Paola Ferrarese

Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

Background: The laryngeal mask airway (LMATM, Laryngeal Mask Co. Ltd, Jersey, UK) is a supraglottic device used to administer positive pressure ventilation (PPV) in adults, pediatric and neonatal patients. Objectives: To avoid endotracheal intubation, we evaluated the feasibility and practicality of administering surfactant via the LMATM in preterm infants with respiratory distress syndrome (RDS). Methods: Infants less than 72 h old with a gestational age of ≤35 weeks and a birth weight of >800 g, treated with nasal continuous positive airway pressure (CPAP, 5 cm H2O) for RDS were eligible for inclusion in the study if the arterial-to-alveolar oxygen tension ratio (a/APO2) was <0.20 over a period of >60 min. Results: Eight preterm infants, median gestational age 31 (range 28–35) weeks; birth weight 1,700 (880–2,520) g, treated with nasal CPAP for RDS were enrolled. Three hours after surfactant instillation, the mean a/APO2 was significantly increased (0.13 ± 0.04 to 0.34 ± 0.11; p < 0.01) without complications. Conclusions: The LMATM may be a useful and noninvasive conduit for the administration of surfactant therapy. A large randomized comparative clinical trial will be required to confirm the efficacy of this technique.

Knowledge gained by pediatric residents after neonatal resuscitation program courses

Background:  The efficacy of the Neonatal Resuscitation Program (NRP) courses was previously evaluated, demonstrating good retention of knowledge in the participants. However, there is a lack of information regarding the participants’ performance in relation to the different steps of neonatal resuscitation. We aimed to assess the knowledge gained and retained by pediatric residents who participated in a NRP course in relation to the different steps.

The laryngeal mask airway: potential applications in neonates

The laryngeal mask airway is a safe and reliable airway management device. This review describes the insertion techniques, advantages, limitations, and potential applications of the laryngeal mask airway in neonates.

Developmental assessment of preterm and term children at 18 months: reproducibility and validity of a postal questionnaire to parents.

Aim: To examine the degree of agreement between the paediatricians assessment and parental reporting of infants’development using a postal questionnaire. Methods: The developmental status of 241 infants in the charge of 9 community paediatricians or discharged from one Neonatal Intensive Care Unit (NICU) was assessed by their parents 18 mo after delivery, using a postal questionnaire regarding childs height, weight, respiratory, hearing and vision problems, and items taken mainly from the Griffiths’Developmental Scales. At this age, infants were seen by the community or NICU paediatricians, for a complete physical and neurodevelopmental examination. Results: The mean agreement on items regarding developmental areas between parents and paediatricians was 93.0%. In general, parents and professionals agreed on items describing gross motor behaviour (k from 0.39 to 0.83) and disagreed on individual questions describing language/ relational behaviour (k from 0 to 0.38). A 97.9% level of agreement was found for hearing status (k= 0), and 96.2% for assessment of vision (k= 0.29), whereas the level of agreement ranged from 43.2% to 86.2% (k from 0 to 0.15) for the three questions describing respiratory problems. The mean weight and height assessments by paediatricians and parents of infants at 18 mo of age were similar.

Nitric oxide 2

Introduction: Permissive hypercapnia (PH) is a beneficial strategy for patients with acute respiratory distress syndrome (ARDS) to minimize barotrauma by decreasing the peak inspiratory pressure (PIP). Hypercapnia and hypoxia cause pulmonary vasoconstriction, pulmonary artery (PA) hypertension, and, thus, an increased afterload to the right ventricle. This increased afterload may result in increased right ventricular (RV) work load and subsequent RV dysfunction. One therapeutic approach is the use of inhaled nitric oxide (iNO), a selective PA vasodilator. The objectives of this study were to test the hypothesis that in a swine model of ARDS with PH, iNO would improve RV work load and not change intrinsic RV contractility. Methods: In 11 swine (25-35 kg), ARDS was induced by surfactant depletion. Hypercapnia was achieved by decreasing the PIP while increasing the PEEP to maintain a constant mean airway pressure. iNO was administered in concentrations of 2, 5, and 10 ppm in a random order, Pulmonary blood flow (Qpa) was determined by an ultrasonic flow probe. RV total power (TP) and stroke work (SW) were calculated by Fourier transformation of the PA pressure (Ppa) and Qpa data. Preload recruitable stroke work (PRSW), a preload and afterload independent measure of ventricular contractility, was determined by a shell-subtraction method and vena caval occlusion) Results: Data are represented as mean ± sent and compared by two-way analysis of variance with repeated measures. (* n < 0.05 vs. 0 nnm) 0 ppm 2 ppm 5 ppm 10 ppm er s*1000 /mL 24.6 ± 1.6 25.2 ± 2.4 23.3 ± 1.8 22.9 ± 2.5 mW 92±11 74±6* 66±6 75±8* [RSW

Neonatal pneumothorax: comparison between neonatal transfers and inborn infants.

