Improving neonatal resuscitation at birth : technique and devices

The transition after birth represents one of the greatest physiologic challenges that humans encounter. Preterm infants often need respiratory support after birth. Little effort has been made to determine the adequacy and efficacy of ventilation in the delivery room. The general aim of this thesis was to evaluate the adequacy and efficacy of neonatal resuscitation. This thesis comprises manikin studies and observational studies in the delivery room to evaluate and optimise current technique and the use of devices. Mask ventilation is difficult and mostly inefficient. It should be trained regularly with a focus on leak and airway obstruction. A respiratory function monitor is a useful device for feedback on mask technique during training and resuscitation in the delivery room. Spontaneous breathing, which is often missed, contributes to the stabilisation of infants after birth. When using a T-piece resuscitator a fixed gas flow rate is recommended. Caregivers often deviate from the guidelines and more time is needed for clinical evaluation of the infant. Future research and clinical practice should focus on training of optimal mask technique, establishing the efficacy of a respiratory function monitor in the delivery room, and the development of ventilation techniques that focus on the presence of breathing.Willem-Alexander Children’s Hospital of the Leiden University Medical Center, J.E. Jurriaanse Stichting, Fisher & Paykel Healthcare, Bronovo Hospital the Hague, Laerdal Benelux B.V., Regionale Ambulance Dienst Hollands-Midden, SectraUBL - phd migration 201

Severe Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children from Wild-type to Population Immunity: A Prospective Multicenter Cohort Study with Real-time Reporting

Background: SARS-CoV-2 variant evolution and increasing immunity altered the impact of pediatric SARS-CoV-2 infection. Public health decision-making relies on accurate and timely reporting of clinical data. Methods: This international hospital-based multicenter, prospective cohort study with real-time reporting was active from March 2020 to December 2022. We evaluated longitudinal incident rates and risk factors for disease severity. Results: We included 564 hospitalized children with acute COVID-19 (n = 375) or multisystem inflammatory syndrome in children (n = 189) from the Netherlands, Curaçao and Surinam. In COVID-19, 134/375 patients (36%) needed supplemental oxygen therapy and 35 (9.3%) required intensive care treatment. Age above 12 years and preexisting pulmonary conditions were predictors for severe COVID-19. During omicron, hospitalized children had milder disease. During population immunity, the incidence rate of pediatric COVID-19 infection declined for older children but was stable for children below 1 year. The incidence rate of multisystem inflammatory syndrome in children was highest during the delta wave and has decreased rapidly since omicron emerged. Real-time reporting of our data impacted national pediatric SARS-CoV-2 vaccination- and booster-policies. Conclusions: Our data supports the notion that similar to adults, prior immunity protects against severe sequelae of SARS-CoV-2 infections in children. Real-time reporting of accurate and high-quality data is feasible and impacts clinical and public health decision-making. The reporting framework of our consortium is readily accessible for future SARS-CoV-2 waves and other emerging infections

Improving neonatal resuscitation at birth : technique and devices

The transition after birth represents one of the greatest physiologic challenges that humans encounter. Preterm infants often need respiratory support after birth. Little effort has been made to determine the adequacy and efficacy of ventilation in the delivery room. The general aim of this thesis was to evaluate the adequacy and efficacy of neonatal resuscitation. This thesis comprises manikin studies and observational studies in the delivery room to evaluate and optimise current technique and the use of devices. Mask ventilation is difficult and mostly inefficient. It should be trained regularly with a focus on leak and airway obstruction. A respiratory function monitor is a useful device for feedback on mask technique during training and resuscitation in the delivery room. Spontaneous breathing, which is often missed, contributes to the stabilisation of infants after birth. When using a T-piece resuscitator a fixed gas flow rate is recommended. Caregivers often deviate from the guidelines and more time is needed for clinical evaluation of the infant. Future research and clinical practice should focus on training of optimal mask technique, establishing the efficacy of a respiratory function monitor in the delivery room, and the development of ventilation techniques that focus on the presence of breathing