Publications by authors named "Kristel Kuypers"
Article Synopsis
- Chorioamnionitis (HCA) and funisitis (FUN) are linked to preterm birth, and their combined effects can negatively influence an infant's respiratory drive after birth.* -
- A study involving 186 infants found that those with HCA and FUN had significantly lower gestational ages and birthweights compared to those without these conditions.* -
- While HCA and FUN were associated with reduced breathing effort in the first five minutes of life, subclinical HCA and FUN showed no significant impact on breathing metrics.*
Article Synopsis
- Preterm rabbits were studied to see how changing expiratory resistance (Re) affects lung aeration during positive pressure ventilation right after birth.
- Increasing Re slowed down lung deflation and increased functional residual capacity (FRC), indicating that higher resistance may improve lung function during mechanical ventilation.
- The findings suggest that improving the expiratory phase in ventilation devices could enhance outcomes for preterm infants by preserving more FRC, despite breath-related work reduction efforts.
Article Synopsis
- Most very premature infants breathe at birth but often need respiratory support due to issues like chorioamnionitis, which is inflammation of the fetal membranes.
- Chorioamnionitis can release inflammatory substances that may depress the brain's respiratory drive, leading to risks of hypoxic injury in these infants.
- The review suggests that understanding how chorioamnionitis affects breathing can help develop interventions to stimulate spontaneous breathing in these infants during birth.
Article Synopsis
- The study aimed to visualize vocal cords (VCs) in preterm infants using ultrasound (US) to understand their position and movement during non-invasive respiratory support right after birth.
- Researchers monitored 20 infants born before 30 weeks gestation, finding they could successfully visualize VCs without disrupting the infants’ stabilization process.
- Results showed that VCs were often closed during breathing and apnoea, which could negatively affect the effectiveness of ventilation provided to these infants.
Introduction: Recent reports have raised concerns of cardiorespiratory deterioration in some infants receiving respiratory support at birth. We aimed to independently determine whether respiratory support with a facemask is associated with a decrease in heart rate (HR) in some late-preterm and term infants.
Methods: Secondary analysis of data from infants born at ≥32+0 weeks of gestation at 2 perinatal centres in Melbourne, Australia.
Background: The importance of neonatal resuscitator resistance is currently unknown. In this study we investigated peak flows and pressure stability resulting from differences in imposed resistance during positive pressure ventilation(PPV) and simulated spontaneous breathing (SSB) between the r-PAP, low-resistance resuscitator, and Neopuff™, high-resistance resuscitator.
Methods: In a bench test, 20 inflations during PPV and 20 breaths during SSB were analysed on breath-by-breath basis to determine peak flow and pressure stability using the Neopuff™ with bias gas flow of 8, 12 or 15 L/min and the r-PAP with total gas flow of 15 L/min.
Effect of initial and subsequent mask applications on breathing and heart rate in preterm infants at birth.
Arch Dis Child Fetal Neonatal Ed
November 2023
Article Synopsis
- A study examined the effects of face mask applications on preterm infants during birth, focusing on the trigeminocardiac reflex and its possible relation to apnoea and bradycardia.
- Out of 111 infants, 404 mask applications were analyzed, revealing that the first application led to more frequent instances of apnoea and bradycardia compared to later applications.
- The findings indicate that lower breathing and heart rates before applying the mask increase the likelihood of apnoea, suggesting a need for careful monitoring during resuscitation.
Rationale: Antenatal inflammation, usually associated with chorioamnionitis, is a major cause of premature birth. As inflammation could depress respiratory drive, we have examined the effect of clinical chorioamnionitis (CCA) on spontaneous breathing in premature infants at birth.
Methods: Infants with CCA born <30 weeks' gestation were matched with control infants based on gestational age (±6 days), birth weight (±300 g), antenatal corticosteroids, sex and general anaesthesia.
Aim: The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation.
Methods: The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM.
Technology in the delivery room supporting the neonatal healthcare provider's task.
Semin Fetal Neonatal Med
October 2022
Article Synopsis
- Very preterm infants are particularly vulnerable and require precise medical interventions due to their limited physiological stability.
- The transition from fetus to newborn involves rapid and complex changes, making initial care and resuscitation in the delivery room challenging for caregivers.
- While NICUs are adopting advanced technologies to support infant care, similar innovations are needed in delivery rooms to enhance caregiver effectiveness and improve outcomes for preterm infants.
