Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: Report of five cases

Background: Despite an increased use of non-invasive ventilatory strategies and gentle ventilation, pneumothorax remains a common complication in preterm infants. The ventilator management of infants with air leaks remains challenging in terms of both prevention and treatment. Recently the safety and efficacy of expectant management avoiding chest tube drainage to treat large air leak in preterm infants hemodynamically stable has been reported. Case presentation: In the present study, we report five cases of preterm infants with birth weight \ue2\u89\ua4 1250 g affected by respiratory distress syndrome and treated with nasal continuous positive airway pressure as first intention. They were intubated for worsening of respiratory distress with increasing oxygen requirement and concomitant increase of respiratory rate and PCO2values due to occurrence of pneumothorax, and they were successfully treated using high-frequency oscillatory ventilation without chest tube insertion. Conclusion: In our experience high-frequency oscillatory ventilation provided a conservative management of a significant pneumothorax in preterm newborns hemodynamically stable and requiring mechanical ventilation. This approach allowed us to avoid the increasing of air leak and the insertion of chest tube drainage and all the subsequent associated risks

Supplementary Material for: “Mild’’ Hypoxic-Ischaemic Encephalopathy and Therapeutic Hypothermia: A Survey of Clinical Practice and Opinion from 35 Countries

Introduction: We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE). Methods: A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries. Results: A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p v HIC 26%, p v HIC 32%, p v HIC 40%, p v HIC 95%, p Conclusions: This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider “cooling” an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported

Brain development and perinatal vulnerability to cerebral damage

The recent exponential rise in detailed magnetic resonance (MR) imaging studies has emphasized the concept of gestationally determined regional vulnerability in the brain: the site and nature of the injury sustained being determined by a combination of the characteristics of the insult, the specific tissue and cell vulnerability and the gestation of the infant. The type of insult may also be partly dependent on gestation. However, it is now known that acute perinatal hypoxic ischemic events, previously considered characteristic for the term born neonate presenting with hypoxic-ischemic encephalopathy (HIE), may occur at earlier points in gestation [1, 2]. Nevertheless, such events occur less often in the infant born preterm where lesions develop in similar brain regions and in other areas characteristically more vulnerable in more premature babies (Fig. 127.1). Similarly, white matter (WM) lesions, which are considered the hallmark of injury to the preterm brain because they are characteristic of perinatal injury relating to inflammation, infection or hypoglycemia in the term brain, may also occur in a small percentage of neonates with an encephalopathy (Fig. 127.2) [3]