Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants.

BACKGROUND: Apnoea of prematurity (AOP) is a common problem in preterm infants which can be treated with various modes of nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV). It is not known which mode of NCPAP or NIPPV is most effective for AOP. OBJECTIVE: To assess the effect of four NCPAP/NIPPV systems on the rate of bradycardias and desaturation events in very low birthweight infants. METHODS: Sixteen infants (mean gestational age at time of study 31 weeks, 10 males) with AOP were enrolled in a randomised controlled trial with a crossover design. The infants were allocated to receive nasal pressure support using four different modes for 6 h each: NIPPV via a conventional ventilator, NIPPV and NCPAP via a variable flow device, and NCPAP delivered via a constant flow underwater bubble system. The primary outcome was the cumulative event rate of bradycardias (< or =80 beats per minute) and desaturation events (< or =80% arterial oxygen saturation), which was obtained from cardio-respiratory recordings. RESULTS: The median event rate was 6.7 per hour with the conventional ventilator in NIPPV mode, and 2.8 and 4.4 per hour with the variable flow device in NCPAP and NIPPV mode, respectively (p value<0.03 for both compared to NIPPV/conventional ventilator). There was no significant difference between the NIPPV/conventional ventilator and the underwater bubble system. CONCLUSION: A variable flow NCPAP device may be more effective in treating AOP in preterm infants than a conventional ventilator in NIPPV mode. It remains unclear whether synchronised NIPPV would be even more effective.

Randomised crossover trial of different postural interventions on bradycardia and intermittent hypoxia in preterm infants.

BACKGROUND: Apnoea of prematurity has been shown to respond to changes in posture. OBJECTIVE: To investigate the effect of three postural interventions on the rate of bradycardia and desaturation events. METHODS: 18 infants (< or =32 weeks' gestational age; 11 boys) with apnoea of prematurity underwent recordings of breathing movements, electrocardiogram and instantaneous heart rate, pulse oximeter saturation (SpO2), photoplethysmographic waveforms and digital video frame while in one of three different prone positions. The following interventions were applied in random order: horizontal position (HP), 15 degrees head-up tilt position (TP) and three-level position (3P) according to Kinaesthetics Infant Handling. The primary study variable was the combined event rate of desaturations (SpO2 <85%) and bradycardias (heart rate <80 bpm). One secondary study variable was the duration of body movements. RESULTS: The median (range) combined event rate was 26.7/h (0.3-72.7) in HP, 25.2/h (0.3-70.5) in TP and 21.2/h (0-66.3) in 3P (p>0.05). The median (range) duration of body movements was 10.8 s/h (0-48.2) in HP, 7.1 s/h (0-72.4) in TP and 7.0 s/h (0-47.7) in 3P (p>0.05). CONCLUSIONS: No significant advantage of a head-up tilt or a three-level position over a standard horizontal position could be confirmed.

Factors influencing the detection of visual developmental deficits in 3-year-old kindergarten children.

PURPOSE/BACKGROUND: In the 'Tübingen Kindergarten study', an orthoptic screening program for amblyopia in three-year-olds was evaluated. In the retrospective analysis presented here, the association between a child's history--especially participation in the regular preventive care examinations in Germany (U4 to U7)--and the time of detection of target diseases was investigated. METHODS AND SUBJECTS: The parents of three groups of children were interviewed by telephone. Group 1 consisted of 21 children already treated for amblyopia before orthoptic screening; group 2 of 26 children with target conditions newly detected by orthoptic screening; and group 3 of 32 children with newly detected moderate ametropia. The groups were tested for differences in history and utilization/results of the regular preventive care examinations. RESULTS: Participation in regular preventive care ranged from 82% to 92%. There were no significant differences between the groups. Nearly 90% of parents from groups 2 and 3 had not heard of amblyopia before orthoptic screening. Only one child had been referred after regular preventive care examinations. CONCLUSIONS: The regular preventive care examinations contributed little to the detection of amblyopia. The strong position of the pediatrician should be used for the early information of parents.