6 research outputs found
Less invasive beractant administration in preterm infants: a pilot study
OBJECTIVES: The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born a
New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring
Objective: To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA).
Study design: Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28-29+6, or ≥30 weeks).
Results: Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age.
Conclusion: Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEpu
New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring
Alteraciones extremas del sodio durante el periodo neonatal: presentación de dos casos
Resumen: Objetivo: Resaltar la importancia durante el periodo neonatal de las alteraciones del sodio que pueden llevar a situaciones extremas que pongan en compromiso la vida del paciente y supongan un desafío terapéutico. Casos clínicos: Presentamos 2 casos con alteraciones extremas del sodio.1°: Recién nacido a término de 17 días con deshidratación hipernatrémica: pérdida de peso del 32% respecto al nacimiento. Cifra máxima de sodio 195 mmol/L. Fallo multiorgánico con necesidad de soporte en oxigenación por membrana extracorpórea (ECMO) y hemodiafiltración.2°: Recién nacido prematuro de 31 semanas con cifra de sodio de 95 mmol/L a los 15 días de vida sin otra sintomatología acompañante. Precisa reposición hidroelectrolítica lenta intravenosa. Resultado: Buena evolución clínica. El caso 1 presenta un desarrollo psicomotor adecuado (actualmente 18 meses). El caso 2 presenta a los 7 años parálisis cerebral con diplejía espástica. Desde nacimiento presentaba lesiones compatibles con leucomalacia periventricular. Conclusiones: El periodo neonatal es probablemente el periodo de la vida con mayor riesgo de presentar alteraciones hidroelectrolíticas. Es importante realizar un seguimiento estrecho de la pérdida ponderal en los recién nacidos en los primeros días de vida para prevenir la deshidratación hipernatrémica, así como monitorizar los niveles de sodio en los recién nacidos prematuros. Las alteraciones severas de la natremia son una urgencia vital que puede requerir tratamientos avanzados para conseguir una supervivencia con mínimas secuelas. Abstract: Aim: To highlight the importance of sodium changes during the neonatal period, which can lead to extreme situations that pose therapeutic challenges and compromise patient lives. Case report: We present 2 cases with extreme sodium alterations.1st: A 17 day old full term newborn with hypernatremic dehydration: 32% of weight loss compared to birth weight and maximum sodium of 195 mmol/L. He suffered multiorgan failure requiring ECMO support and haemodiafiltration.2nd: A 31 week premature newborn with a sodium level of 95 mmol/L at 15 days of life without other accompanying symptoms. He required slow intravenous hydroelectrolytic replacement. Results: Good clinical evolution. Case one presents adequate psychomotor development (currently 18 months). Case two presents cerebral palsy with spastic diplegia at 7 years of age. From birth she presented cerebral injuries compatible with periventricular leukomalacia. Conclusions: The neonatal period is probably the period of life with the highest risk for hydroelectrolytic alterations. It is important to perform a strict weight control in newborns during their first days of life to prevent hypernatremic dehydration. It is also important to monitor sodium levels in preterm infants. Severe changes in natremia are a vital emergency that may require advanced treatments in order to achieve survival with minimal sequelae