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Pocivalnik M.,Medical University of Graz | Urlesberger B.,Medical University of Graz | Ziehenberger E.,Medical University of Graz | Binder C.,Medical University of Graz | And 6 more authors.
Early Human Development | Year: 2015

Background: Routine oropharyngeal suctioning in term vigorous neonates immediately after birth is a questionable practice. Current recommendations favor suctioning only in the presence of considerable obstruction due to secretions, blood or other matter. We aimed to analyze the influence of oropharyngeal suctioning on cerebral and peripheral muscle oxygenation in term neonates during transition immediately after birth. Methods: We included term neonates after elective cesarean section for this prospective observational study. Oropharyngeal suctioning was performed based on the clinicians' judgment of threatening airway obstruction. From a total of 138 enrolled neonates, 36 were suctioned and then compared to 36 controls matched for gestational age. Heart rate (HR) and pre/postductal arterial oxygen saturation (SpO2pre/SpO2post) were measured by pulse oximetry. Cerebral (rSO2brain) and pre/postductal peripheral muscle tissue oxygenation (rSO2pre/rSO2post) were measured by near infrared spectroscopy during the first 15. min of life. Results: All neonates in both groups experienced normal postnatal transition with normal Apgar scores (Apgar 9/10/10) and with no events of apnea or bradycardia induced by suctioning. SpO2pre values were slightly lower at 2 and 4. min after birth. Suctioning had no main and interaction effect on HR, SpO2post, rSO2brain, rSO2pre and rSO2post in the first 15. min after birth. Conclusion: In the present study we were able to show that, in term neonates, when correctly indicated, immediate postnatal oropharyngeal suctioning does not compromise cerebral and peripheral muscle tissue oxygenation. However, any suction maneuver must be performed with caution and strict indication during neonatal transition. © 2015 Elsevier Ireland Ltd.

Nicoll J.,Center for the Studies of Asphyxia and Resuscitation | Cheung P.-Y.,Center for the Studies of Asphyxia and Resuscitation | Aziz K.,Center for the Studies of Asphyxia and Resuscitation | Rajani V.,University of Alberta | And 3 more authors.
The Journal of pediatrics | Year: 2015

OBJECTIVES: To examine the amount of exhaled carbon dioxide (ECO2) with different breathing patterns in spontaneously breathing preterm infants after birth.STUDY DESIGN: Preterm infants had a facemask attached to a combined carbon dioxide/flow sensor placed over their mouth and nose to record ECO2 and gas flow. A breath-by-breath analysis of the first 5 minutes of the recording was performed.RESULTS: Thirty spontaneously breathing preterm infants, gestational age (mean ± SD) 30 ± 2 weeks and birth weight 1635 ± 499 g were studied. ECO2 from normal breaths and slow expirations was significantly larger than with other breathing patterns (P < .001). ECO2 per breath also increased with gestational age P < .001. The expiratory hold pattern was the most prevalent breathing pattern both during the first minute of recording and overall. Breathing pattern proportions also varied by gestational age. Finally, ECO2 from the fifth minute of recording was significantly greater than that produced during the first 4 minutes of recording (P ≤ .029).CONCLUSIONS: ECO2 varies with different breathing patterns and increases with gestational age and over time. ECO2 may be an indicator of lung aeration and that postnatal ECO2 monitoring may be useful in preterm infants in the delivery room. Copyright © 2015 Elsevier Inc. All rights reserved.

Schmolzer G.M.,Center for the Studies of Asphyxia and Resuscitation | Schmolzer G.M.,Monash University | Schmolzer G.M.,University of Alberta | Schmolzer G.M.,Murdoch Children Research Institute | And 8 more authors.
Journal of Pediatrics | Year: 2015

