Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants

La conciliazione fra tempi di vita, di lavoro e tempo per s\ue9

La nascita colora la vita \ue8 la declinazione forlivese del Percorso Nascita, un progetto che accompagna la donna, la coppia e poi il neonato, dalla gravidanza ai primi anni di vita del piccolo. Inserito nel Piano di zona distrettuale per la salute e il benessere sociale, connette la dimensione sanitaria con quella sociale, i servizi territoriali con quelli ospedalieri, ponendo particolare attenzione alla promozione, alla prevenzione ma anche alla tutela e alla cura nelle situazioni di rischio e vulnerabilit\ue0, sia sociali che sanitarie. L\u2019integrazione socio-sanitaria, l\u2019approccio multidisciplinare nella programmazione, realizzazione e valutazione, l\u2019attenzione alla funzione educativa sono elementi portanti, e indubbiamente innovativi, del progetto. Attorno a un\u2019esperienza gi\ue0 decennale, cuore di politiche e azioni rivolte alle donne, alla vita nascente e alle famiglie, si sviluppano poi azioni e riflessioni che si allargano verso la comunit\ue0. Nuovi temi quali la multiculturalit\ue0, la conciliazione fra tempi di vita e lavoro, il ruolo paterno, l\u2019interruzione volontaria di gravidanza, la promozione delle competenze genitoriali, il coinvolgimento di altri soggetti rappresentano i passi pi\uf9 recenti, oggi necessari quanto l\u2019analisi sulla sostenibilit\ue0 del percorso. Il testo presenta la descrizione degli interventi, i materiali e la metodologia di lavoro dei servizi, offrendo interessanti spunti per la trasferibilit\ue0 dell\u2019esperienza

Medicina and Noto VLBI Radiotelescopes: gravitational deformations evaluated with terrestrial laser scanning

The Medicina and Noto VLBI antennas are Az-El telescopes that experience gravitational deformations as they move in elevation. The ideal parabolic shape of the primary mirrors is therefore perturbed and the dishes are deformed according to the elevation pointing position of the antenna. Receivers at different frequencies, in particular the S/X geodetic receivers, are placed on the quadrupode, at the primary focus position; they also experience a displacement due to gravitational forces as the elevation changes. A third effect induced by gravity is the sag which might be possibly experienced by the dish as the elevation changes. The determination of the contribution and magnitude of all the different effects are of primary importance. The realization of an elevation dependent gravitational deformation model that can be implemented in the VLBI data analysis is our target; it would allow to quantify and correct any bias of gravitational origin which affects the observations. In order to face this complex task, terrestrial laser scanning and terrestrial observations have been applied to the antenna of Medicina and Noto. The VLBI dishes\u2019 movements in elevation prevent full visibility of the inner part of the parabola from the ground: ad hoc supports were therefore installed nearby the antenna secondary focus allowing a complete laser coverage of the inner dish surface at different elevations. The raw data acquired with the laser scanner intrinsically define clouds of points expressed with respect to an instrumental reference system; in order to connect the observed points to an external reference system, it is necessary to relatively align the different clouds using tie points and moreover ad hoc terrestrial surveys are required to frame the laser survey in to the external reference system. The surveys and their results will be presented, along with the data analysis procedure and the most recently estimated deformations

Radiotelescopi di Noto e Medicina: deformazioni gravitazionali valutate tramite un\u2019indagine laser terrestre

I radiotelescopi VLBI (Very Long Baseline Interferometry) subiscono delle deformazioni gravitazionali al variare della loro elevazione che tendono a modificare la posizione del punto di riferimento. Tale punto normalmente coincide, per i telescopi VLBI, con il \u201ctracking point\u201d ITRF utilizzato per la realizzazione dell\u2019ITRS (International Terrestrial Reference System). La determinazione delle deformazioni \ue8 pertanto di importanza primaria e, a tutt\u2019oggi, gli studi effettuati sull\u2019argomento ed i relativi metodi di indagine risultano essere scarsi. Per affrontare questa complessa problematica, si \ue8 applicata alle antenne di Noto e Medicina la metodologia del laser scanning terrestre. La scansione delle parabole \ue8 stata possibile ponendo il laser all\u2019interno della struttura, su due supporti stabili fissati in prossimit\ue0 del fuoco secondario. Tali supporti sono stati appositamente realizzati per questo rilievo. Non era possibile, infatti, utilizzare le alte piattaforme esterne, impiegate solitamente nei rilievi fotogrammetrici, a causa della loro instabilit\ue0. Il laser ad impulsi utilizzato per questa indagine possiede una risoluzione di circa 1,5 mm a 50m e ha permesso di ottenere nuvole di punti, rappresentanti le parabole scansionate, in un sistema di riferimento solidale allo strumento. Al fine di inserire le nuvole di punti acquisite dal laser in un sistema di riferimento topocentrico esterno sono stati utilizzati target sferici collegati a prismi retrodirettivi che sono stati osservati sia dal laser, sia tramite un rilievo terrestre eseguito con una coppia di total stations di alta precisione