Insulation effects of Icelandic dust and volcanic ash on snow and ice

In the Arctic region, Iceland is an important source of dust due to ash production from volcanic eruptions. In addition, dust is resuspended from the surface into the atmosphere as several dust storms occur each year. During volcanic eruptions and dust storms, material is deposited on the glaciers where it influences their energy balance. The effects of deposited volcanic ash on ice and snow melt were examined using laboratory and outdoor experiments. These experiments were made during the snow melt period using two different ash grain sizes (1 phi and 3.5 phi) from the Eyjafjallajokull 2010 eruption, collected on the glacier. Different amounts of ash were deposited on snow or ice, after which the snow properties and melt were measured. The results show that a thin ash layer increases the snow and ice melt but an ash layer exceeding a certain critical thickness caused insulation. Ash with 1 phi in grain size insulated the ice below at a thickness of 9-15 mm. For the 3.5 phi grain size, the insulation thickness is 13 mm. The maximum melt occurred at a thickness of 1 mm for the 1 phi and only 1-2 mm for 3.5 phi ash. A map of dust concentrations on Vatnajokull that represents the dust deposition during the summer of 2013 is presented with concentrations ranging from 0.2 up to 16.6 g m(-2).Peer reviewe

Repeat prenatal corticosteroid prior to preterm birth: a systematic review and individual participant data meta-analysis for the PRECISE study group

The aim of this individual participant data (IPD) meta-analysis is to assess whether the effects of repeat prenatal corticosteroid treatment given to women at risk of preterm birth to benefit their babies are modified in a clinically meaningful way by factors related to the women or the trial protocol. The Prenatal Repeat Corticosteroid International IPD Study Group: assessing the effects using the best level of Evidence (PRECISE) Group will conduct an IPD meta-analysis. The PRECISE International Collaborative Group was formed in 2010 and data collection commenced in 2011. Eleven trials with up to 5,000 women and 6,000 infants are eligible for the PRECISE IPD meta-analysis. The primary study outcomes for the infants will be serious neonatal outcome (defined by the PRECISE International IPD Study Group as one of death (foetal, neonatal or infant); severe respiratory disease; severe intraventricular haemorrhage (grade 3 and 4); chronic lung disease; necrotising enterocolitis; serious retinopathy of prematurity; and cystic periventricular leukomalacia); use of respiratory support (defined as mechanical ventilation or continuous positive airways pressure or other respiratory support); and birth weight (Z-scores). For the children, the primary study outcomes will be death or any neurological disability (however defined by trialists at childhood follow up and may include developmental delay or intellectual impairment (developmental quotient or intelligence quotient more than one standard deviation below the mean), cerebral palsy (abnormality of tone with motor dysfunction), blindness (for example, corrected visual acuity worse than 6/60 in the better eye) or deafness (for example, hearing loss requiring amplification or worse)). For the women, the primary outcome will be maternal sepsis (defined as chorioamnionitis; pyrexia after trial entry requiring the use of antibiotics; puerperal sepsis; intrapartum fever requiring the use of antibiotics; or postnatal pyrexia). Data analyses are expected to commence in 2011 with results publicly available in 2012

Effects of repeat prenatal corticosteroids given to women at risk of preterm birth: An individual participant data meta-analysis

BACKGROUND:Infants born preterm compared with infants born at term are at an increased risk of dying and of serious morbidities in early life, and those who survive have higher rates of neurological impairments. It remains unclear whether exposure to repeat courses of prenatal corticosteroids can reduce these risks. This individual participant data (IPD) meta-analysis (MA) assessed whether repeat prenatal corticosteroid treatment given to women at ongoing risk of preterm birth in order to benefit their infants is modified by participant or treatment factors. METHODS AND FINDINGS:Trials were eligible for inclusion if they randomised women considered at risk of preterm birth who had already received an initial, single course of prenatal corticosteroid seven or more days previously and in which corticosteroids were compared with either placebo or no placebo. The primary outcomes for the infants were serious outcome, use of respiratory support, and birth weight z-scores; for the children, they were death or any neurosensory disability; and for the women, maternal sepsis. Studies were identified using the Cochrane Pregnancy and Childbirth search strategy. Date of last search was 20 January 2015. IPD were sought from investigators with eligible trials. Risk of bias was assessed using criteria from the Cochrane Collaboration. IPD were analysed using a one-stage approach. Eleven trials, conducted between 2002 and 2010, were identified as eligible, with five trials being from the United States, two from Canada, and one each from Australia and New Zealand, Finland, India, and the United Kingdom. All 11 trials were included, with 4,857 women and 5,915 infants contributing data. The mean gestational age at trial entry for the trials was between 27.4 weeks and 30.2 weeks. There was no significant difference in the proportion of infants with a serious outcome (relative risk [RR] 0.92, 95% confidence interval [CI] 0.82 to 1.04, 5,893 infants, 11 trials, p = 0.33 for heterogeneity). There was a reduction in the use of respiratory support in infants exposed to repeat prenatal corticosteroids compared with infants not exposed (RR 0.91, 95% CI 0.85 to 0.97, 5,791 infants, 10 trials, p = 0.64 for heterogeneity). The number needed to treat (NNT) to benefit was 21 (95% CI 14 to 41) women/fetus to prevent one infant from needing respiratory support. Birth weight z-scores were lower in the repeat corticosteroid group (mean difference -0.12, 95%CI -0.18 to -0.06, 5,902 infants, 11 trials, p = 0.80 for heterogeneity). No statistically significant differences were seen for any of the primary outcomes for the child (death or any neurosensory disability) or for the woman (maternal sepsis). The treatment effect varied little by reason the woman was considered to be at risk of preterm birth, the number of fetuses in utero, the gestational age when first trial treatment course was given, or the time prior to birth that the last dose was given. Infants exposed to between 2-5 courses of repeat corticosteroids showed a reduction in both serious outcome and the use of respiratory support compared with infants exposed to only a single repeat course. However, increasing numbers of repeat courses of corticosteroids were associated with larger reductions in birth z-scores for weight, length, and head circumference. Not all trials could provide data for all of the prespecified subgroups, so this limited the power to detect differences because event rates are low for some important maternal, infant, and childhood outcomes. CONCLUSIONS:In this study, we found that repeat prenatal corticosteroids given to women at ongoing risk of preterm birth after an initial course reduced the likelihood of their infant needing respiratory support after birth and led to neonatal benefits. Body size measures at birth were lower in infants exposed to repeat prenatal corticosteroids. Our findings suggest that to provide clinical benefit with the least effect on growth, the number of repeat treatment courses should be limited to a maximum of three and the total dose to between 24 mg and 48 mg.Caroline A. Crowther, Philippa F. Middleton, Merryn Voysey, Lisa Askie, Sasha Zhang, Tanya K. Martlo

Corticosteroid treatment in the perinatal period:efficacy and safety of antenatal and neonatal corticosteroids in the prevention of acute and long-term morbidity and mortality in preterm infants

Abstract The aim of the study was to evaluate the efficacy and safety of antenatal and postnatal corticosteroids in the prevention for mortality and acute and long-term morbidity in preterm infants. Altogether 109 eligible preterm infants participated in a randomized, multi-center, double-blinded controlled trial studying the efficacy of early dexamethasone (DX) treatment. The infants received either four doses of DX or placebo. DX treatment did not have a detectable influence on survival without bronchopulmonary dysplasia (BPD), severe intracranial hemorrhage, or periventricular leukomalacia. In a meta-analysis of 15 trials, we found that early prolonged DX treatment (> 96 h, n = 1594 infants) decreased the risk of BPD (RR 0.72 95% CI 0.61–0.87), whereas early short DX course did not (n = 1069 infants). However, prolonged DX increased the risk of gastrointestinal (GI) complications (RR 1.59 95% CI 1.02–2.46). Fifty-one very preterm infants participated in a randomized placebo-controlled trial studying early hydrocortisone (HC) started before 36 hours of age and continued for 10 days. The basal and stimulated serum cortisol levels were measured before the intervention. The study was interrupted because of GI perforations in the HC group. HC decreased the risk of patent ductus arteriosus. HC-treated infants with serum cortisol concentrations above the median had a high risk of GI perforation. HC increased survival without BPD among infants with low endogenous cortisol levels. Altogether 45 surviving infants were enrolled in the follow-up of the early HC trial at 2 years of age. None of the study patients had died after discharge. There was no difference in the recorded rehospitalization rate, growth characteristics, or neurological development between HC and placebo-treated children. Altogether 249 women pregnant at less than 34.0 gestational weeks participated in a randomized trial studying the efficacy of a single additional dose of betamethasone (BM). All of the 159 infants in the BM group and 167 in the placebo group were born before 36 weeks of gestation. Intact survival was comparable between the BM and placebo groups, whereas the need for surfactant therapy in RDS was increased in the BM group. According to a post hoc analysis of 206 infants delivered within 1–24 hours, the BM booster tended to increase the risk of RDS and to decrease intact survival

