Neurally adjusted ventilatory assist in neonates with congenital diaphragmatic hernia.

OBJECTIVE: To measure short-term outcomes of neonates with congenital diaphragmatic hernia (CDH) while on Neurally Adjusted Ventilator Assist (NAVA), and to measure the impact of a congenitally abnormal diaphragm on NAVA ventilator indices. STUDY DESIGN: First, we conducted a retrospective-cohort analysis of 16 neonates with CDH placed on NAVA over a treatment period of 72 h. Second, we performed a case-control study comparing NAVA level and Edi between neonates with CDH and those without CDH. RESULTS: Compared to pre-NAVA, there were clinically meaningful improvements in PIP (p < 0.003), Respiratory Severity Score (p < 0.001), MAP (p < 0.001), morphine (p = 0.004), and midazolam use (p = 0.037). Compared to a 1:2 matched group without CDH, there was no meaningful difference in NAVA level (p = 0.286), Edi-Peak (p = 0.315), or Edi-Min (p = 0.266). CONCLUSIONS: The potential benefits of NAVA extend to neonates with CDH. There is minimal compensatory change in Edis, and higher/lower ventilator settings compared to neonates without CDH.

Lower respiratory tract infection in infancy in relation to feeding pattern.

OBJECTIVE: To assess the relation between lower respiratory tract infection and feeding pattern in infancy. SETTING: Hospital based descriptive. METHODS: Two hundred and five infants presenting with lower respiratory infection (LRTI) admitted in the ward were studied over a period of one year. Criteria for the clinical diagnosis of LRTI were based on the lines of TUCSON CHILDREN RESPIRATORY STUDY. RESULTS: Forty three percent of LRTI in infancy were seen in age group of 0 to 3 months. Sixty percents of pre-lacteal feeding and 71% of bottle-feeding were observed. Late introduction of solid food was very commonly practiced. In 64.7% solid food was introduced at the age of 9 to 12 months. Fifty three percent of LRTI were associated with diarrhoea, which was the commonest factor associated with mortality due to LRTI. There was male preponderance with male:female = 2.8:1(P value <0.001), which is highly significant. Mixed feeding/artificial feeding had more incidence of LRTI than exclusively breast-fed children (1.7:1) and the mortality rate was 10 times more in mixed/artificial fed infants than exclusively breast fed infants.