Benefits Of Caffeine: Birth Weigth Over 1250 g Infants With Respiratuar Distress

INTRODUCTION: Prophylactic caffeine therapy, reduces the frequency of apnea in premature babies. Moreover, its effect has been well established in reducing the intermittent hypoxemia, and the need for additional ventilator support of infants with a birthweight of <1.250 g. The aim of this study is to determine the effects of prophylactic caffeine use on neonatal outcomes in preterm babies with a birthweight of >1.250 g and respiratory distress. METHODS: Sixty-eight infants with birthweight of 1.250 to 2.000 g with respiratory distress and born at 32-34 GA and intubated with the indication of respiratory distress who also needed nasal ventilation for at least 48 hours were included in this prospective randomized controlled study, starting from birth one group received prophylactic caffeine citrate at loading dose of 20 mg/kg, and maintenance dose of 5 mg/kg in addition to respiratory support, long term neurological and developmental outcomes were recorded with Bayley-II. RESULTS: There was no difference in weight or gestational age at birth between the groups. Also, the groups were smilar in respiratory states. The caffeine group, was associated with a significant reduction in intubation requirement within the first 72 hr and shorter duration of mechanical and nasal ventilation, while there was no difference between the groups in total duration of oxygen therapy, and frequency of apneic episodes (respectively p=0.03, p=0.00, p=0.02, p>0.05). Any differences were not detected in terms of prematurity morbidities (p>0.05). Any significant intergroup differences were not detected as for PDA, NEC, IVC, laser-requiring ROP, and BPD (p>0.05). While the study was continuing regarding long-term neurodevelopmental outcomes Bayley neurodevelopmental tests were applied to 15 infants in the caffeine and 18 infants in the caffeine group at 12. and 18. months, and test results were csimilar in both groups (p>0.05). DISCUSSION AND CONCLUSION: The prophylactic use of caffeine in older preterm babies with respiratory distress, have short term benefits as lesser requirement for ntubation within the first 72 hours and decreased duration of ventilatory support without any advers side effects. Therefore if symptoms of respiratory distress are seen in preterm babies with a birthweight of >1.250 g, then initiation of prophylactic treatment may be considered. Larger scale randomized kontrollü studies are needed regarding this issue

Effects of a closed system suction connector on airway resistance in ventilated neonates

Background/aim: Increased airway resistance reduces the effectiveness of ventilation treatment. Endotracheal tubes (ETTs) and connectors contribute to resistance. However, the effect of a closed system suction (CSS) connector is not well known. We compared the in vivo resistance occurring with a CSS connector with that of the standard connector. Materials and methods: This prospective study was conducted at Gazi University Hospital's neonatal intensive care unit. Intubated neonates were studied for two cycles; each cycle contained two periods of ETT + connector pairs (15 min/period) as follows: cycle 1 {[}A: long ETT + standard connector; B: long ETT + CSS connector] and cycle 2 {[}C: shortened ETT + standard connector; D: shortened ETT + CSS connector]. Resistance of 40 breaths/period was averaged for each case, and the means were analyzed by Wilcoxon test for pairwise comparisons between standard and CSS connectors. As each case provided two cycle data, 16 cycle data were compared. Results: The CSS connector increased resistance by 13.8\% (range: 3.0\%-22.1\%) compared to the standard connector; P < 0.001. The resistance increase was similar between long {[}17.3\% (range: 3.0\%-17.7\%)] and shortened ETTs {[}15.3\% (range: 5.0\%-29.6\%)]; P = 0.834. Conclusion: CSS connectors were found to increase airway resistance in ventilated neonates. The contribution of CSS should be considered during ventilation, particularly in the presence of difficulty in providing sufficient tidal volume

Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.

Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants

Perfusion index assessment during transition period of newborns: an observational study.

Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as "delayed transition", others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN

Perfusion index assessment during transition period of newborns: an observational study

Background: Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as ``delayed transition{''}, others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN. Methods: Neonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN. Results: Forty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature. Conclusion: PI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition

Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants

BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV +VG and PSV+ VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. METHODS: Preterm infants who were born in our hospital between 24-32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV + VG or PSV + VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. RESULTS: The study enrolled 42 subjects. Clinical data were similar between groups. PSV +VG delivered closer tidal volumes to set tidal volumes (60\% vs 49\%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV + VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-1 beta in the tracheal aspirates increased during both modes. CONCLUSION: PSV + VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV + VG. Therefore, PSV + VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome