structured interview, average length 47 min. Interviews focussed on changes in different aspects of family functioning including family roles, routines, and rules; parenting practices; communication and relationships; and strengths, challenges, and tensions. Data were analysed using reflexive thematic analysis applied in an idiographic and inductive manner to reduce the loss of individual experiences and perspectives. Four superordinate themes were identified: shifting family roles and boundaries throughout the pandemic; impacts on routines and relationships; opportunities and resourcing; and, experiences of support and unity. Gender differences were evident across some themes, particularly changing roles, workload and work-home boundaries. Challenges and tensions were frequently highlighted, particularly by “vulnerable” family groups such as those with children with disabilities. Parents also described a renewed sense of family and community that underpinned adaptive coping responses. The results highlight the importance of family connectedness in times of need

Initiation of resuscitation with high tidal volumes causes cerebral hemodynamic disturbance, brain inflammation and injury in preterm lambs

Aims: Preterm infants can be inadvertently exposed to high tidal volumes (VT) in the delivery room, causing lung inflammation and injury, but little is known about their effects on the brain. The aim of this study was to compare an initial 15 min of high VT resuscitation strategy to a less injurious resuscitation strategy on cerebral haemodynamics, inflammation and injury. Methods: Preterm lambs at 126 d gestation were surgically instrumented prior to receiving resuscitation with either: 1) High VT targeting 10-12 mL/kg for the first 15 min (n = 6) or 2) a protective resuscitation strategy (Prot VT), consisting of prophylactic surfactant, a 20 s sustained inflation and a lower initial VT (7 mL/kg; n = 6). Both groups were subsequently ventilated with a VT 7 mL/kg. Blood gases, arterial pressures and carotid blood flows were recorded. Cerebral blood volume and oxygenation were assessed using near infrared spectroscopy. The brain was collected for biochemical and histologic assessment of inflammation, injury, vascular extravasation, hemorrhage and oxidative injury. Unventilated controls (UVC; n = 6) were used for comparison. Results: High VT lambs had worse oxygenation and required greater ventilatory support than Prot VT lambs. High VT resulted in cerebral haemodynamic instability during the initial 15 min, adverse cerebral tissue oxygenation index and cerebral vasoparalysis. While both resuscitation strategies increased lung and brain inflammation and oxidative stress, High VT resuscitation significantly amplified the effect (p = 0.014 and p<0.001). Vascular extravasation was evident in the brains of 60% of High VT lambs, but not in UVC or Prot VT lambs. Conclusion: High VT resulted in greater cerebral haemodynamic instability, increased brain inflammation, oxidative stress and vascular extravasation than a Prot VT strategy. The initiation of resuscitation targeting Prot VT may reduce the severity of brain injury in preterm neonates. © 2012 Polglase et al

The partial pressure of arterial (Pa) carbon dioxide (CO₂; A), oxygen (O₂; B), oxygenation index (C) and the alveolar-arterial difference in oxygen (AaDO₂; D) in High V_T (open circles) and Prot V_T (cl

<p>*p&lt;0.05 High V_T vs. Prot V_T.</p

Assessment of brain injury.

<p>Incidence and severity of gross anatomical brain injury expressed as % of the lambs displaying evidence of mild or severe injury. *indicates significant difference between High V_T and UVC. ^#indicates significant difference between High V_T and Prot V_T.</p

Peak inspiratory pressure (A), tidal volume (B), dynamic compliance (C) and the fraction of inspired oxygen (FiO2; D) in High V_T (open circles) and Prot V_T (closed circles) lambs.

<p>*p&lt;0.05 High V_T vs. Prot V_T.</p

Lung pro-inflammatory mRNA cytokine expression of interleukin (IL)-1β, IL-6 and IL-8 in unventilated controls (open bars), Prot V_T (shaded bars) and High V_T (black bars) lambs.

<p>Values are expressed relative to UVC. Resuscitation, irrespective of the strategy, increased lung inflammation. *p&lt;0.05 vs UVC.</p