Management of neonatal respiratory distress syndrome employing ACoRN respiratory sequence protocol versus early nasal continuous positive airway pressure protocol

Respiratory distress syndrome [RDS] is a common cause of respiratory distress in premature infants. This study was designed to evaluate two different RDS treatment protocols by comparing the outcomes. This study was a double center cross sectional study performed from June to December 2012. During that period, 386 neonates with RDS were hospitalized and treated according to two different therapeutic protocols so-called Acute Care of at-Risk Newborns [ACoRN] respiratory sequence protocol [group I] and Early Nasal Continuous Positive Airway Pressure [E-NCPAP] protocol [group II]. The variables and main outcomes of this study were gestational age, birth weight, bronchopulmonary dysplasia [BPD], pulmonary hemorrhage [PH], intraventricular hemorrhage [IVH], air leak and mortality rate [MR]. Out of 386 infants, 202 infants were in group I [male 60.4%, female 39.6%, mean gestational age 316/7 weeks, mean birth weight=1688 grams] and group II included 184 infants [male 61.4%, female 38.6%, mean gestational age 32 weeks, mean birth weight 1787 grams], P= 0.07. The ratios of BPD of group I to group II and PH of group I to group two were not significant [P=0.6 and P=0.8, respectively]. Air leak ratio in group I was higher than in group II [P=0.001]. Although IVH ratio in group II was higher than in group I [P=0.01], grade III and IV IVH was higher in group I [30% vs. 4.6%]. In case of MR, it was higher in group I than in group II [P=0.001]. According to the findings the incidence of air leak, grade III and IV IVH and MR was less common in E-NCPAP protocol, so it may show the effectiveness of this protocol. The authors suggest that more researches are needed for more accurate results

Nasal intermittent positive pressure ventilation vs. nasal continuous positive airway pressure in preterm infants with respiratory distress

The trend today is to minimize the use of mechanical ventilation. Nasal continuous positive airway pressure [NCPAP] and nasal intermittent positive pressure ventilation [NIPPV] are 2 non-invasive treatments for respiratory distress syndrome [RDS]. There is little study in literature comparing early use of NIPPV with NCPAP as primary modes of respiratory support. The aim of this study is to determine whether NIPPV and NCPAP would have different survival rates and possible complications. In this prospective clinical trial study, 120 preterm neonates [gestational age 28-36 weeks] who were admitted due to respiratory distress between January and May 2012 in the neonatal intensive care unit of Afzalipour hospital. Sixty infants were randomized to NCPAP and comparable infants to NIPPV [birth weight 1807.05 +/- 52 vs. 1882.50 +/- 56 g, gestational age 32.05 +/- 2.94 vs. 32.16 +/- 2.08 weeks, respectively]. Patients were randomly allocated into 2 treatment groups using minimization technique. One group was treated by NCPAP and the second one treated by NIPPV. Survival analysis was applied to estimate and compare survival rates. Infants treated initially with NIPPV needed less endotracheal ventilation than infants treated with NCPAP [13.3% vs. 41.7%, p=0.001]. Estimated survival rates at 24 h in NIPPV were 97% versus 82% for NCPAP group. We have seen that the risk of failure for those received NCPAP was nearly 4 times higher than NIPPV group. According to our results, among preterm infants with suspected [RDS], the use of NIPPV reduces the need for intubation and mechanical ventilation in comparison to NCPAP

