Arun Sasi

CONGENITAL CHYLOTHORAX: ASSOCIATIONS AND NEONATAL OUTCOMES

Congenital chylothorax is a rare but significant neonatal entity with major morbidity and mortality. The study aims to describe the related associations, management and outcomes of this condition in neonates.

High flow nasal cannula for continuous positive airway pressure weaning in preterm neonates: A single-centre experience

High flow nasal cannula therapy (HFNC) is an emerging method of non‐invasive respiratory support therapy for premature infants. Recent evidence around its safety and efficacy for post‐extubation respiratory support is encouraging. However, its effect on long‐term respiratory outcomes is not known. The aim of this study is to determine the effect of HFNC on respiratory outcomes (chronic lung disease (CLD), need for home oxygen) when used to wean babies from continuous positive airway pressure (CPAP).

Does fetal growth restriction lead to increased brain injury as detected by neonatal cranial ultrasound in premature infants

Intra‐uterine growth restriction (IUGR) is an important cause for prematurity as well as a significant risk factor for neurodevelopmental deficits. In this study, we aimed to examine the association between IUGR and early brain injury on neonatal cranial ultrasound in preterm infants.

Vasopressin as an adjunct therapy for pulmonary hypertension: a case report

Vasopressin is emerging as a therapeutic adjunct option towards treatment of shock states in the pediatric population. Its effects on pulmonary vasculature are less well understood. This report describes a 5-month-old infant with nitric oxide-unresponsive pulmonary hypertension, oxygenation failure, and systemic hypotension. Vasopressin therapy improved oxygenation and blood pressure and biventricular function, allowing weaning of nitric oxide and inotropic support. No decrease in coronary flow was noted. Conclusions: Vasopressin could be considered as an adjunct option in infants with pulmonary hypertension and systemic hypotension. Echocardiographic monitoring during treatment is recommended.

The efficacy of surfactant replacement therapy in the growth-restricted preterm infant: what is the evidence?

Background: Surfactant replacement therapy (SRT) is an integral part of management of preterm surfactant deficiency respiratory distress syndrome (RDS). Its role in the management of RDS has been extensively studied. However, its efficacy in the management of lung disease in preterm infants born with intrauterine growth restriction (IUGR) has not been systematically studied. Objective: To evaluate the efficacy of exogenous SRT in the management of preterm IUGR lung disease. Methods: A systematic search of all available randomized clinical trials (RCT) of SRT in preterm IUGR infants was done according to the standard Cochrane collaboration search strategy. Neonatal respiratory outcomes were compared between the preterm IUGR and appropriately grown for gestational age (AGA) preterm infant populations in eligible studies. Results: No study was identified which evaluated the efficacy or responsiveness of exogenous SRT in preterm IUGR infants as compared to preterm AGA-infants. The only study identified through the search strategy used small for gestational age (SGA; defined as less than tenth centile for birth weight) as a proxy for IUGR. The RCT evaluated the efficacy or responsiveness of SRT in preterm SGA group as compared to AGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary air leaks, and days on the ventilator did not differ between both groups. However, the requirement for prolonged nasal continuous positive airway pressure (p < 0.001), supplemental oxygen therapy (p < 0.01), and the incidence of bronchopulmonary dysplasia at 28 days and 36 weeks (both p < 0.01) was greater in SGA-infants. Discussion: There is currently insufficient data available to evaluate the efficacy of SRT in preterm IUGR lung disease. A variety of research strategies will be needed to enhance our understanding of the role and rationale for use of SRT in preterm IUGR lung disease.

Impact of intrauterine growth restriction on preterm lung disease

Intrauterine growth restriction (IUGR) is an important cause for prematurity and adversely influences prematurity‐related morbidities. This study evaluates the impact of IUGR on respiratory outcomes in infants <32 weeks with IUGR and birthweight <10th centile (SGA) compared to matched appropriate for gestation (AGA) controls.

Neonatal self‐inflating bags: Achieving titrated oxygen delivery using low flows: An experimental study

To determine delivered O2 concentration (dFiO2) during manual inflations using neonatal self‐inflating resuscitation bags (SIBs) at oxygen (O2) flow rates <1 L/min.