Patrick Van Reempts

ILCOR ADVISORY STATEMENT: RESUSCITATION OF THE NEWLY BORN INFANT An Advisory Statement From the Pediatric Working Group of the International Liaison Committee on Resuscitation

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours following birth and the techniques for providing advanced life support.

An Advisory Statement From the Pediatric Working Group of the International Liaison Committee on Resuscitation

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Personnel trained in the basic skills of resuscitation should be in attendance at every delivery. A minority (fewer than 10%) of newly born infants require active resuscitative interventions to establish a vigorous cry and regular respirations, maintain a heart rate >100 beats per minute (bpm), and maintain good color and tone. When meconium is present in the amniotic fluid, it should be suctioned from the hypopharynx on delivery of the head. If the meconium-stained newly born infant has absent or depressed respirations, heart rate, or muscle tone, residual meconium should be suctioned from the trachea. Attention to ventilation should be of primary concern. Assisted ventilation with attention to oxygen delivery, inspiratory time, and effectiveness judged by chest rise should be provided if stimulation does not achieve prompt onset of spontaneous respirations and/or the heart rate is <100 bpm. Chest compressions should be provided if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. Chest compressions should be coordinated with ventilations at a ratio of 3:1 and a rate of 120 “events” per minute to achieve approximately 90 compressions and 30 rescue breaths per minute. Epinephrine should be administered intravenously or intratracheally if the heart rate remains <60 bpm despite 30 seconds of effective assisted ventilation and chest compression circulation. Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

Microbiology and risk factors for catheter exit-site and -hub colonization in neonatal intensive care unit patients

OBJECTIVE To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates. DESIGN During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal. SETTING A neonatal intensive care unit at a university hospital. RESULTS Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%; P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6; P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244, P<.001), and colonization of the catheter hub (OR, 8.9; CI, 3.5-22.8; P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95, 1.029-1.083; P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34; P<.001). No association was found between colonization at these sites and duration of catheterization and venue of insertion, physicians experience, postnatal age and patients weight, ventilation, steroids or antibiotics, and catheter repositioning. CONCLUSION These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.

Stress Responses to Tilting and Odor Stimulus in Preterm Neonates After Intrauterine Conditions Associated With Chronic Stress

The effect of conditions linked with chronic intrauterine stress (CIUSTR) on the function of the autonomic nervous system (ANS) has not yet been evaluated systematically in premature neonates. We hypothesized that intrauterine stress deranges the function of the ANS as assessed by the clinical responses to certain stimuli. Twenty-one premature neonates who had suffered from CIUSTR, such as maternal smoking, maternal hypertension, and intrauterine growth retardation (STR Group), and 30 neonates who had not suffered from those intrauterine conditions were studied (C Group). They were exposed to a 10-s postural change test and a 10-s odor test. Heart rate, respiratory rate, and noninvasive blood pressure were measured at 15 s, 30 s, and at 1, 2, 3, 4, and 5 min after the test. The overall reaction pattern after the postural change test was mainly sympathetic, and was more pronounced in the STR Group. After the odor test, the overall response was parasympathetic but less pronounced in the STR Group. We, therefore, speculate that neonates who suffer from conditions known to be associated with CIUSTR exhibit a higher adrenergic state with little reserve to counteract stressful situations that may make them more vulnerable.

INTRAVENOUS IBUPROFEN (IBU) FOR THE TREATMENT OF PATENT DUCTUS ARTERIOSUS(PDA) IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME (RDS). † 1486

Background: IBU has been used as an alternative cyclo-oxygenase inhibitor for prophylactic treatment of PDA and for the prevention of intraventricular hemorrhages (IVH) in preterm infants.

Ethical aspects of cardiopulmonary resuscitation in premature neonates: where do we stand?

Advances in diagnosis, techniques, therapeutic interventions, organisation of perinatal care, and socio-economic factors have all contributed to the survival after resuscitation and intensive care of neonates with extremely low birth weight and gestational age. While morbidity during the first years of life in those infants does not increase, at school age multiple dysfunctions may become apparent. What are the limits of intensive care for the newborn? Is it right to use extreme technical and economic measures for neonates with a borderline chance of survival? What is justifiable for the neonate, the family, the society and how does legislation interfere in a decision process which involves starting, stopping or continuing intensive care? A short historical overview for the care of the newborn is given, followed by the outcome after resuscitation and treatment of the very low birth weight infant. Published management strategies and recommendations are discussed.

Comparative Evaluation of the Respiratory and Circulatory Responses after the Instillation of Two Bovine Surfactant Preparations

Comparative Evaluation of the Respiratory and Circulatory Responses after the Instillation of Two Bovine Surfactant Preparations

Postneonatal Sleep Characteristics in BPD Infants † 1768

Premature neonates with bronchopulmonary dysplasia show different sleep patterns, a depressed arousal response and are at risk for SIDS. We examined the sleep patterns between 1 and 6 months post term age of 33 preterm BPD(PT-BPD), 15 normal preterm (PT), and 138 normal term (T) infants during a 10 hour night polysomnography (™ Oxford Medilog). Nonparametric analysis was used.

ONTOGEMY OF NEUROCHEMICAL MARKERS IN THE ADRENAL MEDULLA OF THE PIG

Within the framo of a study on the influence of intra-uterine hypoxia on the maturation of the adrenal medulla, the ontogeny of different neurochemical marker o in the adrenal modulla of the pig was studied. Obtained data are the result of measurements on the extract of the adrenals of all piglete from one litter. Gestational age was determined according to the crown-rump length of the piglets (full term being about day 114 of gestation). Adrenal from pig fetuses with 16 different gestational ages between 43 and 100 daya were investigated. The amount of adrenaline (A) increases with gestational age. The noradrenaline (NA) content as well as the dopamine-β-hydraxylane (DβH) content augment steeply at about day 60, are maximal at about day 75 and decline slightly towards term. The ratio A/NA rises with gestational age. The chromogranin A (CgA) content in maximal at about day 65 and also decreases slightly towarde term (Table).Conclusion: In the pig adrenal medulla A, NA and CgA synthesis early in gestation, before adrenal innervation is completely (around birth). This suggests an important role of the adrenal in the regulation of hemodynamics prior to and shortly after birth.