Evaluation of a respiratory care protocol including less invasive surfactant administration in preterm infants.

BACKGROUND: Respiratory care protocol including less invasive ssurfactant administration (LISA) in ≤29 weeks' gestational age (GA) infants introduced in October 2018. METHODS: Retrospective study of infants admitted on continuous positive airway pressure (CPAP) October 2018 to December 2021. Maternal and neonatal variables were compared between infants managed on CPAP with and without LISA. Infants who received LISA and subsequently required mechanical ventilation (MV) within 72 h of life (HOL) [LISA failure (LF)] were compared with those who required no MV [LISA success (LS)]. RESULTS: 249 infants were admitted on CPAP, 5 were intubated prior to LISA, 143 required LISA and 101 remained on CPAP without surfactant. Of those receiving LISA, 108 were LS and 35 were LF. Compared to LS, LF infants were of lower GA and birth weight, required higher fractional inspired oxygen (FiO2), and CPAP level at birth, admission, one HOL, and an hour after LISA. Moreover, LF infants had higher mortality and morbidity. Together GA ≤ 25 weeks' and FiO2 ≥ 0.3 an hour after LISA best predicted LF. CONCLUSIONS: Over 80% of infants admitted on CPAP avoided MV within 72 HOL. Early predictors of LF provide targets for future interventions to decrease need for MV in preterm infants. IMPACT: Less invasive surfactant administration (LISA) decreases the need for mechanical ventilation (MV) and improves outcomes. However, some infants require MV within 72 h of life (HOL) despite LISA (LISA failure). Over 80% of ≤29 weeks' gestational age (GA) infants can be successfully managed on CPAP with or without surfactant in the first 72 HOL. A combination of factors including ≤25 weeks' GA and fraction of inspired oxygen ≥0.3 an hour after LISA predict LISA failure. Evaluation of a noninvasive respiratory support strategy including LISA provides targets for intervention to decrease need for MV in preterm infants.

Decreasing Continuous Positive Airway Pressure Failure in Preterm Infants.

BACKGROUND AND OBJECTIVES: Many preterm infants stabilized on continuous positive airway pressure (CPAP) at birth require mechanical ventilation (MV) during the first 72 hours of life, which is defined as CPAP failure. Our objective was to decrease CPAP failure in infants ≤29 weeks' gestational age (GA). METHODS: A quality improvement bundle named OPTISURF was implemented for infants ≤29 weeks' GA admitted on CPAP, consisting of stepwise escalation of CPAP and less invasive surfactant administration guided by fractional inspired oxygen concentration ≥0.3. The CPAP failure rate was tracked by using control charts. We compared practice and outcomes of a pre-OPTISURF cohort (January 2017 to September 2018) to a post-OPTISURF cohort (October 2018 to December 2019). RESULTS: Of the 216 infants ≤29 weeks' GA admitted to NICU on CPAP, 125 infants belonged to the pre-OPTISURF cohort (OSC) and 91 to the post-OSC. Compared with the pre-OSC, a higher proportion of infants in the post-OSC received CPAP 7 cm H2O within 4 hours of life (7% vs 32%; P < .01). The post-OSC also had lower rates of CPAP failure (54% vs 11%; P < .01), pneumothoraces (8% vs 1%; P < .03), need for MV (58% vs 31%; P < .01), and patent ductus arteriosus treatment (21% vs 9%; P = .02). Additionally, in a subgroup analysis, CPAP failure was lower in the post-OSC among infants 23 to 26 weeks (79% vs 27%; P < .01) and 27 to 29 weeks' GA (46% vs 3%; P < .01). CONCLUSIONS: Implementation of a quality improvement bundle including CPAP optimization and less invasive surfactant administration decreased CPAP failure and need for MV in preterm infants.

Vitamin E does not modulate plasma lipid profile or C-reactive protein despite suppressing oxidative stress in orchiectomized rats.

