Validation of the disposable T-piece resuscitator (Neo-Tee): a bench study.

Objective: The Neo-Tee Infant T-piece resuscitator is a disposable T-piece resuscitator. The aim of this bench study was to assess the accuracy of the Neo-Tee using a measurement set-up and settings mimicking clinical practice.

Study Design: Nine Neo-Tee devices were tested using a face mask interface and a manikin.

Restricted Ventilation Associated with Reduced Neurodevelopmental Impairment in Preterm Infants.

Background And Objective: Restrictive use of invasive mechanical ventilation (IMV) in preterm infants reduces the risk of bronchopulmonary dysplasia (BPD). Our objective was to determine its effect on neurodevelopmental impairment (NDI) at 24 months' corrected age (CA).

Methods: This retrospective single-center cohort study included all patients with a gestational age <30 weeks born in 2004/2005 (epoch 1) and 2010/2011 (epoch 2).

Systemic corticosteroid regimens for prevention of bronchopulmonary dysplasia in preterm infants.

Background: Cochrane systematic reviews show that systemic postnatal corticosteroids reduce the risk of bronchopulmonary dysplasia (BPD) in preterm infants. However, corticosteroids have also been associated with an increased risk of neurodevelopmental impairment. It is unknown whether these beneficial and adverse effects are modulated by differences in corticosteroid treatment regimens.

Individualized lung recruitment during high-frequency ventilation in preterm infants is not associated with lung hyperinflation and air leaks.

Unlabelled: Lung recruitment during high-frequency ventilation (HFV) in preterm infants with respiratory distress syndrome (RDS) has been associated with an increased risk of lung hyperinflation and air leaks. Individualizing the lung recruitment procedure to the severity of lung disease of each patient might reduce these risks. In this prospective cohort study, we evaluated chest X-ray (CXR) characteristics during individualized oxygenation-guided lung recruitment with HFV in preterm infants with RDS, before and after surfactant therapy.

Incidence of hypo- and hyper-capnia in a cross-sectional European cohort of ventilated newborn infants.

Objective: To determine the incidence of hypo- and hyper-capnia in a European cohort of ventilated newborn infants.

Design And Setting: Two-point cross-sectional prospective study in 173 European neonatal intensive care units.

Patients And Methods: Patient characteristics, ventilator settings and measurements, and blood gas analyses were collected for endotracheally ventilated newborn infants on two separate dates.

Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation.

Aim: To predict early nasal continuous positive airway pressure failure within the first 2 h after birth in preterm infants.

Methods: Patient and respiratory support variables significantly associated with continuous positive airway pressure failure in the first 72 h after birth were identified in a cohort of preterm infants <30 weeks gestation. Using multivariable logistic regression analysis, risk estimates for early nasal continuous positive airway pressure failure were calculated.

Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants (the SToP-BPD study); a multicenter randomized placebo controlled trial.

Background: Randomized controlled trials have shown that treatment of chronically ventilated preterm infants after the first week of life with dexamethasone reduces the incidence of the combined outcome death or bronchopulmonary dysplasia (BPD). However, there are concerns that dexamethasone may increase the risk of adverse neurodevelopmental outcome. Hydrocortisone has been suggested as an alternative therapy.

Surfactant replacement therapy in preterm infants: a European survey.

Background: Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have published recommendations on the optimal surfactant replacement strategy.

Objective: To determine how evidence-based guidelines on surfactant replacement therapy are implemented in daily clinical practice.

Open-label glucocorticoids modulate dexamethasone trial results in preterm infants.

Context: Open-label glucocorticoids (OLGs) were often used in trials that investigated postnatal dexamethasone treatment in ventilated preterm infants.

Objective: To determine if OLG use modulates the dexamethasone treatment effect on mortality, bronchopulmonary dysplasia (BPD), and neurodevelopmental outcome.

Methods: Electronic databases, abstracts from the Pediatric Academic Societies, and results of manual reference searches were used as data sources.

Ventilation practices in the neonatal intensive care unit: a cross-sectional study.

Objective: To assess current ventilation practices in newborn infants.

Study Design: We conducted a 2-point cross-sectional study in 173 European neonatal intensive care units, including 535 infants (mean gestational age 28 weeks and birth weight 1024 g). Patient characteristics, ventilator settings, and measurements were collected bedside from endotracheally ventilated infants.

Finding the optimal postnatal dexamethasone regimen for preterm infants at risk of bronchopulmonary dysplasia: a systematic review of placebo-controlled trials.

Context: Postnatal dexamethasone therapy reduces the incidence of bronchopulmonary dysplasia in preterm infants but may be associated with an increased risk for adverse neurodevelopmental outcome.

