PaCO 2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT)

To determine the association of PaCO2 with severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18–22 months in premature infants

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs

Current Perspectives on Interoperability

This report describes current research within the software engineering community on the topic of interoperability between software systems. That research includes analyses of the different types of interoperability problems and issues and efforts to define models of interoperability that will aid in creating solutions to those problems. The report also describes work that is currently underway at the Software Engineering Institute (SEI) in this area. That work originated in an independent research effort and now has grown into a separate technical initiative in the area of interoperability. The SEI initiative is currently focused on analyzing several aspects of interoperability: how it is manifest in different kinds of activities (i.e., programmatic vs. constructive vs. operational activities), the essential characteristics of interoperability, and the key principles on which solutions will depend

PaCO 2

OBJECTIVE: To determine the association of PaCO(2) with severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18–22 months in premature infants. DESIGN: Secondary exploratory data analysis of SUPPORT. SETTING: Multiple referral NICUs. PATIENTS: 1316 infants 24 0/7 to 27 6/7 weeks gestation randomized to different oxygenation (SpO(2) target 85–89% vs 91–95%) and ventilation strategies. MAIN OUTCOME MEASURES: Blood gases from postnatal days 0–14 were analyzed. Five PaCO(2) variables were defined: minimum [Min], maximum [Max], standard deviation, average (time-weighted), and a 4 level categorical variable (hypercapnic [highest quartile of Max PaCO(2)], hypocapnic [lowest quartile of Min PaCO(2)], fluctuators [both hypercapnia and hypocapnia], and normocapnic [middle two quartiles of Max and Min PaCO(2)]). PaCO(2) variables were compared for infants with and without sIVH, BPD, and NDI (+/− death). Multivariable logistic regression models were developed for adjusted results. RESULTS: sIVH, BPD, and NDI (+/− death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO(2) and outcomes persisted after adjustment (Per 10 mmHg increase: sIVH/death: OR 1.27 [1.13–1.41]; BPD/death: OR 1.27 [1.12–1.44]; NDI/death: OR 1.23 [1.10–1.38], Death: OR 1.27 [1.12–1.44], all p <0.001). No interaction was found between PaCO(2) category and SpO(2) treatment group for sIVH/death, NDI/death, or death. Max PaCO(2) was positively correlated with maximum FiO(2) (r(s)0.55, p<0.0001) & ventilator days (r(s)0.61, p<0.0001). CONCLUSIONS: Higher PaCO(2) was an independent predictor of sIVH/death, BPD/death, and NDI/death. Further trials are needed to evaluate optimal PaCO(2) targets for high risk infants

Growth Outcomes of Preterm Infants Exposed to Different Oxygen Saturation Target Ranges from Birth.

OBJECTIVE: To test whether infants randomized to a lower oxygen saturation (peripheral capillary oxygen saturation [SpO2]) target range while on supplemental oxygen from birth will have better growth velocity from birth to 36 weeks postmenstrual age (PMA) and less growth failure at 36 weeks PMA and 18-22 months corrected age. STUDY DESIGN: We evaluated a subgroup of 810 preterm infants from the Surfactant, Positive Pressure, and Oxygenation Randomized Trial, randomized at birth to lower (85%-89%, n = 402, PMA 26 ± 1 weeks, birth weight 839 ± 186 g) or higher (91%-95%, n = 408, PMA 26 ± 1 weeks, birth weight 840 ± 191 g) SpO2 target ranges. Anthropometric measures were obtained at birth, postnatal days 7, 14, 21, and 28; then at 32 and 36 weeks PMA; and 18-22 months corrected age. Growth velocities were estimated with the exponential method and analyzed with linear mixed models. Poor growth outcome, defined as weightage, was compared across the 2 treatment groups by the use of robust Poisson regression. RESULTS: Growth outcomes including growth at 36 weeks PMA and 18-22 months corrected age, as well as growth velocity were similar in the lower and higher SpO2 target groups. CONCLUSION: Targeting different oxygen saturation ranges between 85% and 95% from birth did not impact growth velocity or reduce growth failure in preterm infants