Vitamin E is known to improve antioxidant status and to prevent lipoprotein oxidation. However, the effect of vitamin E on other cardiovascular risk factors, including C-reactive protein (CRP) and lipid profile status, in orchiectomized rats is unknown. In the present study, 32 1-year-old male rats were randomized into two groups: a sham-control group (n = 8) and an orchiectomized group (n = 24). The orchiectomized group was divided into three groups of eight and assigned to one of the following treatments: orchiectomy (ORX), ORX + vitamin E mixture (65.6 mg/kg) diet, or ORX + vitamin E mixture (656 mg/kg) diet. For 120 days all four groups consumed a basal AIN-93M diet, while the vitamin E groups ate diets containing an additional vitamin E mixture. Four months after the study began, all the rats were killed, the blood was collected, and the plasma was assayed for antioxidant status, CRP, lipid profile, and indices of peroxidation. ORX decreased (P < .05) the plasma antioxidant status, superoxide dismutase (SOD) activity, and CRP level and increased (P < .05) the plasma malondialdeyde, nitrite, and lipid profile compared with that of the sham-control group. In contrast to the ORX group, supplementation with vitamin E mixture increased (P < .05) plasma antioxidant status and dose-dependently increased (P < .05) SOD activity, while the vitamin E decreased (P < .05) plasma malondialdeyde and nitrite. The vitamin E mixture had no effect on CRP or on lipid profiles when compared to the orchiectomized rats. In conclusion, vitamin E appears to reduce oxidative stress without modulating lipid profile or inflammatory response.

Orange pulp improves antioxidant status and suppresses lipid peroxidation in orchidectomized male rats.

OBJECTIVE: Oxidative stress is linked to an increased incidence of cardiovascular disease in men. The objective of this research was to delineate whether daily consumption of orange pulp (OP) modifies antioxidant status and decreases cardiovascular risk factors in orchidectomized rats. METHODS: In the present study, 45 1-y-old male rats were randomized to a sham-control group (n = 9) and an orchidectomized group (n = 36). The orchidectomized group was equally divided among the following five treatments: orchidectomy (ORX), ORX + 2.5% OP, ORX + 5% OP, and ORX + 10% OP. One hundred twenty days after the study began, all rats were sacrificed and plasma was harvested for its antioxidant status, C-reactive protein (CRP), lipid profile, and indices of peroxidation. Superoxide dismutase (SOD) and catalase activities in the liver were also monitored. RESULTS: Orchidectomy decreased (P < 0.05) plasma levels of antioxidant, SOD, catalase, and CRP and increased (P < 0.05) plasma levels of malondialdehyde, nitrite, and lipid profile compared with the sham-control group. In contrast to ORX, ORX + OP increased (P < 0.05) plasma antioxidant, dose-dependently increased (P < 0.05) SOD and catalase, decreased (P < 0.05) plasma malondialdehyde, nitrite, cholesterol, and triacylglycerol concentrations in the liver; and had no effect (P > 0.1) on plasma CRP or lipid profiles. CONCLUSION: The beneficial effect of eating an orange is demonstrated by the increasing antioxidant status and by the decreasing peroxidation independent of plasma triacylglycerol, cholesterol, or CRP concentrations.

Cranberry juice increases antioxidant status without affecting cholesterol homeostasis in orchidectomized rats.

Oxidative stress and hypogonadism are linked to the increased incidence of cardiovascular disease in males. The objective of this research was to delineate whether drinking cranberry juice for 4 months affects antioxidant capacity and lipid profile in orchidectomized rats. Thirty-two 1-year-old male rats were randomized to two groups: a sham-control group (n = 8) and an orchidectomized group (n = 24). The orchidectomized group was divided into three groups of eight and assigned to one of the following treatments: orchidectomy, orchidectomy plus 27% cranberry juice, and orchidectomy plus 45% cranberry juice. At 120 days after initiation of the study, all rats were killed, blood was collected, and plasma was harvested for total antioxidant status, malondialdehyde, nitrate + nitrite, and superoxide dismutase (SOD) activity in liver, and concentrations of cholesterol and triglyceride in liver and in plasma. Orchidectomy depressed (P < .05) plasma antioxidant capacity and SOD activity, elevated (P < .05) nitrate + nitrite and malondialdehyde in plasma, and increased (P < .05) triglyceride and cholesterol values in liver and in plasma. Cranberry juice increased (P < .05) plasma antioxidant capacity and SOD activity and reduced (P < .05) nitrate + nitrite and malondialdehyde concentrations. Drinking cranberry juice did not affect cholesterol concentrations in liver and in plasma. Triglyceride concentration in plasma of orchidectomized rats that were drinking cranberry juice increased (P < .05), but its concentration in liver decreased (P < .05) to the level of shams. The protective effect of cranberry juice from oxidative damage may be mediated by a decrease in nitrate + nitrite and dose-dependent decrease in peroxidation.