National survey revealed variable practices in paediatric procedural sedation and patient monitoring

Abstract Paediatric procedures requiring sedation are increasingly being performed off site, but there are no national guidelines for paediatric procedural sedation in Finland or studies on it. Therefore, the aim of this survey was to assess national practices for paediatric procedural sedation outside operation rooms and intensive care units in terms of indications, sedative medication, treatment facilities, patient safety and training of the personnel. An online survey including single- and multiple-choice questions and open-ended questions was sent to Finnish paediatricians, paediatric surgeons and paediatric anaesthesiologists via the electronic mailing lists of national societies in December 2019. A total of 71 responses were received. Lumbar puncture (41%), intra-articular injections (38%) and MRI (17%) were the most common procedures that required routine sedation. Benzodiazepines were the most frequently used sedatives during both painful procedures (80%) and imaging (61%). Pulse oximetry monitoring was reported by 75% of the respondents, but other physiological parameters were rarely monitored (ECG 28%; blood pressure 39%; respiratory rate 34%). The level of sedation was not objectively assessed. Adrenaline (72%) and equipment for managing adverse respiratory outcomes (supplemental oxygen 98%; ventilation equipment 92%) were available in most facilities in which sedation was performed. Only one-third of the respondents had undergone training for paediatric procedural sedation, and only 39% of the hospital units compiled statistical data on sedation-related adverse events. The paediatric procedural sedation practices vary across hospitals. National guidelines for patient monitoring and training of personnel could improve treatment quality and patient safety

Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

Abstract Aim: This systematic review and meta‐analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room. Methods: Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure. Results: We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives. Conclusion: Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures

Miten hoidamme vastasyntyneen kipua?

Tiivistelmä Sikiön kipujärjestelmä kehittyy 20 raskausviikkoon mennessä, joten jo pienimmät ja epäkypsimmät keskoset aistivat kipua. Hoitamaton kipu heikentää älyllisten ja liikunnallisten taitojen kehittymistä. Kivun hoidossa oleellista on sitä aiheuttavan syyn tunnistaminen ja sen poistaminen. Kivun voimakkuuden arvioimisessa käytetään menetelmiä, joilla vastasyntyneen käyttäytymistä ja fysiologisia vasteita tarkkailemalla saadaan arvio kivun vaikeudesta ja pystytään reagoimaan siihen tarvittavalla tavalla välttäen ylihoitoa. Lääkkeettömät keinot ovat hoidon perusta. Niitä tehostetaan tarvittaessa miedoilla kipulääkkeillä, erityisesti parasetamolilla. Tulehduskipulääkkeet eivät sovi vastasyntyneen kivunhoitoon. Voimakkaammassa ja toimenpidekivussa opioidit, morfiini ja fentanyyli ovat vaihtoehtoja. Deksmedetomidiini on uusi kipua hoitava ja rauhoittava lääke vastasyntyneiden hoidossa. Seuraava tavoite on korkeatasoinen, näyttöön perustuva vastasyntyneiden kivunhoitosuositus

Effect of Prophylaxis for Early Adrenal Insufficiency Using Low-Dose Hydrocortisone in Very Preterm Infants: An Individual Patient Data Meta-Analysis.

OBJECTIVE: To assess the effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone on survival without bronchopulmonary dysplasia (BPD) in very preterm infants using an individual patient data meta-analysis. STUDY DESIGN: All existing randomized controlled trials testing the efficacy of the prophylaxis of early adrenal insufficiency using low-dose hydrocortisone on survival without BPD were considered for inclusion when data were available. The primary outcome was the binary variable survival without BPD at 36 weeks of postmenstrual age. RESULTS: Among 5 eligible studies, 4 randomized controlled trials had individual patient data available (96% of participants identified; n = 982). Early low-dose hydrocortisone treatment for 10-15 days was associated with a significant increase in survival without BPD (OR, 1.45; 95% CI, 1.11-1.90; P = .007; I CONCLUSIONS: This individual patient data meta-analysis showed that early low-dose hydrocortisone therapy is beneficial for survival without BPD in very preterm infants