Abstract Objective: To assess the differences in clinical characteristics, management and outcome between the neonatal transfers and inborn neonates with pneumothorax. Methods: The records of 36 neonatal transfers (Group A) and 25 inborn (Group B) neonates with symptomatic pneumothorax were retrospectively analyzed. Results: In Group A, gestational age (36±2 vs. 31±4 weeks; P<0.01), birth weight (2720±537 vs. 1736±1028 g; P<0.01), exclusive oxygen-therapy before the event (47% vs. 20%; P<0.05) and tube thoracostomy (78% vs. 44%; P<0.05) were significantly higher than in Group B. The need of resuscitation at birth (19% vs. 44%; P<0.05), conventional mechanical ventilation (20% vs. 56%; P<0.05), presence of associated major congenital malformations (0% vs. 20%; P<0.01), length of hospital stay (9±6 vs. 32±32 days; P=0.01) and mortality (0% vs. 16%; P=0.01) were significantly lower in Group A than in Group B. Conclusions: Neonatal transfers and inborn neonates with pneumothorax have different clinical characteristics and outcome. This information could be useful for all persons involved in the interhospital care of perinatal patients.

Laryngeal Mask Airway for the Interhospital Transport of Neonates

Airway control during interhospital transport may present enormous management difficulties, even for experienced personnel. The laryngeal mask airway is an airway management device that has been established as a safe reliable tool in adult and pediatric practice. We describe 2 cases of successful interhospital transfer of infants with congenital airway malformations with the use of the laryngeal mask airway, and we review the literature.

Neonatal resuscitation courses for pediatric residents: comparison between Khartoum (Sudan) and Padova (Italy)

Background:  The efficacy of a Neonatal Resuscitation Program (NRP) has been previously evaluated in developed countries, but there is a lack of information regarding the impact of this teaching program in developing countries. Our aim was to compare the knowledge gained by University of Khartoum (Sudan) and University of Padova (Italy) pediatric residents following participation in the NRP course.

Effect of patent ductus arteriosus and indomethacin treatment on serum cardiac troponin T levels in preterm infants with respiratory distress syndrome

Abstract Cardiac troponin T (cTnT) represents a sensitive and specific marker of ischemic myocardial damage in adult and neonatal populations. The aim of this study was to detect the potential ischemic effect of persistent patent ductus arteriosus (PDA) and indomethacin treatment on the coronary vascular bed by measuring cTnT concentrations. cTnT levels were measured in 23 preterm infants (<32 weeks of gestational age) with respiratory distress syndrome (RDS), 11 with PDA and 12 without, at 2, 4, and 7 days after birth. cTnT concentrations (mean ± SEM) significantly decreased (P < 0.05) from the 2nd (0.63 ± 0.09 μg/l) and the 4th (0.77 ± 0.13 μg/l) to the 7th postnatal day (0.28 ± 0.04 μg/l). At day 2 after birth, cTnT levels in preterm infants with RDS were significantly higher (P < 0.05) than our reference values for healthy preterm neonates (0.63 ± 0.09 μg/l vs 0.18 ± 0.04 μg/l). No differences were found between RDS infants with and without PDA at 2 (0.65 ± 0.13 vs 0.61 ± 0.14 μg/l), 4 (0.71 ± 0.21 vs 0.87 ± 0.16 μg/l), and 7 (0.26 ± 0.05 vs 0.29 ± 0.07 μg/l) days of life. In infants with PDA, cTnT levels did not differ before the first dose of indomethacin was given (0.65 ± 0.14 μg/l) or 2 h (0.65 ± 0.15 μg/l) and 48 h (0.71 ± 0.21 μg/l) afterwards. Conclusion In preterm infants with RDS the occurrence of PDA and indomethacin treatment are not associated with ischemic cardiac damage as detected by cTnT measurements.

Routine mechanical ventilation for transferred neonates with duct-dependent congenital heart disease

Browning Carmo et al showed that neonates with duct-dependent congenital heart disease (CHD) treated with low-dose prostaglandin E1 (PGE1) may not require mechanical ventilation for safe transport.1 The Pediatric Department, University of Padova Neonatal Emergency Transport Service undertakes about 200 neonatal transports every year in the East-Veneto Region, Italy. The service has a population referral base of 2.3 million people over a radius of approximately …