Objective To measure exhaled carbon dioxide (ECO2) in term infants immediately after birth. Study design Infants >37 weeks gestation born at The Royal Women's Hospital, Melbourne, Australia were eligible. A combined flow sensor and mainstream carbon dioxide (CO2) analyzer was placed in series proximal to a facemask to measure ECO2 and tidal volumes in the first 120 seconds after birth. Results Term infants (n = 20) with a mean (SD) birth weight of 2976 (697) g and gestational age of 38 (2) weeks were included. Infants took a median (range) 3 (1-8) breaths before ECO2 was detected. The median (range) of maximum ECO2 was 51 (40-73)mmHg at 70 (21-106) seconds after birth. Within the first 10 breaths, CO2 increased from 0-27 (22-34) mm Hg. The median (IQR) tidal volume during the breaths without CO2 was 1.2 (0.8-3.1) mL/kg compared with 7.3 (3.2-10.9) mL/kg during the first 10 breaths where CO2 was exhaled. Conclusions The first breaths for an infant after birth did not contain ECO2. With aeration of the distal gas exchange regions, tidal volume and ECO2 significantly increased. ECO2 can be used to monitor lung aeration immediately after birth. Copyright © 2015 Elsevier Inc. All rights reserved.

Solevag A.L.,Akershus University Hospital | Solevag A.L.,Center for the Studies of Asphyxia and Resuscitation | Kann I.C.,Akershus University Hospital
Early Human Development | Year: 2015

Background: Since November 1st 2008, our Norwegian neonatal intensive care unit has used nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation as first-line treatment after nasal continuous positive airway pressure (n-CPAP) failure in infants with respiratory distress syndrome (RDS). Aim: To assess utility of a national patient register to compare outcomes of infants in our unit before and after November 1st 2008 as well as to hospitals that did not utilize n-BiPAP during the observation period. Study design: A retrospective study, using a national patient register and a difference-in-difference (DID) statistical approach, adjusting for confounders. Subjects: Infants with RDS admitted to hospital 2002-2010. Outcome measures: We compared our unit before and after November 1st 2008 and to other hospitals with regards to morbidity, mortality, and number of hospital days (NHD). Results: Infants with RDS in our unit had a significantly lower risk of bronchopulmonary dysplasia (BPD) (odds ratio (OR) 0.59, p < 0.05), retinopathy of prematurity (ROP) (OR 0.57, p < 0.05), and intraventricular hemorrhage (IVH) (OR 0.37, p < 0.001); as well as the combined outcome of periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), ROP, IVH, and/or BPD (OR 0.53, p < 0.05) after November 1st 2008 and compared to other hospitals. PVL, NEC, and mortality did not change. NHD was reduced by 8. Conclusion: Increasing use of n-BiPAP was associated with reduced morbidity and NHD in infants with RDS. Using a patient register and DID analyses may be a health economic and ethically sound way of generating hypotheses and knowledge about disease and treatment. © 2015 Elsevier Ireland Ltd.

Baik N.,Medical University of Graz | Urlesberger B.,Medical University of Graz | Schwaberger B.,Medical University of Graz | Schmolzer G.M.,Medical University of Graz | And 6 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2015

Objectives: To investigate the occurrence of peri/intraventricular haemorrhage (P/IVH) in preterm infants and its potential association with cerebral regional oxygen saturation (crSO2) during the immediate transition. Methods: In this two-centre prospective observational cohort study, crSO2 was measured with near-infrared spectroscopy in preterm infants (<32 weeks of gestational age) during the immediate neonatal transition (15 min). In addition, arterial oxygen saturation (SpO2) and heart rate (HR) were monitored with pulse oximetry. Cranial ultrasound scans were performed on day 4, day 7 and day 14 after birth and before discharge. Neonates with IVH of any grade (IVH group) were matched to the neonates without IVH (Non-IVH group) on gestational age (±1 week) and birth weight (±100 g). The duration and magnitude of deviation from the 10th centile in crSO2 during immediate transition was analysed and expressed in %minutes. Results: IVH was found in 12 of the included neonates, who were matched to 12 neonates without IVH. There was no difference in SpO2 and HR between these two groups. The duration and magnitude of centiles-deviation of crSO2 was significantly pronounced in the IVH group compared with the Non-IVH group (1870%min vs 456%min). Conclusions: The neonates of the IVH group showed significantly lower crSO2 values during the immediate transition, although there was no difference concerning SpO2 and HR. The additional monitoring of crSO2 during the immediate transition could reveal neonates with higher risk of developing an IVH later in the course. © 2015 Japan Society for Bioscience, Biotechnology, and Agrochemistry.

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