Intensivtransport Neugeborener mit respiratorischem Versagen

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Hintergrund und Ziel der Studie</jats:title> <jats:p>Der Transport von Früh und Neugeborenen mit respiratorischem Versagen ist mit einem hohen Transportrisiko assoziiert und stellt höchste Anforderungen an medizinisches Personal und technische Ausrüstung. Eine kontinuierliche Überprüfung der Qualität ist daher unumgänglich. Ziel dieser monozentrischen retrospektiven Analyse ist es, die Mortalität transportierter Neugeborener mit respiratorischem Versagen mithilfe eines Outcomescores, Transport Risk index of Physiologic Stability, Version II, (TRIPS-II-Score) und im Vergleich zu bereits publizierter Literatur zu analysieren.</jats:p> </jats:sec><jats:sec> <jats:title>Methodik</jats:title> <jats:p>Es wurden 79 Intensivtransporte von Früh- und Neugeborenen mit hochgradigem respiratorischem Versagen retrospektiv analysiert. Zur Einschätzung des Transportrisikos und der Transportqualität wurde der TRIPS-II-Score erhoben und mit der Literatur verglichen.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnisse</jats:title> <jats:p>Insgesamt wurden 77 Patienten luft- (<jats:italic>n</jats:italic> = 56, 73 %) oder bodengebunden (<jats:italic>n</jats:italic> = 21, 27 %) transportiert. Zwei Patienten verstarben vor dem Transport. Kein Patient verstarb während des Transports. Alle Patienten mussten invasiv beatmet werden, davon 22 (29 %) mit Hochfrequenzoszillation (HFOV) und 55 (71 %) erhielten inhalatives Stickoxid (iNO). Der mittlere Oxygenierungsindex (OI) betrug 33 [4-100, min.-max.] Insgesamt mussten 24 Patienten (31 %) nach Aufnahme einer ECMO-Therapie unterzogen werden. Insgesamt verstarben 20 (26 %) Neugeborene, 7 davon in der ECMO-Therapie-Gruppe.</jats:p> </jats:sec><jats:sec> <jats:title>Schlussfolgerung</jats:title> <jats:p>Transporte von Neugeborenen mit schwerem Lungenversagen können durch den Einsatz eines spezialisierten Teams mit Sonderequipment meist komplikationslos durchgeführt werden. Die scheinbar sehr hohe Mortalität ist mit Daten der internationalen Literatur vergleichbar.</jats:p> </jats:sec&gt

Increase of Parkin and ATG5 plasmatic levels following perinatal hypoxic‐ischemic encephalopathy

Brain injury at birth is an important cause of neurological and behavioral disorders. Hypoxic‐ischemic encephalopathy (HIE) is a critical cerebral event occurring acutely or chronically at birth with high mortality and morbidity in newborns. Therapeutic strategies for the prevention of brain damage are still unknown, and the only medical intervention for newborns with moderate‐to‐severe HIE is therapeutic hypothermia (TH). Although the neurological outcome depends on the severity of the initial insult, emerging evidence suggests that infants with mild HIE who are not treated with TH have an increased risk for neurodevelopmental impairment; in the current clinical setting, there are no specific or validated biomarkers that can be used to both correlate the severity of the hypoxic insult at birth and monitor the trend in the insult over time. The aim of this work was to examine the presence of autophagic and mitophagic proteins in bodily fluids, to increase knowledge of what, early at birth, can inform therapeutic strategies in the first hours of life. This is a prospective multicentric study carried out from April 2019 to April 2020 in eight third‐level neonatal intensive care units. All participants have been subjected to the plasma levels quantification of both Parkin (a protein involved in mitophagy) and ATG5 (involved in autophagy). These findings show that Parkin and ATG5 levels are related to hypoxic‐ischemic insult and are reliable also at birth. These observations suggest a great potential diagnostic value for Parkin evaluation in the first 6 h of life

Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: Study protocol for a randomized controlled trial

Background: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. Methods/design: In this study, 206 spontaneously breathing infants born at 24+0-27+6 weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. Discussion: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. Trial registration: ClinicalTrials.gov identifier: NCT02482766. Registered on 1 June 2015

