Prone versus supine position in artificially ventilated neonates

Changes in body position can significantly improve gas exchange with few complications related to the maneuver. This may result in a shorter stay in the critical care unit and improved outcome for the critically ill patient. This study was carried out on 60 neonates [39 females, 21 males] admitted to the neonatal intensive care unite, Tanta University Hospital. All neonates were suffering from respiratory failure and requiring intubation and mechanical ventilation. Patients were classified into four groups group la includes 15 neonates who were ventilated by PCV mode in the prone position. Group IIb includes 15 neonates who were ventilated by PCV mode in the supine position. Group Ila includes 15 neonates who were ventilated by SIMV mode in the prone position. Group lib includes 15 neonates who were ventilated by SIMV mode in the supine position. In group la and Ila, parameters were measured during supine position before turning infants to the prone position [baseline] and then they were turned prone and parameters were measured after 1 hour. Infants remained in the prone position for 20 hours and parameters were measured again and after those infants returned to the supine position and parameters were measured after 1 hour. In group Ib and lIb, parameters were measured at baseline after 1 hour, 20 hours and 21 hours. The results of our study showed that there was a significant increase in tidal volume in group Ila when compared to group lIb at 1 hour and 20 hours after turning infants to the prone position but there was no significant difference after returning to the supine position. Also there was a significant decrease in mean airway pressure in group la and Ila when compared to group Ib and lib respectively after 20 hours of the prone position and also after returning to the supine position. The results of our study also showed a significant improvement in PaO[2]k/FiO[2] ratio and SpO[2] after turning infants to the prone position and also after returning to the supine position when compared to the base line data. When comparing short duration of prone position to long duration there were also a significant improvement in PaO[2]/FiO[2] and SpO[2] with longer duration of the prone position. When comparing group la and Ila to Ib and lIb respectively, PaO[2]/FiO[2] ratio and SpO[2] were significantly higher in group la and Ila. When comparing group la to Ila, PaO[2]/FiO[2] ratio and SpO[2] were significantly higher in group Ila. Our results revealed that the oxygenation index was significantly lower [better oxygenation] after turning infants to the prone position and also after returning to the supine position when compared to the base line data. When comparing short duration of prone position to long duration there were also a significant decrease in oxygenation index with longer duration of the prone position. When comparing group la and Ila to Ib and lIb respectively, the oxygenation index was significantly lower in group la and Ila. When comparing group la to Ila, the oxygenation index was significantly lower in group Ila. But there were no significant changes in PH, PaCO[2], HCO[3], minute volume, heart rate and mean arterial blood pressure either within the same group or when comparing the groups with each other. Prone positioning can be accomplished safely and it should be done early in critically ill neonates with respiratory failure. Prone positioning for long periods [20 hours/day] have a cumulative and persistent improvement in oxygenation with less airway pressure even after return to the supine position

Otitis media with effusion in children: cytokines profile, nasopharyngeal colonization and prevention of recurrence

Otitis media with effusion [OME] is a common disease in children and there is a growing evidence that bacterial infection and immune response to bacteria and /or its antigens might be involved in the initiation and prolongation of OME. The present study was designed to characterize the pattern of nasopharyngeal colonization, effusion and serum cytokines in children with OME and to evaluate the possibilities of preventing recurrence by bacterial vaccination. 50 patients with OME and 50 subjects [control group] were enrolled in this study. The study groups were subjected to bacteriofogic and immunologic analysis, in addition the patients group was classified into 2 subgroups [group A and B] according to postoperative administration of bacterial vaccine to evaluate its effect in prevention of recurrence. Positive nasopharyngeal cultures were 100% in the patients group compared to 82% in the control group. IL-6 was detected in [60%] of middle ear effusions [MEEs] [33.65 +/- 29. 76 pg/ml], IL-8 in [80%] [52.60 +/- 30.88 pg/ml] while TNF-alpha was detected in only [54%] [26.24 +/- 24. 80 pg/ml]. The levels of IL-6, IL-8 and TNF- alpha in the serum were significantly higher in comparison to their levels in the MEEs of the same patients group [P<0. 05]. Also the levels of these cytokines in the serum of patients group were significantly increased compared to that in serum of the control group. In patients who received postoperative vaccination [group A] [7.1%] showed OME recurrence in 3 -years follow up period, while 31.8% of non_immunized group [group B] showed recurrence during the same follow up period. In conclusion, these data suggest a regulatory role for cytokines in OME. Our clinical experience with the use of polyvalent bacterial vaccination proved to be effective in preventing recurrence of this disease. However, further studies is needed to assess the impact of vaccination on reduction of bacterial colonization