Objective: The resistance created by the PEEP-valve of a T-piece resuscitator is bias gas flow dependent and might affect breathing in preterm infants. In this study we investigated the effect of a higher bias gas flow on the imposed inspiratory and expiratory T-piece resistance and expiratory breaking manoeuvres (EBM) in preterm infants during spontaneous breathing on CPAP at birth.
Methods: In a retrospective pre-post implementation study of preterm infants <32 weeks gestation, who were stabilised with a T-piece resuscitator, a bias gas flow of 12 L/min was compared to 8 L/min.
Article Synopsis
- Preterm infants (24-30 weeks gestation) were studied to compare the effects of high initial CPAP levels (12-15 cmHO) that decrease after stabilization (PB-CPAP) versus standard CPAP levels (5-8 cmHO) administered at birth.
- The trial aimed to assess the feasibility of PB-CPAP and its impact on oxygen saturation (SpO) and other physiological outcomes, but was halted after enrolling 31 infants due to low inclusion rates and conflicting local guidelines.
- Results showed no significant difference in SpO between the two groups, but PB-CPAP led to higher heart rates and shorter mask ventilation times, with stabilization taking less time, although the differences were not statistically significant for
Article Synopsis
- The study aimed to evaluate if using a respiratory function monitor (RFM) during positive pressure ventilation (PPV) improves the percentage of inflations with the desired tidal volume in extremely preterm infants.
- Conducted as a clinical trial in neonatal intensive care units across 6 countries, infants were randomly assigned to either have the RFM visible or not while receiving PPV, with a focus on comparing the percentage of inflations within the target range of 4-8 mL/kg.
- Results showed no significant difference in the percentage of correct inflations between the two groups; however, the group with visible RFM had a lower incidence of serious brain conditions, indicating possible benefits despite the primary outcome not being met.
The trigeminocardiac reflex (TCR) is a well-recognized brainstem reflex that represents a unique interaction between the brain and the heart through the Vth and Xth cranial nerves and brainstem nuclei. The TCR has mainly been reported as an intraoperative phenomenon causing cardiovascular changes during skull-base surgeries. However, it is now appreciated that the TCR is implicated during non-neurosurgical procedures and in nonsurgical conditions, and its complex reflex pathways have been explored as potential therapeutic options in various neurological and cardiovascular diseases.
View Article and Find Full Text PDFObjective: Applying a face mask could provoke a trigeminocardiac reflex. We compared the effect of applying bi-nasal prongs with a face mask on breathing and heart rate of preterm infants at birth.
Methods: In a retrospective matched-pairs study of infants <32 weeks of gestation, the use of bi-nasal prongs for respiratory support at birth was compared to the use of a face mask.
Reflexes that impact spontaneous breathing of preterm infants at birth: a narrative review.
Arch Dis Child Fetal Neonatal Ed
November 2020
Some neural circuits within infants are not fully developed at birth, especially in preterm infants. Therefore, it is unclear whether reflexes that affect breathing may or may not be activated during the neonatal stabilisation at birth. Both sensory reflexes (eg, tactile stimulation) and non-invasive ventilation (NIV) can promote spontaneous breathing at birth, but the application of NIV can also compromise breathing by inducing facial reflexes that inhibit spontaneous breathing.
View Article and Find Full Text PDFObjective: Applying a mask on the face for respiratory support could induce a trigeminocardiac reflex leading to apnoea and bradycardia. We have examined the effect of applying a face mask on breathing and heart rate in preterm infants at birth.
Methods: Resuscitation videos of infants ≤ 32 weeks gestation recorded from 2010 until 2018 at the Leiden University Medical Centre and the General University Hospital in Prague were reviewed.
Paromomycin (PMM) has recently been introduced for treatment of visceral leishmaniasis in India. Although no clinical resistance has yet been reported, proactive vigilance should be warranted. The present in vitro study compared the outcome and stability of experimental PMM-resistance induction on promastigotes and intracellular amastigotes.
View Article and Find Full Text PDFSchistosomiasis is characterised by periovular granuloma formation within the portal tract and presinusoidal venules. As inflammation wanes, continued attempts to wall off and repair hepatic injury, lead to the development of extensive fibrosis. The codependence of chronic inflammation and angiogenesis is a well-known phenomenon.
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