Work of breathing at different tidal volume targets in newborn infants with congenital diaphragmatic hernia.

Unlabelled: Congenital diaphragmatic hernia (CDH) results in varying degrees of pulmonary hypoplasia. Volume targeted ventilation (VTV) is a lung protective strategy but the optimal target tidal volume in CDH infants has not previously been studied. The aim of this study was to test the hypothesis that low targeted volumes would be better in CDH infants as determined by measuring the work of breathing (WOB) in CDH infants, at three different targeted tidal volumes.

Volumetric capnography pre- and post-surfactant during initial resuscitation of premature infants.

Background: Volumetric capnography allows for continuous monitoring of expired tidal volume and carbon dioxide. The slope of the alveolar plateau of the capnogram (S) could provide information regarding ventilation homogeneity. We aimed to assess the feasibility of measuring S during newborn resuscitation and determine if S decreased after surfactant indicating ventilation inhomogeneity improvement.

Prediction of extubation success using the diaphragmatic electromyograph results in ventilated neonates.

Objectives Extubation failure is common in infants and associated with complications. Methods A prospective study was undertaken of preterm and term born infants. Diaphragm electromyogram (EMG) was measured transcutaneously for 15-60 min prior to extubation.

Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia.

Both proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) provide pressure support synchronised throughout the respiratory cycle proportional to the patient's respiratory demand. Our aim was to compare the effect of these two modes on oxygenation in infants with evolving or established bronchopulmonary dysplasia. Two-hour periods of PAV and NAVA were delivered in random order to 18 infants born less than 32 weeks of gestation.

End-tidal carbon dioxide levels during resuscitation and carbon dioxide levels in the immediate neonatal period and intraventricular haemorrhage.

Abnormal levels of end-tidal carbon dioxide (EtCO) during resuscitation in the delivery suite are associated with intraventricular haemorrhage (IVH) development. Our aim was to determine whether carbon dioxide (CO) levels in the first 3 days after birth reflected abnormal EtCO levels in the delivery suite, and hence, a prolonged rather than an early insult resulted in IVH. In addition, we determined if greater EtCOlevel fluctuations during resuscitation occurred in infants who developed IVH.

Electrical activity of the diaphragm following a loading dose of caffeine citrate in ventilated preterm infants.

Background: Administration of caffeine citrate can facilitate extubation. Our aim was to determine whether a loading dose of caffeine citrate given to ventilated, preterm infants affected the diaphragm electrical activity.

Methods: Infants <34 weeks of gestational age were recruited if requiring mechanical ventilation and prescribed a loading dose of caffeine citrate.

Diaphragm electromyography results at different high flow nasal cannula flow rates.

Heated, humidified, high-flow nasal cannula (HHHFNC) is increasingly being used, but there is a paucity of evidence as to the optimum flow rates in prematurely born infants. We have determined the impact of three flow rates on the work of breathing (WOB) assessed by transcutaneous diaphragm electromyography (EMG) amplitude in infants with respiratory distress or bronchopulmonary dysplasia (BPD). Flow rates of 4, 6 and 8 L/min were delivered in random order.

Tidal volume monitoring during initial resuscitation of extremely prematurely born infants.

Background Airway obstruction can occur during facemask (FM) resuscitation of preterm infants at birth. Intubation bypasses any upper airway obstruction. Thus, it would be expected that the occurrence of low expiratory tidal volumes (VTes) would be less in infants resuscitated via an endotracheal tube (ETT) rather than via an FM.

Key paediatric messages from the 2018 European Respiratory Society International Congress.

In this article, the Group Chairs and early career members of the European Respiratory Society (ERS) Paediatric Assembly highlight some of the most interesting findings in the field of paediatrics which were presented at the 2018 international ERS Congress.

Sustained inflations during delivery suite stabilisation in prematurely-born infants - A randomised trial.

Background: Sustained inflations at initial stabilisation in the delivery suite may reduce the need for intubation and result in a shorter duration of initial ventilation, but have not been compared to routine UK practice.

Aims: To compare the early efficacy of sustained inflation during stabilisation after delivery to UK practice.

Study Design: A randomised trial was performed of a fifteen second sustained inflation compared to five inflations lasting 2 to 3 s, each intervention could be repeated once if no chest rise was apparent.

Work of breathing during HHHFNC and synchronised NIPPV following extubation.

Our aim was to compare the work of breathing (WOB) during synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) when used as post-extubation support in preterm infants. A randomised crossover study was undertaken of nine infants with a median gestational age of 27 (range 24-31) weeks and post-natal age of 7 (range 2-50) days. Infants were randomised to either SNIPPV or HHHFNC immediately following extubation.

Small for gestational age and extremely low birth weight infant outcomes.

Background Small for gestational age (SGA) infants are less likely to develop respiratory distress syndrome (RDS), but more likely to develop bronchopulmonary dysplasia (BPD) and have a higher mortality. Our aim was to focus on outcomes of those with a birth weight less than or equal to 750 g. Methods The mortality, BPD severity, necrotising enterocolitis (NEC), home oxygen requirement and length of hospital stay were determined according to SGA status of all eligible infants in a 5-year period admitted within the first 24 h after birth.

Detection of exhaled carbon dioxide following intubation during resuscitation at delivery.

Objectives: End tidal carbon dioxide (ETCO) monitoring can facilitate identification of successful intubation. The aims of this study were to determine the time to detect ETCO following intubation during resuscitation of infants born prematurely and whether it differed according to maturity at birth or the Apgar scores (as a measure of the infant's condition after birth).

Design: Analysis of recordings of respiratory function monitoring.

Sustained inflations versus UK standard inflations during initial resuscitation of prematurely born infants in the delivery room: a study protocol for a randomised controlled trial.

Background: Many infants born at less than 34 weeks of gestational age will require resuscitation in the delivery suite. Yet, different resuscitation techniques are specified in different national guidelines, likely reflecting a limited evidence base. One difference is the length of mechanical inflation initially delivered to infants either via a facemask or endotracheal tube.

Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonatal respiratory support.

Background: Effective synchronisation of infant respiratory effort with mechanical ventilation may allow adequate gas exchange to occur at lower peak airway pressures, potentially reducing barotrauma and volutrauma and development of air leaks and bronchopulmonary dysplasia. During neurally adjusted ventilatory assist ventilation (NAVA), respiratory support is initiated upon detection of an electrical signal from the diaphragm muscle, and pressure is provided in proportion to and synchronous with electrical activity of the diaphragm (EADi). Compared to other modes of triggered ventilation, this may provide advantages in improving synchrony.

Special needs require special attention: a pilot project implementing the paediatric pain profile for children with profound neurological impairment in an in-patient setting following surgery.

There is a lack of knowledge regarding the implementation of pain assessment tools for children with profound neurological impairment (PNI) in in-patient settings. This article describes a pilot project to evaluate the Paediatric Pain Profile (PPP) for children with PNI undergoing surgery. Five families of children 5 to 16 years of age with a primary diagnosis of cerebral palsy and admitted for surgical procedures were interviewed.