Evaluation of an Intubation Readiness Score to Assess Neonatal Sedation before Intubation

Background: Premedication for neonatal intubation facilitates the procedure and reduces stress and physiological disturbances. However, no validated scoring system to assess the effect of premedication prior to intubation is available. Objective: To evaluate the usefulness of an Intubation Readiness Score (IRS) to assess the effect of premedication prior to intubation in newborn infants. Methods: Two-center prospective study in neonates who needed endotracheal intubation. Intubation was performed using a standardized procedure with propofol 1-2 mg/kg as premedication. The level of sedation was assessed with the IRS by evaluating the motor response to a firm stimulus (1 = spontaneous movement; 2 = movement on slight touch; 3 = movement on firm stimulus; 4 = no movement). Intubation was proceeded if an adequate effect, defined as an IRS of 3 or 4, was reached. IRS was compared to the quality of intubation measured with the Viby-Mogensen intubation score. Results: A total of 115 patients, with a median gestational age of 27.7 weeks (interquartile range 5.3) and a median birth weight of 1,005 g (interquartile range 940), were included. An adequate IRS was achieved in 105 patients, 89 (85%) of whom also had a good Viby-Mogensen intubation score and 16 (15%) had an inadequate Viby-Mogensen intubation score. The positive predictive value of the IRS was 85%. Conclusions: Preintubation sedation assessment using the IRS can adequately predict optimal conditions during intubation in the majority of neonates. We suggest using the IRS in routine clinical care. Further research combining the IRS with other parameters could further improve the predictability of adequate sedation during intubation

Diversity among Bi-ethnic students and differences in educational outcomes and social functioning

The number of bi-ethnic children is increasing. The focus of this study is on bi-ethnic students in the Netherlands with one parent with an ethnic majority background and one parent with an ethnic minority background. Most studies that have investigated educational outcomes and social functioning in school for bi-ethnic students have not focused on the diversity within this group. In this study, we described the demographic, social and cultural diversity among bi-ethnic students and examined whether, in particular, ethnic background and gender of the migrant parent were related to the educational outcomes and social functioning of bi-ethnic students. Data on a total of 653 sixth grade bi-ethnic students (age 11–12) in primary education of the national Dutch cohort study (COOL5−18) were used in this study. To analyse the relationship between the ethnic background and gender of the migrant parent and the educational outcomes and social functioning among bi-ethnic students, multivariate multilevel analyses were performed. The research findings indicate that bi-ethnic students differ demographically, socially and culturally in a manner dependent on ethnic background and gender of the migrant parent. We also found that the ethnic background and the gender of the migrant parent were related to cognitive outcomes, social-emotional functioning and citizenship competences. When trying to understand and support bi-ethnic students, we must consider the diversity among them

Pain coping strategies:neonatal intensive care unit survivors in adolescence

\u3cp\u3eBackground Data on long-term consequences of preterm birth on pain coping later in life are limited. Aim The aim of this study was to assess whether gestational age, birth weight and neonatal disease severity have an effect on the pain coping strategy in adolescents born preterm or with low birth weight. Study design Observational, longitudinal study. Subjects We analyzed data of 646 children aged 19 years, who were born at a gestational age < 32 weeks or with a birth weight < 1500 g in the year 1983 in the Netherlands. Outcome measures Participants were asked to complete a validated questionnaire that assesses pain coping strategies in eight subscales: information seeking, problem solving, seeking social support, positive self-statement, behavioral distraction, cognitive distraction, externalizing and internalizing. In total, 537 children also completed an IQ test. Results Out of the eight subscales, only behavioral distraction was used more often with increasing gestational age (linear regression analysis, b 0.05, confidence interval CI 0.02–0.08). Behavioral distraction was employed more often by small-for-gestational-age adolescents in comparison with their appropriate-for-gestational age peers (b 0.26, CI 0.09–0.42). However, this effect disappeared when adjusted for gestational age. Intelligence at the age of 19 was significantly correlated with increased use of adaptive strategies (problem solving, positive self-statement, behavioral and cognitive distraction) and less use of maladaptive strategies (internalizing). Conclusions Characteristics at birth and neonatal disease history did not influence pain coping strategy in adolescence. Intelligence, however, moderated pain coping strategy in adolescents born preterm or with low birth weight.\u3c/p\u3