36 research outputs found
Key paediatric messages from Amsterdam
The Paediatric Assembly of the European Respiratory Society (ERS) maintained its high profile at the 2015 ERS International Congress in Amsterdam. There were symposia on preschool wheeze, respiratory sounds and cystic fibrosis; an educational skills workshop on paediatric respiratory resuscitation; a hot topic session on risk factors and early origins of respiratory diseases; a meet the expert session on paediatric lung function test reference values; and the annual paediatric grand round. In this report the Chairs of the Paediatric Assembly’s Groups highlight the key mess
Recommendations for neonatologist performed echocardiography in Europe: Consensus Statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN)
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171351.pdf (Publisher’s version ) (Open Access
Symptoms of depression in parents after discharge from NICU associated with family-centred care
AimsThe aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents’ depressive symptoms at discharge and at 4 months corrected for infant age.DesignA longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.MethodsParents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants’ hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents’ depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age.ResultsThe mothers’ and the fathers’ perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents’ participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents’ perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents.ConclusionsOur study shows that family-centred NICU care associates with parents’ depressive symptoms after a NICU stay.ImpactDepression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.</p
Decreased surfactant phosphatidylcholine synthesis in neonates with congenital diaphragmatic hernia during extracorporeal membrane oxygenation
Purpose: Congenital diaphragmatic hernia (CDH) may result in severe respiratory insufficiency with a high morbidity. The role of a disturbed surfactant metabolism in the pathogenesis of CDH is unclear. We therefore studied endogenous surfactant metabolism in the most severe CDH patients who required extracorporeal membrane oxygenation (ECMO). Methods: Eleven neonates with CDH who required ECMO and ten ventilated neonates without significant lung disease received a 24-h infusion of the stable isotope [U-13C] glucose. The13C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Mean PC concentration in epithelial lining fluid (ELF) was measured during the first 4 days of the study. Results: Fractional surfactant PC synthesis was decreased in CDH-ECMO patients compared to controls (2.4 ± 0.33 vs. 8.0 ± 2.4%/day, p = 0.04). The control group had a higher maximal enrichment (0.18 ± 0.03 vs. 0.09 ± 0.02 APE, p = 0.04) and reached this maximal enrichment earlier (46.7 ± 3.0 vs. 69.4 ± 6.6 h, p = 0.004) compared to the CDH-ECMO group, which reflects higher and faster precursor incorporation in the control group. Surfactant PC concentration in ELF was similar in both groups. Conclusion: These results show that CDH patients who require ECMO have a decreased surfactant PC synthesis, which may be part of the pathogenesis of severe pulmonary insufficiency and has a negative impact on weaning from ECMO
Decreased surfactant phosphatidylcholine synthesis in neonates with congenital diaphragmatic hernia during extracorporeal membrane oxygenation
Purpose: Congenital diaphragmatic hernia (CDH) may result in severe respiratory insufficiency with a high morbidity. The role of a disturbed surfactant metabolism in the pathogenesis of CDH is unclear. We therefore studied endogenous surfactant metabolism in the most severe CDH patients who required extracorporeal membrane oxygenation (ECMO). Methods: Eleven neonates with CDH who required ECMO and ten ventilated neonates without significant lung disease received a 24-h infusion of the stable isotope [U-13C] glucose. The13C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Mean PC concentration in epithelial lining fluid (ELF) was measured during the first 4 days of the study. Results: Fractional surfactant PC synthesis was decreased in CDH-ECMO patients compared to controls (2.4 ± 0.33 vs. 8.0 ± 2.4%/day, p = 0.04). The control group had a higher maximal enrichment (0.18 ± 0.03 vs. 0.09 ± 0.02 APE, p = 0.04) and reached this maximal enrichment earlier (46.7 ± 3.0 vs. 69.4 ± 6.6 h, p = 0.004) compared to the CDH-ECMO group, which reflects higher and faster precursor incorporation in the control group. Surfactant PC concentration in ELF was similar in both groups. Conclusion: These results show that CDH patients who require ECMO have a decreased surfactant PC synthesis, which may be part of the pathogenesis of severe pulmonary insufficiency and has a negative impact on weaning from ECMO
Surfactant metabolism in the newborn : The impact of ventilation strategy and lung disease
Developmental deficiency in pulmonary surfactant leads to respiratory
distress syndrome (RDS) in preterm infants, but all newborns may have
impaired surfactant metabolism secondary to lung disease or ventilator
induced lung injury. Exogenous surfactant treatment is usually
administered in conjunction with mechanical ventilation. If instead
surfactant administration is followed by nasal continuous positive airway
pressure (nCPAP), the treatment response appears to be more sustained.
The aims of the thesis were to (1) distinguish normal and abnormal
surfactant turnover in term and preterm infants using a novel stable
isotope technique, (2) determine if high frequency oscillatory
ventilation (HFOV) decreases surfactant production in preterm infants
with RDS, (3) systematically examine stable isotope methodology for in
vivo studies of surfactant metabolism (4) follow-up the implementation of
INSURE, i.e. surfactant administration during a brief intubation, and (5)
experimentally test the hypothesis, that surfactant administration
followed by spontaneous breathing improves the treatment response.
