Effect of decreasing target oxygen saturation on retinopathy of prematurity.

Introduction: The authors of previous studies suggest that the oxygenation status of premature infants contributes to the development of retinopathy of prematurity (ROP). In this study we compared the incidence and severity of ROP before and after institution of a new neonatal intensive care unit oxygen protocol.

Methods: A retrospective chart review was performed of all eligible inborn patients screened for ROP during the 2 years immediately before (Group 1) to and the 2 years after (Group 2) the initiation of a new oxygen protocol.

Clinical considerations for the pharmacologic management of patent ductus arteriosus with cyclooxygenase inhibitors in premature infants.

When medical management is warranted for closure of a persistent patent ductus arteriosus (PDA) in premature infants, treatment with a cyclooxygenase (COX) inhibitor is indicated. Indomethacin, available since 1976, has been the conventional pharmacologic treatment for PDA, but its use is associated with vasoconstrictive effects that impair renal, mesenteric and cerebral blood flow. Intravenous (IV) ibuprofen lysine, approved in the United States in 2006, has less severe vasoconstrictive effects on these vital organs than IV indomethacin.

Practical considerations in the selection and use of pulmonary surfactant therapy for neonatal respiratory distress syndrome in the intensive care setting.

Pulmonary surfactant is the treatment of choice for neonatal respiratory distress syndrome, as it significantly reduces infant morbidity and mortality. Extensive clinical trials compare the surfactant products and their optimal usage, but often the practical administration issues are less frequently discussed. Herein, a panel of respiratory therapists and neonatal nurse practitioners share their experience regarding surfactant usage.

Retinopathy of prematurity in infants with birth weight>or=1250 grams-incidence, severity, and screening guideline cost-analysis.

Purpose: To determine the incidence and severity of retinopathy of prematurity (ROP) in infants with birth weight (BW) 1250 to 1800 g, to examine the influence of systemic conditions on the development of ROP in this population, and to evaluate the cost-effectiveness of various screening guidelines.

Methods: We reviewed records from 259 consecutive infants with BW 1250 to 1800 g who were screened for ROP over a 3-year period. Extracted data included presence and severity of ROP, and the following potential risk factors (RF) for ROP development: sepsis, meningitis, necrotizing enterocolitis, intraventricular hemorrhage greater than stage I, pneumothorax, direct bilirubin>2 mg/dl, central line placement, antibiotic treatment>14 days, greater than seven red blood cell (RBC) transfusions, and mechanical ventilation>96 hours.

Room air resuscitation versus oxygen resuscitation in the delivery room.

The use of 100% oxygen for delivery room resuscitation is currently the recommended standard of the American Academy of Pediatrics and the Neonatal Resuscitation Program. However, there is mounting evidence from animal and human studies suggesting that resuscitation with room air (RA, 21% oxygen), including positive pressure ventilation with bag and face mask, may be as effective as that with 100% oxygen, and that the use of 100% oxygen may pose a risk of adverse physiologic sequelae. Resuscitation with RA has been demonstrated to result in faster recovery and improved neonatal mortality in comparison to 100% oxygen resuscitation.