Objective: Our goal was to determine if the effects of dexamethasone on mortality and pulmonary and neurodevelopmental sequelae in preterm infants are modified by the cumulative dose given.

Methods: Randomized, controlled trials comparing dexamethasone with placebo in ventilated preterm infants >7 days old were identified by searching the electronic databases and the abstracts from the Pediatric Academic societies and by performing manual reference searches.

Feasibility of weaning and direct extubation from open lung high-frequency ventilation in preterm infants.

Objective: High-frequency ventilation (HFV) is increasingly used in preterm infants, but data on weaning and extubation are limited. We aimed to establish if weaning the continuous distending pressure (CDP) below 8 cm H2O and the Fio2 below 0.30 is feasible in preterm infants on open lung HFV and if these settings result in successful extubation.

Effects of higher versus lower dexamethasone doses on pulmonary and neurodevelopmental sequelae in preterm infants at risk for chronic lung disease: a meta-analysis.

Objectives: Systemic postnatal dexamethasone treatment reduces the risk of chronic lung disease in preterm infants but also may be associated with increased risk of neurodevelopmental impairment. Because it is not known whether these effects are modulated by the cumulative dexamethasone dose, we systematically reviewed the available randomized evidence on the effects of lower versus higher cumulative dexamethasone doses, in terms of death, pulmonary morbidity, and neurodevelopmental outcomes, in preterm infants.

Methods: Randomized, controlled trials comparing higher- versus lower-dosage dexamethasone regimens in ventilated preterm infants were identified by searching the main electronic databases, references from relevant studies, and abstracts from the Societies for Pediatric Research (from 1990 onward).

Lung recruitment using oxygenation during open lung high-frequency ventilation in preterm infants.

Rationale: Changes in oxygenation are often used to guide the recruitment procedure during open lung high-frequency ventilation in preterm infants. However, data on the feasibility and safety of this approach in daily clinical practice are limited.

Objective: To prospectively collect data on ventilator settings, gas exchange, and circulatory parameters before and after surfactant therapy during open lung high-frequency ventilation.

Response to exogenous surfactant is different during open lung and conventional ventilation.

Objective: Previous studies have shown that the efficacy of exogenous surfactant is dose-dependent during conventional positive pressure ventilation (PPVCON). The present study aimed to determine whether this dose-dependent relationship is also present during open lung (OLC) ventilation. We also explored the effect of exogenous surfactant on the ventilation pressures applied during ventilation.

Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia.

Besides being one of the mechanisms responsible for ventilator-induced lung injury, atelectasis also seems to aggravate the course of experimental pneumonia. In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or open lung ventilation on bacterial growth and translocation in a piglet model of Group B streptococcal pneumonia. After creating surfactant deficiency by whole lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80%.

Open lung ventilation improves gas exchange and attenuates secondary lung injury in a piglet model of meconium aspiration.

Objective: Previous studies failed to show clear benefits of high-frequency ventilation compared with conventional positive pressure ventilation (PPV(CON)) in experimental meconium aspiration syndrome. However, none of these studies applied an open lung ventilation strategy (OLC), which aims to reduce intrapulmonary shunt due to alveolar collapse. We hypothesized that, if combined with an open lung strategy, both high-frequency oscillatory ventilation (HFOV(OLC)) and positive pressure ventilation (PPV(OLC)) would improve gas exchange and attenuate ventilator-induced lung injury in experimental meconium aspiration syndrome.

Application of the open-lung concept during positive-pressure ventilation reduces pulmonary inflammation in newborn piglets.

It has been shown that application of the open-lung concept (OLC) during high-frequency oscillatory ventilation (HFOV) attenuates pulmonary inflammation. We hypothesized that this attenuation could also be achieved by applying the OLC during positive-pressure ventilation (PPV). After repeated whole-lung lavage, newborn piglets were assigned to one of three ventilation groups: (1) PPV(OLC); (2) HFOV(OLC), or (3) conventional PPV (PPV(CON)).

Positive pressure ventilation with the open lung concept optimizes gas exchange and reduces ventilator-induced lung injury in newborn piglets.

Previous studies demonstrated that high-frequency oscillatory ventilation using the open lung concept (OLC) resulted in superior gas exchange and a reduction in ventilator-induced lung injury (VILI). We hypothesized that these beneficial effects could also be achieved by applying the OLC during positive pressure ventilation. After repeated whole-lung-lavage, newborn piglets were assigned to either OLC positive pressure ventilation (PPV(OLC)), OLC high-frequency oscillatory ventilation (HFOV(OLC)), or conventional positive pressure ventilation (PPV(CON)) and ventilated for 5 h.