After an intravenous infusion of stable isotope (13C) labeled precursors
for surfactant phospholipid, the 13C-enrichment over time was measured in
serial tracheal aspirates using gas chromatography/mass spectrometry.
Term infants without lung disease had significantly faster endogenous
surfactant turnover compared to preterm infants with RDS. Term infants
with severe respiratory failure exhibited disrupted surfactant metabolism
and decreased amounts of surfactant phospholipids in tracheal aspirates,
suggesting delayed maturity of the surfactant system or impairment from
the underlying disease. HFOV versus conventional ventilation did not
affect the surfactant metabolic indices in preterm infants with RDS. The
method yielded reproducible data and similar surfactant metabolic indices
regardless of mass spectrometry instrumentation and the surfactant
phospholipid pool being analysed. Fractional catabolic rate, which is
tracer independent, is suggested to be the primary measure of surfactant
turnover.
A retrospective, 10-year follow-up of all inborn infants with RDS (n=420,
gestational age >=27 to <34 weeks) at two Stockholm neonatal units showed
that after the implementation of INSURE, the number of infants requiring
mechanical ventilation was reduced by 50%, with no adverse effects on
outcome. Surfactant treatment by INSURE resulted in a sustained
improvement in oxygenation and a significant reduction in additional
surfactant doses. In a preterm rabbit model, animals received
radiolabeled surfactant and were randomized to spontaneous breathing or
mechanical ventilation. The mechanical ventilation group exhibited
impaired tissue association of labeled surfactant, lower dynamic
compliance and evidence of surfactant inactivation, consistent with a
poorer treatment response.
In conclusion, this investigation is one of the first to describe normal
surfactant turnover in vivo in term infants. Severe lung disease in term
infants disrupts endogenous surfactant metabolism similar to that of
infants with developmental surfactant deficiency. Mode of mechanical
ventilation has minimal impact on endogenous surfactant turnover in
preterm infants with RDS. However, the treatment response to exogenous
surfactant is significantly impaired by mechanical ventilation, both
clinically and experimentally. The INSURE strategy for surfactant
treatment is a powerful approach to improve the treatment response and
reduce the need for mechanical ventilation in moderately preterm infants
Physical Activity in 6.5-Year-Old Children Born Extremely Preterm
Physical activity (PA) can prevent cardiovascular diseases. Because of increased risks of impairments affecting motor activity, PA in children born preterm may differ from that in children born at term. In this prospective cohort study, we compared objectively measured PA in 71 children born extremely preterm (Peer reviewe
Long-term impact of preterm birth on exercise capacity in healthy young men: a national population-based cohort study.
BACKGROUND: Increasing numbers of survivors of preterm birth are growing into adulthood today. Long-term health-effects of prematurity are still poorly understood, but include increased risk for diabetes, obesity and cardiovascular diseases in adult life. To test if reduced physical fitness may be a link in the causal chain of preterm birth and diseases in later life, the association of preterm birth and adult exercise capacity was investigated. The hypothesis was that preterm birth contributes independently of other risk factors to lower physical fitness in adulthood. METHODS AND FINDINGS: Population-based national cohort study of all males conscripting for military service in 1993-2001 and born in Sweden 1973-1983, n = 218,820. Data were retrieved from the Swedish Conscript Register, the Medical Birth Register and the Population and Housing Census 1990. Primary outcome was the results from maximal exercise test (Wmax in Watt) performed at conscription. Association to perinatal and socioeconomic risk factors, other co-variates and confounders were analysed. General linear modelling showed that preterm birth predicted low Wmax in a dose-response related pattern, with 25 Watt reduction in Wmax for the lowest gestational ages, those born ≤27 weeks. Low birth weight for gestational age also independently predicted low Wmax compared to normal and high birth weight (32 Watt reduction for those with a birth weight Standard Deviation Score <2). Low parental education was significantly associated with reduced Wmax (range 17 Watt), as well as both low and high current BMI, with severe obesity resulting in a 16 Watt deficit compared to Wmax top performance. CONCLUSION: Being born preterm as well as being born small for gestational age predicts low exercise capacity in otherwise healthy young men. The effect size of being born preterm equal or exceed that of other known risk factors for unfitness in adults, such as low parental education and overweight
Surfactant replacement therapy: from biological basis to current clinical practice.
This review summarizes the current knowledge on the physiological action of endogenous and exogenous pulmonary surfactant, the role of different types of animal-derived and synthetic surfactants for RDS therapy, different modes of administration, potential risks and strategies of ventilation, and highlights the most promising aims for future development. Scientists have clarified the physicochemical properties and functions of the different components of surfactant, and part of this successful research is derived from the characterization of genetic diseases affecting surfactant composition or function. Knowledge from functional tests of surfactant action, its immunochemistry, kinetics and homeostasis are important also for improving therapy with animal-derived surfactant preparations and for the development of modified surfactants. In the past decade newly designed artificial surfactants and additives have gained much attention and have proven different advantages, but their particular role still has to be defined. For clinical practice, alternative administration techniques as well as postsurfactant ventilation modes, taking into account alterations in lung mechanics after surfactant placement, may be important in optimizing the potential of this most important drug in neonatology