Bubble-CPAP vs. ventilatory-CPAP in preterm infants with respiratory distress

Application of Continuous Positive Airway Pressure [CPAP] in neonate with respiratory distress is associated with reduction of respiratory failure, reduced complications and mortality. Bubble CPAP [B-CPAP] and ventilator-derived CPAP [V-CPAP] are two most popular CPAP modes. We aimed to determine whether B-CPAP and V-CPAP would have different survival rate and possible complications. This prospective clinical trial was performed on 50 preterm neonates weighing 1000-2000 gr who were admitted to the neonatal intensive care unit of Afzalipoor Hospital because of respiratory distress between June 2009 and May 2010. Patients were randomly allocated into treatment groups using minimization technique. Survival analysis was applied to estimate and compare survival rates. Duration of oxygen therapy, hospital stay as well as hospitalization costs were compared using independent sample t-test. Estimated survival rates at 24 hours in B-CPAP and V-CPAP groups were 100% and 77% respectively. Corresponding figures at 48 hours were 100% and 71%. In addition the hospitalization cost in V-CPAP group was significantly higher than in B-CPAP group. According to our results, B-CPAP was effective in the treatment of neonates who were suffering from respiratory distress and reduced the duration of hospital stay. In addition to mentioned benefits, its low cost may be the reason to use B-CPAP broadly compared with V-CPAP

Distribution of retinopathy of prematurity and its risk factors

This study was conducted to determine the distribution and risk factors of retinopathy of prematurity [ROP] in premature infants referred to neonates intensive care unit [NICU] of central hospital of Kerman University of Medical Sciences, to obtain primary information on ROP in Kerman, Iran. In a cross sectional prospective study, data of premature infants screened for ROP including possible risk factors and eye examination results were recorded during 2006-2008 and analyzed by using logistic regression and chi-square tests. Out of 83 premature infants, 24 [29%] had different stages of ROP [CI 95%: 0.19-0.39]. The infants' mean gestational age [GA] and mean birth weight [BW] in ROP group were 30.17 +/- 1.8 weeks and 1247.92 +/- 237.1 grams [g], respectively. Logistic regression analysis showed a significant relation between GA and BW with ROP [P<0.001]. Indication for treatment was set in 6 [25%] infants. The results of this study illustrate a relatively high prevalence of ROP in this series. GA and BW were independent ROP determinants

Intermittent versus continuous phototherapy for reducing neonatal hyperbilirubinemia

Clinical studies comparing intermittent versus continuous phototherapy for reducing neonatal hyperbilirubinemia have produced conflicting results. This study was conducted to compare the efficacy of intermittent with continuous phototherapy. This study was performed on 114 neonates with indirect hyperbilirubinemia. Inclusion criteria were body weight above 2000 grams, absence of other concomitant diseases, and hyperbilirubinemia neither requiring intensive phototherapy nor exceeding the range of exchange transfusion. The neonates were randomly divided into two groups. Continuous phototherapy group received phototherapy on and off for 2 hours and half an hour respectively and the intermittent phototherapy group on and off for one hour. The phototherapy units were identical and serum total bilirubin levels were measured every 12 hours after starting phototherapy. Two groups were matched regarding weight and risk factors such as ABO and Rh incompatibility. The difference of total serum bilirubin levels between two groups was insignificant at the start of phototherapy and also after 12, 24, 36 and 48 hours [P > 0.2]. Intermittent phototherapy defined as one hour on and one hour off is as effective as continuous phototherapy defined as 2 hours on and half an hour off, in reducing total serum bilirubin level in full term babies

Practical problems and the efficacy of intraosseous infusion: solving the problems by employing an animal model

In critically ill infants and children, intravascular [IV] access is sometimes very difficult. In such cases intraosseous [IO] infusion should be used as the method of choice. However, in practice, different problems are experienced with this procedure. To overcome the practical problems and to confirm the efficacy of IO infusion in reversing hypovolemic shock, an animal model was used by employing three rabbits. In rabbit I, after insertion of a 14-gauge bone marrow aspiration needle in the proximal tibia, the flow rate of normal saline was very slow by gravity, but pressure infusion devices including manual pushing with a syringe, blood pressure cuffs, or infusion pumps all increased the flow rate remarkably. In rabbit II, the circulation time of a dye given by IO route was very short; therefore drugs are expected to appear in the systemic circulation shortly after IO injection. In rabbit III, hypovolemic shock was induced by withdrawing blood and then, rapidly and successfully treated by IO infusion of normal saline