The effect of a smaller target range on the compliance in targeting and distribution of oxygen saturation in perterm infants

BACKGROUND: Following recent recommendations, the oxygen saturation (SpO2) target range for preterm infants in our nursery was narrowed towards the higher end from 85%-95% to 90%-95%. We determined the effect of narrowing the SpO2 target range on the compliance in target range and distribution of SpO2 in preterm infants. METHODS: Before and after changing the target range from 85%-95% to 90%-95%, infants <30 weeks of gestation receiving oxygen were compared during their admission on the neonatal intensive care unit. For each infant, distribution of SpO2 was noted by collecting SpO2 samples each minute, and the percentage of time spent with SpO2 within 90%-95% was calculated. Oxygen was manually adjusted. Hypoxaemic events (SpO2 <80%) where oxygen was titrated were analysed. RESULTS: Data were analysed for 104 infants (57 before and 47 after the range was narrowed). The narrower range was associated with an increase in the median (IQR) SpO2 (93% (91%-96%) vs 94% (92%-97%), p=0.01), but no increase in median time SpO2 within 90%-95% (49.2% (39.6%-59.7%) vs (46.9% (27.1%-57.9%), p=0.72). The distribution of SpO2 shifted to the right with a significant decrease in SpO2 <90%, but not <80%. The count of minute values for Sp02 <80% decreased, while the frequency and duration of hypoxaemic events and oxygen titration were not different. CONCLUSION: Narrowing the target range from 85%-95% to 90%-95% in preterm infants was associated with an increase in median SpO2 and a rightward shift in the distribution, but no change in time spent between 90% and 95%

High variability in nurses' tactile stimulation methods in response to apnoea of prematurity: a neonatal manikin study

Aim: Neonatal intensive care unit (NICU) nurses provide tactile stimulation to terminate apnoea in preterm infants, but guidelines recommending specific methods are lacking. In this study, we evaluated current methods of tactile stimulation performed by NICU nurses.Methods: Nurses were asked to demonstrate and explain their methods of tactile stimulation on a manikin, using an apnoea scenario. All nurses demonstrated their methods three times in succession, with the manikin positioned either prone, supine or lateral. Finally, the nurses were asked how they decided on the methods of tactile stimulation used. The stimulation methods were logged in chronological order by describing both the technique and the location. The nurses' explanations were transcribed and categorised.Results: In total, 47 nurses demonstrated their methods of stimulation on the manikin. Overall, 57 different combinations of technique and location were identified. While most nurses (40/47, 85%) indicated they learned how to stimulate during their training, 15/40 (38%) of them had adjusted their methods over time. The remaining 7/47 (15%) stated that their stimulation methods were self-developed.Conclusion: Tactile stimulation performed by NICU nurses to terminate apnoea was highly variable in both technique and location, and these methods were based on either prior training or intuition.Developmen

Consent for delivery room studies: what can be learned from perceptions of parents

Background: Obtaining ethically valid consent to participate in delivery room (DR) studies from parents facing an imminent premature birth can be challenging. This study aims to provide insight into parental experiences with and perceptions of consent for DR studies. Methods: Semistructured interviews were conducted with parents of very and extreme preterm infants. Interviews were audio-recorded, transcribed, and analyzed using the qualitative data analysis software Atlas. ti V.8.4. Results: Twenty-five parents were interviewed. Despite being in an emotional and stressful situation, most parents considered being approached for DR studies as valuable. According to parents, this was mostly due to appropriate timing and communication, compassion, and investigators not being obtrusive. Interviewed parents generally decided to accept or decline study participation based on perceived risk. Parents differed widely in how risk of specific study interventions was perceived, but agreed on the fact that parental consent is needed for DR studies that involve risk. There was no consensus among parents on deferred consent for DR studies running at our NICU. However, parents considered deferred consent appropriate for observational studies. Furthermore, it became clear that parental misunderstanding of various aspects of DR studies, including aims, the concept of randomization, and risk associated with specific interventions, was common. Conclusions: Insight into parental perceptions of consent for DR studies allowed us to determine areas where the validity of parental consent can be improved. Further research on parental perspectives for consent for DR studies will allow us to establish consent procedures that are considered both valid and valuable.Developmen

Improving manual oxygen titration in preterm infants by training and guideline implementation

To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants 21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004). CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC

Resuscitators' opinions on using a respiratory function monitor during neonatal resuscitation

Aim The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation. Methods The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM. The survey was online for 4 months after the trial ended in May 2019. Results The survey was completed by 74 (70%) resuscitators of which 99% considered the RFM to be helpful during neonatal resuscitation and 92% indicated that it influenced their decision-making. The majority (76%) indicated that using the RFM improved their practice and made resuscitation more effective, even when the RFM was not available. Inadequate training was the key issue that limited the effectiveness of the RFM: 45% felt insufficiently trained, and 78% felt more training in using and interpreting the RFM would have been beneficial. Conclusion Resuscitators considered the RFM to be helpful to guide neonatal resuscitation, but sufficient training was required to achieve the maximum benefit.Developmen

Cytomegalovirus antibodies in dried blood spots: a minimally invasive method for assessing stress, immune function, and aging