Neonatal ethics in ELBW

The delivery of extremely low gestational age newborns and extremely low birth weight infants presents challenging ethical issues for caregivers and parents. Major concerns regard the high mortality and morbidity resulting in long term sequelae, the limit of viability as well as the conflict and difficulty in judgement involving “quality of life” and “sanctity of life” issues. Other paramount ethical concepts include the newborn’s best interest, the decision to initiate or withhold treatment at birth and the decision to withdraw treatment with the consequence that the infant will die. On the basis of the ethical principles of beneficence, autonomy, justice and nonmaleficence we will discuss the best interest standards, the standard for the decision making process and treatment decisions, which should always be governed by the prospect for the individual infant. In this paper we propose that ethical questions should not be regulated by law and the legal system should not interfere in the patient-physician relationship. Continuous improvement in medicine over the last decades led to increased treatment possibilities, which on the other hand also resulted in more ethical dilemmas. Therefore, today more than ever, it is essential that the neonatologist becomes familiar with basic ethical concepts and their application to clinical reality.   Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgio

Transport of the high-risk neonate

Photograph used for a story in the Daily Oklahoman newspaper. Caption: "A report of fresh leopard tracks created this jam at Britton bridge a mile east of N Easter. Below is a closer view.

Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study

none6Healthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission.noneCavallin, Francesco; Lupi, Fiorenzo; Bua, Benedetta; Bellutti, Marion; Staffler, Alex; Trevisanuto, DanieleCavallin, Francesco; Lupi, Fiorenzo; Bua, Benedetta; Bellutti, Marion; Staffler, Alex; Trevisanuto, Daniel

Decision making and situational awareness in neonatal resuscitation in low resource settings

Introduction: Data on non-technical skills (i.e. task management, team working, situation awareness and decision-making) of healthcare providers during real-life newborn resuscitation in low-resource settings are lacking. We aimed to assess non-technical skills of trained midwives during real-life newborn resuscitation in a low-resource setting before and after participation in a modified NRP course, and after a low-dose/high-frequency training. Methods: One-hundred and fifty video-recorded resuscitations (50 before and 50 after participation in a modified NRP course, and 50 after a low-dose/high-frequency training) collected at the Beira Central Hospital (Mozambique) were independently viewed and rated by two neonatologists with expertise in high fidelity simulation. Non-technical skills regarding task management, situation awareness and decision-making were evaluated using the modified Anesthetists' Non-Technical Skills tool. Results: Overall, most non-technical skills were scored as poor or marginal. Small improvements were observed in task management (planning and preparing p = 0.02; providing/maintaining standards p = 0.03) after the course. Limited improvements were observed in task management (prioritizing p = 0.03; providing/maintaining standards p = 0.04; identifying and utilizing resources p = 0.02) and decision-making (identifying options p = 0.04; balancing risk/selecting options p = 0.02) after the low-dose/high-frequency training. No differences were observed in situation awareness, apart from a small improvement in recognizing/understanding (p = 0.04) after the low-dose/high-frequency training. Conclusion: An educational intervention including a modified NRP course and a low-dose/high-frequency training on neonatal resuscitation had a limited impact on non-technical skills of participants. All items remained significantly under the recommended standards. Behavioral skills should be considered in training programs in order to improve the quality of neonatal resuscitation in low resource settings

Recommendations of the Netzwerk Kindersimulation for the Implementation of Simulation-Based Pediatric Team Trainings: A Delphi Process

Background: Serious or life-threatening pediatric emergencies are rare. Patient outcomes largely depend on excellent teamwork and require regular simulation-based team training. Recommendations for pediatric simulation-based education are scarce. We aimed to develop evidence-based guidelines to inform simulation educators and healthcare stakeholders. Methods: A modified three-round Delphi technique was used. The first guideline draft was formed through expert discussion and based on consensus (n = 10 Netzwerk Kindersimulation panelists). Delphi round 1 consisted of an individual and team revision of this version by the expert panelists. Delphi round 2 comprised an in-depth review by 12 external international expert reviewers and revision by the expert panel. Delphi round 3 involved a revisit of the guidelines by the external experts. Consensus was reached after three rounds. Results: The final 23-page document was translated into English and adopted as international guidelines by the Swiss Society of Pediatrics (SGP/SSP), the German Society for Neonatology and Pediatric Intensive Care (GNPI), and the Austrian Society of Pediatrics. Conclusions: Our work constitutes comprehensive up-to-date guidelines for simulation-based team trainings and debriefings. High-quality simulation training provides standardized learning conditions for trainees. These guidelines will have a sustainable impact on standardized high-quality simulation-based education

Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study)

Abstract Background The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. Methods/design In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks’ gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. Discussion Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. Trial registration ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022