Closed-loop automated oxygen control in late preterm and term, ventilated infants: A randomised controlled trial.

Aim: To compare the time spent above the target oxygen saturation range (SpO > 96%) and the duration of supplemental oxygen between ventilated infants receiving closed-loop automated oxygen control (CLAC) or manual oxygen control in late preterm and term ventilated infants.

Methods: Infants were randomised to receive CLAC or manual oxygen control from recruitment and within 24 h of mechanical ventilation until successful extubation.

Results: Forty infants with a median (IQR) gestational age of 37.

Invasive ventilation at the boundary of viability: A respiratory pathophysiology study of infants born between 22 and 24 weeks of gestation.

Background: Invasive ventilation of infants born before 24 weeks of gestation is critical for survival and long-term respiratory outcomes, but currently there is a lack of evidence to guide respiratory management. We aimed to compare respiratory mechanics and gas exchange in ventilated extremely preterm infants born before and after 24 weeks of gestation.

Methods: Secondary analysis of two prospective observational cohort studies, comparing respiratory mechanics and indices of gas exchange in ventilated infants born at 22-24 weeks of gestation (N=14) compared to infants born at 25-27 weeks (N=37).

Temporal effects of caffeine on intrapulmonary shunt in preterm ventilated infants.

Objectives: We hypothesized that caffeine would be associated with a transient reduction in the right-to-left shunt and V/Q. We aimed to explore the temporal effects of caffeine on right-to-left shunt, ventilation perfusion ratio (V/Q) and shift of the oxyhaemoglobin dissociation curve (ODC) in premature ventilated infants.

Methods: Retrospective cohort study at a tertiary neonatal unit of infants born at less than 31 weeks of gestation that were mechanically ventilated on day three of life.

A neonatal in-vitro study on the effect of the inflation pressure on end-tidal carbon dioxide levels.

Background: Describing the association of the peak inflation pressure (PIP) with end-tidal carbon dioxide (ETCO) is a prerequisite for the development of closed loop ventilation in neonatal intensive care. We aimed to develop an in-vitro system to study this relationship.

Methods: A ventilator was connected to a test lung, supplied with a stable CO concentration from a cylinder.

Postnatal corticosteroid usage in United Kingdom and Ireland neonatal units.

Aim: To perform a survey on postnatal corticosteroids usage in neonatal units in the United Kingdom and Ireland.

Methods: An 18-item structured questionnaire was created asking for the level of neonatal care and corticosteroid prescribing practices. A consultant neonatologist or senor specialty training registrar/advanced neonatal nurse practitioner was contacted in every neonatal unit in the UK and Ireland between September and December 2022.

Permissive hypercapnia and oxygenation impairment in premature ventilated infants.

Aim: In permissive hypercapnia high levels of carbon dioxide (CO) are tolerated in ventilated preterm infants to minimise lung injury, but hypercapnia could directly impair oxygenation. We aimed to quantify the association of elevated CO with oxygenation impairment in preterm infants by measuring the right-to-left shunt and the ventilation/perfusion (V/Q) ratio.

Methods: Pre-existing datasets from preterm infants during the acute phase of respiratory distress syndrome or with evolving or established bronchopulmonary dysplasia were analysed.

Systematic review of the long-term effects of postnatal corticosteroids.

Background: Dexamethasone administration can reduce bronchopulmonary dysplasia, our objective was to identify long term adverse effects.

Content: A systematic review was performed to determine the childhood and adolescent cardiopulmonary and cognitive effects of dexamethasone systemically administered to preterm infants during neonatal intensive care. Relevant studies were identified by searching two electronic health databases and the grey literature.

Neonatal respiratory support strategies-short and long-term respiratory outcomes.

Mechanical ventilation (MV), although life-saving, is associated with chronic respiratory morbidity in both preterm and term born infants. New ventilation modes have been developed with the aim of minimising lung injury. These include invasive and non-invasive respiratory support strategies, techniques for less invasive surfactant administration (LISA) and closed-loop automated oxygen control (CLAC) systems.

Does closed-loop automated oxygen control reduce the duration of supplementary oxygen treatment and the amount of time spent in hyperoxia? A randomised controlled trial in ventilated infants born at or near term.

Background: Ventilated infants frequently require supplemental oxygen, but its use should be monitored carefully due to associated complications. The achievement of oxygen saturation (SpO) targets can be challenging as neonates experience frequent fluctuations of their oxygen levels that further increase the risk of complications. Closed-loop automated oxygen control systems (CLAC) improve achievement of oxygen saturation targets, reduce hyperoxaemic episodes and facilitate weaning of the inspired oxygen concentration in ventilated infants born at or near term.

Ventilatory response to added dead space in infants exposed to second-hand smoke in pregnancy.

Maternal cigarette smoking in pregnancy can adversely affect infant respiratory control. In utero nicotine exposure has been shown to blunt the infant ventilatory response to hypercapnia, which could increase the risk of sudden infant death syndrome. The potential impact of maternal second-hand smoke exposure, however, has not yet been determined.

Race, hypoxaemia and oxidative stress in prematurely-born infants.

Background: Disparities in neonatal respiratory outcomes in prematurely-born infants might be partially explained by racial differences and the relationship of hypoxia and oxidative stress.

Aims: To determine if Black, preterm infants were exposed more frequently to hypoxaemia compared to White infants and had a higher level of oxidative damage.