<p>Abstract</p> <p>Background</p> <p>Cytomegalovirus (CMV) is a prevalent herpesvirus with links to both stress and aging. This paper describes and validates a minimally invasive method for assessing antibodies against CMV in finger stick whole blood spot samples for use as an indirect marker of an aspect of cell-mediated immunity.</p> <p>Results</p> <p>Analysis of CMV in dried blood spot samples (DBS) was based on modifications of a commercially available protocol for quantifying CMV antibodies in serum or plasma. The method was evaluated through analysis of precision, reliability, linearity, and correlation between matched serum and DBS samples collected from 75 volunteers. Correlation between DBS and plasma values was linear and high (Pearson correlation <it>R </it>= .96), and precision, reliability, and linearity of the DBS assay were within acceptable ranges.</p> <p>Conclusions</p> <p>The validity of a DBS assay for CMV antibodies will enable its inclusion in population-based surveys and other studies collecting DBS samples in non-clinical settings, increasing scientific understanding of the interaction of social and biological stress and immune function.</p

Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study

Background Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA. Methods Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires. Results Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2. Conclusion Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA

The effect of implementing an automated oxygen control on oxygen saturation in preterm infants

OBJECTIVE: To evaluate the effect of implementing automated oxygen control as routine care in maintaining oxygen saturation (SpO2) within target range in preterm infants. METHODS: Infants 95% decreased (41.9 (30.6-49.4)% vs 19.3 (11.5-24.5)%; p<0.001). The time SpO2<90% increased (8.6 (7.2-11.7)% vs 15.1 (14.0-21.1)%; p<0.0001), while SpO2<80% was similar (1.1 (0.4-1.7)% vs 0.9 (0.5-2.1)%; ns). CONCLUSIONS: During oxygen therapy, preterm infants spent more time within the SpO2 target range after implementation of automated oxygen control, with a significant reduction in hyperoxaemia, but not hypoxaemia

Review of AERIUS Monitor : Data quality of Monitor (version 2014.2 and 2015) as used for the Dutch Nitrogen Action Programme (PAS)

In Nederland wordt de kwaliteit van de natuur in de meeste Natura 2000-gebieden beperkt door de hoge stikstofbelasting. Deze hoge belasting is een gevolg van de uitstoot van stikstofoxiden en ammoniak door onder meer verkeer, industrie en landbouw. Deze uitstoot bereikt via de lucht de natuurgebieden en slaat neer op de grond / bodem. De stikstofbelasting zal in de toekomst afnemen door het huidige beleid voor de uitstoot van vooral stikstofoxiden. Een deel van deze daling mag voor economische groei worden gebruikt door nieuwe vergunningen voor bijvoorbeeld stallen en wegen af te geven. Deze afweging wordt via de Programmatische Aanpak Stikstof (de PAS) geregeld, die op 1 juli 2015 van start ging. AERIUS is het rekeninstrument waarmee de initiatiefnemer een vergunning aanvraagt. RIVM heeft in 2015-2016 gefaseerd het beheer van AERIUS op zich genomen. Uit onderzoek van het RIVM blijkt dat de manier waarop AERIUS werkt correct is. Het gaat hierbij om de manier om de uitstoot van ammoniak en stikstofoxiden te verwerken en de modellering van de hoeveelheid stikstof die in de natuurgebieden terechtkomt - nu en in de toekomst. Er zijn geen onverklaarbare verschillen waargenomen ten opzichte van de systemen van het RIVM waarmee voor andere beleidsterreinen gegevens over de luchtkwaliteit worden berekend (de Emissieregistratie, grootschalige concentratie en depositiekaarten, de Monitoringstool en de diverse meetnetten om de concentraties in de lucht te meten). Wel doet het RIVM een aantal aanbevelingen om de verwerking van de emissiegegevens eenvoudiger te maken. Daarnaast constateert het RIVM dat de onderbouwing ontbreekt van een aantal beleidsbeslissingen om voor AERIUS hogere emissies te gebruiken dan voor andere beleidstrajecten, zoals voor de NEC-rapportage (emissieplafonds). Dit geldt vooral voor de emissies van het wegverkeer op het hoofdwegennet en voor de emissies van industrie en scheepvaart in het Rijnmondgebied. Het RIVM heeft dit onderzoek op verzoek van het ministerie van Economische zaken uitgevoerd.In the Netherlands the quality of nature in the 'Natura 2000' areas is - in most cases - limited by a high nitrogen load. This high load is caused by the large emission of nitrogen oxides and ammonia resulting from economic activities in agriculture, traffic, industry and other sources. The Dutch Nitrogen Action Programme (PAS) was launched to reduce the high nitrogen loads in 'Natura 2000' areas, and at the same time to enable spatial planning and economic development. The PAS went into effect on 1 July 2015, establishing that initiators of economic activities causing nitrogen deposition have to use the AERIUS instrument to calculate the nitrogen load in Natura 2000 areas. The calculation outcomes have to be sent with the application for the permit. In 2015-2016 RIVM became responsible for the deployment and maintenance of the AERIUS system and for making it available to the users. During this period RIVM checked how the AERIUS system works. This report describes the outcomes of the evaluation and concludes that AERIUS calculation of the nitrogen load on Natura 2000 areas is correct. Firstly, the AERIUS deposition results are in line with the outcomes from modelling air quality based on the same emission data, which are calculated by RIVM for other policy areas. And secondly, AERIUS gives a comparable fit to the concentrations measured with the national monitoring network for ammonia and nitrogen oxides. This report makes some recommendations to streamline the use of emission data in AERIUS. Furthermore, the report warns about the use of different policy assumptions in the PAS compared to those in other reporting obligations, such as the National Emission Ceiling (EU-NEC directive), which often result in higher emissions in AERIUS. This mainly refers to the emissions from road traffic, and emissions from the industry and international shipping in the Rijnmond area (Rotterdam harbour). This research was commissioned by the Netherlands Ministry of Economic Affairs.Ministerie van E