Study Design: Single-centre retrospective cohort study at King's College Hospital, London, UK between 2018 and 2021.

Closed-loop oxygen system in late preterm/term, ventilated infants with different severities of respiratory disease.

Aim: To evaluate closed-loop automated oxygen control (CLAC) in ventilated infants >33 weeks of gestation with different respiratory disease severities.

Methods: Infants were studied on two consecutive days for 6 h each day. They were randomised to receive standard care or standard care with CLAC (Oxygenie) first.

Closed-loop automated oxygen control in ventilated infants born at or near term: A crossover trial.

Aim: To determine if the use of closed-loop automated oxygen control (CLAC) reduced the incidence and duration of hypoxemic episodes (SpO  < 92%) in ventilated infants born at or above 34 weeks of gestation.

Methods: Infants were studied on two consecutive days for 6 h each day. They were randomised to receive standard care (manual oxygen control) or standard care with a CLAC system (automated oxygen control) first.

Cumulative hypoxia, socioeconomic deprivation and neurodevelopmental outcomes in preterm infants.

Background: Hypoxia can adversely affect cognition, while socioeconomic deprivation has also been associated with impaired neurodevelopment in the newborn. We aimed to assess the impact of hypoxia and socioeconomic deprivation on the neurodevelopmental outcomes of preterm infants.

Methods: Retrospective cohort study at a tertiary neonatal unit between 2015 and 2018.

Does closed-loop automated oxygen control reduce the duration of mechanical ventilation? A randomised controlled trial in ventilated preterm infants.

Background: Many preterm infants require supplemental oxygen in the newborn period but experience frequent fluctuations of their oxygen saturation levels. Intermittent episodes of hypoxia or hyperoxia increase the risk of complications. Compliance with achievement of oxygen saturation targets is variable, and the need for frequent adjustments of the inspired oxygen concentration increases workload.

Second course of systemic dexamethasone: efficacy and respiratory function changes.

Background: There is a paucity of data concerning the efficacy of a second course of systemic postnatal corticosteroids resulting in a successful extubation of prematurely-born, ventilated infants and its effect on their respiratory function.

Objectives: To determine the efficacy of a second course of systemic dexamethasone in successful extubation of prematurely-born infants and to describe the respiratory function changes that occur following the administration of the second course.

Methods: Retrospective cohort study of ventilated infants less than 30 weeks of gestation who received a nine-day second course of intravenous dexamethasone in a tertiary neonatal unit.

Chronology and Determinants of Respiratory Function Changes Following Administration of Systemic Postnatal Corticosteroids in Extremely Preterm Infants.

Objective: To describe the effect of systemic corticosteroids administered to treat evolving bronchopulmonary dysplasia on oxygen diffusion and ventilation efficiency.

Study Design: This was a retrospective cohort study of ventilated infants who received a 9-day course of dexamethasone in a tertiary neonatal unit. We calculated the transcutaneous oxygen saturation-to-fraction of inspired oxygen (FO) ratio (SFR), the ventilation perfusion ratio (V/Q), and the ventilation efficiency index (VEI) before, during, and after the course of corticosteroids.

Deltoid muscle morphometry as an index of impaired skeletal muscularity in neonatal intensive care.

Unlabelled: We hypothesised that extremely premature infants would have decreased muscle mass at term-corrected age compared to term-born infants and that the degree of reduced muscle mass acquisition would correlate with the duration of invasive mechanical ventilation. The MRI brain scans of infants admitted in the neonatal unit at King's College Hospital between 1 January 2010 and 1 June 2016 were retrospectively reviewed. The coronal cross-sectional area of the left deltoid muscle (DCSA) was measured in 17 infants born < 28 weeks of gestation and in 20 infants born at term.

Effect of maturity and infection on the rate of relaxation of the respiratory muscles in ventilated, newborn infants.

Aim: To assess the respiratory muscle time constant of relaxation (τ), an index of respiratory muscle function in ventilated newborns.

Methods: Sixty-two infants (42 born prematurely) with a median gestational age of 29 [interquartile range (IQR) 26-37] weeks were prospectively studied. Measurement of τ was taken during spontaneous breathing on endotracheal continuous positive airway pressure prior to extubation, and τ was calculated from the reciprocal of the slope of the airway pressure decline versus time.

Relaxation Rate of the Respiratory Muscles and Prediction of Extubation Outcome in Prematurely Born Infants.

Background: Accurate prediction of extubation outcome could result in a significant reduction of respiratory morbidity in premature neonates.

Objectives: To assess whether the respiratory muscle time constant of relaxation (τ) predicted extubation outcome in mechanically ventilated, premature infants.

Methods: Forty-six mechanically ventilated infants with a median gestational age of 26 (interquartile range [IQR] 25-29) weeks were prospectively studied.

Determinants of pulmonary dead space in ventilated newborn infants.

Background: Pulmonary dead space (V) is an index of ventilation inhomogeneity and one of the determinants of the magnitude of tidal volume to maintain optimal blood gases.

Aims: To identify the determinants of V in ventilated newborns and to investigate differences in V between prematurely born and term infants and those prematurely born infants who did or did not develop bronchopulmonary dysplasia (BPD).

Methods: Sixty-one mechanically ventilated infants (15 term, 46 preterm) were studied at a median age of 8 (IQR 2-31) days; 32 of the preterm infants developed BPD.